Trump Administration Issues Guidelines to 'Revolutionize' Private Sector Role in Veterans Health Care

The Trump administration has released new standards to give veterans access to private sector health care on the government’s dime, issuing guidelines that will expand the role of private providers in caring for former military personnel.

Veterans living more than a 30-minute drive on average from the nearest Veterans Affairs Department facility can use a pre-approved network of private providers for services such as primary care, mental health and non-institutional extended care. For specialized care, veterans must live outside of a one-hour drive from the nearest VA facility. The new standards were required by an overhaul of VA health care signed into law last year known as the Mission Act, which consolidated existing private care programs and aimed to make it easier for more veterans to access those providers.

The law will also enable vets to access private care if services they require are not available at their VA facility, they live in a state without a full-service government facility, they qualified under the previous Choice Program, their VA facility is not meeting quality standards or their doctor decides it is in their “best medical interest.” Under the new standards, which are expected to go into effect in June, veterans needing urgent care will be eligible to access a network of private facilities but may be charged a copayment.

Veterans will no longer have to live more 40 miles from a VA facility to get private care.

The Mission Act easily sailed through Congress after lawmakers worked for years on a carefully-struck compromise, but its implementation has been plagued by controversy. At a bicameral hearing in December, lawmakers expressed concern that VA had taken the law in a different direction than Congress’ initial intent and said the implementation could be a “train wreck.” On Tuesday, a group of 28 Senate Democrats criticized VA officials for a lack of transparency on their decision-making process and said the expanded access would cause costs to skyrocket. The Congressional Budget Office estimated last year the bill would cost $46.5 billion over five years.

“Given that the administration opposes increasing overall federal spending, these increased costs for community care will likely come at the expense of VA’s direct system of care,” the senators said in a letter to VA Secretary Robert Wilkie. “And that is something we cannot support.”

Wilkie anticipated backlash prior to releasing the new standards, saying in a statement earlier this week that some opponents of the department’s approach would “claim falsely and predictably that they represent a first step toward privatizing” VA. He boasted the implementation would “revolutionize VA health care as we know it,” but maintained that expanding choice for veterans would not hamper services within the government-run network.

“Under President Trump,” Wilkie said, “VA is giving veterans the power to choose the care they trust, and more veterans are choosing VA for their health care than ever before.”

On Wednesday, he reiterated that his only goal was to meet veterans’ needs.

“Most Americans can already choose the health care providers that they trust, and President Trump promised that veterans would be able to do the same,” Wilkie said. “With VA’s new access standards, the future of the VA health care system will lie in the hands of veterans–exactly where it should be.”

The American Legion, whose support for the Mission Act helped ensure its passage, said it “generally supports” the implementation plan.

The standards “generally fall along the lines of what The American Legion supports such as basing wait time and driving distance on time, rather than straight-line mileage,” said Brett Reistad, the Legion’s national commander. He added his group will continue to monitor the law’s rollout to ensure resources are not being shifted away from the department, and will push for VA to construct a government facility in any area where private care costs climb particularly high.

Rep. Phil Roe, R-Tenn., and Sen. Johnny Isakson, R-Ga., who ushered the Mission Act through Congress last year as the then-chairmen of their respective Veterans' Affairs committees, fully supported VA’s proposal.

“The VA Mission Act provides the VA secretary the flexibility to determine what standards for access to community care are necessary to accomplish this goal, and we believe these new standards will enable veterans to receive care that best fits their individual needs while making the VA healthcare system stronger,” they said in a joint statement.

Concerned Veterans of America, a right-leaning group funded by the Koch network that has often drawn the ire of other veteran service organizations, also fully embraced VA’s plan.

“These proposed access standards will ensure veterans have better access to health care and will give them more choices in how they receive their care,” said Dan Caldwell, CVA’s executive director. “These standards are simple and straightforward, eliminating much of the confusion created by the Veterans Choice Program and the VA’s other community care programs.”