Lawmakers and veterans groups raised concerns Wednesday over the Veterans Affairs Department's ability to implement a consolidation plan for its community care programs, citing the department's past failures and ongoing issues in executing initiatives.
VA announced last month an ambitious plan to consolidate seven community health care programs, including the newest and largest, Veterans Choice, into a New Veterans Choice Program, with clearer eligibility rules, improved access to care and faster payments to participating providers.
On Wednesday, VA Deputy Secretary Sloan Gibson and Undersecretary for Health Dr. David Shulkin took their arguments for the new program to the Senate but faced tough questions from senators and groups such as the American Legion and Veterans of Foreign Wars as to whether they can follow through with the plan.
Sen. Dan Sullivan, an Alaska Republican, said a pilot program designed to improve Veterans Choice in the state and promised to start in November has failed to launch despite assurances from Shulkin.
The pilot aimed at improving the VA's system for making medical appointments at the VA and through Veterans Choice. But weeks after the promised system was scheduled to go online, it has not been implemented and VA staff told Sullivan it may be delayed further or abandoned, according to the senator.
"The whole point was to fix it and use Alaska as a template for the national program. … I am pissed," Sullivan said. "You are asking for $13 billion, $14 billion to fix VA Choice and you can't even fix it in my state?"
Sen. Mazie Hirono, D-Hawaii, said the VA's plan, which includes spending $300 million of $421 million initially requested to create a portal for veterans and providers to use the New Veterans Choice Program, puts her on edge.
She cited the failure of the Defense Department and VA to create a joint electronic health record, despite spending $1 billion for development, and expressed concern that VA would not use the money wisely.
"I think we want all of this to actually happen," Hirono told VA officials.
Veterans Choice was created in response to a nationwide scandal at VA over lengthy wait times for veterans who sought medical care at medical centers and clinics. It allows veterans who can't get an appointment at a VA facility within 30 days, or those who live more than 40 miles from a clinic with a full-time doctor, to get their medical care from a private physician.
But VA also has a number of legacy and regional programs that provide private care for veterans, and VA wants to consolidate them to make the program more efficient and easier for veterans to use.
"We're facing a historic opportunity to make a major advance in health care for veterans," Gibson said.
Shulkin assured committee members that VA is not "walking back" on any commitments made regarding VA Choice and is making changes to the program to ensure all veterans can get care, even if they can't get it at a VA facility.
"We are going to stick with it. I don't want to hear excuses, I only want to fix it," Shulkin said.
Veterans advocacy groups expressed mixed reactions to the VA's plan, saying it lacked specifics on how it will achieve goals or address ongoing problems like the failure to create an electronic health records system that could be used by VA doctors as well as private physicians.
Darrin Selnick, senior veterans adviser with Concerned Veterans for America, a conservative nonprofit that has voiced support for shrinking the VA and allowing veterans to choose between using VA services or civilian physicians at government expense, said the VA's consolidation plan "perpetuates the status quo and cherry-picks" from CVA's proposal.
"VA has fallen back to its old ways and developed a grandiose dream concept plan that does not deal with the reality," Selnick said.
Gibson said the plan can work but the VA needs full congressional support to ensure its success.
"We're eager to move forward with consolidation, but it must be a collaborative effort with Congress," Gibson said. We need Congress to provide the necessary legislation to support change and the required funding to implement and execute [it]."