VA Secretary David Shulkin announced last week that his priorities for improving services to veterans include expanding their access to private sector health care in part by asking Congress to remove two irksome cost controls.
Under the oft-criticized Choice program, enacted in 2014 in response to a wait-time scandal across the VA health system, veterans can seek private sector care at VA expense only if they face wait times longer than 30 days for a VA appointment or they live more than 40 miles from a VA healthcare facility.
Congress set these restrictions to limit the exodus of patients to private sector care during what was seen as temporary crisis. Without them, the Congressional Budget Office predicted, Choice users would burn through the $10 billion set aside for a three-year emergency program in less than a year.
The Trump administration now wants Choice extended and expanded, as do key congressional leaders, despite warnings from veteran service organizations that shifting too many patients and too much funding to private sector care could begin a slide toward full privatization of VA health care.
Shulkin told a conference of the American Legion Tuesday that he wants Congress to extend authority for Choice past its Aug. 7 sunset date "because we need those resources to be able to provide the care for veterans that they deserve."
More surprisingly, Shulkin said VA will seek authority to redesign Choice to provide faster access to private sector care, which "means we're going to need to eliminate the 40-mile/30-day rule." President Trump, he added, is committed to such moves to ensure more timely care.
VA policymakers made those early-cost projections by congressional auditors look wildly high. They did so by continuing to serve as gatekeepers on access to non-VA care, referring patients whenever possible to approved networks of civilian providers, and leaving veterans frustrated, angry and complaining to Congress.
By early 2016, VA had revised the 40-mile-rule twice to broaden eligibility, first by replacing "as-the-crow flies" distance with driving distance to the nearest VA hospital or clinic, and later mandating that a VA facility must have at least one primary care physician to be counted in the 40-mile rule.
Rep. Phil Roe, R-Tenn., a physician who now chairs the House Veterans Affairs Committee, noted that the VA health budget has climbed from $97 billion in 2009 to almost $180 billion this year while VA hired 100,000 more health care employees, he told Legionnaires. Still, Roe said, he wants to see access to private sector care expanded and veterans put "in charge of health care decisions."
Sen. John McCain, R-Ariz., an architect of the Choice program, also wants it expanded. He said VA "does the best job of anybody on PTSD, traumatic brain injury, prostheses" and other select health services. But veterans shouldn't have to wait to get routine medical care, McCain told the Legion conferees.