Veterans Health Administration Under Attack

November 12, 2021

Summary: Veterans Day weekend is the perfect moment to contemplate actions from Washington that threaten the Veterans Health Administration, one of the finest elements of the US healthcare system. The VHA is government single payer, providing very high access to and quality of care. Or was until recent aggressive privatization started to undermine it. The VHA must be saved. Our veterans deserve nothing less.

Broken promises: Veteran health care is being replaced by the private sector
The Hill
November 5, 2021
By Russell B. Lemle and Suzanne Gordon

In 2018, Congress passed then-President Trump’s signature veterans’ legislation, the VA MISSION Act, which was designed to shift many more patients from the Veterans Health Administration (VHA) to the private sector through a newly formed Veterans Community Care Program (VCCP). Lawmakers assured wary stakeholders that the VCCP would “supplement, not supplant” the VHA. This law was about options, they were told, not privatization.

Three years on, it’s clear that those were empty promises. VHA services are being rapidly replaced by private-sector care, even as studies continue to confirm that non-VA care generally is of lower quality and higher costs.

A recent study reveals the situation has become dire. Between April 2019 and December 2020, VHA’s total monthly encounters shrank by 25 percent. Over that same period, VCCP continued its non-stop expansion, rising to 34 percent of all care delivered to veterans at taxpayer expense. …

The hollowing out of the VHA is a direct result of MISSION Act provisions that were then exploited by the Trump administration in developing eligibility regulations for private sector care. When the VCCP was implemented in 2019, one-third of all veteran patients suddenly became automatically eligible for non-VA care if driving to a VHA facility takes more than a half-hour. A referral is offered even if a VHA clinic/hospital is geographically closer than a non-VA one, which is often the case.  

Although wait times in the VHA are typically shorter than those in the private sector, regulations nonetheless cause massive numbers of veterans to be sent to the private sector if the VHA cannot schedule an appointment within 20 or 28 days. … Once in the VCCP, which has no wait time requirement, veterans often languish for months to be seen.

VHA Caregivers Provide Privatization Reality Check
The American Prospect
September 30, 2021
By Suzanne Gordon

[J]ust as MISSION Act critics predicted, using private-sector contractors is no guarantee that veterans will get equivalent or better care in more timely fashion.

Two small but important surveys of well-informed VHA caregivers, along with interviews conducted by the Prospect itself, confirm that “community care” is neither quicker nor subject to effective federal oversight, despite its ballooning cost to the VHA. …

While some veterans haven’t experienced long delays to see a private-sector provider, most are waiting between one and four months for mental-health, medical, and surgical appointments, according to VHA nurses who answered the NOVA survey. When patients do end up going outside the VHA, nurses often don’t receive required progress reports from private-sector providers.
…

Mental-health services are particularly at risk under the CCN. Some observers who have been following VA mental health are concerned by reports that, in some VA medical centers around the country, hundreds of veterans who were referred to private-sector mental-health professionals were waiting for up to three months for just a telehealth appointment.
…

One nurse surveyed by NOVA reported that their teams may be spending from 10 to 60 hours a week trying to monitor private-sector care, which means they can’t provide direct care to veterans. In some facilities, one or two mental-health professionals may be shifted from taking care of veterans to chasing down information from private-sector providers.

Comment by: Jim Kahn

The Veterans Health Administration is a fine example of single payer, indeed of a national health service, like in the United Kingdom. It has a long history of high quality of care.

But Washington is eager to privatize, especially aggressively with Trump administration regulation manipulations. As reported by these two recent articles, the rules used to guide veterans to the private sector are irrational and biased. And the result is diverting critical resources – funding and staff time – from VHA clinical capacity. Care is shunted to inferior private sector providers; as we recently reported, clinical outcomes suffer.

There are efforts to protect the VHA. Suzanne Gordon, author of both reported articles today and Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans, is a senior analyst at the Veterans Healthcare Policy Institute (VHPI), which provides detailed analysis of legislation affecting VHA and studies the benefits provided by the nation’s largest government-run healthcare system. She also works with Save Our VA Project (SOVA), which issues Calls to Action (CTAs) — letters to Congress and the administration on issues crucial to halting and reversing the privatization of VHA.

In honor of the veterans, support the high quality VHA care.