Since January 2003, nearly 400,000 veterans have been denied enrollment in the Department of Veterans Affairs health system because they have no service-connected disabilities and have incomes that exceed a VA means test.

The Bush administration's decision to suspend enrollment in VA healthcare for these "Priority Group 8" veterans was explained four years ago as necessary to ensure continued access to VA care for higher priority veterans — those with service disabilities, low incomes or special needs.

Whether Congress should force the administration to reopen the VA system to new Group 8 enrollees was the topic of a contentious hearing held last week by the House Veterans Affairs Committee.

For many years, veterans who were not disabled or indigent could gain access to VA facilities only on a case-by-case and space-available basis. It was the Veterans' Health Care Eligibility Act of 1996 that directed VA to build many more clinics and establish an enrollment system based on seven and later eight priority groups.

Suddenly, starting in 1999, VA healthcare was opened to any veteran. Over the next three years, the proportion of higher-income, nondisabled veterans enrolled in the VA system climbed to 30 percent. By 2003, then-VA Secretary Anthony Principi decided the flood of Group 8 veterans was endangering the system's ability to care for higher-priority veterans. He used his authority under the 1996 law to suspend new Group 8 enrollments. Those already enrolled were unaffected. Group 8 veterans remain 27 percent of all VA care enrollees.

Republicans argued that wars in Iraq and Afghanistan make opening VA healthcare to all veterans more difficult given the rising strain on staff and resources. Also, Group 8 veterans who have served in these wars do, in fact, gain access to VA healthcare for two years under the law. And if they enroll during that period, they can remain enrolled.

The VA estimates that 1.7 million new Group 8 veterans would enroll, if given the chance, and 600,000 would seek VA care. The added cost to VA over the next 10 years would be $33 billion.

The first witness Rep. Bob Filner, D-Calif., called to testify was Dr. Steffie Woolhandler, a professor of medicine at Harvard and co-founder of Physicians for a National Health Program. She cited 2004 surveys showing 1.8 million veterans had no health insurance and were not receiving VA care. An additional 3.8 million persons living with these veterans also lack health coverage.

Republicans Steve Buyer of Indiana and Jeff Miller of Florida suggested Democrats want VA healthcare open to all veterans as a first step toward a national health program. Woolhandler conceded that she envisions a day when veterans will be able to choose between care in the VA or using a national health insurance card anywhere else.

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