By Sandra Basu
WASHINGTON—Lawmakers have approved a continuing resolution that included $2.1 billion to temporarily continue VA’s Choice program.
Prior to passage of the measure late last month, VA Secretary David Shulkin, MD, had warned lawmakers that the Choice program would run out of money soon if Congress did not pass a bill.
“Without additional funds before the end of the year, there will be a dramatic impact on the ability of the Department of Veterans Affairs to provide care for veterans,” he wrote in a December letter to Senate Committee on Veterans Affairs Chairman Sen. Johnny Isakson (R-GA).
He said that, “unless additional funds are provided, veterans utilizing the current VCP will be less able to access timely health care as close to their homes as possible.”
The approval of funding comes after leaders of key committees unsuccessfully tried to get comprehensive legislation passed before the end of the year to reform VA’s community care programs. In 2017, VA authorized 6.1 million community care appointments, a 42% increase over 2016, according to Shulkin. VA’s Choice Program, which was created by Congress in 2014, has been the source of ongoing debate.
On the Senate side, Isakson urged the full Senate to pass a bipartisan bill he and Sen. Jon Tester (D-MT) were championing that would revamp and extend funding for the Choice program, following the committee’s approval of the bill on Nov. 29.
“Well now we have before the Senate what we call the Caring for Our Veterans Act, and it is the finishing touches of what was originally the Choice Act. We are taking the things that we learned were wrong and repealing them. We are taking the things we learned were right and enhancing them,” he told lawmakers on Dec. 21.
On the House side, House Committee on Veterans’ Affairs Chairman Rep. Phil Roe (R-TN) and Ranking Member Tim Walz (D-MN) also cosponsored a bill to reform the Choice program that was approved by their committee, but ultimately was passed by the committee without the support of Walz and other Democrats.
“I could not in good conscience vote in favor of the H.R. 4242. The bill lacked a clear and sustainable way to pay for VA care in the community,” Walz said of the bill.
Roe said after the committee vote that he hopes that “Democrats on this committee will return in January and negotiate in good faith to give veterans the health care they deserve.”
Both the House and Senate proposals scrap the current rules for VA’s Choice program, which restrict use of the community care program to veterans who reside more than 40 miles from the closest VA medical facility with a full-time primary care provider or are experiencing wait times of 30 days or more or when the service is unavailable at their VA facility. Instead, under both proposals, a veteran and their doctor would decide where that veteran will receive care.
VA Secretary David J. Shulkin, MD, has called the current criteria to access community care “arbitrary” and “unnecessarily cumbersome.”
One key difference between the House and Senate bills is that attached to Isakson’s bill is a provision that would expand caregiver benefits. Currently, only post 9/11 veterans are eligible for the program. Under the new bill, those benefits would be extended to veterans with a serious injury incurred or aggravated in the line of duty on or before May 7, 1975, and then to veterans seriously injured in the line of duty after May 7, 1975, and before Sept. 11, 2001.
Under the bill, VA would be required to certify that it has fully implemented the information technology system to support that program by June 2018.
Several organizations praised the provision in the Senate bill that would expand comprehensive caregiver benefits to veterans of all eras.
“The legislation would finally correct a serious inequity between veterans who served before September 11, 2001, and their post-9/11 comrades, who believe the caregivers of pre-9/11 veterans must have access to comprehensive caregiver services that are fully funded and properly managed,” the veterans’ advocacy groups wrote.
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.