Unseen battles: The harsh realities of veterans’ access to health care

By Jenn Kerfoot, Chief Strategy and Growth Officer at DUOS

Originally published on STAT

I remember the day I left the military after six years of active-duty service. The crisp salute, the finality of it all. I was stepping into a world vastly different from the regimented life I had known. As a third-generation veteran, the military was more than a career; it was a legacy. But what I didn’t realize then was that leaving the military would mean entering a labyrinth of health care bureaucracy that seemed designed to confound and discourage.

The statistics are stark and sobering. As a veteran, I am part of a community where the suicide rate is 72% higher than that of non-veteran U.S. adults. This is not just a number; it’s a clarion call for change. My journey, my struggles, and my observations have led me to a simple yet profound conclusion: The health care system and government must make it easy for veterans to access care, easy to navigate the system, and easy to receive treatment.

It shouldn’t be easier to enlist in the military than it is to get good health care. And it shouldn’t be easier to go to war than to come home from it.

Enlisting in the Navy consisted of stopping by a Navy recruitment office on a walk home from school during my senior year. After a few signatures and a quick medical exam, for which transportation was provided, I had committed the next five years of my life to the United States Navy. The contrast couldn’t be more jarring when compared to the convoluted process of accessing Veteran Affairs health care. I recall, with a sense of frustration, my first visit to a VA hospital in 2015. A three-week wait for mental health care was its best offer — unless I was on the brink of self-harm. I left, disillusioned, and never returned for behavioral health support at the VA again. My experience isn’t unique; it’s a shared narrative among many veterans.

The transition from military to civilian life is a leap into the unknown.

In the military, especially for someone who enlists at 18, the world of health care is a distant, almost alien concept. From the moment you don your uniform, every aspect of your health care is meticulously managed for you. Terms like coverage, eligibility, copayments, and scheduling complexities are foreign languages in this well-oiled machine. But upon being discharged, a veteran is in uncharted waters, navigating a sea of administrative tasks that are as crucial as they are bewildering.

This transition isn’t just about adapting to civilian life; it’s about relearning how to manage your very existence, including the intricacies of health care administration. Even in the best scenarios, like mine, where familial support and managed mental health were my anchors, the process was overwhelming. Now consider the magnified challenges faced by those who aren’t as fortunate, those who step into this complex world under less than ideal circumstances. For them, the journey is not just overwhelming; it’s a steep, uphill battle, often fought in the shadows of their service and sacrifice.

Immediately upon being discharged, a veteran is no longer automatically covered for health care, a fact that often comes as a shock. I’ve seen the surprise on the faces of senior executives in the health industry when they learn that even combat service doesn’t guarantee immediate VA health care enrollment. The VA health care enrollment process for veterans offers multiple application methods, including online, by phone, or in person at a VA facility, which can be confusing and overwhelming as veterans may not know the best route to take, especially if dealing with lost documents, housing instability, or untreated medical conditions. Further complicating the process, once enrolled, veterans are placed into priority groups that determine their level of access to care. These groups are based on factors such as service-connected disabilities, income levels, and the nature of their military service. Understanding and navigating these priority groups adds another layer of complexity to the enrollment process, as veterans must figure out where they fit into the system, impacting how quickly they can receive services. This multifaceted process can thus be daunting for many veterans, especially those facing additional personal challenges.

In 2023 there were an estimated 18 million veterans, of that, 9 million were eligible for VA care, and only 6 million were using it. This gap isn’t just a statistic; it represents real people battling mental health challenges, PTSD, and substance misuse, often in isolation. The complexity of their needs mirrors the complexity of the system they’re struggling to navigate.

So, what’s the solution? The PACT Act, which President Biden signed in 2022, is a step forward, historically expanding eligibility for VA care and increasing access to it. But it’s like placing a Band-Aid on a gaping wound. Veterans are facing a logjam in the VA system, a backlog reminiscent of the post-Covid health care crisis. Legislative support and increased funding are crucial, but they’re not panaceas.

What can be done?

I see several solutions to improving veterans’ access to quality health care.

• Automatic enrollment. Veterans who are honorably discharged should be automatically enrolled into VA health care. It’s a simple change that can have a profound impact.

• Streamlined communication. Better integration and communication between departments like the Centers for Medicare and Medicaid Services and the VA are a key to simplifying the labyrinthine bureaucracy that currently exists. It’s not just about working in tandem; it’s about making the most of resources and funding.

• Simplified applications. The complexity of applying for benefits is daunting. Veterans need clarity and simplicity to encourage them to apply for benefits rather than deterring them from seeking help.

Money alone won’t solve this crisis. Collaboration is key. Clinicians, government entities, and technology providers must unite to improve health equity, provider adequacy, and network strength.

This isn’t just about combating the rising cost of health care; it’s about valuing the service and sacrifice of those who’ve at one point in their life wrote a blank check made payable to “The United States of America,” for an amount up to and including their life.

The nation owes its veterans a debt of gratitude. It also owes them a system that respects their service, acknowledges their sacrifices, and supports their health and well-being. It’s time to transform the labyrinth into a clear path forward.

Jenn Kerfoot is the chief strategy and growth officer at DUOS, a digital health company based in Minneapolis, Minn. As a hospital corpsman in the U.S. Navy, she deployed to Afghanistan in support of Operation Enduring Freedom.