New legislation before Congress aims to make it easier for veterans to access private-sector care and have the Department of Veterans Affairs pick up the tab.
The Veterans Health Care Freedom Act would largely take the VA out of the community care process by allowing veterans themselves to find and schedule necessary appointments at private-sector clinics in the department's network.
Right now, veterans must be approved by the agency to receive community care; the department then refers the patient to a facility. If this measure becomes law, veterans would need approval only from their primary-care doctor.
"This legislation is a step in the right direction that ensures our veterans will be able to obtain timely and quality care," said Rep. Andy Biggs, R-Ariz., the bill's sponsor. "By allowing our veterans to access community care facilities, we can ensure that no veteran goes without care."
The legislation is largely based on 2016 recommendations by a congressionally appointed commission, which included a proposal to allow veterans themselves to choose their private-sector care to alleviate wait times.
The time it takes a veteran to receive community care by going through the current referral system varies depending on where they live, the services they need, and the urgency of the health situation.
"When a veteran is in need of care on an urgent basis, veterans are consistently receiving it within two days in the community," a VA spokesperson said. "For routine care services, the time between when a request for care is placed and when a veteran receives an appointment will vary due to the urgency of the appointment and the Veteran's individual preferences for when to receive the care."
On average, it takes 30 days for a veteran to receive routine care, according to the spokesperson. However, that average includes a wide range of procedures, including screenings, that are sometimes ordered months ahead of time. This fact may skew the data.
Yet a Government Accountability Office report last year strongly urged the VA to take its recommendations to "ensure veterans' appointments are scheduled in a timely manner."
"Given VA's lack of action over the prior seven years implementing wait-time goals for various community care programs, congressional action is warranted to help achieve timely health care for veterans," the GAO said in its report.
The legislation would direct the VA to test the program for three years in four regions that cover a diversity of locations, including rural and urban areas. The program would become permanent across the country after four years.
"It's common sense, very practical that we try it out instead of just doing it to make sure it works and makes adjustments," Darin Selnick, senior adviser to the right-leaning Concerned Veterans for America, said in an interview with Military.com
Community care became a much larger element of VA care with the 2018 passing of the Mission Act, which dramatically expanded veterans' access to VA-funded private-sector care as a reaction to scandals involving egregious wait times.
But expanding community care has had serious impacts on the VA's already mammoth budget. The VA is the second-largest federal agency, and its budget has ballooned over the years.
President Joe Biden's proposed budget for VA health care next year is $97.5 billion, an increase of $7.6 billion. VA Secretary Denis McDonough told lawmakers at a budget hearing that the boost was needed partly because of the larger role of private-sector care.
"Much of the growth we're requesting is as a result of care in the community," he said. "Going back to the moment when the Mission Act was signed into law, you see a significant increase of care going into the community."
Privatized VA health care has been a contentious issue among some progressives, who argue that expanded use of community care could slowly drain resources away from VA hospitals. Yet the issue rarely comes up among Democrats in the VA committees on Capitol Hill.
Biden told Stars and Stripes last year that he does "not under any circumstances support moving to total privatization" of the VA. He argued that the department is uniquely positioned to handle the "consequences of war and pressure."
-- Steve Beynon can be reached at Steve.Beynon@military.com. Follow him on Twitter @StevenBeynon.