On October 16, the U.S. Department of Veterans Affairs (VA) submitted legislation to the House and Senate Veterans Affairs Committees designed to overhaul the VA Choice program. The VA Choice program was created in 2014 following a scandal involving long wait times at VA facilities that left many veterans waiting months for care and resulted in multiple deaths. Under the current Choice program, veterans may receive health care from a third-party outside the VA system, paid for by the VA, if they live over 40 miles from a VA facility, have to wait longer than 30 days for an appointment or meet certain other conditions. Counties invest over $80 billion each year in health services for our residents, including veterans and their families, and the VA Choice program can help counties care for veterans who are otherwise eligible for VA healthcare.
The Veterans Coordinated Access and Rewarding Experiences (CARE) Act would replace the current 30-day/40-mile rule with more personalized and flexible decision-making. The bill would allow veterans to receive private health care if the VA cannot schedule an appointment within a “clinically acceptable timeframe” or if the veteran and his/her doctor determines it is in the veteran’s best interest to seek private care. Additionally, the bill would consolidate the VA’s various community care programs and allow veterans to visit walk-in clinics for minor illnesses and injuries.
While many veterans groups and lawmakers have acknowledged problems with the VA Choice program and its 30-day/40-mile rule, the VA’s CARE Act proposal is not without skeptics. Sen. Mike Rounds (R-S.D.), in a Senate hearing earlier this year where VA Secretary Shulkin first outlined his plan for a Choice program replacement, expressed doubt that the new program would increase choice and health care access for veterans, as they would still need to consult a VA doctor before receiving care outside the VA system. Others have argued that, rather than improve VA health care services, the CARE Act would weaken the VA and move the agency further toward privatization. However, Secretary Shulkin has argued that measures included in the bill would help strengthen VA’s medical staff, increase staffing levels and improve VA facilities – particularly in areas with substandard care. Further, he has assured Congress that the VA will develop guidance to ensure that veterans maintain control of their health care choices.
The House Committee on Veteran’s Affairs will hold a hearing on Tuesday, October 24, where they will discuss the VA’s proposal, as well as a separate Choice replacement bill crafted by the committee itself. During the hearing, the committee is expected to debate how Congress will fund a replacement for the Choice program and will hear feedback from various stakeholders.
Secretary Shulkin has expressed his desire for Congress to pass the CARE Act before Thanksgiving, though it remains to be seen whether that is possible given other congressional priorities such as health care, tax reform and FY 2018 appropriations. However, Congress must work quickly, as funds for the Choice program are running out faster than expected and may be fully exhausted by the end of December, despite Congress providing emergency funding for the program in August to the tune of $2.1 billion.
Counties support improving access to quality health services for all, including our nation’s veterans, and encourage full funding of veterans’ services, particularly those that provide reimbursements to community agencies, including county service providers, for services provided to veterans who are otherwise eligible for VA care. NACo will continue to monitor developments to ensure counties have the tools and resources necessary to meet the needs of our veterans.