Several of the country's largest veterans' service organizations say Sen. John McCain's plan to reform VA health care has merit but aren't on board with expanding a program to steer vets to private health care providers.
Under the so-called Veterans Choice Program, those who live more than 40 miles from a VA facility or who face long wait times for care can go to community health care providers.
While advocates see expanding the program as a way to provide veterans with more options, the groups -- including The American Legion, the Veterans of Foreign Wars, the Disabled American Veterans and Paralyzed Veterans of America -- say it would lead to a fraying and shrinking of an integrated managed care system they say serves veterans best.
"The American Legion appreciates Senator McCain's efforts to improve the provision of health care for America's veterans. However, one of the central, core elements of the bill expands care in the community in a way that is concerning," Lou Celli, veterans affairs and rehabilitation division director for the Legion, said Tuesday during a hearing of the Senate Veterans Affairs Committee.
Celli said the Legion supported the Choice Program when it was proposed and passed but not as a broad replacement for VA health care.
"Veterans should be provided with the option of receiving care in the community as a supplement to VA health care and not to supplant VA care," he said.
Celli also said Legion members surveying veterans' care across the country since the program was passed in 2014 found that many ran into some of the same problems with private sector providers, including long wait times for appointments.
He said the Legion would not support McCain's bill.
Some veterans groups offered qualified or partial support for the legislation.
Carlos Fuentes, senior legislative associate for the VFW, had the same concerns about expanding the program to all enrolled veterans, warning it would result in veterans "receiving disparate and uncoordinated care" instead of the "integrated and managed health care" that medical researchers claim provides better outcomes.
He urged the committee to amend the bill to ensure that program eligibility applies to veterans unable to be served at a VA facility by a clinically necessary date or when the distance to the facility makes a community option reasonable to the veteran and the provider.
Fuentes said his group does support several other sections of McCain's bill, including one requiring the VA to provide veterans access to private sector urgent care clinics; one authorizing some providers to practice telemedicine across state lines; and the extension of VA pharmacy operating hours, including authorizing VA to contract with health care providers, such as temps, to operate clinics on nights and weekends.
Adrian Atizado, deputy national legislative director for the Disabled American Veterans, said his organization is on board with the provision expanding pharmacy hours, including bringing in temporary providers to staff the facilities.
Beyond that, however, the organization will not endorse the legislation, he said.
Atizado testified that McCain's plan to allow all vets enrolled in VA health care to go to community providers "only addresses demand by expanding it into the private sector. The group, however, opposes any legislative proposal that would have the effect of privatizing VA health care and diminishing the VA health care system, he said.
Similarly, Atizado said his organization cannot back the provision requiring VA to contract with a national chain of walk-in clinics to service veterans enrolled in VA health care. He said the legislation does not define a walk-in clinic -- something the committee would have to clarify and spell out the costs and the implications for veterans.
If by walk-in the legislation means "urgent care," then Disabled American Veterans would support the intent of the bill, he said.
But the group's greatest concern with that provision is that it could lead to a fragmentation of veterans' health care unless the services are coordinated with VA primary care providers.
Carl Blake, associate executive director of government relations for Paralyzed Veterans of America, argued in his prepared testimony that a Choice program enabling countless number of veterans to go into the private sector would undermine the care that serves all veterans, in particular those who require specialized services.
"Many advocates for greater access to care in the community also minimize, or ignore altogether, the devastating impact that pushing more veterans into the community would have on the larger VA health care system, and by extension the specialized health services that rely upon the larger system,"
"Broad expansion of community care could lead to a significant decline in the critical mass of patients needed to keep all services viable," he said.