WASHINGTON — House lawmakers are looking to dramatically increase the number of veterans who can seek medical care outside the Veterans Affairs system, but department officials want them to go even further.
They’re arguing in favor of an even more radical shift in traditional veterans’ medical care, opening community care options to nearly any veteran and allowing free walk-in care at local doctor’s offices for routine appointments.
“We don’t believe there should be strict mileage criteria or wait time criteria,” Secretary of Veterans Affairs David Shulkin told members of the House Veterans’ Affairs Committee on Tuesday. “These are going to be individual clinical decisions based on feasibility and access.”
Shulkin’s plan — the new Coordinated Access & Rewarding Experiences (CARE) Act — has already received criticism from federal unions for shifting too many department responsibilities and funds to private-sector practices. Last week, those critics labeled the plan a full “voucherizing” of veterans’ care.
Shulkin, himself a practicing physician along with his Cabinet role, has repeatedly insisted the sweeping overhaul does not amount to diminishing or privatizing VA health care but instead, simplifying and modernizing the overburdened system.
“Having a veteran drive 100 miles for a blood test or flu shot doesn’t make sense,” he said Tuesday. “We’re trying to model VA after how medicine is practiced across America today.”
It’s also in keeping with U.S. President Donald Trump’s repeated promises to free up veterans to see doctors in their neighborhoods instead of requiring them to get their free health care directly from VA clinics and hospitals.
The CARE plan and a similar slate of VA health care reforms unveiled by the committee on Tuesday would consolidate a host of community care initiatives into a single, more flexible program with a single funding source.
That has been a goal in recent years of both Republicans and Democrats, who say current systems are too complicated for patients, doctors and bill collectors. Veterans groups have endorsed the idea.
Both plans would also abandon the current eligibility rule allowing only veterans facing a 30-day wait or 40-mile distance to the nearest VA facility to access the Choice program, letting them seek private-sector care at government expense.
But the House plan, offered by committee Chairman Rep. Phil Roe, R-Tenn., would leave VA physicians with “the right of first refusal” of patients and allow them to seek outside care only if a primary care provider or specific medical services aren’t available within the VA system.
“It should go without saying that VA cannot be everywhere, providing everything to every veteran,” he said at the hearing. “Expecting VA to perform like that sets VA up to fail.”
“That is why my draft bill preserves VA’s role as the central coordinator of care for enrolled veteran patients,” he said. “But when VA can’t do that, my bill would ensure that veterans aren’t left out to dry.”
Shulkin said he supports much of the House plan but indicated it still may fall short of the goal of a meeting patients’ “clinical needs.” He pushed for even more flexible rules with a goal of having veterans work with their VA doctors to set up a care plan that may be almost entirely outside the current department network.
About one-third of VA medical appointments each year are conducted by physicians outside the department.
Veterans groups have expressed concerns about a massive expansion of that number, arguing it could undermine the integrity of the department and harm veterans’ health care by sending them to doctors unfamiliar with issues like post-traumatic stress disorder and traumatic brain injury.
Officials from Iraq and Afghanistan Veterans of America questioned whether VA medical records are modern enough to allow seamless sharing with private-sector offices. AMVETS officials said sending more veterans into the community to find medical appointments won’t solve VA’s own physician recruitment and retention problems.
Several groups also objected strongly to the potential cost. Earlier this year, a coalition of veterans groups forced lawmakers to add nearly $2 billion in funding to existing VA programs to offset a new $2.1 billion extension of the Choice program.
The CARE proposal includes a round-down of cost-of-living disability pay increases to help pay for the costs of the expanded program. Officials from the Veterans of Foreign Wars said they continue to “strongly oppose” that plan and a proposal to cap some education benefits to provide other savings.
Officials did not provide specifics on the costs of either the House or VA plans, saying the details are still being worked out. Shulkin said he suspects an overhaul of VA community care will save “billions” over the next decade, with thousands of employees potentially cut as the administrative burden of the programs are simplified.
Critics have called that unrealistic and said that promises of cheaper care from private-sector offices are misleading.
Committee ranking member Tim Walz, D-Minn., said those cost details will determine whether his caucus will be able to support the plan.
“While I am pleased at how close we are to settling on the policy underlying a Choice replacement program, I am concerned with how it will be funded,” he said. “I continue to believe that veterans do not benefit when we scrape the barrel for money by skimming from some veterans’ benefits or health care programs to pay for others.”
Shulkin has said that lawmakers need to make a decision on potential reforms before the end of the year, when money funding the current Choice program is scheduled to run out. Without a replacement plan, medical care for tens of thousands of veterans could be disrupted in the new year.
Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.