On Wednesday, July 12, 2023, the Senate Committee on Veterans’ Affairs held a hearing to consider a series of pending bills affecting VA, the most critical of which were two bills that focus on provision of private services through the Veterans Community Care Program (VCCP).

NAVAPD joined with Veterans Healthcare Policy Institute (VHPI) and with nine other organizations representing all VA physicians, dentists, nurses, psychologists, social workers, optometrists, physician assistants and nurse anesthetists; the American Psychological Association, and the Military and Veterans Committee of the Group for the Advancement of Psychiatry – in submitting a statement for the record opposing these proposals. The Statement warns that, if passed, the bills under consideration could quickly lead to the dismantling of the Veterans Health Administration (VHA). VHPI Policy Director Suzanne Gordon recently wrote an article on these bills for The American Prospect. 

The meeting’s tone was set in opening remarks by Ranking Member Jerry Moran, (KS-Rep). He recounted instances when veterans did not receive the community care services that they were seeking. As he did at a previous hearing last month, Moran emphasized that he forms opinions about the VA, not on objective data analyzed by respected healthcare researchers like the RAND Corporation, or through investigations conducted by the independent VA Office of Inspector General, but instead on anecdotal stories from his constituents. For many years, he’s used these one-sided stories from his constituents to justify privatization, regardless of the adverse impacts on the VHA.

At the core of the July 12th hearing was discussion of three major legislative provisions, each of which has the potential destroy VA Healthcare. The provisions are: 

1. Veteran preference. Tucked into Senator Moran’s HEALTH Act is language that, would require VA to explicitly consider a “veteran’s preference” for obtaining their healthcare in the private sector. 

 Meggan Thomas, the Associate Director of National Legislative Service at the Veterans of Foreign Wars, noted that this bill contained “contradictory guidance” over how preference would become a criterion for eligibility. The VA’s testimony similarly stated, “it is unclear whether the ‘preference of the covered veteran regarding where, when, and how to seek hospital care, medical services, or extended care services’ would allow a veteran to unilaterally to determine his or her eligibility for community care if the Veteran stated a preference for community care.”

Senator Moran insisted that technically he was only asking the VA to “consider” preference for private sector care. Yet explicitly put the “preference” language in the bill. This will create the expectation among veterans and lawmakers of a new allowance which would be extremely dangerous to the long-term viability of the VA. If this provision were this to pass, every veteran would potentially become eligible for community care based solely on their preference which would then create an unstoppable drainage of VHA budget resources.

2. Self-referral.  The Making Community Care Work for Veterans Act, a draft bill authored by Sen. Jon Tester, (MT-Dem), calls for allowing routine vaccinations and vision and hearing services without VHA referral or authorization.

On the surface, that may be a tiny fraction of care provided by VA.  However, NAVAPD and VHPI have argued that once you propose self-referral for just a few services, supporters of privatization will, in no time, add even more services to which veterans can self-refer. Megan Thomas and Jim Lorraine, President and CEO of America’s Warrior Partnership, said the same during the July 12th hearing. In their testimony, both stated that there’s “no reason to limit self-referral to eyeglasses and hearing aids”. They argued self-referral should immediately include mental health, substance use, podiatry, prosthetics, laboratory services, dermatology, and diabetes. If the language of the bills remains imprecise, this could lead to disastrous effects to VHA and VA clinicians.

3. Unfettered access. The HEALTH Act contains another provision in which veterans would be allowed to receive outpatient care without VHA referral, authorization, or oversight.

Any enrolled veteran could simply make an appointment with any community care mental health or substance use disorder provider for care for any duration of time. VHA’s only role would be to pay the invoices, relegating VHA to the role of insurance provider. Senator Kyrsten Sinema, (AZ-I) and co-author of the bill, reiterated her enthusiasm for this change, which would convert VHA from its primary role as a provider of healthcare to one an insurance carrier.  So did Jim Lorraine, who testified that veterans should be “managing their own care themselves.” He continued: “Allowing veterans to take ownership of their own care, schedule it in their own communities – at their convenience – is a terrific step.” When Senator Tester asked Lorraine whether this would encourage a dangerous overutilization of treatment and lead to overbilling, (something that would be virtually guaranteed due to the VA’s lack of private sector oversight), Lorraine sidestepped the question and argued for putting no preventive measures in place. It was not discussed how this privatization plan would be paid for as it is estimated to cost the taxpayer an extra $96 to $179 billion  per year.

Mr. Lorraine then further claimed that “ensuring the VA has strong and effective community partnerships helps safeguard the VA healthcare system and keeps it strong for future generations of veterans.”  NAVAPD sees this as twisted logic, unsound reasoning because funds earmarked for VA healthcare would be redirected to community care.

The provisions outline above were only the most dangerous three. There are plenty of others that worry NAVAPD and the other signatory organizations.

Both the HEALTH Act and Making Community Care Work bills would codify into law the community care access standards developed by former VA Secretary Robert Wilkie. Jon Retzer, Assistant National Legislative Director of the Disabled American Veterans (DAV), warned that codifying the criteria into law “would limit VA's ability to modify those access standards in response to changing conditions”; righting noting that “codifying access standards—by itself—will not improve veterans' access to care, lower wait times, improve quality, or produce better health outcomes.”

Retzer pointed to the real solution: ensuring veterans can access high quality care. This is achieved, as Retzer noted, by “investing in VA's health care infrastructure and staffing … this is particularly true for veterans who live in rural and remote areas where VA is most likely to be a stable, long-term health care option for veterans, since, private sector medical facilities and practices tend to close more often, and without notice, regardless of the needs of veterans who live in those areas.”  NAVAPD has been fighting for the same solution for several years.

Retzer also questioned provisions in the bill that would transform the VA healthcare delivery system into a Value-Based Care model. NAVAPD, DAV and VHPI share the same concerns about applying failed private sector models to the nation’s most successful healthcare system.  Indeed, yet another study recently confirmed the problems embedded in efforts by the Centers for Medicare and Medicaid services to impose value-based payment systems, ones that reward or punish hospitals based on quality measures. The article, published in Health Affairs, reports that these systems too often penalize providers that care for underserved populations, and patients who live alone. NAVAPD suggests that who support these value-based models should carefully consider the article’s conclusion, that they “might not adequately account for health equity factors at the community level.”

Throughout the July 12th hearing, veterans’ groups and lawmakers reiterated their commitment to finding a bipartisan compromise on the best provisions in these two bills. While we applaud the sentiment, NAVAPD worries that lawmakers will not zero in on the positive provisions in both bills but rather may produce an even worse version of the MISSION Act. That is why, in the months ahead, NAVAPD will continue to encourage legislators and advocates to seriously reconsider these two bills and carefully analyze the long-term consequences of any compromise that includes veteran preference, self-referral, unfettered access, and other stipulations that will imperil the long-term viability of our nation’s most successful healthcare system. Our veterans do not deserve less, more expensive healthcare.

NAVAPD encourages you to watch the full Senate hearing, read the Statement for the Record and let your law makers know that you do not support the bills with the language as proposed. Please encourage your colleagues to join NAVAPD and Like Us and Follow Us on Facebook and LinkedIn.