WASHINGTON–Six months after President Donald Trump signed the VA MISSION Act–a bill that will, among other things, streamline and expand veterans’ access to non-VA healthcare providers–many legislators are concerned whether VA has the ability to implement the extensive provisions in the bill without the painful speed bumps experienced with past legislation.
Others are questioning the actual cost of the bill and whether VA will end up outsourcing more care than was discussed during original negotiations.
Among those most concerned are the leading Democrats on both the House and Senate VA committees, who voiced those worries at a joint committee hearing shortly before Congress adjourned in December.
The implementation of the MISSION Act has been rocky so far, and legislators said they have felt misled and misinformed, Rep. Mark Takano (D-CA), the newly-appointed chair of the House VA Committee, told VA leadership. “How will veterans be referred to doctors outside of VA, and how much of your budget will be required to pay for this care, which we know is often more expensive than VA’s internal services? I remain concerned with the department’s lack of transparency.”
Democrats on the Senate committee expressed their concern in much more dire terms. Both Senators Jon Tester (D-MT) and Bernie Sanders (D-VT) predicted that funneling more money into community care–the estimated cost for which has ranged anywhere from $1 billion for the first year to $20 billion over five years–will leech resources from the VA healthcare system.
“The VA now indicates it plans to designate access standards that will apply to each and every type of care a veteran might need. This would essentially outsource all segments of VA healthcare to the community, based on arbitrary wait times or geographic standards,” declared Tester. “You’re going to spend a whole lot of money sending veterans into the community for care that’s less timely and not as high in quality. That’s a bad deal for taxpayers. That’s a bad deal for veterans, who would ultimately bear the brunt of cuts to other services or benefits to cover the increased costs of community care.”
Sanders brought up the fear of the gradual privatization of VA healthcare. “My worry is that we are in the process of dismembering the VA, taking resources away from VA and putting it in the private sector. The result will be that many of our veterans will not get the quality care that they deserve,” he said. “[Privatization] is going to happen piece by piece by piece until over a period of time there’s not much in the VA to provide the quality care that our veterans deserve.”
VA Secretary Robert Wilkie addressed those concerns, especially that of privatization. “I don’t believe that veterans will allow VA to be privatized. Veterans want to be where people understand their culture and speak their language,” he said. “What we see [community care] access doing is allowing veterans, particularly in rural America, to alleviate a burden on themselves and their families by giving them the option to seek care that is closer to home if they have to.”
He also noted that the MISSION Act will give VA more resources to recruit healthcare professionals and strengthen the VA system. “We do not exist in a vacuum. The United States is suffering from a shortage of mental health professionals, is suffering from a shortage of women’s health professionals, is suffering from a shortage of primary care physicians and interns. We are competing for those,” he said. “Now I have the opportunity to offer more impressive packages to bring those providers into VA.”
Even legislators who are less critical of the bill questioned VA’s ability to roll out the provisions in the MISSION Act effectively and in time to meet the June 2019 deadline for having a new community care network in place.
“Community care–that deadline is coming up in six months. Will we have networks in place? Can you schedule an appointment to the doctors in those networks? Will VA pay the bills once the veterans are seen?” asked Rep. Phil Roe (R-TN), a physician who is the previous chair of the House committee. “I’d rather we keep doing what we’re doing than have this fall on its face. I remember very well in 2014 the fiasco that occurred there.”
The “fiasco” Roe was referencing is the implementation of the VA Choice Program, an experience that’s lurking in the background of many of these concerns. The Choice Program, which the VA MISSION Act is replacing, came as a direct response to 2014 reports out of Phoenix reporting massive waiting lists of veterans trying to access care at the Phoenix VA. Other government oversight reports followed showing similarly long waiting lists across the country. With a speed that legislators at the time applauded, Congress created the VA Choice Program–a temporary program that made veterans who faced a wait time of 30 days or more eligible to see non-VA providers.
The haste with which the program was implemented is now seen as one of the reasons it did not meet expectations. A lack of in-place infrastructure, sluggish claims processing, and adequate data collection had eligible veterans still waiting as long as 70 days for an appointment, according to a GAO report released in June.
“The Choice Program was rushed, and we were given such unreal, unnatural timelines to implement a program,” Wilkie said. “My understanding is that VA had to move as rapidly as possible and there was not that time for reflection that you’d usually take on an issue like this.”He assured legislators that VA had learned its lessons from Choice. “I do believe we have the beginnings of a comprehensive set of standards that we will take to the country to bring those community care providers into the networks,” Wilkie said. “And as this committee has noted on a number of occasions, we have an IT problem when it comes to claims processing. What we’ve done is look to the market for off-the-shelf technology that will allow us to automate the claims process, so that individuals will not have to touch each claim. This will put VA in line with the most modern healthcare administrations in the country.”