Big demographic changes pose challenge to caring for veterans’ needs  

We need to be proactive in planning to preserve infrastructure for those who serve  

MASSACHUSETTS OFFICIALS REGULARLY brag about the Commonwealth being a leader when it comes to our veterans. However, in terms of our population trend, this is one area where we may not want to crow too loudly. While nationally, the overall veteran population is declining 1.8 percent each year, the number of veterans in Massachusetts is dropping 3.5 percent annually, almost twice the national average. This has significant implications for the delivery of veterans services, and we need to be planning and making adjustments now to ensure we continue to meet our obligation to serve those who have served our country. 

According to the US Department of Veterans Affairs National Center for Veterans Analysis & Statistics, America’s total number of veterans in all states and territories in 2021 is approximately 19.2 million. This number is projected to decrease by 7 million veterans in 2048. That is a 36 percent drop in 27 years.  

In Massachusetts, according to VA, the Commonwealth has lost 42 percent of its veterans population since 2000. The trend is projected to continue, with estimates that the total number of Massachusetts veterans will further decline from its current level of 287,000 to 120,000 in the next 24 years. This is not all that surprising if you factor in that, of the current state population, over 157,000 of these veterans are 65 years or older.

Despite this overall decline, there are some sub-categories of veterans where the population is actually on the rise. A 2017 VA report on the status of minority veterans shows that non-white veterans comprised about 23.7 percent of living veterans in the United States and is projected to increase to about 36.2 percent by 2045. In Massachusetts, it is projected that our population of minority veterans will increase from the current number of just under 31,000 to almost 42,000 by the year 2045.

Women veterans are also making population gains. Whereas nationally, we will lose approximately 2.2 percent of male veterans annually, the number of women veterans will increase by 0.6 percent each year for the next 30 years. In Massachusetts, women’s share of the total state veteran population will double from the current 8.5 percent to almost 18 percent during the same period.

Our fellow New England states are experiencing a similar decline in overall veteran population. Rhode Island, New Hampshire, Vermont, Connecticut and Maine have seen, on average, a 36 percent decline in their total number in the last 20 years.  

This rapidly evolving trend will most certainly have a significant effect on access to care and services for our New England veterans community, especially our older heroes. Taken as a whole, our region hosts eight in-patient VA hospitals, 51 VA outpatient clinics, and 32 Vet Centers.  

These bring in over $4.4 billion annually in health-related expenditures and employ thousands of people. The six New England states also operate seven VA-funded state veterans’ homes for long-term care services. The rapidly declining numbers could result in many of these locations becoming so underutilized that some may be forced to close or consolidate. This could also negatively impact jobs, shift more VA health patients on to other public plans, and leave those who rely on these services significantly disenfranchised. Such a large reduction in federal funds and potential closures could have secondary repercussions to the surrounding local economic sectors that support this infrastructure (i.e. outside vendors, tradespeople, restaurants, bars, etc.).

Why is this decline happening so rapidly? There are a few factors to consider. One is that our mobilization of troops for World War II was at a level that was unique and will most likely never be seen again in modern American history. Also, the US ended the draft in 1973 and moved to an all-volunteer force in the aftermath of Vietnam.   

By the time we reengaged in large-scale combat operations in the first Gulf War, the evolutions in weaponry and technology, combined with new thinking around military war strategy, required fewer troops than previous conflicts. Consider this: During World War II, 9 percent of the US population was in military service, yet at the height of the wars in Iraq and Afghanistanfewer than 1 percent of Americans were in the armed forces. 

What about future wars? Won’t that replenish the ranks? Actually, any future combat operations (absent a national draft) should have no significant bearing on this decline. Since 2002, approximately 2.8 million troops have served in Iraq and Afghanistan and more than half that number were deployed more than once. From 1965 to 1971, 2.4 million troops served in Vietnam, with the vast majority serving only one tour. In other words, six years of fighting in Vietnam produced only 400,000 fewer deployed veterans than almost 20 years of our current wars.  

Interestingly, the wars in Iraq and Afghanistan have produced another anomaly that will affect how we will care for veterans in the future. The average age of a service member who served in today’s wars is 34.5.  In World War II, the average age of our troops was 26. In Vietnam it was 22. Because our most recent veterans have a wider range of ages, they will not produce the so-called “grey wave” currently hitting our system. The veterans from Iraq and Afghanistan are not generationally moving en masse from one life stage to the next.  Rather, these veterans are coming into different phases of their lives at a more steady and manageable rate. 

Whether there are 20 million or 200 veterans, America has a legal, civic, and moral obligation to care for and support those that served in its defense. Yet, fewer veterans could mean less total utilization of federal and state health services overall, resulting in significant funding implications for those programs.  

Higher numbers of minority and women veterans, who tend to utilize VA health care benefits more often than their white male counterparts, are more likely to experience barriers to receiving care, economic inequality, and health disparities. Thoughtful planning and analysis must be done to ensure that these veterans have safe and convenient access to critical services in a manner that better respects cultural and gender diversity.  

The good news here is that we can recognize the issues before it’s too late. All six New England governors and state legislatures, state veterans’ affairs Departments, the region’s congressional delegation, and veteran advocates should be looking closely at this trend and working together to plan for these reductions and potential impacts on our veterans and local communities in a thoughtful manner. This will require intense analysis and making essential changes and reforms to our federal and state laws, regulations, and delivery systems sooner rather than later.

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The data and projections are both valid and clear. We can look at this as a major problem or a major opportunity. If we are willing to roll up our sleeves and do the hard work now, we can ensure that those who were willing to risk their lives for the nation are provided access to needed integrated quality care and services wherever they reside and no matter how many require these services. If we ignore it, we risk significant negative impacts to our veterans and their health care in the not too distant future. That is too great a price to pay for those that were willing to pay the ultimate price for all of us.

Coleman Nee served as secretary of veterans services under Gov. Deval Patrick.  He is a veteran of the United States Marine Corps and served in the Persian Gulf War.