VA expands private care to more vets
Critics fear major shift will erode publicly run system
WASHINGTON — New rules due shortly from the Department of Veterans Affairs will enable tens of thousands more Texas veterans to get treatment outside the VA system, providing more choices but also triggering worries that the nation’s largest health care system could be “hollowed out” over time.
Veterans who must drive at least 30 minutes to a VA medical clinic or wait 20 days for an appointment can get primary and mental health care outside the VA system, one of the changes in the Trump administration’s revamped community care program that takes effect June 6.
As it stands, veterans who must drive 40 miles or wait 30 days have private options. About 40 percent of the 9 million veterans enrolled in VA programs will qualify, suggesting that the new rules could bring a major shift in VA-funded outside appointments in the years ahead.
The expansion of private care, which Veterans Affairs Secretary Robert Wilkie has compared to the G.I. Bill in significance, could be especially appealing to veterans in rural areas. It enables President Donald Trump to fulfill a
campaign promise to give veterans more choice. Conservative supporters of the president relish the prospect of private options outside a publicly run system after failing for years to destroy the Affordable Care Act.
VA senior officials briefing reporters this week promised “a single and simple community care program” and “an excellent experience” for veterans. Given the breadth of change, the veterans’ agency has set up an operations center to handle problems, they said.
“This is a large undertaking. We understand that there might be issues with any such implementation,” said one official, like the others speaking on the condition they not be named.
‘Back-door effort’?
Congress last year gave the VA authority to make the shift as worries persisted about VA shortcomings and a wait time scandal five years ago that cost top Veterans Affairs officials their jobs. Those problems ushered in the VA Choice Program, the system of private care now in place with the 40-mile, 30-day eligibility rules.
But some of the nation’s leading veterans service organizations, along with Democrats in Congress, worry that opening the door to private care widely will erode the Veterans Health Administration over time.
Texas U.S. Rep. Colin Allred, a first-term member of the Veterans Affairs Committee, says he has been hearing from some of the 1.6 million veterans in Texas about “a backdoor effort to privatize” the veterans agency.
“There is a danger here that we can siphon off necessary resources from our VA health care centers, and also not drive the VA to do the things they need to be doing if we shift too many of the resources to community care,” said Allred, DDallas.
Disabled American Veterans and Veterans of Foreign Wars, which together have 2.7 million members, have publicly criticized VA planning. The VFW in March accused the VA of setting arbitrary standards and offering “ridiculous excuses” for not working with some organizations.
Adrian Atizado, the DAV’s deputy national legislative director, said he is concerned that the VA won’t be able to enforce standards on private physicians comparable to care requirements within the agency’s 1,250 health care facilities.
The VA bears no legal responsibility if a veteran has problems with private care. In a Senate hearing last month, a VA official said the patient’s recourse would be the courts.
Atizado said the prospect of many newly eligible veterans remaining with private care after trying it could have a profound effect on some of the VA’s medical centers and outpatient sites.
“What happens if the system starts to collapse?” he asked. “A lot of veterans rely solely on the VA. We hear about choices, but there’s the potential of taking choice away from those veterans.”
Atizado referred to parts of Texas as “a medical resources desert,” arguing that many veterans could have difficulty finding private care, particularly those seeking mental health treatment. The DAV has 61 Texas chapters.
“In Texas, where you have a tremendous amount of combat veterans, I would be very concerned about sending them out into the community,” he said, referring to a shortage of specialized PTSD treatment.
For now, the VA will rely on Arizona-based TriWest Healthcare Alliance as its contractor for private services. The agency will expand starting this summer to identify contract networks of physicians in each of six regions.
Veterans like Michael Thompson, a San Antonian who served in the Navy, will need to weigh the prospects of care closer to home with their experiences in the VA system. On its website, the VA has begun advising veterans about eligibility, appointments and co-pays and soon will begin advising veterans of their options when they reach out for services.
Thompson, 68, said he has faith in the VA since he received excellent care in a bout with esophageal cancer five years ago. He thinks the new rules could be good for veterans in rural areas but sees problems ahead.
“Private doctors are not going to want to see a vet because they’re not going to get paid at their full rate. And veterans are going to find doctors on the outside of VA just as busy as VA doctors,” he said.
“It’s just passing the buck around.”
Concerns on Capitol Hill
A study published earlier this year in the Journal of the American Medical Association buttressed arguments that the VA is moving toward private care with unnecessary haste. The study, done by the VA, showed that VA wait times nationwide have improved markedly and now are shorter than in the private sector.
Requests for new appointments for primary care, cardiology and dermatology — common needs for veterans — were shorter at the VA, sometimes markedly so, although it still takes longer at the VA to receive care for orthopedic issues, the study found.
The VA Mission Act, which enables the changes, was signed into law a year ago with bipartisan support. But critics in Congress worry that the VA has expanded the scope of privatizing beyond what was discussed as the bill advanced.
Dealings between the White House and Capitol Hill on veterans’ matter have been cordial over the years. But relations have eroded recently, as evidenced this week when the Department of Veterans Affairs refused to take part in the House veterans’ subcommittee hearing delving into VA problems.
Earlier this spring, top Democrats on veterans affairs committees in both the Senate and House accused the VA in a letter of violating agreements about the extent of change. Legislators wrote that they understood that reimbursed care outside the VA would be limited to several types, including x-rays, lab tests and urgent treatment.
But in what the lawmakers call “a significant departure from congressional intent,” the VA now plans to allow an eligible veteran to seek all clinical services outside the VA, they wrote.
“On this basis alone, we have significant concern about what this decision means for the future of VA health,” the members of Congress wrote.
VA spokesman Curt Cashour, responding to the charge that Congress was double-crossed, said the bill gives his agency the authority to set standards. “It did not provide any further direction regarding the services to be included,” he added.
In operating the VA, the Trump administration has relied often on advice from Concerned Veterans of America, a group funded heavily by billionaire industrialists Charles and David Koch. With influence in Washington and its grassroots network, which is viewed with suspicion by traditional veterans groups, it has carried the banner among conservatives pressing to outsource VA care.
“We’ve made our ideas popular and prominent and we are fortunate that many policymakers, including the president, have willingly adopted them,” said Dan Caldwell, the organization’s senior adviser and until recently executive director.
“The new standards are not about hollowing out the VA or privatizing the VA. They’re simply about giving veterans more control over their own health care,” he said. “It’s disappointing to see the VFW and DAV misrepresent what this new program will ultimately do.”
Caldwell, a Marine Corps combat veteran in Iraq, said many Texas veterans will find that outside care suits them. He asserted that VA centers in San Antonio and some parts of Texas have good reputations but that “when you get out to West Texas and in the Rio Grande Valley, you have some of the worst-performing VA hospitals in the country.”
He added: “Hopefully, these changes will give veterans who have been up to this point trapped in VA facilities that aren’t performing well more health care choices and the ability to access better quality care.”
The VA disputes assertions that the Trump administration is pushing aggressively to privatize the agency.
Cashour, the VA spokesman, observed that the agency has an alltime high of over 420,000 full-time positions bolstered by the addition of 9,333 employees in the last quarter alone, among them 1,045 mental health specialists.
“VA privatization is a myth that has been thoroughly debunked,” he said.