by Dr. Tom Zampieri, BVA Director District 6
Veterans in both small communities and large cities throughout the country may have been listening to recent national cable news stories about the Department of Veterans Affairs (VA). In some cases they may assume that these major stories have no relevance to or impact on their own VA facility, their doctor, or, in the case of a blinded veteran, their Visual Impairment Service Team (VIST) Coordinator.
However, recent congressional debate and media reports regarding the quality of VA health care services, waiting times, and the resignations of VA Secretary Eric Shinseki and Under Secretary for Health Dr. Robert Petzel are all significant. Veterans should understand that there is more to these issues than a five-minute evening news story and that the consequences of current events are far-reaching.
A story by reporter Bryant Jordan posted on Military.com on June 3 sums up one of the more important issues currently up for debate in Congress.
Senators Push VA to Offer Private Sector Care
Four Republican senators on June 3 introduced legislation they say will improve veteran health care and restore accountability to a Department of Veterans Affairs rocked by allegations of mismanagement and manipulated patient schedules.
The Veterans Choice Act intends to eliminate lengthy wait times for veterans seeking care by letting them go to the private sector, with the VA picking up the tab. Although VA officials have that authority now, the VA mostly rejects outside care, Sen. John McCain, R-Arizona, said Tuesday.
“With … this proposal if a veteran wants to go to a health care provider and he has this Medicare and Tricare [alternative] then that veteran can choose that,” McCain said. “The veteran should have the choice of where he thinks he or she can get the best treatment. That’s what this is all about.”
The bill is the second filed in less than a week in the Senate aimed at making it easier for veterans to get the health care and for the VA secretary to more easily dismiss senior managers for not performing.
The other bill, the Restoring Veterans’ Trust Act of 2014, was filed Monday by Sen. Bernie Sanders, I-Vermont, chairman of the Senate Veterans Affairs Committee. But the Sanders bill would also expand veterans’ access to federal and community health centers and medical facilities that receive Defense Department and Indian Health Service funds. It also authorizes the VA to lease 27 new health facilities in 18 states.
This last provision, along with others, was drawn from an omnibus VA bill that Sanders failed to get passed in February. These provisions include extending the period of health care eligibility for combat veterans from five years to 10, giving in-state tuition status for all vets, restoration of a 1 percent cut in retirement cost-of-living adjustments, and expanded services to victims of military sexual assault.
“Altogether, the bill would provide education, retirement security and other benefits for millions of veterans and their families,” Sanders said in a statement on the bill. “Virtually all of the provisions already have been approved by the Senate committee, many of them by unanimous votes during previous legislative markup sessions.”
Sen. Richard Burr, ranking member of the Senate Veterans Affairs Committee and one of the co-sponsors of the bill filed Tuesday, acknowledged that the Veterans Choice Act is limited in scope.
“It’s choice, it’s transparency and it’s change,” he said. “It’s not encompassing everything that Congress would like to pass as it relates to VA legislation but it addresses the urgent things needed right now.”
Sens. Jeff Flake of Arizona and Tom Coburn of Oklahoma are also sponsors of the Choice Act. The two Senate bills were spurred by allegations that the VA Medical Center in Phoenix, Arizona, maintained an unofficial secret list of veterans waiting for an appointment. According to some whistleblowers, up to 40 patients may have died before even getting an appointment.
Recent VA reports, including one by its Inspector General, confirmed the manipulation of appointments and found that similar practices were occurring across the country. Thus far, there has been no evidence that any patients died while waiting to see a doctor, the VA IG testified last month.
VA Secretary Eric Shinseki resigned on Friday after some of the allegations were confirmed through an audit and Sloane Gibson, named deputy secretary in February, was appointed to fill the top job until a permanent successor is named.
Only hours before he left, however, Shinseki endorsed the Sanders legislation. It was the first time he had publicly backed any increased authority to sack VA employees. He had testified he did not need increased authority to fire senior managers, and did not back the Department of Veterans Affairs Management Accountability Act filed by House Veterans Affairs Committee Chairman Rep. Jeff Miller, R-Fla.
Miller’s bill passed overwhelmingly in the House last month. A sister bill filed in the Senate by Sen. Marco Rubio, R-Fla., has been stalled.
McCain said on Tuesday there are a number of Democrat senators interested in backing the Choice Act. If Senate Majority Leader Sen. Harry Reid fast-tracked the bill it would probably pass the chamber in a week, McCain said.
Under the Choice Act, all veterans enrolled for VA care would be given a card enabling them to get care from a non-VA provider if the VA can’t schedule an appointment within the required time frame or if the veteran lives more than 40 miles from a VA hospital or outpatient clinic.
The bill also requires that the VA use Medicare prices and that any co-pay a veteran might have to pay goes to the VA, not to the outside provider.
McCain also said the law would end via a sunset clause at the end of two years, and that an audit be done every two years after that to ensure that VA has not fallen down on getting care to veterans.
Louis Celli, legislative director for The American Legion, said the organization worked closely with McCain’s office on the bill.
“We wanted to ensure that the VA remains the main and primary source for health care for our veterans,” he said. “In cases of emergency as we have now … with veterans on this secret list that we need to eradicate, we support using all available resources to get veterans the help they need in as short a time as possible.”
He also said the bill includes directive language ensuring that any notes and diagnoses made by private sector doctors and providers are forwarded to the VA, so there are never any lapses in patient history. And the providers will be responsible for getting them to the VA, not the veteran patient.
Celli said they have found instances in the past where veterans had to pay to have their medical notes sent to the VA. This would not happen under the Choice Act, he said.”
Veterans in different areas of the country may be wondering how passage of S. 2450, the “Veterans Access to Care through Choice, Accountability, and Transparency Act of 2014” now being considered by the Senate, may affect them. First, if those on waiting lists were sent to private doctors for health care, money would have to be taken out of general Veterans Health Administration (VHA) funds to pay for that care, thereby reducing the amount for veterans inside the system who may require specialized services or care. This is of concern to members of both BVA and Paralyzed Veterans of America (PVA). Secondly, the effort to push veterans into community providers could decrease the possibility that a newly blind veteran receiving contracted ophthalmology services would, in consultation, be sent to a VA Blind Rehabilitation Service program. As an organization, BVA has expressed concerns regarding this in meetings during the past year with senior VA officials, Members of Congress, and current contracted managed care providers. We have indicated to them that if private, eye care doctors deal with visually impaired veterans, they should be made aware of the specialized VA rehabilitation care and services.
We fully expect a vote very soon, perhaps within a week, on the “Veterans Access to Care through Choice, Accountability, and Transparency Act of 2014.” While BVA supports many aspects of this legislation, every officer and member of the organization should be aware that the recent problems can have an impact on the system of care for blinded veterans in the future. We must also let Members of Congress know that our legislation on Beneficiary Travel, S. 633, should be included in this omnibus bill. If this effort is about improving access to care and reducing wait times for all veterans, we can make the argument that including a provision for transportation to blind centers for our low-income, severely disabled veterans is essential.
To express your views about S. 633 to the Senate Committee on Veterans Affairs, go to http://www.veterans.senate.gov. Find the link that says “Contact Us” on the upper right portion of the webpage. A drop down menu will provide the following options: “CONTACT THE CHAIRMAN” and “CONTACT THE RANKING MEMBER.” From that point you will be able to enter comments either one, perhaps requesting that S. 633 (Beneficiary Travel) now be inserted into S. 2450. The other option is to call the Senate Committee phone number, 202-224-9126, expressing the same views and emphasizing that the Beneficiary Travel legislation has a minimal cost of $3 million.