VA's 'choice' program for health care off to slow start

WASHINGTON - Far fewer veterans than expected are taking advantage of a new law aimed at making it easier for them to get private health care and avoid the long waits that have plagued Department of Veterans Affairs facilities nationwide.

Only 27,000 veterans have made appointments for private medical care since the VA started mailing out "Choice Cards" in November, the VA said in a report to Congress this month. The number is so small, compared to the 8.6 million cards that have been mailed out, that VA Secretary Robert McDonald wants authority to redirect some of the $10 billion Congress allocated for the program to boost care for veterans at the VA's 970 hospitals and clinics.

Republicans and Democrats insist the problem is the department and that it needs to do a better job promoting the choice program. They also want to change a quirk in the law that makes it hard for some veterans in rural areas to prove they live at least 40 miles from a VA health site.

The government measures the distance as the crow flies, rather than by driving miles, leaving thousands of veterans ineligible.

"Veterans put their lives on the line to defend this country. The very least we can do is ensure they don't have to jump through hoops to receive the care they need and have earned," said Sen. Jon Tester, D-Mont., whose vast state has just one VA hospital.

The choice program was a key component of last year's sweeping law approved in response to reports that dozens of veterans died while waiting for appointments at a VA hospital in Phoenix, and that appointment records were manipulated to hide the delays. A series of government reports said workers throughout the country falsified wait lists while supervisors looked the other way, resulting in chronic delays for veterans seeking care and bonuses for managers who falsely appeared to meet on-time goals.

The law, signed by President Barack Obama in August, allows veterans who have waited more than 30 days for an appointment to get VA-paid care from a local doctor. It also allows veterans who live at least 40 miles from a VA hospital or clinic to get private care and makes it easier to fire VA employees accused of wrongdoing.

The choice program expands an existing program that allows veterans to get outside care for emergencies or procedures not available at the VA. Veterans have long complained about waiting months or even years to be reimbursed for private care, and many are skeptical the choice card will alleviate those problems, despite promises by the VA.

"I don't believe any of us thought that there would be a wholesale rush to leave the VA system at all, but we are still early in the program," Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, told reporters during a recent tour of the VA.

McDonald's bid to shift the money has met a bipartisan wall of opposition in Congress, where leaders said the landmark law they adopted last summer to overhaul VA has not been fully implemented. Taking money away from the choice program just three months after it was launched is premature, even irresponsible, lawmakers and veterans advocates said.

Miller called the plan a complete nonstarter. His Senate counterpart, Johnny Isakson, R-Ga., called it unacceptable. And Sen. John McCain, R-Ariz., one of the law's chief authors, said Congress not only would reject the idea "but refuse to even consider" it.

Connecticut Sen. Richard Blumenthal, the senior Democrat on the Senate veterans panel, said in an interview he would oppose any reallocation of funds "so long as there are delays and issues with quality of care" at VA.

McDonald counters that the proposal, which has not been formally submitted to Congress, would help ensure that "every veteran receives the care they have earned and deserve regardless of where they choose to get it from."

McDonald, who took over as VA secretary in July, said he never intended to "gut the choice program or somehow eliminate" it. Instead, he said, he simply seeks the kind of budget flexibility he enjoyed as Procter & Gamble CEO.

"Imagine your household. You are hungry, but you can't move the money from the gasoline account to the food account. Well, that is the situation I face," he said at a Feb. 11 budget hearing before the House Veterans Affairs Committee.

Louis Celli, director of veterans affairs and rehabilitation at The American Legion, the largest veterans service organization, called McDonald's explanation disingenuous.

"Draining funds from the bill short-circuits the program and ultimately hurts vets," Celli said, noting that VA officials had pushed for the choice program as a short-term way to expand patient access to care.

McDonald will get another chance to explain the proposal Thursday as the Senate Veterans Affairs Committee considers the VA's budget.

Rep. Tim Huelskamp, R-Kan., said a veteran in his rural district drives 340 miles one-way for cardiology treatment at a VA hospital in Kansas City.

"If the VA choice program can't provide something closer for him, then we need to relook at how we are implementing that," Huelskamp told McDonald at the Feb. 11 hearing.

McDonald said VA officials are willing to look at the 40-mile rule to see if it needs to be changed. The VA is committed to doing all it can to "make sure the program is robust," he said.