what is trump doing to the va medical program
Terminal June, President Trump signed the VA Mission Deed, commonly considered the biggest overhaul of veterans' health intendance in a generation. Mission was designed to replace the hastily enacted Veterans Choice Program of 2014, which has made it easier for veterans to get intendance in the individual sector if they lack fast or easy access to care inside the Veterans Wellness Administration (VHA).
Choice was a temporary plan, i that would offer supplementary individual care to veterans while Congress bolstered the VA's capacity. Yet this piece of work has not happened. Instead, Mission is making permanent the privatizing principles set up along in Option.
The logical conclusion from the Mission is not as its boosters claim, to shore up the VA for the future and create a system that would be "veteran axial," but to tear downward the agency, brick by brick, visit by visit. This strategy will not only erase what has been the most successful American experiment in authorities-delivered health care, but will besides send veterans out into a individual system that is more expensive, less accountable, and unable to encounter their detail needs.
The key notion underpinning the Mission Act, that the private sector can offer comparable care to the VHA, is deeply flawed. Study afterward study (after study) has institute that the VHA by and large outperforms the private sector on key quality metrics, and that private providers are woefully unprepared to treat the often unique and difficult veteran patient population. The nearly recent evidence came in a Dartmouth College written report published in December, which compared operation betwixt VHA and private hospitals in 121 regions across the country. The results: In 14 out of 15 measures, government care fared "significantly better" than private hospitals.
Yet these statistics were all but ignored as the Mission Act moved forward. The legislation saw intense and effective lobbying from private health-care interests eager to peel of VA patients, from the American Wellness Care Clan to Ascension Wellness, the largest nonprofit health system in the state.
This lobbying continued into the rulemaking process. Terminal July, during the start public hearing on the implementation of Mission, last July, Joanne Frederick, Wellpoint Military Care's vice president for strategy and innovation. Wellpoint, a subsidiary of the second largest health-care company in America, said "providers across the Canticle network would be honored to evangelize loftier-quality care to veterans" earlier calling for private health-care interests to be deputized with new referral authority over veterans' appointments and rejecting VA efforts to conduct quality oversight of private wellness-care contractors.
Health care companies have plant allies in Trump advisers who are similarly hellbent on dismantling the agency for ideological reasons. They include a cadre of shadow advisers including electric current and onetime officials at the Koch-funded grouping Concerned Veterans for America (CVA) and a trio of billionaire members of Mar-a-Lago. (Senator Jerry Moran, a Kansas Republican and a fundamental congressional builder of the Mission Act, hails from the Koch'southward home state and is one of the top recipients of Koch family cash.)
Many Democrats, and virtually every veterans service system, also supported Mission. As the beak made its way through Congress, these more moderate forces were able to strip out a number of onerous provisions. They were likewise promised that the police force would not open up the floodgates to private care. Yet the details of the outsourcing rules are now being written by the devils, like quondam CVA staffer Darin Selnick, who helped write Mission and is now working at the VA on its implementation.
Meanwhile, tiptop veterans advocates and Autonomous lawmakers say they are being frozen out of key discussions, and that the spirit of the police is not being followed.
"There'southward been lots of conflicting information over Mission'due south statutes, and no transparency about the process since the neb was signed into law," a senior legislative staffer at a major veterans' system told the Prospect. "We have some concerns that whoever they are collaborating with might be running this thing off the tracks, and pushing for privatization. It appears that nosotros're going to have to strength our way into the door."
Rick Weidman, executive manager of the Vietnam Veterans of America, offered similar frustrations with Secretary Robert Wilkie's VA. "These guys are incredible," he said. "They summon you to a coming together with less than 24 hours find and then if y'all can't come they say you're not interested. Nonetheless, nosotros are going to go after them and keep to exert pressure to make certain veterans get the highest quality intendance."
During a December hearing with Wilkie, Democratic Senator Jon Tester of Montana, who championed the Mission Act, said he was "increasingly concerned with the department's planned implementation" of the police, and that it was "moving abroad from the direction it was headed just vi months ago, brand no error near that."
A senior staffer in the agency'due south cardinal Washington office observed that "nether the Trump assistants, political appointees seem to take far more than influence in policy making than agency policy experts."
Tester and other members of the House and Senate Veterans Diplomacy Committees repeatedly asked Wilkie for details about the access and quality measures he is because, but got no physical replies. Wilkie said simply that that he would notify committee members after conference President Trump, who has ultimate authority over how the rules are written. (Trump is expected to broadly announce his decision over Mission rules in his State of the Matrimony addresses next month.)
The text of The Mission Act mandates that private care only be offered nether a narrow set of circumstances, including when the VA can't offer a specific service, a veteran faces an excessive wait or drive fourth dimension, or when private care "would be in the best medical interest of the covered veteran based upon criteria developed by the [VA Secretary]." Yet Tester said in December that rules in the works could essentially create "automatic eligibility for community care."
No new rules volition exist finalized until the summer, and VA sources are confused well-nigh exactly what the new standards may exist. What's articulate, all the same, is that the new standards will almost certainly make information technology easier for individual health care companies to capture more than patients. The exact price tag for this increased level of individual care is unclear, and Tester told Wilkie in Dec that it "concerns me that each time nosotros've discussed this issue in the last ii months, VA officials have given us wildly unlike estimates of how much this will cost."
