WASHINGTON — Veterans Affairs officials on Monday presented Congress with their formal plan to ease rules concerning veterans seeking medical appointments outside the VA system at government expense, potentially sending tens of thousands of new veterans into the private sector for care.
The proposal once again raises questions about the long-term goals of the VA medical system and potential privatization of veterans care, issues that have already caused infighting among some veterans groups and Capitol Hill lawmakers.
The new plan, which VA leaders spent most of the summer drafting, would do away with rules limiting outside care for veterans who face a 30-day wait for appointments or a 40-mile travel to VA facilities. That requirement was the basis of the Choice program formed by Congress in 2014, meant to speed access for veterans frustrated with limited VA health options.
Instead, the new Veterans Coordinated Access & Rewarding Experiences (Vets CARE) Act would allow medical appointments to any veteran who is seeking specialty care not provided by VA or who faces a wait longer than “a clinically acceptable period.”
VA officials could also authorize outside care when “the veteran and the veteran’s primary care provider agree that furnishing care and services through a non-department entity or provider would be in the best medical interest of the veteran.”
The new plan would also make it easier for private-sector doctors to access walk-in care at private-sector clinics for minor ailments, with veterans paying a shifting scale of copays to help cover the cost of more convenient care.
In a statement, VA Secretary David Shulkin said the new plan puts veterans at the center of all health care plans, instead of bureaucrats.
“We want veterans to work with their VA physicians to make informed decisions that are best for their clinical needs, whether in the VA or in the community,” he said “This bill does just that, while strengthening VA services at the same time.”
The department plan would also consolidate a host of outside care programs into a single funding pot, giving VA officials more flexibility in paying for community care offerings. Department leaders began pushing for that during former President Barack Obama’s administration, arguing it would lead to quicker and more efficient options for veterans.
The Vets CARE Act would also expand telehealth options for veteran patients, eliminating department restrictions on where doctors and patients must be located to participate in online sessions.
Department officials would also increase partnerships with community clinics and hospitals through new contracts, to create a more formal network of outside physicians accustomed to working with veterans and VA administrators. That includes some sharing of medical records of current VA patients, in hopes of creating seamless care across different offices.
VA officials did not release any cost estimates for the new plan, or say how many VA appointments might be shifted outside the department with the changes. Currently, about one-third of all medical appointments that VA funds are conducted with physicians outside the government network.
Those cost details will be key in the fight ahead. Critics have said that shifting more appointments to non-VA doctors will end up costing taxpayers more over time, and will lead to the gradual erosion of VA services as funds are shifted from federal facilities to private-sector ones.
Shulkin has repeatedly promised that he is not trying to privatize VA facilities or responsibilities, but instead working to increase access to medical care for veterans.
House Veterans’ Affairs Committee leaders have already scheduled a hearing on their VA health care reforms proposals on Oct. 24. The new VA proposal, which was made available to Capitol Hill staffers only in recent days, will be among the topics of focus at that event.
In a statement, committee spokesman Tiffany Haverly said the chairman and committee staff “are reviewing VA’s community care proposal and will take it and stakeholder feedback into consideration as the legislative process moves forward.”