Private care for vets might get boost
WASHINGTON — The Department of Veterans Affairs is preparing to shift billions of dollars from government-run veterans hospitals to private healthcare providers, setting the stage for the biggest transformation of the medical system for veterans 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 also would 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 insurance co-payments 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-era 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 increasing the number of doctors in the VA.
Many details of the proposed rules remain unclear as they are negotiated within the Trump administration, but officials inside and outside the Department of Veterans Affairs say the plan closely resembles the military’s insurance plan, Tricare Prime, which sets a lower bar than the department when it comes to getting private care.
If the proposed rules are put into effect, they would be a win for the once-obscure advocacy group Concerned Veterans for America, which is funded by billionaire industrialists Charles and David Koch and their network of donors. It 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 co-payments — 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 healthcare system — the largest in
the nation — uses to provide specialty care.
Critics also have 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.
President Donald Trump, who made reforming health care for veterans a major point of his campaign, might 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 previous 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 hospital system for veterans 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.
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.”
Tricare, the military’s insurance plan, automatically allows patients to see a private doctor if they have to travel more than 30 minutes for an appointment with a military doctor, or if they have to wait more than seven days for a routine visit or 24 hours for urgent care.
Under current law, veterans qualify for private care only if they have waited 30 days, and sometimes they have to travel hundreds of miles. The administration might propose for veterans a time frame somewhere between the seven- and 30-day periods.
Health care experts say that 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.
Although 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.