Change in VA health care welcome, but confusing as launch date nears

Trey Casimir stands inside an exercise room at his office in Lewisburg.

On Oct. 1 the entire veterans health care system changes, according veterans using the system.

Confusion remains despite the quickly approaching launch of the new VA Mission health care plan, not only among area veterans, but also county officials tasked with helping vets when they have health problems.

“We received a memo about a new plan called VA Mission that goes into effect Oct. 1,” said Tony Korzanaski, director of veterans affairs, Snyder County. But beyond that memo, he said, little detail is yet available. VA Mission replaces the Veterans Choice Program, initiated in 2014.

President Donald Trump signed the VA Mission Act in June to replace the Veterans Choice Program and expand private health care options amid a fight between the White House and Congress over how to pay for it.

“I can’t give you any details about the new plan, other than when it starts,” Korzanaski said, flatly. “Really, I wish I could tell you more.”

In the past, veterans’ chief complaints about VA health care involved timely scheduling of appointments, care and services.

According to the VA Mission Act, the Department of Veterans Affairs is required to coordinate timely care, including help for those who need VA medical services outside their region of residence.

The Act outlines a number of requirements, including making sure “veterans do not experience a lapse in health care services.”

Improvements

Under the VA Mission Act, the Department of Veterans Affairs is now required to provide, “access to community care if VA does not offer the care or services the veteran requires, VA does not operate a full-service medical facility in the state a veteran resides, and the veteran was eligible for care in the community under the 40-mile rule in the Veterans Choice Program” and when the veteran meets certain requirements.

To implement requirements under the Missian Act for the consolidated VA community care program, the VA began drafting the required regulations immediately, according to Curt Cashour, press secretary for the VA. 

Regulations are targeted to be completed in the summer of 2019. In the meantime, the Mission Act includes an additional $5.2 billion in funding for the Veterans Choice Program to continue until June 6, 2019, while VA develops the regulations to implement the new consolidated community care program, Cashour said.

VA Mission also expands caregivers assistance to the families of disabled veterans and orders an inventory of the Department of Veterans Affairs’ more than 1,100 facilities with a long-term view to trim excess.

So far, so good, said some providers.

“The idea that I’ll be able to deal directly with the VA is a good return to the way things were before Health Net (Federal Services) got involved,” said acupuncturist Trey Casimir, of Lewisburg, a VA-approved healthcare provider for about five years.

“This is a very big day,” said Trump, when he signed the bill on Jun 18. Trump made veterans care one of the signature issues of his run for the White House. “All during the campaign, I’d say, ‘Why can’t they just go out and see a doctor instead of standing in line?’ We’re allowing our veterans to get access to the best medical care available, whether it’s at the VA or at a private provider.”

In his remarks, Trump did not mention that funds to pay for the bill have yet to be identified, or that the White House and Congress are at odds on funding mechanisms. The bill’s projected costs over five years are also in dispute.

Critics of the bill have warned that over-reliance on private-care options could lead to the “privatization” of VA health care, but Trump said, “If the VA can’t meet the needs of the veteran in a timely manner, that veteran will have the right to go right outside to a private doctor. It’s so simple and yet so complicated.”

Funding issues remain

The issue of funding has plagued the existing Veterans Choice Program since it was enacted in response to the wait-times scandals of 2014 in which VA officials were caught doctoring records to show better performance.

The Choice program allowed veterans who lived more than 40 miles from a VA facility or had to wait more than 30 days for an appointment to have access to private care, but the program was time limited and Congress has struggled to come up with money for extensions.

The program was again due to run out of funding May 31, but the VA said there was enough money remaining to keep it in operation until Trump signed the VA Mission Act.

The new bill called for $5.2 billion in funding to keep the existing Choice program in operation for a year while the VA worked through reforms to consolidate the seven private-care options into one system while eliminating the 30-day, 40-mile restrictions.

House Minority Leader Nancy Pelosi, D-Calif., cautioned that the lack of new money for the legislation sets up “another VA crisis and billions in budget cuts to critical veteran initiatives down the road.”

Privatization

The Government Accountability Office said veterans could wait up to 70 days for private-care appointments under the Choice program because of poor communication between the VA and its facilities and “an insufficient number, mix or geographic distribution of community providers.” 

The VA has more than 360,000 employees serving the health care needs of about nine million veterans annually. Most of them are represented by the American Federation of Government Employees (AFGE), which opposed the VA Mission Act.

The AFGE said that the act amounts to “opening the door to privatization of the country’s largest health care system.”

The major veterans service organizations (VSOs) also initially feared privatization but came around to backing the VA Mission Act as a catalyst for improving care while preserving the VA’s role as the main provider of health care.

Backed by VFW

In a statement after the signing ceremony, Keith Harman, national commander of the 1.7 million-member Veterans of Foreign Wars, said, “The VFW and other veterans service organizations worked closely with Congress and the White House to help create a carefully negotiated bipartisan deal with the fingerprints of veterans who rely on the VA all over it.”

Besides expanding private-care options, the bill would also address long-time concerns of the VSOs on the restrictions in the current program to provide small stipends to family members who care for severely disabled veterans.

The program has been limited to post-9/11 veterans, but the bill was aimed at expanding caregivers assistance over two years to veterans of all eras.

The Congressional Budget Office has estimated that more than 41,000 caregivers could be added to the rolls under the new bill over the next five years at a cost of nearly $7 billion.

“If you wore that uniform, if at some point you worked in that uniform,” Trump said, “you deserve the absolute best and that’s what we’re doing.”

The Associated Press contributed to this report.

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