VA Facing Fallout from Publicity and Scandals

A bill to change how care is provided for American veterans could substantially alter the role of the VA.

A bill has been introduced by Congressman Phil Roe (R-TN) to replace the Veterans Choice Act. The Veterans Choice Act was passed in 2014 after a scandal at the Department of Veterans Affairs regarding lengthy waiting times for veterans to receive medical care and falsification of records at the agency.

Under the Veterans Choice Act, veterans were given more flexibility to visit private sector care facilities outside of the VA’s system of 1,233 health-care facilities, including 168 VA Medical Centers.

Increasing Use of Community Care Facilities

According to Congressman Roe, since fiscal year 2014, community care appointments have increased by 61% overall, and in fiscal year 2016, 30% of all VA appointments were held in the community rather than in VA medical facilities.

Congressman Roe writes that the while the VA has been collaborating with community providers to treat veterans since 1945, the recent increase in veteran demand for community care has highlighted serious issues and inefficiencies within the VA’s community care system.

He cites as an example that the VA uses six different methods to refer veteran patients to community providers. These six different methods often conflict with one another, creating confusion for veterans, community providers and VA employees alike.

The House Committee on Veterans’ Affairs, led by Chairman Roe and Ranking Member Walz, have worked on drafting legislation to streamline the VA’s community care programs. H.R. 4242 has 23 co-sponsors with support of both Democrats and Republicans.

The bill still has a long way to go. It is still in a House committee for consideration and, if it should emerge from the House, it is likely to face changes before becoming law.

Purpose of the VA Care in the Community Program

The purpose of H.R. 4242 is to establish a permanent VA Care in the Community Program. The legislation would provide a greater choice of medical care to veterans under certain conditions. The agency would set up regional networks for providing care under contract with the VA.

The VA would negotiate rates for care and services of veterans and reimburse the care facilities for their services.

The bill provides that if the agency is unable to assign an eligible veteran to a patient-aligned care team or a dedicated primary care provider because a care team or provider at a Department facility is not available, the veteran would be involved in selecting available primary care providers from among network providers located in the regional network where the veteran lives or an adjacent regional. The veteran would select one of the available primary care providers to serve as his dedicated primary care provider.

Reactions to the Bill

The American Federation of Government Employees (AFGE) represents a large number of federal employees who work for the Department of Veterans Affairs. The union has taken issue with the legislation and views it as a way to provide more medical care for veterans through the private sector which would threaten the existence of the union in the agency.

According to an AFGE press release, quoting National AFGE President David Cox:

This is a deliberate strategy: Establish the basics of a privatization plan – they call it Choice – and they keep throwing more and more money at it and encourage veterans to use it instead of the VA. At the same time, they starve the VA of staff and other resources in order to make it fail. And of course, when the VA fails, the VA workers’ union disappears as well. It’s a story we all know too well.

Then they have what they want: A broken system that has lost public support, a system with lots of valuable real estate they can sell off, and a privatization infrastructure that sends all the patients whose treatment is profitable to the private sector, with a skeletal VA left to care for the sickest that the private sector doesn’t want.

The Wall Street Journal notes there is disagreement among some veterans groups about the proposed changes.

The group Concerned Veterans for America and several other organizations see the bill as creating the ability to use more private-sector providers to provide care for veterans more quickly, efficiently, and allowing veterans choose where to prefer to receive medical care. The executive director of the organization, Dan Caldwell, noted in a press release:

The VA Care in the Community Act contains some positive reforms but still falls short of delivering real health care choice to our veterans. Under this legislation, the VA will still retain almost complete control over when a veteran can access private health care, which could undermine the better aspects of this legislation. We believe that a few minor modifications can improve this legislation and ultimately ensure that veterans have more control over their health care. CVA will continue to work with members of Congress to improve this bill.

Another veterans group, Amvets, has a different perspective according to Joe Chenelly, the executive national director of Amvets.

We’re very concerned about it, we’re talking about being vastly out resourced here. They’re ignoring what all the legitimate veterans organizations know, which is ‘choice’ would be privatization.


The fate of this bill and the impact it would have on providing care for American veterans will be publicly debated in Congress and through press releases from interested organizations. The impact on veterans and on the role of the Department of Veterans Affairs could be substantial if the bill does become law.

About the Author

Ralph Smith has several decades of experience working with federal human resources issues. He has written extensively on a full range of human resources topics in books and newsletters and is a co-founder of two companies and several newsletters on federal human resources. Follow Ralph on Twitter: @RalphSmith47