What is VA Community Care?

BACKGROUND

The Dept. of Veterans Affairs (VA) operates a healthcare system that serves America’s veterans after they leave military service. The VA has historically been an insular system, in which veterans received care directly from the VA at its clinics and hospitals. Following a scandal in which lengthy wait times resulted in veterans dying before they received treatment, the VA healthcare system has been reformed to allow veterans to see private healthcare providers in the community and pay the same as they would at the VA.

OVERVIEW

Veterans have received benefits from the federal government dating back to the Revolutionary War, but the first exclusively veterans-focused agency was founded as the Veterans Administration in 1930. It was eventually renamed the Dept. of Veterans Affairs (VA) and made a Cabinet-level agency in 1989. 

The VA provides veterans benefits that go beyond healthcare, although its medical services make up the bulk of its budget and workforce, as it has been responsible for administering veterans’ education benefits and disability claims, among other benefits, since the enactment of the GI Bill. The VA divides those responsibilities under several sub-entities, and had a total of roughly 374,000 employees at the end of 2019. Of those, the Veterans Health Administration (VHA) is the largest with about 335,500 active employees, while the Veterans Benefits Administration has about 23,500 employees, staff offices have just over 13,000 employees, and the National Cemetery Administration has nearly 2,000 employees. The VA is also the largest provider of medical teaching programs in the U.S., and each year about 120,000 health professional trainees learn there.

The VA’s budget has grown significantly in recent years, from about $45 billion in FY2001 to $125 billion in FY2011, and its budget reached an all-time high of $217 billion for FY2020 ― about three-fifths of which goes to medical benefits and disability claims. These increases have been associated with a growing medical caseload as the VA cares for aging veterans from World War II, the Korean War, and the Vietnam War; along with veterans of more recent conflicts in Iraq & Afghanistan enrolling in the system after retiring from military service. Many veterans from the latter group presented with conditions such as post-traumatic stress, amputations, and traumatic brain injuries that require complex treatment regimens.

The VHA’s growing caseload and its mismanagement of it became the focus of a nationwide scandal in 2014. It was revealed that veterans with urgent medical issues seeking care at several dozen VHA facilities across the country were faced with lengthy waits before an appointment.

These problems at the VHA went undetected until a whistleblower came forward because facilities were maintaining two appointment lists ― an “official” list showing timely appointments that was reported to the VA & Congress; and an internal list reflecting the protracted delays. The falsified list was reported so that managers at the VHA would receive performance bonuses associated with meeting objectives for patient wait times.

The House Veterans Affairs Committee found that as many 293 veterans died from their illnesses while waiting for care on an actual or hidden wait list, and an investigation by then-Sen. Tom Coburn (R-OK) reported that the death toll may have exceeded more than 1,000 veterans. An audit by the VA found that over 120,000 veterans were left waiting or never received care by the time of the report. The scandal resulted in the resignation of the Obama administration’s VA secretary at the time, Eric Shinseki, and the firing of several VHA managers at facilities around the country.

Congress responded by passing what became known as the Veterans’ Choice Act in 2014, which was negotiated by Sens. John McCain (R-AZ) and Bernie Sanders (I-VT). It increased funding for the VA, required public wait list times, cleared the way to the hiring of additional medical personnel, banned performance bonuses, and increased the VA’s power to fire poorly performing managers. 

One of its most significant provisions was a two-year pilot program allowing veterans who lived more than 40 miles from a VA facilities or couldn’t get an appointment in a reasonable timeframe. Eligible veterans were given a “choice card” to receive care at private facilities that accept Medicare patients or at facilities run by the Dept. of Defense at no greater expense than they would’ve incurred in the VA system. The Choice program was extended in early 2017 ahead of its sunset date, and in 2018 the Choice program was effectively rebranded and made permanent through the enactment of the VA MISSION Act.

WHAT IS THE VA MISSION ACT?

The bipartisan VA MISSION Act was signed into law by President Donald Trump in June 2018 renamed the Choice program as the Veterans Community Care Program after a one-year transition period, and reformed it to broaden the circumstances in which veterans could receive at private healthcare providers in the community. It continued the distance & timeliness provisions, and enabled veterans to seek care in the community when the VA’s services would be deficient or if a veteran’s physician determined it would be in their best interest.

Additionally, the VA MISSION Act: 

• Set in motion a multi-year process of reviewing the VA’s organization and infrastructure with an eye toward modernizing both to better meet the needs of veterans in the future;
• Required annual reports on performance awards and bonuses to executives;
• Created a program to award scholarships to medical students in exchange for service to the VA; and
• Established criteria for designating VA medical facilities as underserved and created a pilot program for deploying medical teams to those facilities.

WHAT IS VA PRIVATIZATION?

Some argue that the VA should be privatized after a wind-down period. This would see the VA, which is essentially a government-run healthcare system (aside from the Community Care program), transition into a fully-private healthcare system. 

There isn’t a strong push for the outright privatization of the VA at the moment, so there aren’t many examples of plans to carry it out. However, it would likely involve selling its assets (hospitals, clinics, equipment) to private healthcare providers, which would also look to absorb its medical professionals to accommodate an increased base of patients.

WHAT DO SUPPORTERS OF VA COMMUNITY CARE SAY?

VA Community Care allows veterans to see local healthcare providers when it allows them to receive better care in a more timely manner, at no greater cost than if they’d gone to the VA. It strikes a balance in terms of keeping the best attributes of the VA healthcare system infrastructure for veterans, and introducing competitive forces that will foster improvement.

WHAT DO OPPONENTS OF VA COMMUNITY CARE SAY?

The VA Community Care program may meet a short-term need, but it opens the door to the outright privatization of the VA over the long-term. That would be harmful to veterans, as the specialized care the VA provides to veterans and the extensive training it provides to medical professionals would be lost, potentially at a higher cost to veterans.

RESOURCES

• VA Access to Care Wait Times
• Congressional Research Service - The Veterans Choice Program (VCP): Program Implementation
• Countable - VA MISSION Act

— Eric Revell

(Photo Credit: Veterans Health Administration via Flickr / Public Domain)