American Legion National Legislative Division Assistant Director Jeff Steele testified before the U.S. Senate Veterans’ Affairs Committee on June 7 in Washington, D.C., to comment on the Veterans Choice Program and the future of care in the community.

“As Congress is now discovering and as The American Legion has previously testified, costs are skyrocketing beyond all budget predictions as the quest to provide ‘choice’ has overtaken common sense governing,” Steele said in his written testimony. “Following the Phoenix (VA) scandal (in 2014), Congress appropriated $10 billion to help VA address any and all veterans who ended up on off-the-books waitlists that schedulers had developed in an attempt to juggle the overwhelming requests they were receiving for VA care. By committing $10 billion to this new procurement vehicle, Congress ignored all of the established contracting control measures used in VA’s other community care programs.”

Steele said the Choice Program is a textbook example of how well intended overregulating can turn into troublesome, unintended consequences. Choice instituted third party administrators, additional eligibility criteria, higher and inconsistent reimbursement rates and a disconnected billing authority. “In addition, the Choice Act mandated VA to issue paper Choice cards to every enrolled veteran that were essentially worthless, wasting millions and millions of dollars on designing, procuring and mailing millions of these cards in 90 days or less,” he said.

As part of the Choice legislation, Congress called for comprehensive studies into the VA’s wait time issues. Steele said VA found that the widespread assumption that these problems are worse in the VA than elsewhere is simply untrue.

A 2015 study from the independent RAND Corporation found that, “Wait times at the VA for new patient primary and specialty care are shorter than wait times reported in focused studies of the private sector.” Overall, the report concluded that VA wait times “do not seem to be substantially worse than non-VA waits.”

The one thing the Choice Act effectively did, Steele said, was expose VA’s practice of managing to budget as opposed to managing to need. “While the Choice Act set a restrictive access boundary of 30 days of wait time, and 40 driving distance miles by presenting it as increasing access, the truth is VA already had the authority to contract patients out to community care,” Steele said. “They just rarely used the authority because their budget could serve twice as many veterans if redirected toward organic campus care or already negotiated and established community care contracts.”

Earlier this year on April 19, President Trump signed a law that removed the Aug. 7, 2017, expiration date and allows VA to now utilize funding dedicated to the Veterans Choice Program until it is exhausted.

“While many veterans initially clamored for ‘more Choice’ as a solution to scheduling problems within the VA health care system, once this program was implemented, most have not found it to be a solution,” Steele said. “Instead, they have found it to create as many problems as it solves. The American Legion operates our System Worth Saving program, which travels the nation annually examining the delivery of health care to veterans. What we have found over the past decade (by directly interacting with veterans) is that many of the problems veterans encountered with scheduling appointments in VA are mirrored in the civilian community outside VA.”

Rather than a move toward vouchers and privatization, Steele said the Legion supports a strong VA that relies on outside care as little as possible and only when medically necessary. Sending patients off VA campuses to community providers, absent of well-crafted contracts, has led to inadequate compliance by local physicians, he said.

“Their inability to return treatment records to VA following care provided by Choice led to uncoordinated care and putting veterans at serious risk for medical complications,” Steele said. “This is important for a litany of reasons, not the least of which includes the risk of harmful drug interaction, possible overmedication and a better understanding of the patient’s previous military history — all important factors in wellness.”

When the Choice legislation was being developed, Steele said The American Legion insisted that any doctor treating a referred veteran have access to the veterans medical records so that doctors would have a complete history of the veterans medical history and be able to provide a diagnosis based on a holistic understanding of the patient’s medical profile.

Furthermore, the Legion was adamant that any treating physician contracted through Choice have a responsibility to return treatment records promptly to be included in the patients’ VA medical file so that VA could maintain a complete and up-to-date medical record on their patients. “We believed then, as we do now, that safeguarding of the veterans’ medical records was so important that we helped craft a provision that was included in the language which prevented VA from paying physicians until they turned over the treatment records to VA,” Steele said.

Unfortunately, Steele said the Legion was forced to acquiesce its position in favor of paying doctors whether they turned over the medical records or not.

“Since it was more important that veterans had access to sufficient medical care and not have their credit damaged, the Legion supported repealing that provision,” he said.

This, among other reasons including unsustainable cost, is why the Legion believes Choice is not the answer. For Steele, the equation is simple – a dramatic increase in cost is guaranteed to result in an increased financial burden to veterans using VA care that will include higher co-pays, premiums, deductions and other out-of-pocket expenses currently suffered by non-VA health care programs.

To ensure veterans receive the care and benefits they have earned, Steele said The American Legion, with the help of Congress, can start by:

  • opening VA to more patients;
  • making VA more competitive and allow them to accept all forms of insurance including Medicare, Medicaid, etc.;
  • making VA a destination employer by offering physicians rotations in research, emergency preparedness and education areas;
  • calling on VA to stand up a medical school; and
  • insisting VA engage in public-private partnerships with community hospitals across the country by renting wings of existing hospitals.

“Hundreds of thousands of caring, well-trained and highly-competitive professionals stream through the doors of VA medical centers throughout this nation, day in and day out for one purpose and one purpose only,” said Steele. “To care for those who have borne the battle – and overall, they do an excellent job.”

With the recent release of the president’s budget plan, including proposed cuts to several benefits that disabled veterans rely on, The American Legion released the following statement expressing extreme disappointment in the administration’s fiscal year 2018 budget for the Department of Veterans Affairs. You can read the statement here.

At the hearing, Steele concluded his remarks before the committee by urging Congress not to fund the new program on the backs of veterans.

“The American Legion adamantly opposes the degradation of organic VA health care services and calls on this Congress and administration to reinforce and strengthen the Department of Veterans Affairs so that it can do what we all agree it needs to do – support veterans because they have earned it,” Steele said. “So, moving forward, and appreciating the sincere need for community care, The American Legion simply urges Congress to fund the community care program at appropriate levels, which should be no less than what is currently being allocated, without cannibalizing other areas of the VA budget.”

Bottom line: The Legion adamantly opposes these benefit cuts and will work tirelessly to defeat them.