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Updated October 24, 2019
Introduction to Veterans Health Care
The federal government’s role in providing health care to
not greater than an amount established by a “means test.”
the nation’s veterans can be traced back to World War I.
Veterans who do not meet any of the criteria in the first
The veterans’ health care system was first developed in
category compose the second eligibility category and may
1919 with the enactment of P.L. 65-326, which authorized
be eligible to receive care through the VHA to the extent
the Public Health Service to provide needed care to
resources permit. Once veterans are determined to be
veterans injured or sick as a result of military service—
eligible for care in VHA, most veterans are required to
having a disability that is incurred or aggravated during
formally enroll in the VHA health care system to receive
active military, naval, or air service (today known as a
services. Once a veteran is enrolled, the veteran remains in
service-connected disability). In 1924, with the enactment
the system and does not have to reapply for enrollment
of the World War Veterans Act (P.L. 68-242), veterans with
annually. Veterans are placed in one of eight priority
no service-connected disability but who were “financially
enrollment categories. Veterans in some priority enrollment
unable to pay” for care were also given access to
categories are required to pay co-payments for certain
Department of Veterans Affairs (VA) health care, thus
benefits. Enrolled veterans do not pay any premiums,
creating a safety net mission. Congress has enlarged the
deductibles, or coinsurance for their care. This is in contrast
scope of VA’s health care mission, and it has enacted
to major medical insurance plans, which typically have
legislation to create new programs and expand benefits and
premiums, deductibles, and co-payments.
services. This In Focus briefly outlines the mission,
eligibility and enrollment requirements, health care delivery
Trends in Enrollment
system, and funding for veterans health care. Selected
As required by the Veterans’ Health Care Eligibility
trends in enrollment and budget are provided as well.
Reform Act of 1996, VHA began formally enrolling
veterans for the first time in FY1999. As shown in Figure
Mission of the VA Health Care System
1, just over 4.9 million veterans (18% of all living veterans)
The VA provides health care and health-related services
were enrolled in the VHA in FY2000; by FY2019, that
through the Veterans Health Administration (VHA). VHA’s
number was estimated to have increased to 9.2 million
primary mission is to provide health care services to
enrollees (48% of all living veterans). This increase is due,
eligible veterans and some family members. The VHA is
in part, to factors such as enrollment of newer veterans
also statutorily required to conduct medical research, to
from Operation Enduring Freedom/Operation Iraqi
train health care professionals, to serve as a contingency
Freedom/Operation New Dawn (OEF/OIF/OND), a larger
backup to the Department of Defense (DOD) medical
number of female veterans, and economic conditions,
system during a national security emergency, and to
among other factors.
provide support to the National Disaster Medical System
and the Department of Health and Human Services (HHS)
Figure 1. VHA Enrolled Veterans, FY2000 to FY2019
as necessary (38 U.S.C. §§7301-7303; §8111A; §1785).
Eligibility and Enrollment for Care
Not all veterans are eligible to receive care, and not every
eligible veteran is automatically entitled to medical care
from the VHA. The system is neither designed nor funded
to care for all living veterans (The Journal of Law,
Medicine & Ethics, Volume 36, Issue 4, Figure 1, Winter
2008). Eligibility for veterans health care has evolved over
time, and laws governing eligibility have been amended by
Congress many times. The last major eligibility
amendments occurred in 1996 with enactment of the
Veterans’ Health Care Eligibility Reform Act of 1996 (P.L.
104-262). This law established two broad eligibility
Source: Chart prepared by CRS based on VA enrol ee numbers in
categories and required the VHA to manage the provision
the Department of Veterans Affairs budget justifications.
of hospital care and medical services through a priority
Note: The FY2019 number is an estimate.
enrollment system.
In a given year, not all enrolled veterans receive their care
from the VA—either because they do not need services or
The first eligibility category includes veterans with service-
because they have other forms of health coverage, such as
connected disabilities, Medal of Honor recipients, Purple
Medicare, Medicaid, or private health insurance. Figure 2
Heart recipients, former prisoners of war, veterans exposed
shows the percentage of enrollees who used the VHA per
to toxic substances and environmental hazards such as
year since FY2000. Generally, around two-thirds of
Agent Orange, and veterans whose attributable income is
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Introduction to Veterans Health Care
enrollees in a given year are VHA patients and receive
Health Care Services
some or all of their health services from the VHA.
