WASHINGTON – The battle over the future of Medicaid in the Republican effort to repeal and replace the Affordable Care Act has given little attention to how reduced funding will affect military veterans.

Veterans groups are now speaking out, saying rolling back financial support for Medicaid, the health insurance program for the low-income and vulnerable, could put at risk the 1.7 million veterans receiving Medicaid benefits.

Contrary to popular belief, they report, less than half of America’s veterans, about 43 percent, get health insurance coverage from the Department of Veterans Affairs.

Those that don’t qualify have either served less than two years or have non-military related injuries, according to the Congressional Research Service. Still others qualify but rely on private insurance for supplemental coverage or because they live in rural areas far from the nearest VA hospital.

In addition, about 660,000 spouses of veterans get health coverage through Medicaid, according to an estimate by Families USA, a pro-Affordable Care Act group, based on Census figures.

Paralyzed Veterans for America wrote to senators last week urging them not to pass the Republican health care bill that would also put millions of other Americans at risk if Medicaid is scaled back.

Conservatives arguing for Medicaid cuts contend the rate of spending growth is unsustainable; that if it isn’t reined in, the program will imperil the millions of poor people, including children, who rely on it.

The Senate Republican bill would reduce federal spending to the 31 states and District of Columbia that expanded Medicaid under the Affordable Care Act to cover adults whose income is just above the poverty line.

It would also reduce the growth of spending for the traditional Medicaid program to a rate below medical inflation costs, a step health care advocates say will force states to cut back coverage to many needy individuals.

The Paralyzed Veterans of America, Disabled American Veterans, AMVETS and other veterans groups worry their members will also be adversely affected.

“What will become of these veterans as they face higher insurance costs and as states are faced with severely constrained Medicaid budgets?” Carl Blake, executive vice president of the paralyzed veterans’ organization, asked in a letter to Senate Majority Leader Mitch McConnell of Kentucky and Senate Minority Leader Chuck Schumer.of New York.

Others took a stronger tone.

“I don't think anyone who supports Trumpcare can call themselves pro-veteran,” said Will Fisher, government relations director for the group VoteVets and a former Marine who served in Iraq.

The opposition from veterans groups comes at a time when Senate Republicans and President Donald Trump are struggling to round up the 50 votes needed to pass legislation that repeals and replaces much of the Affordable Care Act, commonly called Obamacare.

While some conservative senators like Texas’ Ted Cruz and Kentucky’s Rand Paul say the bill doesn’t go far enough, moderates are worried about the impact of Medicaid funding cuts, particularly on opioid addicts who rely on Medicaid for treatment.

Now veterans groups are putting heat on Senate Republicans undecided about the bill, such as Sen. Johnny Isakson of Georgia, chairman of the Senate Veterans Affairs Committee. So far, he has not taken a position on the Senate bill and the rolling back of Medicaid benefits.

Isakson’s spokeswoman Amanda Maddox said Wednesday judging the bill’s impact while it is still being negotiated by GOP leaders amounts to “speculation.” She declined to comment on how the Medicaid cuts would affect veterans.

Isakson has, however, long supported veterans’ issues. He recently alerted the news media to his committee hearing next week on bills aimed at improving veterans’ health care under the Veterans Administration.

He has also hailed passage of a bill in the Senate to streamline the appeals process for veterans to qualify for disability benefits through the VA system, and released a July 4th video celebrating Trump’s signing of the bill making it easier for the VA secretary to fire bad employees.

Sen. Joni Ernst, R-Iowa, who served in the U.S. Army Reserves and National Guard for 23 years, called Obamacare “unsustainable” in a statement. But she declined to comment on the Republican health care plan or its Medicaid impact on veterans, saying she is still studying the Senate bill.

Families USA estimated Texas has 105,000 veterans on Medicaid, Pennsylvania 82,000, Georgia 50,000 and Iowa 19,000 – either as their primary insurance or to supplement their VA coverage.

Democrat Congressman Seth Moulton of Massachusetts, who served four tours of duty in Iraq as a Marine infantry officer, said he made VA Secretary David Shulkin aware of the risk to veterans during a meeting with a group of bipartisan members of Congress last week.

Moulton posted this item on Twitter following the meeting: “Asked Sec Shulkin how VA will deal with all the vets who lose healthcare under the @GOP bill: “You’re right. It’s something we’re watching.”

Another Moulton tweet moments later said: “Strange how every R in the room seemed suddenly consumed by his phone when Sec Shulkin explained that lots of vtes need help. #AHCA”

VA spokesman James Hutton declined to comment on the Moulton tweets.

“We’re watching the debate on the Healthcare legislation,” he said. “But until the legislative process runs its course, we are not going to speculate on details of a possible bill. Once a bill is agreed on, we will be in a position to review potential impacts on VA.”

Contact Washington reporter Kery Murakami at kmurakami@cnhi.com.