Ten percent of California veterans don't have health insurance or don't use Veterans Affairs (V.A.) care. That's just slightly below the 10.3 percent rate among veterans around the country.
"In our study someone is uninsured if they don’t have any of the types of insurance coverage you’d think of for general population and they also don’t report using V.A. care," says Haley.
Haley used data from the 2010 American Community Survey to look at the rates among non-elderly vets, ages 19-64. She says disproportionate numbers of the uninsured were also unemployed and unmarried.
All of them reported big gaps in accessing health services compared to their insured counterparts. 41.2 percent of the uninsured reported unmet medical needs in the past 12 months as opposed to 12.7 percent of vets with insurance. And 33.7 percent of vets without health insurance said they were delaying care due to cost, compared to 8.4 percent of those with insurance.
Amy Fairweather director of policy with the San Francisco veterans advocacy group Swords to Plowshares says people often incorrectly assume that veterans automatically have health insurance through the V.A.
“They have to prove eligibility," she says. Certain service distinctions automatically qualify you, she says, as does having a service connected illness. There is also a poverty means test, and certain treatments require co-pays.
Fairweather says because veterans are overrepresented in the homeless population in San Francisco "it comes as no surprise that there are so many veterans who are completely uninsured... except for the really community based system of care which is overburdened and can’t meet everyones needs.”
Still, she is quick to point out that for those who do have access in Northern California, the VA hospitals are excellent and are often connected with first class teaching hospitals.
"They’re very good with PTSD," Fairweather says. "They’re very good with Agent Orange for older veterans, because that’s been their area of expertise. They obviously have to catch up with women and some other things."
But she says it can be difficult to get in the door. Fairweather says the Oakland Veterans Benefit Administration, which determines eligibility has 34,000 claims backlogged.
"Claims are taking a year to two years for the initial walk through," she says. "A lot of the initial decisions are appealable so that takes going through the system again."
But the Urban Institute report did find that in California - and around the country - veterans are uninsured at lower rates than the general population. Among the non-elderly, about 18 percent of the general population was without insurance in 2010.
As with the general figure, where veterans live does seems to play a role in insurance status. The report found uninsurance rates among veterans fluctuated across states, from 4.3 percent in Massachusetts to 17.3 percent in Montana.
The Urban Institute's Jennifer Haley says they were interested in what caused the state variation, and tried controlling for factors like differences in veterans' incomes.
"But even when we controlled for that, the state differences didn’t go away," she says. "It could be due of Medicaid enrollment differences or other state policy differences but we didn’t look in depth at that."
The study was funded by the Robert Wood Johnson Foundation.