President Trump has signed The Veterans Choice Improvement Act. This new law will significantly expand a existing program at the Department of Veterans Affairs (VA). The final printed copy of the signed legislation was not available at the time of this writing.
Key Factors of the Choice Improvement Act
The new legislation has several key items:
- The program allows patients to seek care from private doctors if they want to go outside of the VA system.
- The new law removes barriers that Congress inserted in the original “choice” initiative.
- It eliminates the expiration date of the law that would have closed the program in August 2017.
- The law makes the VA the primary payer (currently the VA is the secondary payer) for medical care relating to non-service connected disabilities and recovery of costs from third parties for certain care under the program.
Congress created the choice program in 2014. It was a result of the VA scandal involving wait time maneuvering at some VA facilities around the country. The system generally resulted in hiding how long it was taking some Veterans to receive care at the VA.
Originally, the choice program was set up as a pilot program limiting when and where Veterans could elect to use private doctors. Patients could only use the choice program if they lived more than 40 miles away from the nearest VA hospital or if they could not get an appointment from their local VA facility within 30 days.
Reaction to the Choice Improvement Act
The Concerned Veterans for American issued the following statement regarding the new legislation:
President Trump is upholding the promises he made to Veterans and we applaud him for continuing to make them a priority. However, there is more to be done. The Choice Program was passed as a quick fix to the wait list manipulation scandal that broke three years ago, and while it’s helped, too many Veterans still are forced to seek care at failing VA facilities. Congress now has some time to work with Secretary Shulkin on broader, more permanent choice reforms that will truly put the Veteran at the center of their health care and remove VA bureaucrats as the middlemen.
The signing of this legislation follows more problems uncovered in another very recent investigation at a VA facility. This investigation concerned the VA Medical Center in Washington, DC. The interim investigation uncovered a number of serious deficiencies were identified at the VAMC that placed patients at unnecessary risk. The head of this facility was removed shortly after the deficiencies came to light. (See More Patient Care Problems Cited at VA)
The legislation appears to track the conclusions of the Commission on Care. The Commission was established by Congress to examine Veterans’ access to Department of Veterans Affairs health care and to examine how to effectively organize the Veterans Health Administration, locate health resources, and deliver health care to Veterans. It recommended providing more private sector services for Veterans beyond the restrictions placed in the original Choice legislation which, at least to some degree, the new legislation does.
Opposition from VA Employee’s Union
The American Federation of Government Employees (AFGE) has generally opposed this type of change in the VA. The union represents a large number of VA employees under the federal labor relations statute. (See Union Challenges Recent Recommendations on Care for Veterans)
With regard to the Commission’s findings, the union has previously stated:
[T]he recommendation to establish a new VHA Care System is at odds with compelling evidence of the VHA’s current effectiveness.” AFGE concludes that “given the evidence of overall quality, efficiency, integration and innovation within the VHA, we believe that efforts to reform the VHA can best serve Veterans by expanding access to services the VHA currently provides. Where geographic challenges exist and/or VHA does not offer specific services, the VHA should purchase services from non-VA partners.
A similar philosophy was also provided by the union in its press release with regard to the problems at the VAMC in Washington, DC:
Some politicians and outside groups will inevitably try to exploit this situation to justify their privatization agenda. Others will use it to further their interest in politicizing the VA by installing political cronies rather than competent managers to fix the problems that have been identified. Neither privatization, nor putting political hacks in charge of hospitals is the answer to the crises the IG has identified. Either of these responses will only worsen the situation at the VA.
At the moment, the trend seems to be to have more private sector involvement in providing Veterans care. How this plays out in remedying problems in the VA remains to be seen. But, as noted above, at least one group of Veterans welcomes the changes that are now occurring.