VA aims to move billions to private care

Critics fear plan could starve veterans hospitals

WASHINGTON — The Veterans Affairs Department is preparing to shift billions of dollars from governmentrun veterans hospitals to private health care providers, setting the stage for the biggest transformation of the veterans medical system in a generation.

Under proposed guidelines, it would be easier for veterans to receive care in privately run hospitals and have the government pay for it. Veterans would also be allowed access to a system of proposed walk-in clinics, which would serve as a bridge between VA emergency rooms and private providers and would require copays for treatment.

Veterans hospitals, which treat 7 million patients annually, have struggled to see patients on time in recent years, hit by a double crush of returning Iraq and Afghanistan veterans and aging Vietnam veterans. A scandal over hidden waiting lists in 2014 sent Congress searching for fixes, and in the years since, Republicans have pushed to send veterans to the private sector, while Democrats have favored increas-

ing the number of doctors in the VA.

If put into effect, the proposed rules — the details of which remain unclear as they are negotiated within the Trump administration — would be a win for the onceobscure Concerned Veterans for America, an advocacy group funded by billionaire industrialists Charles and David Koch and their network of donors, which has long championed increasing the use of privatesector health care for vets.

For individual veterans, private care could mean shorter waits, more choices and fewer requirements for copays — and could prove popular. But some health care experts and veterans groups say the change, which has no separate source of funding, would redirect money that the current veterans health care system — the largest in the nation — uses to provide specialty care.

Critics have also warned that switching vast numbers of veterans to private hospitals would strain care in the private sector and that costs for taxpayers could skyrocket. In addition, they say it could threaten the future of traditional veterans hospitals, some of which are already under review for possible consolidation or closing. Trump may give details

President Donald Trump, who made reforming veterans health care a major point of his campaign, may reveal details of the plan in his State of the Union address this month, according to several people in the administration and others outside it who have been briefed on the plan.

The proposed changes have grown out of health care legislation, known as the Mission Act, that was passed by the last Congress. Supporters, who have been influential in administration policy, argue that the new rules would streamline care available to veterans, whose health problems are many but whose numbers are shrinking, and prod the veterans hospital system to compete for patients, making it more efficient.

“Most veterans chose to serve their country, so they should have the choice to access care in the community with their VA benefits — especially if the VA can’t serve them in a timely and convenient manner,” said Dan Caldwell, executive director of Concerned Veterans for America.

One of the group’s former senior advisers, Darin Selnick, played a key role in drafting the Mission Act as a veterans affairs adviser at the White House’s Domestic Policy Council and is now a senior adviser to the secretary of Veterans Affairs in charge of drafting the new rules. Selnick clashed with David Shulkin, who was the head of the VA for a year under Trump and is widely viewed as being instrumental in ending Shulkin’s tenure.

Selnick declined to comment.

Critics, which include nearly all the major veterans organizations, say paying for care in the private sector would starve the 153year-old veterans health care system, causing many hospitals to close.

“We don’t like it,” said Rick Weidman, executive director of Vietnam Veterans of America. “This thing was initially sold as to supplement the VA, and some people want to try and use it to supplant.”

Members of Congress from both parties have been critical of the administration’s inconsistency and lack of details in briefings. At a hearing last month, Sen. John Boozman, R-Ark., told Robert Wilkie, the current Veterans Affairs secretary, that his staff had sometimes come to Capitol Hill “without their act together.” Like the military plan

Although the Trump administration has kept details quiet, officials inside and outside the department say the plan closely resembles the military’s insurance plan, Tricare Prime, which sets a lower bar than the VA when it comes to getting private care.

Health care experts say that, whatever the larger effects, allowing more access to private care will prove costly. A 2016 report ordered by Congress, from a panel called the Commission on Care, analyzed the cost of sending more veterans into the community for treatment and warned that unfettered access could cost well over $100 billion each year.

Tricare costs have climbed steadily, and the Tricare population is younger and healthier than the general population, while VA patients are generally older and sicker.

Though the proposed rules would place some restrictions on veterans, early estimates by the Office of Management and Budget found that a Tricare-style system would cost about $60 billion each year, according to a former VA official who worked on the project. Congress is unlikely to approve more funding, so the costs are likely to be carved out of existing money that funds veterans hospitals. A spokesman for the VA, Curt Cashour, declined to comment on the specifics of the new rules.

“The Mission Act, which sailed through Congress with overwhelming bipartisan support and the strong backing of veterans service organizations, gives the VA secretary the authority to set access standards that provide veterans the best and most timely care possible, whether at VA or with community providers, and the department is committed to doing just that,” he said in an email.