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 the billionaire industrialists Charles G. and David H. Koch, which has long championed increasing the use of private sector health care for veterans.
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. Mr. Selnick clashed with David J. Shulkin, who was the head of the V.A. for a year under Mr. Trump, and is widely viewed as being instrumental in ending Mr. Shulkin’s tenure.
Mr. 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 V.A., 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, Senator John Boozman, Republican of Arkansas, told Robert L. 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.
What The Times didn’t say:
Wait times at the VA are comparable or better than the private sector.
Quality at the VA is comparable or better than the private sector.
Preparedness to treat veterans is a problem for the private sector.
“This will be ‘kaboom’ for the Veterans Health Administration”
If there’s no way to truly measure the quality of private sector care, will those billions really go toward effective care for veterans? More analysis on the VA MISSION Act at the VeteransPolicy.org blog:
Unless the Veterans Health Administration (VHA) requires private providers to specifically track veterans who are receiving services through the Veterans Community Care Program (VCCP), comparisons of quality care will be inaccurate.
Second, many patient conditions, whether treated inside or outside the VHA, have no quality metrics published for public use. A prime example is PTSD. You won’t find information whether evidence-based PTSD treatments are employed on the VA or Medicare websites that compare care across settings. You won’t see whether symptoms are assessed. In fact, PTSD isn’t even listed. Without available scores for specific conditions, how can veterans make decisions about the quality of services provided by the VCCP versus those delivered by the VHA?
Administrators also depend on reliable measures to guide their healthcare decisions. The MISSION Act instructs managers to utilize quality data to designate underperforming VHA clinics and then dispense private care vouchers to thousands of their patients. If the comparative performance data aren’t valid then the distribution of vouchers won’t be either.
Flawed data endangers the entire VHA system. Because payment for private sector providers comes directly from the budget for existing VHA facilities, services will steadily erode, staffing will be cut and veterans will be unable to get care at the VHA. Most veterans insist they want the VHA to be strengthened but that’s not what will happen if more veterans are channeled to private sector providers whose quality has not been proven. As one VHA hospital official told us, “This will be ‘kaboom’ for the VHA.”