Wednesday, March 18, 2015

Veterans Health Care Access and Reform of the VA Health Care System – where we stand and the road ahead

Yesterday, Disabled American Veterans released the following:

Although Congress passed the Veterans Access, Choice and Accountability Act last August, it has only been just over a month since the Veterans Choice Cards were finally distributed to all veterans.

At this point it is far too early to reach any conclusions about this program but as of early February, only 27,000 veterans had scheduled appointments through private health care providers – far less than expected.

Confusion over use of the card, eligibility limitations set by Congress in the law, and the compressed timetables for implementation are likely some of the key reasons for this low participation.   Many veterans simply indicated that they prefer going to VA’s doctors, clinics and hospitals.

VA has reported that it completed 1.8 million more appointments in the final eight months of 2014 compared to the prior year and that non-VA medical care authorization increased by 45% over that same time period. The law also provided VA with new resources to hire more doctors, nurses and clinical staff and to expand treatment space, however those changes will take time before their impact is felt.

While many changes are still underway to reform VA, there have also been some calls for more drastic, even radical changes.

“While we understand the critical need for reforms in the VA system, the total overhaul suggested by some over the past month raises many more questions than it answers,” said Garry Augustine, DAV Washington Headquarters Executive Director.  “A task force study released in late February calls for some rash and imprudent actions that would leave veterans with fragmented care by transforming VA into a government-sponsored corporation and by pushing many veterans out of VA and into new private insurance plans.”

If this proposal were to be enacted, the new and “independent VA” system would actually be less accountable to veterans, the American people and our elected representatives, according to Augustine. Instead, it would tend to be driven more by corporate financial considerations rather than veterans public policy considerations.

Among its many suggestions, this plan proposes:

  • Establishment of new “independent” bureaucratic systems tasked with the responsibility of delivering health care and administering insurance payments on behalf of veterans;
  • Creation of new insurance plans with multiple co-payment/deductible tiers based on veterans priority groups and income levels;
  • Reduction of VA’s future capacity to care for veterans, despite increasing usage by veterans every year for two decades, as well as the expected influx of new enrollees from our continued involvement in current conflicts, and unknown involvement in future conflicts; and
  • Closure of some VA facilities as directed by an unaccountable panel, similar to the Base Realignment and Closure (BRAC) measure instituted for military facilities, which would lead to fewer health care options for veterans in certain areas of the country, particularly in less populated states;
  • Reliance on private health insurance companies to develop “customized” plans that meet the specialized needs of the veteran population by private health care providers.

“We have many concerns about the nature and consequences of such proposals. We believe, as do many independent physicians and medical experts, that the value of the VA system lies in its ability to treat the whole veteran,” said Augustine. “Privatizing part of VA and fracturing the delivery of that care can lead to unnecessary or overtreatment, misdiagnosis and longer, more costly periods of care.”
With the suggested out-of-pocket co-payment tier these proposals suggest, Augustine said it could end up costing some veterans a lot more to seek outside care.

“There is no question reforms are needed, but changes must be made judiciously and with the health of veterans remaining the top priority,” said Marc Burgess, DAV National Adjutant. “More analysis, discussion and action are needed to improve the VA, but we believe these kinds of radical proposals fail to guarantee what veterans are truly in need of – better access, choice and accountability for their health care.”