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‘No semblance of transparency:’ Some concerned VA isn’t collaborating on community care rules

Press Conference on the VA Mission Act. (Jon Tester/Flickr)

With six months before the deadline to implement new rules for when veterans can go into the private sector for medical care, lawmakers and veterans groups voiced their concerns Wednesday that the Department of Veterans Affairs isn’t taking their opinions into account.

“We need to know what you’re doing and how much it is going to cost,” Sen. Jon Tester, D-Mont., told VA officials. “No conflicting or vague answers. No fuzzy math. No games. The stakes are too high.”

The VA Mission Act, signed by President Donald Trump during summer, upends the current Veterans Choice Program, which allows veterans to seek private-sector care when they live more than 40 miles driving distance from a VA facility or it is estimated their wait for a VA appointment is more than 30 days.

Thinking those rules were too rigid, Congress passed the Mission Act to create new standards for when veterans can go outside of the VA for their care.

The House and Senate veterans affairs committees held a joint hearing Wednesday to discuss the VA Mission Act. This month marks the halfway point between when the bill was signed and when it will go into effect.

The new program is supposed to be implemented in June 2019, but some lawmakers said Wednesday that they hadn’t yet received specifics about which veterans will be eligible for private-sector care.

“VA officials have offered us only vague, verbal descriptions of the various sets of potential access standards you are considering,” Tester said. “It also concerns me that each time we’ve discussed this issue in the last two months, VA officials have given us wildly different estimates of how much this will cost.”

Sen. John Boozman, R-Ark., said the VA gave various congressional staff members different sets of information about the potential new rules. Boozman is chairman of the Senate appropriations subcommittee that handles VA funding. Information on the standards for private-sector care is a “key factor” in VA funding, he said.

“When your staff comes over without their act together and no semblance of transparency, that reflects on VA leadership,” Boozman told VA Secretary Robert Wilkie. “It just works better when we can trust each other and work together. We simply don’t have any other choice.”

Wilkie answered questions for more than two hours but didn’t give details about what the new rules for private-sector care might be.

The Mission Act gave the VA secretary broad authority over the new regulations.

The new rules will have major implications for the millions of veterans enrolled in VA health care. Currently, about 30 percent of veterans in the VA system opt for health care elsewhere in their communities.

Wilkie promised to brief lawmakers after he presents his proposal to Trump.

“I owe him that courtesy, and certainly he is responsible for the final decision,” Wilkie said. “Once he makes that decision, I will be up here with our team to brief these committees for any comments and advice you may have, and any corrective actions.”

ProPublica, a nonprofit news organization, reported Trump is expected to unveil a proposal for the new community care program in his State of the Union address in January.

Rep. Mark Takano, D-Calif., said he worried Trump’s decision could be made before his speech, leaving little time for congressional input.

“I’m a little concerned this decision could be made the night before he delivers his speech, and then he makes a grand speech about, ‘Every veteran can see any doctor they want to see,’” Takano said. “That sounds good, but there are a lot of downsides to that kind of model.”

Multiple Democrats on the committees voiced concerns that the rules could be overly broad and allow unfettered access to the private sector – a move they worried could strip resources from the VA and lead to poorer quality health care.

Dozens of military and veterans organizations supported the VA Mission Act with the belief that it wouldn’t be used to allow unfettered access to the private sector. Some of those groups told lawmakers that the VA hasn’t accepted their input.

“A lot of [veterans service organizations] have talked to me about the communication within the VA that’s not where it needs to be,” Tester said.

In written testimony Wednesday, the Veterans of Foreign Wars said the group had “serious concerns about the lack of collaboration… to establish these new regulations.”

“While VA has held meetings… the majority of such meetings have been one-sided conversations,” the VFW wrote. “Without proper stakeholder input, VA will fail.”

Wilkie fought back against those claims.

“They are a vital part of what we do in the department,” he said. “In my time as VA secretary, I’ve doubled the number of [veterans service organization] engagements.”

Wilkie also said he’s allowed more groups into the meetings than were previously allowed under past secretaries.

Takano, expected to be the next chairman of the House Committee on Veterans’ Affairs when the House majority flips next year, ended the hearing by pleading with the VA to work with them.

“I understand you need to await the president’s choices, but I hope you will consider speaking to us before that time,” Takano said. “I see no reason why [veterans service organizations] and Congress cannot participate with you.”


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