WASHINGTON — Is it time to overhaul VA’s eligibility rules? According to some legislators, the process is long overdue for an update, although veterans’ service organizations are split on the issue.
“The current enrollment priority group system that governs which veterans receive care has remained largely unchanged since it was created in 1996,” declared Rep. Phil Roe (R-TN) at a House VA Committee hearing last month. “Think back to the world that existed 25 years ago. The nature of warfare, military service and modern medicine looked virtually nothing like they do today.”
In September, Roe introduced the Modernizing Veterans’ Healthcare Eligibility Act, which would establish an eligibility commission to examine VA’s system and make recommendations on how it can be improved. The bill is based on recommendations made in the 2016 Commission on Care report.
The current eligibility system is based on the Veterans’ Health Care Eligibility Reform Act of 1996, which attempted to clarify decades of complex and confusing eligibility rules. The act established two major categories of veterans—those with service-connected disabilities and those without. It then ranked them into priority groups based on disability status, income and other factors.
Since then, Congress has made adjustments to VA’s eligibility rules for specific veteran groups. For example, making all treatment for military sexual trauma free, regardless of whether a veteran has a service-connected disability, and opening mental health care treatment up to veterans with an other-than-honorable discharge.
Roe suggested that those changes have been to too incremental, however, and that many of the veterans issues that Congress wrestles with are actually about eligibility, even if they don’t seem that way on the surface.
“Debates about increasing diversity of the veteran population have been debates about eligibility,” said Roe, who previously chaired the committee. “Debates about suicide prevention have been debates about eligibility. Our debates about toxic exposure have been debates about eligibility. Our debates about discharges have been debates about eligibility.”
Delays in providing comprehensive reforms to VA’s eligibility system will only deepen the disconnect between that system and the veterans it serves, Roe declared.
Wary of Commission
Yet, some veterans service organizations (VSO) are wary about the creation of an independent commission charged with making major recommendations to VA and told legislators so at the hearing.
“We do not feel a revamping of the system is needed at this time,” explained Patrick Murray, national legislative director for the Veterans of Foreign Wars. “Also, we do not feel a commission like that in this proposal is needed.”
The VFW countered that, while commissions are useful when subject matter experts are needed, enough expertise exists in Congress, VSOs, and from VA providers to make an independent body unnecessary, Murray said.
Murray added that the VFW might support a more specific directive for a commission, such as expanding eligibility or consolidating priority groups.
“We think that the goal of the proposed commission is not sufficiently defined and could result in creating solutions for problems that do not exist,” he said.
He was joined in that opinion by Marquis Barefield, national legislative director for the Disabled American Veterans (DAV). Barefield told legislators that DAV saw no compelling dysfunctions linked to eligibility and no reason to stand up a commission.
The American Legion said it holds a different view. Legislative associate Jeffrey Steele told legislators, “Congress can and should exercise immediate action involving reforms to VA healthcare and eligibility, when possible. Setting up a multimember, bipartisan, independent structure that incorporates participation from across the veteran stakeholder community would be welcomed in this instance.”
Speaking for VA, Tammy Czarnecki, deputy to the undersecretary for health operations, said that, while the agency is open to discussing how the eligibility system can be clarified, streamlined or improved, the VA does not support an independent commission. She said the department believes more discussion needs to happen between VA, VSOs and Congress before “outsourcing” the problem to a commission.
Sidath Panangala, a specialist in veterans’ policy with the Congressional Research Service, provided the committee with some historical perspective on the issue and noted that commissions have been used in the past and that, regardless of what recommendations are made, it will be up to Congress to make major changes.
“Generally speaking, commissions can examine complex policy issues for a longer period of time and greater depth than what is practical for members of Congress and their staff in a short period of time,” Panangala said. “However, any policy positions or choices would rest on Congress. In the [1996 Reform Act], Congress began a series of discussions going back to 1992, then engaged in considerable debate and deliberation.”