April 17, 2018

Ask any veteran if they would like to have more choices for accessing health care, and they likely would say yes. Who wouldn't? I sometimes struggle to get an appointment at the VA or through my TRICARE provider and would welcome the opportunity at times to go elsewhere for care when I have an immediate need.

But in terms of veteran's health care, lawmakers are really only in two camps of thinking when it comes to choice: wanting to give veterans more access to medical services outside of the VA if they choose, allowing veterans to be in the driver's seat, or wanting to leave the VA fully responsible for deciding where veterans should receive their care.

A real philosophical difference exists between House and Senate leaders and administration officials on what veterans' health system reform should look like, particularly how much care should be delivered in VA medical facilities and how much care should be purchased through private providers in the community.

While Senate leadership was able to reach an agreement on provisions in a draft bill - called the Caring for our Veterans Act - the effort failed to get included in the massive 2018 omnibus spending package signed by the president March 23. The $50 billion draft bill would have allowed more flexibility for the VA in determining veterans' eligibility for private-sector care and included provisions to expand VA comprehensive caregiver support to veterans prior to Sept. 11, 2001, and to assess VA facilities and infrastructure needs and assets. Still, some Republicans and the administration didn't see the bill going far enough in giving veterans greater choice to get care in the community.

On the other side of the Capitol, House Republicans and Democrats have been embroiled in similar disagreements around the issue of veterans' choice; some Republicans want to put the decision squarely in the hands of the veteran, while some Democrats see the draft bill going too far in funding VA community care, by diverting funds from infrastructure and medical services to pay for private-sector care - seen as crossing a redline and leading to privatization of veterans' health care.

MOAA and other veterans' groups have worked tirelessly with VA and congressional leaders to protect, strengthen, and reform the VA health care system over the past several years. Efforts to reform the medical system and integrate community-care programs into a broader network of care requires vigilance in striking the right balance of public and private care while ensuring the VA maintains the ability to be the primary resource for delivering veterans' health care. No veteran should be left with the impression the VA isn't responsible for providing them the health care they require.

While MOAA is supportive of reform efforts, there also must be legislative solutions and funding to support and preserve foundational and specialty services inherently under the purview of the VA. As the primary provider of medical care and services, the VA must provide clinically appropriate solutions and patient outcomes across the system, whether care is delivered inside a VA facility or in the community, and leave no veteran behind. To accomplish that, the VA must maintain visibility, management, and accountability of this responsibility. Moving all care completely to the private sector erodes the VA's responsibility and limits Congress' ability to hold the VA directly accountable.

The good news is the VA reform and veterans' choice debate is not over. The chairs of both the House and Senate Veterans' Affairs committees are committed to tackling health care, caregiver, and infrastructure system reforms.

The end goal? The committees will press hard to get a final reform bill enacted before Memorial Day. MOAA and our veterans' service organization partners will remain engaged every step of the way with lawmakers to ensure the needs of veterans today and in the future are met by reforms to the health system - a system that puts veterans at the center of the decision-making process for how and where they'd like to receive their care and keeps the VA responsible and accountable.