Posted on Nov 17, 2023
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Why is Tricare and ChampVA exempt from ACA 26 years old provision for dependents. Military and veteran dependents, mind you some of these people are disabled, you basically have to be severely disabled to qualify for ChampVA. There dependents become ineligible at 21, can be extended to 23 if enrolled in college full time, yet still 3 years short of just about every other healthcare insurance. Seems like a massive disservice to those that served and there dependents.
Veterans Affairs (VA)
Disabled Veterans
Posted >1 y ago
Responses: 2
The short answer is because TRICARE and CHAMPVA are covered in different sections of Federal law which give different stipulations on coverage. The governing laws have to be changed in order for the program to be changed (and in the case of TRICARE, was).
The long answer is more convoluted and comes down to legal opinions on the applicability of certain sections of the law. The Public Health Service (PHS) law was modified by portions of the ACA, one of which was the section that extended dependent coverage*.
Specific to your question, The ACA provision extending health insurance coverage to dependent children until age 26 did not extend to TRICARE beneficiaries nor to CHAMPVA beneficiaries.
There have been subsequent laws passed that expanded coverage to meet the intent of the ACA, such as the authorization of the TRICARE Young Adult Program in the 2010 NDAA (there were provisions that were put into the NDAA in subsequent years for CHAMPVA, but the never made it to the final version (blame whoever you blame when the politicians do something boneheaded).
You may ask "What was the reasoning behind the legal opinion" and it comes down to the difference between "health insurance" and a "federal health care entitlement". TRICARE and CHAMPVA are both defined as a "federal health care entitlement" programs* which have restricted eligibility based on certain criteria (for TRICARE, you have to be in the military or retired from it. For CHAMPVA, you're the family of a disabled veteran or one who died, etc.).
So ... clear as mud now?
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* TRICARE and VA Health Care: Impact of the Patient Protection and Affordable Care Act (ACA) https://sgp.fas.org/crs/misc/R41198.pdf
* 42 USC Chapter 6A - Public Health Service laws - https://www.law.cornell.edu/uscode/text/42/chapter-6A
* Section of the PHS law about dependent coverage - https://www.law.cornell.edu/uscode/text/42/300gg-14
* Unlike health insurance, a federal health care entitlement programs is financed from federal trust funds or paid out of general revenues and the federal government is legally obligated to cover them.
The long answer is more convoluted and comes down to legal opinions on the applicability of certain sections of the law. The Public Health Service (PHS) law was modified by portions of the ACA, one of which was the section that extended dependent coverage*.
Specific to your question, The ACA provision extending health insurance coverage to dependent children until age 26 did not extend to TRICARE beneficiaries nor to CHAMPVA beneficiaries.
There have been subsequent laws passed that expanded coverage to meet the intent of the ACA, such as the authorization of the TRICARE Young Adult Program in the 2010 NDAA (there were provisions that were put into the NDAA in subsequent years for CHAMPVA, but the never made it to the final version (blame whoever you blame when the politicians do something boneheaded).
You may ask "What was the reasoning behind the legal opinion" and it comes down to the difference between "health insurance" and a "federal health care entitlement". TRICARE and CHAMPVA are both defined as a "federal health care entitlement" programs* which have restricted eligibility based on certain criteria (for TRICARE, you have to be in the military or retired from it. For CHAMPVA, you're the family of a disabled veteran or one who died, etc.).
So ... clear as mud now?
---------------------------
* TRICARE and VA Health Care: Impact of the Patient Protection and Affordable Care Act (ACA) https://sgp.fas.org/crs/misc/R41198.pdf
* 42 USC Chapter 6A - Public Health Service laws - https://www.law.cornell.edu/uscode/text/42/chapter-6A
* Section of the PHS law about dependent coverage - https://www.law.cornell.edu/uscode/text/42/300gg-14
* Unlike health insurance, a federal health care entitlement programs is financed from federal trust funds or paid out of general revenues and the federal government is legally obligated to cover them.
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