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The Department of Veterans Affairs has been under close scrutiny as a result of scandals that have plagued the agency in recent months and years. Largely as a result of these issues, Congress established the Commission on Care. This organization was created to examine veterans’ access to Department of Veterans Affairs health care and to examine how best to more effectively organize the Veterans Health Administration, locate health resources, and deliver health care to veterans during the next 20 years.

The Commission on Care has submitted its final report on health care provided by the Department of Veterans Affairs. The report concluded:

“[The] evidence shows that although care delivered by VA is in many ways comparable or better in clinical quality to that generally available in the private sector, it is inconsistent from facility to facility, and can be substantially compromised by problems with access, service, and poorly functioning operational systems and processes. The Commissioners also agree that America’s veterans deserve much better, that many profound deficiencies in VHA operations require urgent reform, and that America’s veterans deserve a better organized, high-performing health care system.”

In its press release, the Commission on Care concluded:

Under the Commission’s proposal, VA would continue as the exclusive veterans’ provider of such distinct services as specialized behavioral health care, spinal cord injury care, prosthetics, and rehabilitative services. To assure veterans receive better access to care, the Commission proposes VA establish high-performing, integrated health networks that include both VA and community-based providers who meet stringent VA credentialing requirements.

The American Federation of Government Employees (AFGE), which represents a number of employees in the Department of Veterans Affairs (VA), has issued a press release challenging the conclusions and analysis of veterans health care by the federal government’s Commission on Care.

The primary complaint about the report appears to be a proposal to create the VHA Care System. AFGE writes:

In the proposed VHA Care System, Veterans would be permitted to receive care from any local facility or provider who has been credentialed by VHA. Oversight for Veterans’ health care would be handed over to a newly created, external governance board.

The union also believes “the recommendation to establish a new VHA Care System is at odds with compelling evidence of the VHA’s current effectiveness.” AFGE concludes that “given the evidence of overall quality, efficiency, integration and innovation within the VHA, we believe that efforts to reform the VHA can best serve Veterans by expanding access to services the VHA currently provides. Where geographic challenges exist and/or VHA does not offer specific services, the VHA should purchase services from non-VA partners.”

The substance of the AFGE position is captured in this paragraph:

“The Final Report anticipates that 60 percent of eligible care will shift from VHA facilities to outside networks (p.31). The net result will reduce, not expand, Veterans’ choices, since to pay for this shift, a VHA Care System will incrementally downsize the number of VHA providers and programs. The VHA system would be weakened.”

That is correct. The final report notes:

“We expect that allowing enrollees to get primary and standard specialty care in the community will increase reliance for care provided in the community because many veterans would have a choice among a larger number of providers and would be more likely to have the option to receive care at a more convenient location. We also expect enrollment to increase because some eligible veterans would be induced to enroll by the prospect of having VA pay for them to see a provider in the community. We assume that 60 percent of eligible care shifts from VA facilities to CDS networks.”

Presumably, if 60 percent of eligible care shifts from VA facilities to other networks, the number of employees at the VA will decrease as would the number of union members for AFGE which has to be a concern for the union and for employees at the VA. No one conclusively knows how much of a reduction there would be in VA employment, if any, as other VA services would presumably expand as the VA system would expanding to make care more convenient for many veterans. The Commission on Care “modeled” enrollment increases as follows:

We modeled enrollment increases of 5, 15, and 20 percent for the low, middle and high estimates, which assume integrated, narrow, and well managed networks that are designed and managed with cost as one of the major considerations. We also modeled an enrollment increase of 50 percent, more consistent with a less-managed, relatively broad network for which cost is a less important consideration.

The union concludes with a plea to avoid taking “risk [to] our Veterans’ healthcare on unproven ideas. We must preserve and strengthen the VHA integrated health care community that Veterans deserve and overwhelmingly prefer.”

As we have seen from the Republican convention this week, veterans health care has been a concern and will continue to be a focused political issue in coming weeks and months. The report by the Commission on Care and the reaction of the AFGE and the other unions and organizations cited in the AFGE press release highlight the significance of this issue to federal employees in the VA, their unions and to military veterans.

Report on Veteran Care by Commission on Care