The Department of Veterans Affairs estimated the funds that allow veterans to receive health care in the private sector will last until the end of the year -- a projection that establishes a new deadline for when Congress needs to come up with a long-term solution for the Veterans Choice Program.
President Donald Trump signed legislation Aug. 12 immediately providing $2.1 billion for the Choice program to prevent a funding crisis. VA Secretary David Shulkin had told lawmakers in June that the account was quickly and unexpectedly running out of money because of increased demand. Now, the money -- originally estimated to last until February 2018 -- is again being spent faster than predicted.
Shulkin told reporters Wednesday that he's confident Choice funding will last at least through the end of the year and rebuked a report from The Associated Press that the program would run out of money as early as December. The VA is spending about $280 million each month to send veterans into the private sector for health care, he said.
"It's a very, very hard program to do accurate financial projections," Shulkin said. "We've always said it's important that Congress needs to act this fall, this legislative session so we do not get into a funding crisis."
Sen. John McCain, R-Ariz., sent a letter to Shulkin on Wednesday asking for an accounting of the program, expressing concern about another unexpected shortfall. McCain helped create the Choice program in 2014 in response to the VA wait-time scandal that originated at the Phoenix VA medical center.
Tiffany Haverly, communications director for the House Committee on Veterans' Affairs and the group's chairman, Rep. Phil Roe, R-Tenn., said Roe's office is receiving regular updates on Choice program spending. At the same time, the House committee is working on legislation to reform how the VA balances private-sector care, Haverly said Friday.
"We are continuing to monitor the account and working to move legislation to reform VA's community care programs so veterans can continue accessing care should funding be expended sooner than expected," she said.
House and Senate lawmakers undertook reform efforts following complaints from veterans that the Choice program is complex and bureaucratic. Current rules allow veterans to seek care outside the VA only if they can't receive an appointment within 30 days or they live more than 40 miles from a VA facility.
Shulkin said Wednesday that in order to avoid another funding shortfall, he wants legislation passed before Congress leaves for Thanksgiving break in mid-November.
"I expect we will get this done," he said. "We are in close communication with Congress and the White House on this. No one wants to see us putting veterans at risk."
It's expected the House and Senate will introduce their versions of Choice program reform in the next few weeks.
Shulkin has devised his own proposal, which is under review by the White House Office of Management and Budget. An early discussion draft of Shulkin's proposal describes a performance-based system in which veterans would be allowed to seek private-sector health care -- if the quality of VA care in a certain area isn't up to par with other providers in that community.
The issue is likely to be subject to intense debate about whether the VA is sliding too far into the private sector.
When the legislation was introduced in the summer to provide $2.1 billion to the Choice program, eight major veterans groups railed against it. Then, they successfully pushed for another $1.8 billion to be included in the legislation for VA hiring and infrastructure. The coalition -- comprising AMVETS, Veterans of Foreign Wars, Disabled American Veterans, Iraq and Afghanistan Veterans of America and other groups -- viewed the original plan as prioritizing private-sector health care while neglecting VA services, and as setting a dangerous precedent.
In preparation for the Choice reform debate, groups on each side of the political divide have already started advocacy efforts.
VoteVets, a left-leaning political action committee, ran a $400,000 ad campaign in September pleading with viewers to "Tell Congress, don't let Trump privatize my VA." The advertisement aired in Alaska, Florida, Kansas, Louisiana, Maine, Minnesota, Montana, Nevada, Ohio, South Dakota, Tennessee, Texas and West Virginia.
Concerned Veterans for America, a conservative veterans advocacy group in the Koch brothers' political network, is also speaking out. The group, which gained more influence since the presidential election, has lobbied to transfer VA oversight to a government-chartered nonprofit and expand veterans' private-sector health care options.
"The Trump Administration and Congress should not be dissuaded from keeping their campaign promises to offer veterans more health care choices by Washington special interests that want to preserve the status quo at the VA," said Dan Caldwell, the policy director for CVA. "There is no excuse for Congress not to put forward a VA choice reform plan that would give all veterans who use the VA the ability to access care in the private sector."
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