Veterans groups and Democrats say they have lingering questions and concerns months after the Department of Veterans Affairs (VA) launched rules seeking to expand veterans’ ability to go to private doctors.
“A lot of what our members are saying is … they don’t know what the new benefits are, they don’t know how to access them, it’s just kind of a lack of communication from their standpoint,” said Tom Porter, vice president of government affairs for Iraq and Afghanistan Veterans of America (IAVA).
The new rules are part of President Trump’s much-touted VA Mission Act, which he usually refers to it by the name of the program it replaced, Choice.
Congress passed the VA Mission Act in 2018 to replace the Veterans Choice Program, established in 2014 after the VA wait-time scandal where administrators were found to be doctoring appointment schedules to cover up problems in providing veterans with health care.
The Choice program faced numerous issues over the years, ranging from complaints it wasn’t being used enough to repeatedly running out of money.
The $55 billion Mission Act sought to address those issues by overhauling and consolidating the network of private health care providers where veterans can use their benefits. The law passed with large bipartisan majorities in both chambers of Congress.
The bill had a one-year implementation period before the new community cares rules would go into effect, a deadline that came in June.
“The changes not only improve our ability to provide the health care veterans need, but also when and where they need it,” VA Secretary Robert Wilkie said in a statement at the time. “It will also put veterans at the center of their care and offer options, including expanded telehealth and urgent care, so they can find the balance in the system that is right for them.”
But since that time, Porter said, veterans have been frustrated with a lack of communication, with little information on new Mission Act reforms, programs and processes.
“When they go see the VA, and they go talk to their provider, they’re not told about these things. That’s the main thing that we’re hearing from them,” Porter said of IAVA members, of which there are 425,000. “I know that the VA is doing a lot of communication about this, it’s just that when I talk to veterans, they don’t seem to be on the receiving end of that.”
Under the old rules, veterans could use their VA benefits to see private doctors if they lived 40 miles away from a VA medical facility or had to wait more than 30 days for an appointment.
But under the new rules, veterans can see a private doctor for primary care or mental health if they live at least 30 minutes away or have to wait more than 20 days for an appointment.
For specialty care, the eligibility threshold is increased to 60 minutes of drive time or a 28-day wait for an appointment.
Veterans can also seek private care if the service they need is not available at a VA facility or they live in a state
without a full-service VA facility, among other new eligibility criteria.
On the first anniversary of the bill’s passage, Senate Veterans’ Affairs Committee Chairman Johnny Isakson (R-Ga.) took to the Senate floor to tout that “we didn’t have a complaint in the first week after its implementation.”
“We took the mistakes we made a year ago and put the answers in place and solutions in place. We did everything we could to make our mission a winner for the veterans, and we did,” Isakson said in June.
A committee spokeswoman told The Hill on Monday that the panel is getting “regular updates” from the VA on the implementation of the Mission Act and that Isakson “is working with the VA to ensure the new community care program runs smoothly and provides veterans with the care and support they deserve.”
Other veterans groups are also urging patience, saying they see the implementation going smoothly so far.
“The implementation of the VA MISSION Act appears to be going fairly well so far,” Sherman Gillums Jr., chief advocacy officer at AMVETS, said in an email. “While it has taken a while for eligible veterans to understand the new referral process for community care and how they can access urgent care without pre-authorization, we do see it happening.”
The changes, though, have brought controversy. Opponents of the new rules argue that they appear to be the first step toward privatizing the VA.
In March, 57 Democrats wrote to the VA to express concerns that the then-proposed rules would “ultimately degrade” the agency “for those veterans who prefer and rely on its health care services to lead more meaningful, healthy lives.”
The Democrats — who included Senate Veterans’ Affairs Committee ranking member Jon Tester (D-Mont.) and House Veterans’ Affairs Committee Chairman Mark Takano (D-Calif.) —also blasted the department for what they described as a lack of transparency in how the rules were developed, saying that raises concerns the new rules “are just as arbitrary” as the old ones.
More recently, Democrats have alleged the VA is blocking their ability to do oversight over the new community care rules.
A report from House Veterans’ Affairs Committee majority staffers provided to The Hill alleges that they faced “significant obstruction” from the VA when trying to arrange visits to facilities on the day the new rules were implemented.
Staffers visited facilities in Detroit; Denver; Richmond, Va.; San Juan, Puerto Rico; and West Palm Beach, Fla., and said they found the VA “did not adequately prepare facilities, providers or veterans for the transition.”
“If community providers and veterans are uninformed, VA medical center staff are untrained to best assist veterans, and the critical technology that assists staff with care coordination and appointment scheduling continues to malfunction, veterans could face significant delays in care or may not receive properly coordinated care,” the report, dated June 11, concluded.
Porter said he’s heard some of those concerns in speaking at length with members of Congress and their staff.
“There’s quite a bit of feeling that there’s lack of transparency, transparency on the implementation of all these things, on cost, on eligibility standards,” he said. “I know that staff have said that they visited or tried to visit VA facilities and the VA has been less than helpful on facilitating those things.”
Gillums, at AMVETS, said he has some outstanding concerns, including that some VA facilities do not yet have the so-called Decision Support Tool that helps determine eligibility. He also said there are still questions about how a new hospital rating system will be incorporated into the eligibility process.
Overall, though, he said, he welcomed the changes and hoped the administration followed through.
“I’d say the VA MISSION Act has proven to be a success so far, and we hope to see that continue.”