VA Secretary Robert Wilkie has announced that drive time to VA facilities will determine a veteran’s eligibility for non-VHA care via the VA MISSION Act. VHPI’s Suzanne Gordon reports at The American Prospect:
As my colleague Jasper Craven and I predicted, Wilkie’s plan is to expand private-sector access for veterans currently at the VHA. But instead of basing this access on the needs of individual patients or the quality of private providers, Wilkie focuses exclusively on wait times. Under his proposal, any VHA patient who has to drive for more than 30 minutes for a primary care or mental health appointment or 60 minutes for a specialty appointment will have access to private doctors and hospitals if they so choose. If a veteran has to wait more than 20 days for mental health or primary care or 28 days for specialty care he or she could also seek care outside the VHA (a stipulation that may shrink to 14 days in the future).
But these parameters are needlessly broad: In many heavily trafficked urban, as well as scantly populated rural areas, drive times can easily exceed 30 or 60 minutes. According to internal VA estimates, the rule change could channel up to 63 percent of VHA patients into the private sector. What’s worse, every dollar spent on outsourcing would come out of the VHA medical care budget. This could quickly drain resources from VHA facilities and programs, which are already understaffed and over-stretched.
Despite its insufficient budget, the VA has time and again shown itself to be far better equipped at caring for veterans than private-sector providers—a fact the administration readily acknowledges.
Democratic legislators, many of whom supported the law, are now expressing buyers’ remorse. On January 28, 29 senators, including Senator Jon Tester, who sponsored the MISSION Act, and Senator Bernie Sanders, who voted against it, sent Wilkie a letter warning against pushing veterans outside of the VHA. The quality of private-sector care, they said, is often inferior to that provided by the VHA, while the cost to taxpayers was not “adequately assessed,” ranging from $1 billion to $21.4 billion over five years. And according to the VA Commission on Care, the cost could be higher still, ballooning as high as $179 billion per year—all for what could be lower quality care. In their letter, all 29 senators agreed that administration’s refusal to increase federal spending, combined with escalating costs for private-sector care, “would likely come at the expense of VA’s direct system of care … something we cannot support.”
Veterans’ service organizations who lobbied for the bill are now equally concerned. In their Independent Budget for the 116th Congress, the Disabled American Veterans (DAV), Veterans of Foreign Wars (VFW), and Paralyzed Veterans of America (PVA) warned that the MISSION Act’s obsession with drive and wait times came at the expense of the individual needs of patients and the quality of private providers. In addition, these groups rightly fear that too much money for private-sector care will be siphoned from the VA budget. Finally, they argue that competency standards for private-sector providers should be “equivalent” to the high standards imposed on the VA. None of these recommendations were incorporated into the secretary’s new guidelines. As such, the groups cautioned that the MISSION Act could have “devastating consequences for veterans who rely on VA for their care” if poorly implemented.
Changes driven by private care access, not high-quality care
“The Trump Administration has bowed to private providers who demanded lower standards,” said Suzanne Gordon, a VHPI senior policy analyst and author of Wounds of War, a book about VA health care. “This plan is right out of the Koch Brothers’ Concerned Veterans for America playbook.”
In a meeting last year, leaders of some of the nation’s largest private health care networks candidly explained that there would be a ‘tradeoff’ between access and quality when outsourcing veterans’ care to the private sector. These leaders also indicated they would be unwilling to deliver care to veterans if asked to match the VA’s high standards.
“These access standards will destroy one of the most successful healthcare systems in the country, enriching shareholders while jeopardizing the health and even the lives of the nation’s most vulnerable veterans,” said Gordon.
The players responsible for VA’s radical reshaping
The new access standards are the most important step toward reshaping the VA in line with Trump’s vision of enlarging the private sector’s role.
“None of this should be a surprise to anybody: President Trump has made it clear from pretty much the moment he started running he wanted full choice,” said Dan Caldwell, the executive director of Concerned Veterans for America, a political group that advocates for more private care and that is backed by the Koch brothers, the industrialists who have donated hundreds of millions of dollars to conservative causes. “This does get us closer to full choice. That’s the model we want to get to.”
In developing these access standards, Wilkie relied extensively on Darin Selnick, who previously worked for Concerned Veterans for America, the organization supported by the Koch brothers. Selnick signed onto an infamous 2016 proposal to dismantle the VA’s **********-run health system. Selnick also worked closely with the trio of unofficial advisers known as the “Mar-a-Lago Crowd.”
Selnick sat on the “executive steering committee” in charge of implementing the Mission Act and reported directly to Wilkie as a senior adviser, according to an organization chart obtained by ProPublica. However, when the VA presented a version of the same chart to Congress at a December hearing, Selnick’s name was not there.
Lawmakers voted for the Mission Act with the understanding that access standards would automatically trigger private care for only a few kinds of services, such as lab tests, X-rays and urgent care, the 28 Senate Democrats said. But now the administration is making the access standards apply to everything, a plan that ProPublica first revealed in November.
“This proposal risks needlessly siphoning away VA resources to private providers, which could irresponsibly starve excellent existing VA clinics and hospitals,” Senate veterans committee member Richard Blumenthal, D-Conn., said in a statement on Wednesday.
But opponents say the new community care program won’t hold outside providers to the same wait-time or quality standards that VA physicians must meet. That puts VA at a disadvantage as they try to explain to veterans why their breadth of experience and associated support resources many outweigh a slightly-shorter car drive for check-ups.
“The standards turn a blind eye to the quality of care veterans would receive in the private sector,” said Russell Lemle, a senior policy analyst at the Veterans Healthcare Policy Institute, a frequent critic of the administration’s VA reform plans.
“These standards will privatize veterans’ health care, plain and simple. They open up the floodgates for veterans to receive vouchers for private sector services. Now for the first time, dollars will follow veterans into the private sector, leaving less money and less staff available for VA facilities.”
Nikki Wentling writes about Veteran Service Organizations’ response to the new access standards for Stars and Stripes.
Comments from Capitol Hill:
“Rather than working to find an equilibrium within the system by building up VA’s ability to deliver high quality care, fill the more than 40,000 vacancies within the department, continue working to reduce wait times, and raise the caliber of service we provide for our nation’s veteran population, today’s announcement places VA on a pathway to privatization and leads Congress to assume the worst.” – Rep. Mark Takano, chairman of the House Committee on Veterans Affairs
“The VA MISSION Act provides the VA secretary the flexibility to determine what standards for access to community care are necessary to accomplish this goal, and we believe these new standards will enable veterans to receive care that best fits their individual needs while making the VA healthcare system stronger.” – Joint statement from Sen. Johnny Isakson, chairman of the Senate Committee on Veterans Affairs, and Rep. Phil Roe, ranking member for the House Committee on Veterans Affairs
“At recent briefings, VA leadership officials have indicated the Department now intends to designate all clinical services as making a veteran nearly-automatically eligible for community care. This will significantly increase the overall cost and amount of care VA will send to the community. Given that the administration opposes increasing overall federal spending, these increased costs for community care will likely come at the expense of VA’s direct system of care. And that is something we cannot support.” – Sen. Jon Tester, ranking member on the Senate Committee on Veterans Affairs in a statement released prior to the announcement of the new access standards
There are currently no hearings scheduled for the House Committee on Veterans Affairs
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