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Scramble on to Fund, Fix VA Choice Program

Navy veteran in consultation with his nurse. (Photo: Department of Veterans Affairs)
Navy veteran in consultation with his nurse. (Photo: Department of Veterans Affairs)

The VA's $10 billion Choice program set up to deal with the wait-time scandals now has its own wait-time problem and will run out of money next month unless Congress acts.

Under complicated rules, veterans have enrolled in the program, which allows them to seek health care in the private sector, in far greater numbers than the Department of Veterans Affairs expected, creating a grocongwing backlog of appointments and exhausting the funding.

VA Secretary Dr. David Shulkin, who initially thought there was more than enough money to keep Choice going into fiscal 2018, which begins Oct. 1, now predicts Choice will go broke as early as Aug. 7 unless Congress comes up with emergency funding and eventually a long-term plan to streamline and expand the program.

Eight million community care appointments were made through the Choice program between January and June, a nearly 50 percent increase from the same period last year, according to Shulkin.

On Monday night, after a hearing of the House Veterans Affairs Committee devoted to making the post-9/11 GI Bill a lifetime benefit for new recruits, Rep. Phil Roe, R-Tenn., the committee's chairman, said he will hold hearings next week on six months of emergency funding for Choice.

He said the funding would buy time while Congress debates the future of the program.

"We need to have it that long [six months] so that third-party administrators can stay as geared up as they are, and it will give us time to work through some of the other issues," Roe said.

Rep. Tim Walz, D-Minn., the ranking member on HVAC, said, "We will make sure there is stability in the Choice program" by funding it for another six months, "and then we will come back and discuss the rest.

"We've learned that when you're going to tackle some of these big things, you've got to build the coalition, you've got to bring in the stakeholders" from the veterans service organizations (VSOs), Walz said.

Roe said, "I listened to all the members about what their concerns were, so did Mr. Walz. We would like to proceed with a fully paid [program] for six months. It will give us six months to hold hearings" on the way forward for Choice.

Roe did not get into numbers for the emergency funding but, on the Senate side earlier this month, Sen. Jon Tester, D-Mont., the ranking member on the Senate Veterans Affairs Committee, introduced the "Veterans Access to Care Act of 2017."

The proposed legislation would provide $4.3 billion for the VA to fund Choice through Sept. 30, 2018, the end of the next fiscal year.

Tester also called for a major overhaul of the Choice program. "The issue of where a veteran receives care and how that process is constructed, has been looming over this committee for years," he said. "We need a dramatic revamp of the VA's community care program."

Despite opposition from the VSOs, Sen. Johnny Isakson, R-Georgia, chairman of SVAC, has introduced a bill to give all enrolled veterans the ability to choose to receive care from an eligible community care provider. Isakson's bill would give a "Choice card" to those veterans to show their eligibility for private care.

The last-minute scrambling to fund and overhaul Choice contrasted with the scene at the White House in April, when vets, Shulkin and VSO representatives gathered round as President Donald Trump signed the Veteran Choice Improvement Act of 2017 to extend the Choice program into fiscal 2018, when $3.5 billion for Choice would become available under Trump's budget proposal.

At the time, Shulkin was confident that the nearly $1 billion left in the Choice program would be enough to last into fiscal 2018 and would give him time to come up with a reform plan in the fall.

In June, Shulkin had to reverse course. He told Congress that funding would run out in August and began to outline his plan for reform.

Shulkin at first proposed shifting $3.5 billion out of the Individual Unemployability (IU) program for more than 225,000 elderly and disabled vets to provide stopgap funding for Choice, but he backed down after storms of protest from veterans and the VSOs.

"On financial projections, we have to do better," he said. "We do not want to see veterans impacted at all by our inability to manage budgets."

In June 7 testimony to the Senate Veterans Affairs Committee, Shulkin said he envisioned expanding the Choice program and making it more efficient while renewing his warnings against any moves to privatize veterans' care and take away the VA's role as the primary health care provider.

"Our overarching concern remains veterans' access to high quality care, when and where they need it. That's regardless of whether the care is in the VA or in the community," he said.

Shulkin called his plan the Veterans Care Program to provide what he said would be "coordinated access" to community care when necessary to receive outside appointments at the VA's expense.

Under current rules, veterans who live more than 40 miles from a VA facility or who can't get an appointment within 30 days are eligible for community care, but the system has jammed up under increased demand for private treatment and lack of funding.

The VSOs have been deluged with complaints from veterans about referrals being denied under the Choice program.

A 77-year-old veteran who lives more than 90 miles from the nearest VA facility in California contacted Military.com about his cataract surgery being delayed. He wanted to know if there were special forms he had failed to complete to speed up the process. There were no special forms.

The Choice program was put in place with $10 billion in funding in 2014 in response to the wait-time scandals at the Phoenix VA center, where records were doctored to show appointments were being kept when they weren't. The program was supposed to sunset in 2017, but the VA never expected it to run out of money this soon.

In his testimony to the Senate Veterans Affairs Committee, Shulkin acknowledged that the "criteria and processes" for the current Choice program are all too often "arbitrary, administrative and unnecessarily cumbersome, but it doesn't have to be that way. Here's how veterans could experience VA health care with your help:

"The veteran talks with their VA provider. That's a conversation over the phone, virtually, or in person. The outcome is a clinical assessment. The clinical assessment may indicate that the VA specialist is the best for the veteran or it may indicate that community care is best to meet the veterans' needs.

"If community care is the answer, then the veteran chooses a provider from a high-performing network. Assessment tools help veterans evaluate community providers to make the best choices themselves," Shulkin said.

"We may help veterans schedule appointments in the community or, in some circumstances, veterans can schedule the appointments themselves. We make sure community providers have all the information they need to treat the veteran. We get the veteran's record back. We pay the veteran's bill," Shulkin said.

The VSOs are still wary of Choice being a cover for the ultimate privatization of the VA. "We don't want to contract out more than we already do," Louis Celli, ‎National Director of Veterans Affairs & Rehabilitation at the American Legion, told Military.com.

"We don't want Choice to continue in its current form," he said, but "we've got to come up with a bridge for Choice over the next couple of months."

The arguments for total privatization of the VA have gone by the wayside, Celli said. "We don't think that's a realistic fear anymore. The costs would be astronomical. It's unaffordable -- we're talking hundreds of billions of dollars."

Opposing the Legion's viewpoint is the Concerned Veterans for America (CVA), which has called for a renewed and greatly expanded Choice program.

In a statement, CVA Policy Director Dan Caldwell said, "Any legislation that replaces the current Choice program and consolidates VA community care should clearly give veterans who use the VA an opportunity to elect to receive care in the community."

The CVA, which is mainly funded by the conservative billionaire Koch brothers, said, "Giving veterans more health care choice will incentivize VHA [Veterans Health Administration] facilities to become higher-performing health care providers through competition and will give veterans other options if existing VHA facilities are not meeting their needs," Caldwell said.

Shulkin told the Senate Veterans Affairs Committee in June, "I am not in support of a program that would lead toward privatization or shutting down the VA programs.

"Unfettered Choice is appealing to some, but it would lead to essentially, I believe, the elimination of the VA system altogether," he said. "It would put veterans with very difficult problems out into the community with nobody to stand up for them and to coordinate their care."

-- Richard Sisk can be reached at Richard.Sisk@Military.com.

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