New Rules Lead to Privatization of the VA by Skip Delano

February 01, 2019

Proposed VA Rules Will Extend Privatization of High-Quality VA Health Care By Sending Millions More Veterans to Inferior Care in the Private Sector

Contact: Skip Delano
Save Our VA Healthcare Working Group, Veterans for Peace

The floodgates for privatization of VA health care will open wider under sweeping new rules (access standards) proposed by the VA on January 29 for the more than 7 million veterans who use their hospitals and clinics. The most significant change in rules would allow veterans who live as little as a 30-minute drive from a VA health care facility to be able to instead choose private sector heath care providers, without pre-authorization from the VA. Current law lets veterans use a private sector health care provider if they must travel 40 miles or more to a VA facility, but the new rules measuring commuting time, rather than distance, will greatly encourage veterans in both rural and high-traffic urban areas like New York City or Los Angeles to seek private health care providers closer to their homes.

The new rules were mandated by the Mission Act, legislation passed by Congress in June 2014. When announcing the new rules mandated by the law, Secretary of Veterans Affairs, Robert L. Wilkie, celebrated how revolutionary the new rule will be when he told the New York Times, that the Mission Act was "the most transformative piece of legislation since the GI Bill." Although critics of the legislation and the VA's new rules claim they will lead to privatization of VA health care, Wilkie asserts they are "unfounded." The evidence suggests otherwise. VA officials estimate the new rules could increase the number of veterans eligible for private sector health care from roughly 560,000 (8%) currently to as many as 2.1 million (30%) or nearly four times as many veterans served by the private sector health care system rather than VA health care. Such a shift of veterans out of the VA system IS PRIVATIZATION of VA healthcare, plain and simple. It will further undermine veterans' healthcare by transferring billions of dollars from the VA into the hands of private sector doctors and hospitals which have higher costs than government-provided care.

Another considerable expansion of current eligibility standards under the new rules will allow veterans who need "urgent care" to go to a private sector walk-in clinic without VA pre-authorization. The first two visits would not require a co-payment by the veteran and likely persuade millions of veterans to take advantage of this new benefit. A further change under the new rules would reduce veterans facing waiting time for an appointment at a VA facility to seek private sector health care from currently 30 days or more to 20 days, with the goal of 14 days by 2020.

The problem that Congress was supposed to solve when they adopted the Choice Act of 2014, the first legislation that encouraged privatization of VA health care, was an effort to fix the years-old troubles for veterans' with too-long VA appointment wait times. It allowed veterans who had either to wait 30 days, or lived 40 miles from a VA facility, to seek private sector health care with the VA paying for it. Although by 2017, independent studies had demonstrated that VA wait times were shorter than wait times in the private sector health care system, Congress nevertheless passed the Mission Act last June with bi-partisan support and the endorsement of almost all the Veterans Service Organizations (VSOs) like the American Legion, the Veterans of Foreign Wars and the Vietnam Veterans of America. However, all these organization of veterans and most Democrats who supported the legislation clearly stated their opposition to using the Mission Act's rules to encourage privatization of VA health care, which these proposed rules clearly do.

The driving force behind the campaign to dismantle the VA healthcare system and trim veterans' benefits has been the Concerned Veterans of America (CVA). Unlike most VSOs which have thousands of veterans as members and provide them services, CVA includes only a handful of veterans and is a front group for the right-wing Koch Brothers who have funneled more than forty-five million dollars to the organization. They not only have led the campaign against VA health care but also spent millions attacking the 2010 Affordable Care Act, advocating a reduction in federal spending, and supporting Republican Congressional candidates. Their members have been appointed to top positions in the Trump Administration including the VA where they have worked to remove all staff who oppose privatization and their efforts to undermine VA healthcare. These new rules represent a zenith for CVA's campaign to privatize VA health care.

What CVA and other privatization backers fail to acknowledge are several essential facts. The VA supports the largest fully-integrated health care system in the U.S. It addresses the unique needs and health conditions of veterans, which are among the most complex in America's health care system. VA healthcare is a world leader in providing veterans safe, high-quality and innovative health care. Nor do its opponents recognize that study after study document that the quality of VA healthcare is equal, and often superior, to care provided by private sector doctors and hospitals. When surveyed, more than 86% of veterans say they want continued, uninterrupted care from their VA, and they overwhelmingly give positive consumer satisfaction with VA healthcare.

The rules represent a step backward for VA healthcare and threaten the health care of millions of veterans. By taking money out of the VA budget to send veterans to the private sector health care system, they will likely expand VA appointment wait times as fewer resources are available to hire staff – nearly 45,000 VA vacancies currently – and leave veterans with less choice for VA health care while enriching private sector doctors and hospitals. While the rules send millions of veterans into the private sector health care system, they turn a blind eye to the quality of care a veteran would receive there. Private doctors and hospitals are not required to match the VA's rigorous quality standards nor are they accountable for 20 or 28-day access requirements. Turning veterans over to inferior care in the private sector is a disservice to veterans.

We oppose the Mission Act rules proposed by the VA, based on drive time rather than quality and their purpose – the privatization of VA health care. They will drain money from the VA, even bankrupt it, lead to the closing of dozens of VA facilities and provide veterans with poorer heath care We support fixing, strengthening and fully-funding VA health care which does an exceptional job of addressing the unique needs and health conditions of veterans.