Just before Memorial Day, Congress passed a law that could lead to closure of veterans hospitals and send more veterans to private doctors for care. President Trump applauded the law’s passage. The AFL-CIO called it “a giant misstep toward privatization.”
Known as the VA Mission Act, the law extends and expands a three-year pilot program called Veterans Choice that pays for veterans to go to private health care providers instead of veterans hospitals. American Federation of Government Employees (AFGE), which represents 250,000 VA employees, says that will result in more costly, less effective care, and will bleed veterans hospitals of patients and resources. The law also creates a commission to look at closing VA facilities, and gives the Secretary of Veterans Affairs the authority to close facilities without consulting Congress.
The VA Choice program, begun in 2014 in response to a media scandal about long wait times at VA hospitals, has up to now been limited to veterans who live more than 40 miles from any VA health facility, or who need procedures those facilities can’t provide within 30 days. The VA Mission Act loosens those rules, so much that the Congressional Budget Office estimates that an additional 640,000 veterans a year will get VA-reimbursed medical care from private doctors.
The VA Mission Act does have elements that AFGE and the AFL-CIO support, including expansion of a program providing in-home care: Up to now in-home care has been available only to post 2001 veterans, but the VA Mission Act expands eligibility to include veterans of previous eras. The VA Mission Act also includes measures to address the personnel shortages that are fueling longer-than-optimal wait times, including recruitment, retention, and relocation bonuses, and a new loan repayment program for specialties where the VA is experiencing a shortage.
More than 9 million veterans depend on the VA health system, which includes 150 hospitals, 819 clinics, and 300 mental health centers. All told, VA facilities see more than 230,000 patients a day. It’s a population that is older, poorer and sicker than the rest of America, and one that suffers from very specific conditions, from traumatic brain injury to post-traumatic stress disorder (PTSD) to Lou Gehrig’s disease, which is related to exposure to Agent Orange during the Vietnam War.
VA doctors specialize in treating those and many other service-related conditions. They also spend more than twice as long with patients in their office visits than doctors in the private sector. And as salaried public employees, they have no incentive to overtreat.
Healthcare journalist Suzanne Gordon, author of a 2017 book about veterans healthcare policy, says the VA health system has gotten an unfairly bad reputation in recent years, mainly because of a wait time scandal in which the Phoenix VA hospital was falsifying wait time records. The wait time scandal led to the passage of the VA Choice Act, in which opening the door to private care was sold as a temporary solution to the wait time problem. But there’s evidence the problem was overstated to begin with, and that the VA system is the victim of a double standard: A 2014 RAND Corporation study that was mandated by the VA Choice Act found that VA wait times are not notably worse than wait times in other health systems.
AFGE legislative and political organizer Ian Hoffman calls the VA Mission Act a Trojan horse. Entering under the guise of an expansion of care, it will divert VA patients to more expensive, less effective private care, and will reduce patient numbers at VA facilities, which will then serve as the justification for the closures the bill enables.
“If in five years you’ve outsourced enough, you’ll have a lot of underutilized facilities that look like they should be closed — because you’ve rigged the game,” Hoffman says.
Privatization is a very real agenda for the Trump administration. After Trump fired VA secretary David Shulkin by tweet on March 28, Shulkin wrote, in an op-ed in the New York Times: “They saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans. … The department’s understanding of service-related health problems, its groundbreaking research and its special ability to work with military veterans cannot be easily replicated in the private sector.”
Every Republican in Congress voted for the VA Mission Act. In the House, it passed 347 to 70, with 70 Democrats voting “no” and 116 Democrats joining 231 Republicans voting “yes.” In the Senate it passed 92 to 5, with only Jeff Merkley (D-OR), Bernie Sanders (I-VT), Brian Schatz (D-HI), Bob Corker (R-TN) and
Mike Rounds (R-SD) voting in opposition.
What S.2372 does:
- More home care: Expands access to home health aides to vets from all eras
- Privatization: Greatly expands a program that pays for vets to get care from private doctors
- Closure: Creates a commission to recommend closure of under-utilized veterans health facilities, at the discretion of the VA chief, not Congress
How local members of Congress voted:
- Senator Ron Wyden (D-OR)
- U.S. Rep. Peter DeFazio (D-OR)
- U.S. Rep.Kurt Schrader (D-OR)
- U.S. Rep.Greg Walden (R-OR)
- Senator Maria Cantwell (D-WA)
- Senator Patty Murray (D-WA)
- U.S. Rep. Jaime Herrera-Beutler (R-WA)
- Senator Jeff Merkley (D-OR)
- U.S. Rep. Earl Blumenauer (D-OR)
- U.S. Rep. Suzanne Bonamici (D-OR)
What local members of Congress said about their votes:
“This bill has many positives, most notably a significant expansion of the VA caregivers program that has successfully helped many veterans stay in their homes while enabling their family members to provide the care that they need. Unfortunately, the positive aspects of this bill were paired with provisions that I simply could not support. The bill invests billions of dollars to support private health care for veterans, but doesn’t put a single dollar into filling 30,000 vacancies in the VA health system. This bias for privatization is extremely troubling.” — Senator Jeff Merkley (D-OR)
“The VA MISSION Act will provide more incentives and inducements to help attract medical providers to the VA and keep them there…. But I fear this bill will give broad authority to VA leadership to send more veterans out of the VA system. Given the relentless push by special interest groups to send an ever greater number of veterans into the private sector, I am concerned about the Trump administration giving into those folks and turning the VA over to ideologues or privatization partisans.” — Senator Ron Wyden (D-OR) [Full statement here.]
Unfortunately, the VA MISSION Act falls short in fulfilling our commitment to veterans. The legislation contains many good provisions to support veterans and their caregivers, but overall this Act is a move away from VA care and toward privatization. I fully support veterans having the flexibility to receive treatment outside the VA for acute health issues or if timely care is not available at a VA facility, but veterans often have unique care needs that are best served by dedicated VA providers. ” — U.S. Rep. Suzanne Bonamici (D-OR) [Full statement here.]
Congrats to the House for passing the VA MISSION Act yesterday. Without this funding our veterans will be forced to stand in never ending lines in order to receive care. Putting politics over our veterans care is UNACCEPTABLE – Senate must vote yes on this bill by Memorial Day!
— Donald J. Trump (@realDonaldTrump) May 17, 2018