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Democrats, vets hesitant about preliminary plans for Choice program extension

By NIKKI WENTLING | STARS AND STRIPES Published: June 7, 2017

WASHINGTON — A new Department of Veterans Affairs community care program will do away with current eligibility restrictions but stop short of unfettered choice, VA Secretary David Shulkin said Wednesday.

A new program to replace the Veterans Choice Program, created in 2014, hasn’t been publicly released but has been given a name – the Veterans Coordinated Access Rewarding Experiences program, or CARE. Shulkin broadly described the program Wednesday to members of the Senate Veterans’ Affairs Committee.

“VA needs a different approach to ensure we can fully care for veterans,” he said. “We believe that a redesigned community care program will not only improve access and provide greater convenience for veterans, but will also transform how VA delivers care within our facilities.”

Since his first public address as VA secretary, Shulkin has promised to end a controversial policy that allows veterans to seek care outside the VA only if they can’t receive an appointment within 30 days or they live more than 40 miles from a VA facility. Lawmakers and veterans have described the current system as complex and confusing.

Instead, under the new program, veterans would consult with their VA doctors about whether to receive care at the VA or in the private sector, Shulkin said. In part, they’d take into consideration the quality of the local VA. Using wait-time and quality-of-care data that the VA posts to its website, the VA would compare its facilities with others in the private sector. If a VA facility rated lower than other providers in the surrounding area, a veteran could seek care outside of the VA.

Though legislation has yet to be introduced, Shulkin said he hopes to push the new program through Congress by Sept. 30, the end of the fiscal year.

Democrats and veterans organizations reacted hesitantly to the plan Wednesday, expressing concerns the change would come at the expense of VA services.

“The large increase for community care is seemingly being made at the expense of in-house VA care,” said Sen. Jon Tester, D-Mont., the ranking Democrat on the committee. “I’m not going to be the guy up here to allow the administration to chip away at VA health care.”

President Donald Trump’s proposed budget for the VA in fiscal 2018 calls for $2.9 billion in new spending for the program. Trump’s budget also requests $3.5 billion for the program in 2019 and every subsequent year.

Plans to offset the cost of continuing the Choice program have been condemned by major veterans organizations during the past few weeks.

The budget proposes pulling $3.2 billion from one benefit program that aids disabled, unemployable veterans. It would also reinstitute a policy to round down veterans’ annual cost-of-living adjustments.

The American Legion last month called the proposals “stealth privatization” and a “cannibalization” of VA resources.

“We noted the strong concerns, not only of members of Congress, but certainly the [veterans service organizations],” Shulkin said Wednesday. “We’re going to take that concern very seriously.”

The American Legion’s Jeff Steele reiterated Wednesday that the group was weary of a Choice expansion creating “unsustainable costs” and eroding VA resources.

“The American Legion supports a strong VA that relies on outside care as little as possible and only when medically necessary, rather than a move toward vouchers and privatization,” he said.

Representatives from Disabled American Veterans, Veterans of Foreign Wars and Paralyzed Veterans of America also said they’d rather see resources go toward improving VA care.

“They’re not paranoid about this, they have legitimate concerns,” said Sen. Bernie Sanders, D-Vermont.

Responding to those concerns, Shulkin repeatedly said he was not trying to privatize the agency.

He claimed the new program would improve VA facilities by directly comparing them to outside health care providers, spurring competition.

“The whole idea here is to improve the VA, not get more care in the community,” he said. “And the very best way I know to improve health care is to let everybody see if you’re not performing at a high quality, and if you’re not, you’re going to want to provide higher quality service. I want the VA to be improving over time.”

It was unclear Wednesday when full details of the new program will be released.

wentling.nikki@stripes.com
Twitter: @nikkiwentling

Outside the hearing room for the House Committee on Veterans Affairs at the Cannon Building on Capitol Hill in Washington, D.C., on Thursday, Feb. 16, 2017.
CARLOS BONGIOANNI/STARS AND STRIPES

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