VA Releases Rules For Law That Would Increase Access To Private Care

The Department of Veterans Affairs released rules for a law that changes how the VA pays for outside, private care. Critics say the move is a stealth effort to privatize the VA.

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Last year Congress passed a bipartisan bill to change the way the Department of Veterans Affairs pays for outside private care. The specifics of those changes were made public today. It's hard to say if the new plan has support. Veterans' organizations and congressional leaders say they've been frozen out of discussions about how the law will work. And there are critics accusing the administration of a stealth effort to privatize the VA. NPR's Quil Lawrence has this update.

QUIL LAWRENCE, BYLINE: VA has been sending patients to outside specialists for years, but mostly that was VA doctors doing it for clinical reasons. The Choice Program, which started in 2014, gave veterans the option of picking a private doctor if VA care was too slow or too far away. Choice has been a mixed bag for people like Iraq vet Kayla Williams.

KAYLA WILLIAMS: I was notified recently that they have not been able to find any providers in the D.C. metro region who are willing to accept the Medicare rates that Choice uses.

LAWRENCE: Choice got a reputation for paying providers late and confused everyone with red tape, though Williams knew the ropes. She's not only a vet, she's a former senior official at VA. When the new expanded version goes into effect this June, there might not be so much choice to choose from, she says, because health care is in heavy demand nationwide.

WILLIAMS: A lot of folks seem to believe that the capacity exists in the community, that providers are equally good, but that's not the data that I've seen.

LAWRENCE: Studies show that VA care is on par or better than private care for speed and quality in most markets. So even as it's about to expand private care, VA officials like Dr. Richard Stone, acting head of VA health, have been stressing the fact that vets who try outside care usually return.

RICHARD STONE: They have had a choice for years on where to go for health care. More than 90 percent of them have chosen to stay with us. And of the 10 percent that choose to go out to commercial health care providers, the vast majority go once and then come back to us.

LAWRENCE: But expanding choice could prove that wrong, says Dan Caldwell, an Iraq vet with the conservative group Concerned Veterans for America.

DAN CALDWELL: When you give veterans the ability to vote with their feet, you're going to see really how the VA is performing and how veterans perceive the VA.

LAWRENCE: Caldwell's group, which is backed by billionaire conservative Charles Koch, advocates for all vets to have a choice between private care and the VA. He calls the new rules a good step in that direction.

CALDWELL: We want to get to a place where veterans have the ability to access a private provider without prior authorization from the VA.

LAWRENCE: Critics say that would amount to privatizing the VA, and because private care is more expensive, would also bleed resources away from the department. And the cost is still an open question for this new VA expansion. House Veterans Affairs Committee Chairman Mark Takano says the Trump administration hasn't been telling Congress how it intends to pay for it.

MARK TAKANO: We don't know what the costs are going to be. We don't know how they're going to pay for all of this, what the cost models are - you know, highly specious arguments about why they couldn't be more transparent with Congress.

LAWRENCE: Takano signed on to a letter from Democratic and Republican committee chairs this month asking VA to collaborate more with Congress. They still haven't received the information they asked for, but two days later, VA put out a press release proclaiming a new and unprecedented level of transparency to lawmakers in Congress. Quil Lawrence, NPR News.

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