More Choice, Better Health Care in Store for Vets

March 10, 2017

VA Secretary, David Shulkin, had a busy week. First, he met with MOAA and other veteran organization leaders at the White House on Tuesday. On Wednesday, he testified before the House Veterans' Affairs Committee, outlining his plans for reforming the agency's health care system.

At his confirmation hearing in February, Shulkin told Congress he intends to build a system that puts veterans first. “Give me the resources and the authority, then hold me accountable,” he said.

Since 2014, amid reports of widespread access problems and hidden wait lists at the Phoenix, Ariz. VA medical center, Congress has been working to improve access and quality of health care for veterans.

Congress responded by passing the Veterans Choice program, which allows qualified veterans to receive care in the private sector.

Thanks to the input of MOAA members, we were able to ask the secretary about his priorities and got the first glimpse of how he plans to reform the VA health system transformation and the Choice program.

Since the roll out of Choice, Congress has made adjustments to the law, but the secretary needs additional funding and authority to fully execute his mandate. Under current law, funding for the Choice program expires this August.

At the hearing, Sen. John McCain (R-Ariz.), chairman of the Senate Armed Services Committee, said, “If the Choice program lapses, the system will again fail.”

Later, Secretary Shulkin similarly affirmed a national disaster would occur if the Choice Act wasn't extended. McCain and Shulkin are working with other Senate and House leaders to introduce a bill called the Veteran Choice Improvement Act. It is a replacement program for Choice, but includes a newer, better version of community care systems, one simpler and easier to understand and navigate, while expanding access to care.

“MOAA is pleased to see such impressive commitment on the part of the Secretary and members of Congress to provide veterans the care and services they earned and deserve,” said Lt. Gen. Dana T. Atkins, USAF (Ret), MOAA President and CEO.

“During my meeting at the White House, and then again at the hearing, Secretary Shulkin reiterated his position that he does not support privatization, but rather an integrated health care system” Atkins said.

The plan includes some private sector contributions, and lays out a vision of eight principles to guide the program's development:

  1. Ensure no degradation of existing care.
  2. Commit to an integrated system.
  3. Increase “choice” [health care options] for all veterans; however, program expansion would start with service-connected veterans (it is estimated that 15.6 percent of veterans are categorized as “service-connected”).
  4. Ensure enrolled veterans get care closer to home (move to a clinical eligibility standard rather than the current 30-day/40-mile rule).
  5. Optimize coordination with other health insurance coverage the veteran may have. The VA would establish a “Primary Coordinator of Benefits” position to manage the effort.
  6. Maintain affordability for the lowest income-level veterans.
  7. Assist veterans supported by multiple providers with a VA primary coordinator of care across the system (in-house or community care).
  8. Apply industry standards for performance, health standards, quality, payment, etc.

Committee members spent significant time questioning Shulkin, the VA Inspector General, and Government Accountability Office witnesses, expressing their concerns and seeking more information about the secretary's plans.

There was consensus on multiple fronts, including the need to immediately extend the Choice Act.

When asked what has been the best thing to come out of the Choice program, Shulkin said, “We helped millions of veterans - over 5,000 exclusively through Choice and 1.2 million veterans using a combination of both VA and community care.”

The way forward will be expensive and take time. VA projects a $3.4 billion deficit next year in community care if Choice goes away.

Additionally, strong leadership commitment, modern electronic health record and IT systems, and investment in personnel are necessary for successful implementation.

House Veterans Affairs Committee Chair Phil Roe (R-Tenn.) told the secretary that addressing the problems in VA health care is one of the most important things Congress must do. He said, “I look forward to solving the problems. They are huge and not easy, but I'm optimistic solutions can be found.”

MOAA will continue to monitor reform efforts and provide members more details as they unfold.

Engaging your representatives and legislators on Capitol Hill and in the VA is critically important to effecting positive change - please continue to keep your lawmakers and local VA officials apprised of your experiences with VA care.


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