In September, three months after signing the mammoth VA Mission Act, President Donald Trump claimed in a speech that soon "if a veteran can't get the care they need from the VA in a timely fashion, they have the right to go see a private doctor. Today, for the first time in American history, I am about to sign a bill that will fully and permanently give our great and cherished veterans choice."
The bill Trump actually signed that day in Las Vegas funded the Department of Veterans Affairs for the next two years and 2019 military construction projects.
The law he signed months earlier will replace the beleaguered Choice program by next June and do much more. It mandates more timely appointments and improved staffing at VA medical centers and clinics. It requires the VA to create a new network of commercial walk-in clinics and to ensure prompt payment to outside health care providers. It orders the VA to expand over the next several years its comprehensive caregiver program to older generations of injured veterans.
At a joint hearing Wednesday of the House and Senate Veterans Affairs Committees, VA Secretary Robert Wilkie reported on his department's progress implementing the VA Mission Act. The facts he shared left many lawmakers concerned that deadlines set only six months ago, particularly for caregiver benefit expansion, might not be met because of the VA's aging computer systems.
More disturbing to Democrats on both committees is the prospect that the VA and the White House will ignore warnings of veteran groups and adopt liberal access standards for the community-care portion of the bill. This would allow Trump, in his State of the Union address next month, to claim again that the law bestows unfettered access to private-sector care on any veteran who qualifies for VA care and is dissatisfied with its timeliness or convenience.
Democrats at the hearing warned that if the VA embraces the vision Trump espouses, it will drive the cost of VA-run community-care programs so high as to put VA medical centers and clinics at risk. In effect, it would achieve what advocates for privatizing VA health care have sought for years.
"We have heard conflicting information regarding VA's development ... of designated access standards" for VA-run private-sector care networks, said Rep. Mark Takano (D-Calif.), who will become chairman of the House Veterans Affairs Committee next month. "We also heard from VA staff that the president is likely to announce the adoption of a designated access standard model during his State of the Union address. However, Congress has not yet been made aware of what models are being considered and the reasoning behind any imminent decision."
Wilkie promised Takano that Congress will be briefed on plans to control veterans' access to its networks of community-care providers soon after the president is briefed on alternatives and endorses one. Wilkie suggested the choice likely will be a "hybrid" of access standards set for military beneficiaries who use Tricare and the access afforded older Americans eligible for Medicare.
Takano said he is worried Trump will make his decision "the night before he … makes a grand speech about how every veteran is going to be able to see any doctor they want to see. I mean that's one model … that sounds good, but there's a lot of downside" given the money that would have to be diverted from essential VA care and staffing to pay for private-sector physicians and community-care facilities.
Other Democrats, including Sen. Jon Tester of Montana, ranking Democrat on the Senate committee, expressed similar concerns. Tester said he shared the frustration of veteran service organizations who, along with congressional staffs, have been shut out of decision-making over private-care access standards though the law mandates the VA involve them in plans for implementing the Mission Act.
"I have grown increasingly concerned with the department's planned implementation of the new veterans community-care program … moving away from the direction it was headed just six month ago," he said.
At that time, Tester said, the VA agreed that if veterans faced excessive wait times or driving distance to get care at a VA facility, they should be offered referrals to community networks.
"Specifically, we discussed designating access standards for services like routine lab work and X-rays. We agreed to give the VA authority to decide exactly what services or categories of care should make veterans automatically eligible to receive care in the community," Tester said.
Now, he said, the VA has indicated it will set access standards for "each and every type of care a veteran might need. This would essentially outsource all segments of health care to the community based on arbitrary wait times or geographic standards, which was what we're supposed to be moving away from by ending the Choice program. And that's despite the fact that several studies, one as recently as last week, have indicated the quality and care at the VA is good or better than the private sector."
"To make matters worse," Tester added, "VA officials have offered only vague verbal descriptions of the various sets of potential access standards under consideration. … We need to know what you're doing, Mr. Secretary, and how much it's going to cost."
Because "if you move further down this path, gutting the VA health care system for those veterans who want and need to use it, you'll end up bringing down the whole boat," he said. "And you're going to spend a whole lot of time and money sending veterans into community for care that is less timely and not as high in quality. That's a bad deal for our taxpayers [and] our veterans."
Tester said his suspicion is that White House-led politics are behind the course correction over access standards and the VA's reluctance to brief congressional staffs and engage veterans groups more deeply. "I hope I'm wrong," he said.
In response, Wilkie reviewed features of the Mission Act that will strengthen VA staffing, allowing the department to offer better compensation packages to fill staff shortages of mental health specialists, internists and primary-care physicians.
Regarding privatization, Wilkie said he agreed with Tester that "veterans are happy with the service they get at the Department of Veterans Affairs. I have not seen any indication that the majority of our veterans are chomping at the bit to find alternative ways to take care of themselves. The most important part … is the communal nature of veterans' care. Veterans want to go places where people speak the language and understand the culture."
On access standards, Wilkie said, "I have in mind not only Senator Tester's state of Montana when it comes to the ability of our veterans to get to services, but also the most heavily congested metropolitan areas of this country. We have to make it easier for our veterans to get that care they need."
Wilkie said the major veteran organizations might feel less involved in the process because he has engaged more than past secretaries with smaller veterans groups -- for example, Purple Heart and blinded veterans, to reflect changes in the demographics of the veterans population.
Blue Water Navy Bill Sinks
Several senators used the joint hearing to express regret that the Senate failed to pass the Blue Water Navy Vietnam Veterans Act (HR 299), even though the House approved it unanimously last June.
Referring to a host of veteran benefit bills that became laws in the 115th Congress, Sen. Johnny Isakson (R-Ga.), Senate committee chairman, conceded to House colleagues "that we dropped the ball with you on one thing: You all got the Blue Water Navy through. ... We failed in the Senate on two [unanimous consent attempts], one today and one last week."
Sen. Mike Lee (R-Utah) became the second senator to block the bill, arguing as did Sen. Mike Enzi (R-Wyoming) last week, that budget offsets identified by the House, to cover the cost of extending Agent Orange-related health care and disability compensation to ailing shipboard veterans of the Vietnam War, were insufficient based on revised calculations by the Congressional Budget Office.
Isakson vowed to lead a fresh effort to pass the bill in the next Congress.
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