Veterans Group Proposes Major Changes in VA Health Care
WASHINGTON A national veterans task force is advocating radical changes in the medical system for America's former military personnel, including a choice to receive subsidized private care and conversion of the Veterans Health Administration into a non-profit corporation rather than a government agency.
The reform measures, if enacted into law, would affect America's roughly 22 million veterans dramatically, especially the 8.5 million enrolled for care through the Department of Veterans Affairs. Repercussions would be even more profound for future veterans.
Concerned Veterans for America, a conservative non-profit, sponsored the study called "Fixing Veterans Health Care" amid a crisis in VA health-care services.
Among key recommendations:
Health care should be reprioritized to focus on veterans with service-connected disabilities and specialized needs. Patients already in the VA medical system would retain their access and eligibility while gaining new options.
All enrolled veterans would be able to continue using VA health facilities or shift to subsidized care through private providers. The government would pay a percentage of medical costs via insurance programs, with coverage levels determined by each veteran's eligibility status. (The VA already provides benefits based on tiered eligibility calculations.)
Future veterans and those not already enrolled in VA health care would be required to enter a new VA insurance system with varying levels of coverage. Not all would qualify for subsidies.
Nearly one-fifth of future veterans those in the lowest VA benefit levels, Priorities 7 and 8 would not be eligible under the new system. About 1.6 million patients now are rated in those categories, but their benefits would be grandfathered in.
The Veterans Health Administration, with 275,000 employees, would be divided.
Half of it would morph into a non-profit government corporation that provides medical care in competition with private providers. The other half would oversee payments, or insurance coverage, for medical care on behalf of veterans using non-VA services.
The VA has 150 hospitals nationwide and about 820 clinics. The reform package also calls for the closure of inefficient medical centers and other facilities, similar to the shutdown of military installations under the controversial Base Realignment and Closure Act of 1990.
VA Secretary Robert McDonald, who did not attend the summit, issued a statement opposing the proposal.
"Unfortunately, many of today's proposals advocate 'contracting out' a sacred mission to care for those who have borne the battle," McDonald said. "There is an important role for outside care in the veteran health model to supplement VA's own care, but that role should not diminish or obscure the importance of VA's health care system. Reforming VA health care cannot be achieved by dismantling it and preventing veterans from receiving the specialized care and services that can only be provided by VA."
Sen. John McCain, R-Ariz., a participant in the summit, described the task force report as "pretty radical stuff" but said he endorses the basic tenets. He rejected McDonald's criticisms.
"What he's doing is binding the veterans only to VA health care and that's wrong," McCain said. "Bureaucratically, they're trying to circumvent the intent of the law."
During a Q&A session, McCain was interrupted by a heckler who yelled, "Hey, John, how many lives could you have saved in Phoenix if...?"
McCain interrupted the man, which the Concerned Veterans for American later identified as an Arizona resident, calling him a "jerk" and declaring he would match his service for veterans to anyone's.
Pete Hegseth, the group's chief executive, said revelations last year of delayed care, falsified record-keeping, mismanagement, and other breakdowns within Veterans Affairs prompted the bipartisan panel of experts to recommend sweeping systemic and policy changes.
"Veterans should come first," Hegseth said Thursday during a summit at which the proposal was unveiled. "They should be at the center of their health care not the VA and not the VA bureaucracy."
In an executive summary, the task force said its proposed reformation would "give veterans control over their own health care, improve the sustainability of (VA) facilities for the long haul and break the government cycle of reform and failure."
Dr. Bill Frist, a former Senate majority leader and a co-chairman of the task force, said the VA has become an outdated organization that evolved by reacting to past problems rather than as a result of planning. He envisions the summit proposals as a new system that focuses on patient needs with accountability, flexibility, efficiency and cost controls.
"Incremental change simply will not fix the system," said Frist, a Republican from Tennessee. "We've got to change. ... It's all about modernization."
Sen. Marco Rubio, R-Fla., told summit participants the VA "is simply buckling under the weight of its own bureaucracy." Repairing the medical system for America's veterans "is a measure of our honor as a society.
"We have an obligation to serve them with the same devotion they have served us," he said. "We owe it to them, and this system simply cannot provide it."
Dan Caldwell, issues and campaign manager with Concerned Veterans for America, said his organization will push for the omnibus measure, a giant reform bill dubbed the Veterans Independence Act.
"This is going to be a legislative battle, and our eyes are wide open as to what could happen," Caldwell said. "Nobody's ever done anything like this before. ... Opponents are going to say we're vouchering the system."
The American Legion made clear in a statement Thursday that it would not back the plan, saying it opposes privatization and vouchers as a long-term solution.
