VA under pressure to deliver Trump reforms

A law overhauling how the Department of Veterans Affairs (VA) allows patients to seek outside care is falling behind in implementation despite President Trump’s boasts about the reforms.

Trump has long touted the law, which makes it easier for veterans to access private or community health-care programs, as essential to improving the beleaguered agency.

The law, signed in June, allows for a yearlong implementation period, and veterans say they would rather it be done right than hastily.

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“It has not got to a point of panic just yet,” said Carlos Fuentes, legislative director at the Veterans of Foreign Wars. “We certainly want to make sure that it’s implemented correctly instead of rushed to implementation. That’s one of the issues with the Choice program.”

But veterans groups are also watching the process intently, and the VA is under pressure to implement the new law in time.

The law in question, the VA Mission Act, is the replacement to the VA Choice Act, a program first established in 2014 during the Obama administration. The Choice program was created after the VA wait-time scandal where administrators were found to be doctoring appointment schedules to cover up problems providing veterans health care.

The Choice program gives veterans facing long wait times at the VA or who would have to travel far to reach a VA facility the ability to seek private health care paid for by the government. About 30,000 appointments per day are funded through the Choice program.

But the program, which had a 90-day implementation period, has faced numerous issues, from complaints that it wasn’t being used enough to, more recently, repeatedly running out of money.

The $55 billion Mission Act seeks to address the issues with Choice by overhauling and consolidating the network of private health-care providers where veterans can use their benefits. The law passed with large bipartisan majorities in both chambers of Congress.

“Congress has done what no Congress has ever done. They have given us the roadmap for success,” Veterans Affairs Secretary Robert Wilkie said Friday at a “State of the VA” address, referring to the Mission Act and other bills. “Today, we are working to give veterans more choice in their health-care decisions because of the Mission Act.”

The Mission Act has become a much-touted accomplishment for Trump, who during his 2016 campaign released a 10-point plan to “make the VA great again.”

Among the 10 points was a promise to expand veterans’ choices to use private health care.

“I’ve done more for the vets than any president has done, certainly in many, many decades, with Choice and with other things, as you know,” Trump said unprovoked at a press conference last week. Trump often refers to the Mission Act as “Choice.”

The implementation involves some difficult choices for VA officials.

Among the questions officials need to answer before June 2019 are who will be eligible for private care, how much involvement VA doctors will have in that decision and how the pay structures will work.

An FAQ posted to the VA website said implementation of the changes will take some time and urged patience.

“Due to the significant complexity associated with health care delivery, the large size of the VA health care system, along with VA’s network of more than half a million community providers, adequate time and consideration is required to properly develop the required regulations and necessary system changes and training for successfully implementing the consolidated community care program,” the VA wrote.

“A lesson learned from the implementation of the Veterans Choice Program is that rushing implementation wasted resources and did not serve Veterans, providers, or VA well.”

Already some issues have cropped up. The VA has yet to award up to four contracts to companies to develop and
administer regional networks of private health-care providers. That delay has already attracted the attention of lawmakers.

“I am troubled that the awarding of these contracts has been repeatedly delayed, given these [networks] will facilitate veterans receiving care in the community by establishing networks of providers ready and willing to see veterans,” Sen. Jon Tester (D-Mont.), ranking member of the Veterans Affairs Committee, wrote in an August letter to Wilkie. 

Last month, the VA announced it reached an agreement with TriWest Health Care Alliance for a one-year extension of its current contract to “ensure access to community care” until the contracts are awarded and implemented.

The VA plans to award the contracts for regions one through three by the end of 2018 and for region four by January 2019, according to Tester’s letter.

The networks for regions one through three aren’t expected to be fully operational until December 2019, Tester said, and “even later” for region four.

“I am extremely frustrated that veterans may not receive the benefit of a fully-operational network to go along with their revamped eligibility for community care on day one,” Tester wrote in the letter.

Adding to the concerns about the Mission Act, many veterans are already on edge because the implementation of another planned overhaul has already brought new problems.

The Forever GI Bill, passed in summer 2017, was supposed to expand education benefits for veterans, but veterans have not been getting their benefits because the new processing systems are not working properly.

For the Mission Act, veterans groups say they are watching closely to make sure both that the implementation isn’t delayed and that the mistakes of the Choice program aren’t repeated.

“We don’t want the VA to be hasty to the point of making mistakes that could negatively impact veterans, but we always don’t want them to be slow or drag their feet,” said John Hoellwarth, a spokesman for AMVETS.

AMVETS is particularly watching to see how the VA keeps private health-care providers accountable, he added.

“The VA answers to Congress; who do community care providers answer to?” Hoellwarth asked.

Fuentes, at the Veterans of Foreign Wars, said the VA has been doing a good job of keeping veterans informed on the progress of implementing the law and that communication has improved since Wilkie was confirmed in July.

Still, he added, the department could do better in soliciting input from veterans rather than just updating them on its work.

Veterans groups are also wary that the Mission Act is a stepping stone to replacing the VA health-care system with private care altogether. While the VA has its issues, they argue, it’s also uniquely qualified to treat veterans and should be fixed rather than undermined with the expansion of private care.

“We want to make sure that at the end of the day, you have VA continue that dual approach and doesn’t ignore the needs of the internal system,” Fuentes said.

“We certainly couldn’t emphasize that more because what we see from our surveys and feedback from our members is they like they care they’re receiving at the VA.”