August 15, 2018
As Congress and the administration are expanding the use of private, for-profit hospitals under the so-called Choice program, organizations that represent veterans are making it clear that the Choice program should continue to be just a temporary fix and that they are against the privatization of the VA.
“The American Legion supports a strong VA that relies on outside care as little as possible and only when medically necessary, rather than a move toward vouchers and privatization,” American Legion Assistant Director Jeff Steele testified before the Senate Committee on Veterans’ Affairs on June 7.
“Even with the additional options of the Choice program, veterans in general overwhelmingly prefer to use VA,” Disabled American Veterans Deputy National Legislative Director Adrian Atizado testified at the same hearing. “DAV strongly urges this committee, Congress, and the administration to honor the clear preference of the vast majority of veterans who choose to use the VA health care system – a system created to meet their unique needs.”
Corporate interests like the Koch brothers and private hospital CEOs who have been pushing Congress to privatize the VA may have celebrated the expansion of the Choice program created “in response” to the waitlist scandal, but veterans organizations have a different take on this issue and the Choice program as a whole. Here’s what they have to say:
Steele told Congress “False narratives instigated by political interests trashed the department in 2015 and 2016 and continued to feed the media’s insatiable appetite for scandal by spotlighting as many isolated incidents of malfeasance as they could find. Transparency is important and exposing criminal behavior is essential to good governance, but taken out of context this biased coverage fails to tell the more accurate story of an agency that serves millions of veterans every day with expert care. Hundreds of thousands of caring, well trained, and hghly competitive professionals stream through the doors of VA medical centers throughout this nation day in and day out for one purpose and one purpose only – to care for those who have borne the battle – and overall, they do an excellent job.”
In talking to veterans from coast to coast, the American Legion found that veterans who go to private hospitals for care under the Choice program face scheduling problems and thousands have returned to the VA because they couldn’t find a doctor or the doctor was too far away.
The organization also told Congress that Choice “instituted third party administrators, additional eligibility criteria, higher and inconsistent reimbursement rates, and a disconnected billing authority.” The law creating the program mandated the VA to issue paper Choice cards to every enrolled veteran that were “essentially worthless, wasting millions and millions of dollars on designing, procuring, and mailing millions of these cards in 90 days or less.”
Sending veterans off to for-profit hospitals without a well-crafted contract presents a huge and expensive problem for veterans. In order for the VA to be able to maintain complete and up-to-date treatment records of veterans, the Choice Act requires private sector doctors to return veterans’ medical records to the VA. The VA is not allowed to pay doctors if they fail to return those records. Many private doctors failed to return the records as they don’t think it’s important. As a result, the VA refused to pay the doctors. The doctors blamed the VA for not paying them. They billed veterans directly and refused to see any more VA patients until they got paid.
“This, among other reasons including unsustainable cost, is why Choice is not the answer,” said Steele.
Some veterans are even left paying out of their own pockets. According to the Veterans of Foreign Wars, veterans were forced to pick up the tab when their Choice doctors performed treatments that are outside the scope of the Choice authorization.
The Choice Act has been amended twice, and the original contract has been modified more than 70 times, yet several issues remain, Atizado said. “DAV does not believe the Choice program should be expanded to new categories of veterans. While the Choice program relieves some of the demand for VA medical care, it does not have the necessary elements to serve as a solid foundation for the future of community care.”
While the Choice program may appear to increase health care access for veterans, the VA can’t always use the authority to contract out patient care as “their budget could serve twice as many veterans if redirected toward organic campus care or already negotiated and established community care contracts,” Steele said.
“Even a limited expansion of the current eligibility for the Choice program would add significant costs at a time when demand for VA health care is already rising faster than resources provided by Congress,” Atizado said.
The VA operates under a tight budget as Congress and administrations never give it the amount of money it really needs. Some members of Congress have suggested that veterans should be free to choose between VA and private sector providers whenever they want – something the Veterans of Foreign Wars thinks is a bad idea.
“While this proposal may sound enticing, it is unsustainable because of cost and the VFW would overwhelmingly oppose any proposal to pass that cost onto veterans,” said VFW National Legislative Service Director Carlos Fuentes.
Fuentes also expressed concerns over the administration’s request to make the Choice program a permanent mandatory program.
“VA’s medical care accounts are under discretionary spending and subject to sequestration budget caps. Having the Choice program as the only VA health care program not subject to spending caps could lead to a gradual erosion of the VA health care system,” he added.
If people want to improve the VA, the first thing they need to do is stop trashing the VA, especially when the agency is struggling to fill up to 49,000 vacancies.
“Stop taking cheap shots at our healthcare system. It’s hurting veterans, it’s hurting morale, and it’s killing VA’s recruiting efforts,” Steele told members of Congress. “If anyone thinks that killing VA will save taxpayer dollars, they are either woefully misinformed, delusional, or lying.”
Atizado said there are a number of things that Congress can do to help improve the VA, including addressing the widening salary gap between the VA and the private sector to allow the VA to attract the best and brightest to meet the increasing demand.
“While there are many factors that contributed to the access crisis, when there are not enough doctors, nurses, and other clinical professionals or enough useable treatment space to meet the rising demand for care by enrolled veterans, the result will inevitably be rationing of care, waiting lists, and access problems,” he added.
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