Trump signs bill to ex­tend vet­eran choice for health care

Turns fo­cus to­ward tack­ling fail­ures with hos­pi­tal sys­tem

The Washington Times Daily - - FRONT PAGE - BY DAVE BOYER

Pres­i­dent Trump took one of his first steps Wed­nes­day to ad­dress chronic prob­lems in the Depart­ment of Veter­ans Af­fairs by sign­ing a bill that ex­tends stop­gap ser­vices for veter­ans to go out­side the VA med­i­cal sys­tem for care.

Af­ter cam­paign­ing on the is­sue of im­prov­ing sub­stan­dard care for veter­ans that dogged Pres­i­dent Obama, Mr. Trump signed a reau­tho­riza­tion of the Veter­ans Ac­cess, Choice and Ac­count­abil­ity Act and an­nounced that he would de­vote a press con­fer­ence to veter­ans is­sues next week.

“The veter­ans have poured out their sweat and blood and tears for this coun­try for so long, and it’s time that they are rec­og­nized and it’s time that we now take care of them and take care of them prop­erly,” Mr. Trump said.

The Choice pro­gram was set to ex­pire in Au­gust with­out the leg­is­la­tion and with nearly $1 bil­lion un­spent in the ac­count. Congress de­vel­oped the pro­gram af­ter a scan­dal erupted in 2014 dur­ing the Obama ad­min­is­tra­tion over wait times at the VA med­i­cal cen­ter in Phoenix, where dozens of veter­ans died wait­ing for care.

Veter­ans groups say the leg­is­la­tion is needed but that Congress and the Trump ad­min­is­tra­tion need to do much more.

“They need more doc­tors, they need nurses,” said Garry Au­gus­tine, pres­i­dent of the 1.3-mil­lion­mem­ber Dis­abled Amer­i­can Veter­ans. “There’s a lot of things in mo­tion now that are mov­ing in a pos­i­tive di­rec­tion. But it’s the sec­ond-largest bu­reau­cracy in the govern­ment. You don’t change it overnight.”

Pro­vid­ing care for the na­tion’s roughly 21 mil­lion veter­ans has chal­lenged pre­vi­ous ad­min­is­tra­tions and some­times has caused ma­jor po­lit­i­cal headaches for pres­i­dents who don’t ad­e­quately ad­dress prob­lems within the VA.

Pres­i­dent Ge­orge W. Bush feuded with fel­low Repub­li­cans who ac­cused him of not in­creas­ing fund­ing enough for the VA as veter­ans re­turned from the wars in Iraq and Afghanistan.

Mr. Obama pledged to elim­i­nate the back­log of dis­abil­ity and pen­sion claims. His ad­min­is­tra­tion re­duced it from about 600,000 to 100,000 but failed to elim­i­nate the moun­tain of pend­ing claims by the time he left of­fice in Jan­uary. Cut­ting into the claims back­log also re­sulted in a dra­matic rise in the num­ber of ap­peals, to a cur­rent back­log of about 450,000.

Mr. Obama fired his first VA sec­re­tary, Eric K. Shinseki, in the wake of the scan­dal over de­layed care. The Obama ad­min­is­tra­tion also was be­set with un­re­solved prob­lems of whistle­blower re­tal­i­a­tion, waste­ful em­ployee bonuses and the fail­ure to hold ac­count­able man­agers found to have en­gaged in wrong­do­ing.

Dur­ing Mr. Obama’s pres­i­dency, fund­ing for the VA rose by about 85 per­cent, al­though some of that in­crease was the re­sult in a rise in the to­tal num­ber of veter­ans who qual­i­fied for manda­tory ben­e­fits. In fis­cal 2017, the VA bud­get was $182.3 bil­lion, in­clud­ing $78.7 bil­lion in dis­cre­tionary spend­ing.

Mr. Trump cam­paigned hard on im­prov­ing ser­vices for veter­ans, say­ing their treat­ment by the pre­vi­ous ad­min­is­tra­tion was a dis­grace.

“Our veter­ans, in many cases, are be­ing treated worse than il­le­gal im­mi­grants,” Mr. Trump said in Septem­ber.

The pres­i­dent has pro­posed a 6 per­cent boost in the VA bud­get for fis­cal 2018. The VA is one of the few fed­eral agen­cies slated for an in­crease in Mr. Trump’s first bud­get.

Some veter­ans are en­cour­aged by Mr. Trump’s choice of physi­cian David Shulkin to lead the VA. Mr. Shulkin served in a top post at the agency at the end of the Obama ad­min­is­tra­tion.

“He knew what was be­ing done to im­prove it be­cause there was im­prove­ment go­ing on un­der [for­mer Sec­re­tary Bob] McDon­ald and [Deputy Sec­re­tary] Sloan Gib­son,” Mr. Au­gus­tine said. “Now he’s con­tin­u­ing the progress that was be­ing made.”

