Facing concerns over the implementation of the new Mission Act, which consolidates the Department of Veterans Affairs' seven private health care programs into a Community Care Network, VA Secretary Robert Wilkie on Tuesday sought to reassure senators that the department is not looking to outsource most of its medical care.
Testifying before the Senate Veterans Affairs Committee on Tuesday, Wilkie said the department's proposed access standards for private care -- which will greatly increase the number of veterans eligible for outside medical services -- do not mean more veterans will seek that care.
About 19 percent of the VA's $87 billion proposed fiscal 2020 medical budget is designated for the Community Care Network created by the VA Mission Act, while 81 percent is earmarked for VA medical care, he said.
Wilkie stressed that the department is committed to providing quality in-house medical services, acknowledging that veterans -- and veterans groups -- say they prefer VA care.
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"The care in the private sector nine times out of 10 is probably not as good as the care you get in VA," he said. "Things are not always greener on the other side of the hill."
VA officials have sought to convince veterans, veterans service organizations and the public that it has no intention of privatizing its health care system. The public affairs blitz began shortly after President Donald Trump won on a platform that included allowing veterans to see any doctor they choose, and it has grown in recent weeks since the release of the proposed access standards, which include: eligibility for those who must drive an average 30 minutes to a primary or mental health appointment or 60 minutes for specialty care, or wait 20 days or more for primary care or 28 days for a specialty care appointment.
"I argue it is the most transformative period in the history of this department. ... I don't believe we are on the cusp of transformation; we are in the middle of it," Wilkie said.
He added that the medical care the VA gives is as "good or better than any medical care in any region of the country. We are proud of it."
But Sen. Joe Manchin, D-West Virginia, said privatization can also occur by neglect. Describing medical facilities in his state that have not been maintained or expanded and a mobile unit that remains inoperable, he said veterans may choose to see a private physician even if they'd prefer to go to the VA.
"Even though our intent and the verbal agreement is that we aren't going to privatize, because of starving [these facilities], there won't be these services ... you can see the concern," Manchin said.
Wilkie said the VA has a $60 billion facilities maintenance backlog and will need to "be creative" in continuing to provide health care to veterans, pointing to VA medical facilities being established across the country in leased buildings, allowing medical center staff to concentrate on medical care rather than infrastructure. He also suggested the department is considering a program similar to the Peace Corps or AmeriCorps to entice doctors and other medical health providers to move to rural areas to serve veterans.
The VA is seeking to implement its access standards for the Community Care Network by June. It has awarded a $55 billion contract for three regions in the network to Optum Public Service Solutions and plans to announce the contract award for the region that covers the western United States in April. Contracts for Alaska and the Pacific Territories will be awarded in the fall.
The VA's proposed fiscal 2020 budget includes $220 billion in total spending, up 9.5 percent from fiscal 2019.
Senate Veterans Affairs Committee Chairman Sen. Johnny Isakson, R-Georgia, said he wants to lay to rest concerns that the VA plans to outsource its medical care.
"We are not going to privatize," he said. "I have no interest in doing so. Let's concentrate on making the VA the best it can be."