Because no supplementary funding has been earmarked for individual sector care through Mission, every dollar spent on individual sector intendance will most likely exist siphoned off from the VA budget, starving the agency of needed resources and making it virtually impossible to fill up the 45,000-pus staffing vacancies that plague agency facilities all over the country. To make matters worse, staff may be moved from providing hands-on care to patients to coordinating care with the private sector.
"If care in the private sector is more expensive than at the VHA and staff accept to exist allocated to coordinate care and get records back from the private sector, then less money and staff will be available for patients cared for directly past the VHA," a VA medical center director told the Prospect.
Over the by several months the Prospect has spoken with regional Veterans Integrated Service Network (VISN) and medical centre staff directors who have either attended meetings with Wilkie or are familiar with his deliberations. These directors, who requested anonymity to avert retaliation, accept become increasingly alarmed that access standards nether consideration are indeed and so broad every bit to give automatic eligibility to private sector care.
I medical managing director told the Prospect that one standard Wilkie is mulling over would send a veteran into the individual sector after only ten days of waiting for a master care appointment and 14 days for a specialty appointment. Directors worried that the VA could too potentially interpret whatever follow-upwards appointments, whether in six weeks or a year, as overshooting acceptable expect times and thereby qualifying about every vet as eligible for private care.
"Everybody is of the same belief that what is going on with the VHA is death past a thousands cuts," one VA VISN director told us. Another said "this is privatization pure and simple," while a hospital chief of staff said bluntly that broad Mission's rules would exist "kaboom for the VA."
According to a senior VA official, Wilkie is also considering moving veterans who have to wait longer than xx days for a mental health appointment into the private sector. Inside a relatively short period of time, (no one knows quite how long) the standard would alter to xiv days and and then, potentially, 7 days, which almost exactly mirrors the wait time standards of the war machine'southward wellness care program, TriCare. (Wilkie is a former Defence force Department undersecretary for personnel and readiness.)
Several VHA directors also told the Prospect that Wilkie is considering making veterans who must drive more than than xxx minutes for a principal care or behavioral health appointment or 60 minutes for a specialty care date eligible for individual sector care, a move that would further open the floodgates.
These standards could then substantially drain veteran patients from the VA arrangement that it could plummet entirely. One chief of staff at a major VA facility told us, "these standards would bring about the end of our centers of excellence since they would no longer have the patient book necessary to deliver quality patient intendance or conduct research."
The same would be true of VA transplant centers, surgical suites, and rehabilitation centers, which are scattered across the nation and inevitably crave that patients travel some distance—travel paid for by the VA, but which evangelize far more affordable and higher quality care than what's offered in the individual sector.
The media and Congress are ignoring an even greater threat to the VHA, a provision in Mission, which kicks in 2020, that could spur closures of VHA facilities and programs across the nation. During that year the president is mandated, later consulting with Congress, to engage a 9-fellow member Asset and Infrastructure Realignment Commission, whose chief job will be to consider whether underutilized facilities should exist shuttered. Creating underutilization volition guarantee that the adjacent logical step is shutting programs and closing facilities.
The legislation stipulates that iii members of the commission must be from veterans service organizations and other interests, including the individual health care sector, also must get seats. As soon as he signed the police force, even so, Trump announced that he was not mandated to consult Congress or to set aside seats for veterans advocates on the committee.
Only ii of the 42 members on the House and Senate Veterans Affairs Committee opposed Mission last year, when it came up for a vote. One of those lawmakers, Bernie Sanders, the Vermont Democrat, reiterated his opposition to Mission in December.
"This is nothing short of a steady march toward the privatization of the VA," Sanders said. "It's going to happen piece by piece by slice until over a period of fourth dimension there'southward non much in the VA to provide the quality care that our veterans deserve."
The question at present is what newly empowered Democrats in the Business firm and frustrated veterans advocates on the Hill practice to halt this overreach. Sources inside the VA opposed to Trump's agenda have suggested to the Prospectthat the House Committee on Veterans Affairs should file subpoenas and hold hearings to uncover the influence health care executives, the Mar-a-Lago group and Koch brothers have had on the implementation of MISSION. Yet the new commission chairman, Representative Mark Takano of California recently told the Military Times that he remains committed to bipartisanship and won't "be issuing subpoenas or demanding witnesses without the backing of his Republican counterparts on the committee."
While work on veterans' diplomacy legislation has historically been a cordial, bipartisan attempt, the bureau will quickly be privatized if veterans organizations and Democratic legislators don't wake up to the fact that the Trump assistants and congressional Republicans have blatantly politicized veterans problems for corporate and ideological gains.
Suzanne Gordon
Suzanne Gordon is a senior policy analyst at the Veterans Healthcare Policy Institute. Her latest volume, 'Our Veterans: Winners, Losers, Friends, and Enemies on the New Terrain of Veterans Diplomacy,' will be published in July by Knuckles University Printing.
Read more by Suzanne Gordon
Source: https://prospect.org/health/trump-s-under-the-radar-push-dismantle-veterans-health-care/
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