Only three months into the ad­min­is­tra­tion, there are am­ple signs of im­prove­ments that still need to be made at the VA. About one-third of veter­ans are go­ing out­side the sys­tem to pri­vate doc­tors but are en­coun­ter­ing de­lays in pa­per­work and sched­ul­ing, as well as in­cor­rect billing.

The Wash­ing­ton DC VA Med­i­cal Cen­ter, a VA fa­cil­ity, was cited by in­spec­tors in a re­port this month for its mis­man­age­ment of med­i­cal equip­ment, sup­plies and staffing.

“The on­go­ing in­ven­tory prac­tices at the med­i­cal cen­ter are plac­ing pa­tients at un­nec­es­sary risk,” VA In­spec­tor Gen­eral Mike Missal wrote in the in­terim re­port, adding that the fa­cil­ity’s lead­ers “have been slow to re­me­di­ate these se­ri­ous de­fi­cien­cies.”

The VA quickly fired the direc­tor of the D.C. med­i­cal cen­ter, call­ing it an “ur­gent pa­tient safety is­sue.”

“We are fo­cused clearly on ac­count­abil­ity. No leader or other em­ployee stands above the para­mount con­cern of en­sur­ing the safety of our veter­ans,” Mr. Shulkin told re­porters.

Some VA work­ers say low morale and man­age­ment prob­lems at the agency have not changed.

“The mood in the field is very pes­simistic,” said one mi­dlevel VA man­ager who spoke on the con­di­tion of anonymity. “Per­son­ally, I am not op­ti­mistic. There are not enough re­sources avail­able to pro­vide same-day ac­cess [for pa­tients] and keep the crum­bling VA in­fra­struc­tures run­ning. They can­not meet the staffing lev­els of the pri­vate sec­tor due to the bizarre na­ture of VA’s fund­ing model. Yet Shulkin is threat­en­ing to fire lead­ers who aren’t ‘fo­cused’ on these ar­eas. Very de­mor­al­iz­ing.”

Mr. Shulkin said at the White House on Wed­nes­day that the mea­sure ex­tend­ing the Choice pro­gram was an ex­am­ple of “how we are mak­ing things bet­ter” for veter­ans.

“By work­ing to­gether, we’re go­ing to con­tinue this progress,” he said.

The Choice law al­lows any veter­ans who ei­ther have had to wait 30 days for an ap­point­ment or live 40 miles or more from the near­est VA fa­cil­ity to visit a pri­vate doc­tor. But bu­reau­cratic prob­lems have pre­vented many veter­ans from us­ing the pro­gram.

Mr. Shulkin has called on Congress to ap­prove a more per­ma­nent so­lu­tion to veter­ans’ health care.

Mark Lu­cas, ex­ec­u­tive direc­tor of Con­cerned Veter­ans for Amer­ica who at­tended the bill sign­ing, said Congress needs to ex­pand pri­vate health care op­tions for veter­ans.

“The Choice pro­gram was passed as a quick fix to the wait list ma­nip­u­la­tion scan­dal that broke three years ago,” Mr. Lu­cas said. “While it’s helped, too many veter­ans still are forced to seek care at fail­ing VA fa­cil­i­ties.”

Ad­min­is­tra­tion of­fi­cials and veter­ans ad­vo­cates por­trayed the leg­is­la­tion as a tem­po­rary fix un­til law­mak­ers can de­vise long-range so­lu­tions.

“What we want to do is put the vet­eran in charge of these choices, not the bu­reau­cracy,” said House Veter­ans’ Af­fairs Com­mit­tee Chair­man David P. Roe, Ten­nessee Repub­li­can. “And I think Dr. Shulkin is just the per­son to see that hap­pen.”

A re­port re­leased Wed­nes­day said more veter­ans younger than 65 have gained health in­sur­ance coverage un­der the Af­ford­able Care Act, which Mr. Trump and his Repub­li­can al­lies in Congress are try­ing to re­peal and re­place.

The study by the non­par­ti­san Ur­ban In­sti­tute found that about 429,000 veter­ans na­tion­wide gained coverage in 20 states with the largest vet­eran pop­u­la­tions, re­duc­ing the unin­sured rate among veter­ans younger than 65 by nearly 40 per­cent from 2013 to 2015.

Mr. Trump held a pri­vate meet­ing at the White House with Mr. Shulkin on Wed­nes­day morn­ing and said the VA sec­re­tary “up­dated me on the mas­sive and chronic chal­lenge he in­her­ited at the VA, but also the great progress that he is mak­ing.”

“It’s one of my most im­por­tant things,” Mr. Trump said of veter­ans is­sues. “I’ve been telling all of our friends at speeches and ral­lies for two years about the VA, how we’re go­ing to turn it around. And we’re do­ing that.”


Pres­i­dent Trump was ap­plauded as he held up the Veter­ans Choice Pro­gram Ex­ten­sion and Im­prove­ment Act that he signed, al­low­ing those who served to go out­side the Veter­ans Af­fairs sys­tem.

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