May 15, 2015

At separate hearings this week, House and Senate lawmakers made no bones about their frustrations with VA officials' implementation of a new program to provide veterans' health care.

"There is no excuse for the plethora of problems the VA was having, and the transition [to the Veterans Choice Program] should have been much better, but it wasn't," said Chairman Johnny Isakson, (R-Ga.) of the Senate Veterans Affairs Committee.

The Choice Program, the result of last year's shocking report of lengthy wait times at VA centers, allows some veterans to receive care outside of VA facilities. 

At the urging of MOAA and several partners in The Military Coalition, last month the VA changed eligibility criteria for the Choice Program. Veterans who live more than 40 miles away from the closest VA health care facility and have wait times of more than 30 days to see a VA physician are eligible. Previously, the VA used a straight-line determination to measure distance from a veteran's home of record to the closest VA facility. Now the VA uses a more appropriate factor of driving distance. The change allows twice as many veterans to become eligible for the program.

The change underscores problems the VA has had with implementation of Choice Program.  

Growing Pains

A unique mixture of demographic factors is leading to increased demand for VA services. Aging Vietnam veterans are using more services at increased costs. Successful marketing of the Choice Program has led to veterans who may have previously decided not to use the VA to seek care. The conclusion of conflicts in Iraq and Afghanistan is bringing in a new generation of Post-9/11 veterans to system. A growing number of women veterans, now 10 percent of the military, are seeking VA treatment.

Despite the growing pains, Deputy Secretary of the VA Sloan Gibson told lawmakers that the department has seen a 44 percent increase in authorizations for care since the Choice Program began in November.

Adding stress to the system is a 25 percent increase in non-VA care costs, like the Choice Program. According to Gibson, estimates for the total cost of the Choice Program now range between $4 billion and $34 billion a year.   

As of April 30, the VA has spent just over $500 million of the $10 billion authorized for the Choice Act - a scant 5 percent. Of that, a little over $200 million has gone to pay for medical services for veterans. 

Gibson insists the agency needs greater flexibility in contracting with community providers to address the expanded Choice Program and its associated costs. 

Despite the frustrations with implementation of the Choice Act, most members of Congress and those testifying agreed that there has been significant progress in a relatively short period. 

"We thank the Congress, the VA, and the HealthNet and TriWest contractors for their unrelenting commitment to making the program a success," said Cdr. René Campos, MOAA's deputy director of Government Relations.

Among the many provisions in the Choice Act, the law calls for a commission to study how to improve access and delivery of veterans' health care for the 21 ^st century. MOAA joined other organizations to ask Congress to appoint members to the commission and give them sufficient time to do their work and present their findings.

The last commission on care was almost a generation ago. That commission created quality and performance benchmarks, and transformed the VA health system for veterans to receive routine primary care needs and specialized care for wartime disabilities.

The VA health care system is the largest integrated system in the country, with nearly 10 million veterans enrolled.