No member of Congress has signed up as sponsor so far, and it was not immediately clear whether such a dramatic overhaul stands any chance of congressional passage, let alone endorsement from President Barack Obama.
However, House Majority Leader Kevin McCarthy, R-Calif., endorsed fundamental tenets advocated by the task force Thursday, declaring, "Let's not be afraid to take the traditions of the past why we created it and apply them to a changing future."
Although Republicans and Democrats took part in drafting the plan, their recommendations are likely to ignite a backlash from some veterans organizations, lawmakers, federal employee unions and others.
Critics are likely to argue that the so-called VetsCare Choice program would explode costs, reduce benefits for some veterans and privatize a system that the government should run. Opponents also may contend that coverage options would bewilder elderly veterans and those with brain injury or post-traumatic stress disorder.
They also may attack the veterans group because it is outspokenly critical of Obama and receives money from the politically conservative Koch brothers, known for "dark money" financing of Republican politicians and causes.
Caldwell stressed that former Rep. Jim Marshall, a Georgia Democrat and Purple Heart recipient, served as one of four co-chairmen in developing Fixing Veterans Health Care. The other chairmen were Frist, a lung surgeon; Dr. Michael Kussman, former VA under secretary for health; and Avik Roy, senior fellow at the Manhattan Institute's Center for Medical Progress.
Sam Foote, the Phoenix veterans hospital physician who exposed health care failings before his retirement last year, was among the task force participants.
An "iron triangle" of politicians, the VA bureaucracy and veterans organizations have blocked real change, Kussman said. So the task force decided not to worry about finding a politically acceptable solution, just a sound one.
"None of us is smart enough to know exactly what to do," he said. "But what we do know is something has to change. And this is a template."
Marshall, another co-chairman, said of the reform plan: "It's a true win-win. It's a win for veterans, and in the long-term it's a win for our country ... It's a sensible plan."
Shutdowns likely would generate local opposition and political fallout. But the report said closures would save money and eliminate inefficiencies, allowing for improved health care overall.
It also stresses that the government needs to address dramatic declines projected in the veteran population from 24 million in 2006 to an estimated 16 million by 2029.
The report predicts that combined reforms would be "revenue-neutral," though authors acknowledged the calculation is murky because the Veterans Health Administration failed to provide critical data on expenditures, or comparative costs for private and VA medical care.
Since the VA health care controversy erupted in Phoenix 10 months ago, Secretary Eric Shinseki resigned and replacement Robert "Bob" McDonald announced the biggest agency overhaul in history. At the same time, Congress passed the bipartisan Veterans Access, Choice and Accountability Act of 2014, signed into law last year, which set aside $16.3 billion to hire more caregivers and allow stonewalled patients to obtain private care.
But backers of the new plan said piecemeal efforts cannot repair a monolithic VA bureaucracy that has resisted change and repeatedly failed veterans.
Chairman Jeff Miller of the House Veterans' Affairs Committee, R-Fla., said amid "the biggest scandal in VA history" the department is struggling to change under congressional oversight. "If we don't take the opportunity to fix this very broken health care system today, ... we may never get the opportunity again."
Miller devoted much of his summit address Thursday to the VA's failure to fire any employees to date in connection with the crisis over delayed care and falsified appointment data. "People are still asking the question: 'Where is the accountability?'"
The report's summary said medical efficiency and care diminished even as the VA budget grew by $91 billion from 2006 to 2014, and as staffing increased by more than 100,000 despite a declining population of U.S. veterans.
"Our proposal puts veterans in control of their health care," the summary said. "This approach is not anti-VHA. It is pro-veterans. The VA should be given every opportunity to compete for veterans' health care dollars. But it can no longer take veterans for granted as customers."
The report authors said medical benefits initially were intended for ex-military personnel who suffered health problems as a result of their service. Through years of political pressure, benefit qualifications gradually expanded to include all veterans, putting huge demands on the system while short-changing those injured in the line of duty.
"We feel strongly that these reforms are an opportunity for Congress to move VA health care gradually back to its service-connected care roots," the report said.
Under the plan, veterans who chose to get their care from VA facilities and physicians would have no co-pay or cost-sharing. Consequently, Concerned Veterans officials said they anticipate enrollment in VA health care might increase, especially among lower-income veterans, if the reforms become law.
At the same time, veterans would have the option to go outside the VA for discounted coverage from private providers based on a tiered subsidy system.
To obtain benefits, veterans already are ranked in eight priority categories. Those with service-connected disabilities could get non-VA medical care with 100% coverage. All other veterans seeking private care would be subsidized at levels of 60% to 90%, depending on their priority rankings.
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