VA seeks to re­di­rect bil­lions of dol­lars into pri­vate care

The Beaufort Gazette (Sunday) - - Stay Connected - BY JENNIFER STEIN­HAUER AND DAVE PHILIPPS

The Depart­ment of Vet­er­ans Af­fairs is pre­par­ing to shift bil­lions of dol­lars from gov­ern­ment-run 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 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 hid­den­wait­ing 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 in­creas­ing the num­ber of doc­tors in the VA.

If put into ef­fect, the pro­posed rules – many of whose de­tails re­main un­clear as they are ne­go­ti­ated within the Trump ad­min­is­tra­tion – would be a win for the once-ob­scure Con­cerned Vet­er­ans for Amer­ica, an ad­vo­cacy group funded by the net­work founded by bil­lion­aire in­dus­tri­al­ists Charles and David Koch, which has long cham­pi­oned in­creas­ing the use of pri­vate sec­tor health care for vet­er­ans.

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 num- bers 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.

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 later 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 also 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 of the ma­jor vet­er­ans’ or­ga­ni­za­tions, say that pay­ing for care in the pri­vate sec­tor would starve the 153-year-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 sec­re­tary of Vet­er­ans Af­fairs, that his staff had some­times come to Capi­tol Hill “with­out their act to­gether.”

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 Depart­ment of Vet­er­ans Af­fairs 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 Vet­er­ans Af­fairs 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 Vet­er­ans Af­fairs 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.

SARAH SILBIGER NYT

At a con­gres­sional hear­ing Dec. 19, Vet­er­ans Af­fairs Sec­re­tary Robert Wilkie faced ques­tions about the pos­si­ble pri­va­ti­za­tion of med­i­cal care for mil­i­tary vet­er­ans. Wilkie has re­peat­edly said his goal is not to pri­va­tize vet­er­ans’ health care.

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