All enrolled veterans are eligible for a standard medical
package, which includes a full range of health care, gender-
Figure 2. VHA Patients as a Percentage of VHA
specific medical services, prescription drugs, long-term
Enrollees, FY2000-FY2019
care, and social support services. The medical package
provides benefits generally not found in private health
insurance plans, such as travel reimbursement for medical
appointments, family caregiver stipends, homeless veterans
programs, and dental care (38 C.F.R. §17.38).
VHA Health Care Appropriations
Congress annually provides discretionary appropriations to
fund VA health care and support services for enrolled
veterans. In addition to annual discretionary appropriations,
Congress has provided VHA the authority to bill some
veterans and most health care insurers for nonservice-
connected care provided to veterans to defray costs.
Source: Chart prepared by CRS based on VA enrol ee and patient
Trends in Appropriations
numbers in the Department of Veterans Affairs Budget Justifications.
In FY2019, Congress provided $73.16 billion for VHA—
Note: The FY2019 number is an estimate.
excluding research, collections, and the Veterans Choice
Fund. In FY1995, this amount was $16.22 billion (in
VA Health Care System
nominal dollars). Between FY1995 and FY2005, VHA’s
Once veterans are eligible and enrolled, they receive their
appropriations grew in real terms by 2% on average.
care directly through an integrated health care system (i.e.,
Overall from FY1995 to FY2018, VHA’s appropriations in
VHA). VHA is one of the largest integrated health care
real terms grew by about 2.8% on average, from about $36
systems in the United States, with over 1,420 sites of care,
billion to $70 billion (Figure 3).
including hospitals, community living centers, health care
centers, community-based outpatient clinics (CBOCs),
Figure 3. VHA Appropriations, FY1995-FY2018
other outpatient service sites, and dialysis centers. To
administer this system, the VHA has divided the country
into Veterans Integrated Service Networks (VISNs), based
on geography. There are currently 18 VISNs, which vary
regarding the types and number of facilities, and in
geographic size. Each VISN has a VISN Director, who has
oversight of the VA facilities within that VISN and who
supervises the facility director at each facility. Although
policies and guidelines are developed at VA headquarters
for the VHA health care system as a whole, management
authority for decisionmaking and budgetary responsibilities
is delegated to the VISNs.
VHA operates under a different model from the
Source: Chart prepared by CRS based on enacted appropriation
predominant health care financing and delivery model in
figures provided by VA Office of Budget.
the United States, in which there is a payer for health care
Notes: Chart includes the medical services, medical administration,
services (e.g., Medicare or private health insurance plan), a
and medical facilities accounts. It excludes medical and prosthetic
provider (e.g., hospital, physician), and a recipient of care
research, medical care col ections, and the Veterans Choice Fund.
(the patient). VHA is not a health insurance financing
program that provides reimbursement to providers for all or
CRS Products
a portion of a patient’s health care costs. VHA is primarily
a direct provider of care; VHA owns the hospitals and
CRS Report R42747, Health Care for Veterans: Answers to
employs the clinicians. However, VHA does pay for care in
Frequently Asked Questions.
the community under certain circumstances. The VA
CRS Report R45390, VA Maintaining Internal Systems and
Maintaining Internal Systems and Strengthening Integrated
Strengthening Integrated Outside Networks Act of 2018 (VA
Outside Networks Act of 2018 (VA MISSION Act; P.L.
MISSION Act; P.L.115-182).
115-182) created the Veterans Community Care Program
(VCCP), which applies eligibility for care in the community
broadly to all enrolled veterans. For example, a veteran can
seek care in the community if he or she needs a service that
Sidath Viranga Panangala, Specialist in Veterans Policy
is unavailable at the VA, resides in a state with no full-
Jared S. Sussman, Analyst in Health Policy
service VA medical facility, meets certain access standards
for drive- or wait-time, qualifies under standards for
IF10555
previous programs, or if it is in the best medical interest of
the veteran.
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Introduction to Veterans Health Care
Disclaimer
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congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
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