General George Washington once said, "A nation is judged by how well it treats its veterans." Not whether we thank them for their service or we honor them on Memorial or Veterans Day, but how we treat them. Society has generally accepted that the Department of Veterans Affairs (VA) bears the responsibility to treat, heal, and rehabilitate the men and women who served in our military and suffered injury or disease as a result. So when the Phoenix VA scandal of 2014 made national news, it represented an abject breach of the country's obligation to provide healthcare for those who ensured our freedom.
This raised to the forefront of public and policy consciousness the critical question of how we, as a country, can best meet our obligation. In light of what happened in Phoenix, some argued that private sector health provided at VA expense was the best option, while others pointed to VA healthcare, if adequately funded by Congress, as the optimal option. This debate eventually led to the passage of the Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014, or “Choice Act,” allowing veterans to choose between VA healthcare and non-VA care in the community.
The initial concern about the Choice Act was whether veterans would have two viable options from which to choose, or if veterans would be given a choice that boiled down to choosing the better between two incredibly bad options. So far, the Choice Act has allowed VA to treat, directly or indirectly, more than one million veterans since 2014 despite the litany of problems that challenged program implementation.
On April 19, 2017, nearly three years after the Phoenix VA scandal made national news, President Donald Trump signed the Veterans Choice Improvement Act into law. The new law addresses problems uncovered during the implementation of the Choice Act, such as veterans having to pay up front for private care and await reimbursement from a red-tape riddled VA. After years of private doctors going unpaid for caring for military veterans, VA is moving away from using third-party contractors to pay its bills, making VA the primary payer to doctors caring for military veterans under the new law. The new law also extends the Choice program beyond its original August 7, 2017 expiration date.
Optimism notwithstanding, the new law should not be considered a watershed moment in how the country treats its veterans. Catastrophically disabled veterans, such as those with spinal cord injuries and diseases, have limited choices for care outside of VA and heavily rely on lifelong VA care. Any erosion of specialized VA services, due to a drop in demand, will not bode well for the country’s most vulnerable veterans whose only real choice is VA. For this reason, Paralyzed Veterans of America (Paralyzed Veterans) has championed Choice Care, which includes VA as one of those choices. It is also important to keep in mind that not every private sector provider has readily embraced the idea of taking on a wave of new patient demand that brings with it unique, uncommon, and complicated health challenges; not to mention an unwillingness on the part of many providers to accept the additional workload at the Medicare/Medicaid rate.
That said, the newly enacted Choice extension that President Trump just signed into law should be considered a major milestone for the VA. It provides a sustained release valve for a system that nearly burst given its undersized capacity to take on swelling demand. If successful, the measure will allow VA to focus on those services it does very well, while facilitating timely access to care for those veterans who have viable non-VA alternatives.
The law also undergirds plans, and Paralyzed Veterans supports, integrating community healthcare more seamlessly with that offered by the VA while ensuring VA itself has the capacity to treat those who make VA their choice.
Sherman Gillums, Jr., executive director, Paralyzed Veterans of America. Written and originally published by the San Diego Tribune on April 21, 2017. http://bit.ly/2pmGR0v