14.7: Other Sources of Public Healthcare
Publicly-funded healthcare is also provided to the military and Department of Defense, federal employees, prisoners, American Indian and Alaska Natives (through the Indian Health Service) and veterans (through the Veterans Administration). The Veterans Health Administration (VHA) includes 172 VA Medical Centers and over 1100 outpatient facilities that provide for the healthcare needs of over 9 million veterans. The VHA also contracts with other community based clinics to provide easier access for outpatient services like primary care visits (Veterans Health Administration, 2023). This partnership was due to legislation passed by Congress in 2014 called the Veterans Choice Act, which was in response to increasing awareness and media coverage of the long wait times that veterans experienced at VA medical facilities. Because the VHA traditionally functions as both the provider and the payer, contracting the provider services out to community-based facilities creates new challenges for coordinating care to meet veterans’ needs (Rasmussen & Farmer, 2023).
The history of the Indian Health Service (IHS) was covered briefly in chapter 3. Healthcare services covered through the IHS are funded differently than Medicare and Medicaid in that they are a part of the federal government’s discretionary budget. Tribes can also have more local control via “compacting” ,which provides a block grant for the tribe to coordinate and provide their own healthcare services according to local needs. Health disparities still exist and access to healthcare is still challenging for many of the 2 million American Indian/Alaskan Natives (AI/AN) served through the IHS, due in large part to chronic underfunding, a lack of trained professionals, a lack of access to healthcare in remote locations, and the need for culturally sensitive healthcare practices (Kruse et al., 2022).