Veterans affairs hospital
Credit: Veterans Health/Flickr

On June 6, the House Committee on Veterans’ Affairs deployed seven staffers to five veterans’ hospitals across the country. Their goal: to monitor the rollout of a new law set to accelerate the outsourcing of hundreds of thousands of veterans served by the Veterans Health Administration (VHA) to private-sector providers.

But this critical monitoring work was actively undermined by officials inside the Department of Veterans Affairs (VA). According to a House report obtained by the Washington Monthly, Congressional staff faced “coordinated and unprecedented obstruction” by national VA staff in these oversight efforts.

For months, lawmakers had been largely frozen out of efforts to build the programs and write the rules to implement this law, formally called the VA Mission Act, leading to widespread concern among both legislators and veterans’ advocacy groups. But in early June, when the staffers were able to exercise limited oversight to find out what was truly happening, their fears were confirmed. “VA did not adequately prepare facilities, providers, or veterans for the transition,” their report reads.

The VA Mission Act is widely considered the most significant—and ideologically motivated—veterans’ law in a generation. Passed by a GOP-controlled Congress and signed into law by President Donald Trump, it established a sweeping new private sector healthcare program, the Veterans Community Care Program (VCCP) and granted the Veterans Affairs Secretary, Robert Wilkie, with wide latitude to set eligibility criteria that determines when veterans can use private-sector care.

The law garnered significant support from powerful healthcare interests, and savvy conservative veterans’ groups who have a great deal of influence in Trump’s Washington. But it was also supported by traditional veterans’ service organizations and some Democrats. This is largely because it expanded services to disabled veterans, but also because the final text contained stringent requirements that veterans could only be moved into private facilities for legitimate clinical needs, or if they faced burdensome wait or drive times at their nearest VHA clinic, assuaging the concerns about VA privatization. (Care inside the VHA, while often maligned in the media, is generally cheaper and better, with shorter wait times than what’s offered in the private sector.)

Still, Democrats and veteran advocates have criticized the Mission Act as a duplicitous drive toward privatization. Secretary Wilkie has insisted that it does no such thing, but he has largely left Congress in the dark as implementation has ramped up. In turn, tensions between the VA and the Hill have intensified. Over the last several months, Wilkie has sniped at House Democrats on Twitter, launched a broadside against the department’s public sector union (which was subsequently criticized by more than 100 lawmakers), and skipped an oversight and investigation hearing. In closed door meetings, congressional staff say VA officials have offered conflicting answers over the law’s cost and eligibility standards.

“Very little is being shared,” a congressional staffer told the Monthly. “VA will say one thing one week, and a different thing the next. The whole process is a shit show.”

Hill staffers hoped the committee’s site visits would bring some clarity, but they soon realized that the VA was trying to prevent them from happening all together. Its Office of Congressional and Legislative Affairs issued guidance to medical center staff that “congressional staff ‘shadowing’ medical center leaders or staff is not permitted;’” it required the staffers be escorted by a public affairs officer or other designee at the facilities; and it mandated that all questions be pre-cleared by national staff, or at least referred directly to them.

In the end, the VA blocked congressional staff from speaking to key employees at four of the five hospitals they visited. At one hospital, staff weren’t even allowed to venture beyond the hospital lobby.

During their visit to the VA’s medical center in San Juan, Puerto Rico, for instance, they were not allowed to meet with emergency management staff to discuss ongoing health and humanitarian work after Hurricane Maria. (Wilkie refuted the findings of the separate House report on Puerto Rico’s VA after NBC News wrote about it.)

Despite this obstructionism, Hill officials came away from the visits with a number of troubling findings. While they were denied access to VA’s new Decision Support Tool, a software program that is used by an authorized staff member to determine a veterans’ eligibility for private sector care, staff unearthed credible reports that the tool was malfunctioning. Specifically, the tool was slow, prone to crashing, didn’t list all community providers, and did not load eligibility data for the drive time standards.

According to the congressional report, these workarounds likely compromised “VA’s ability to ensure accurate eligibility.” One staffer bluntly acknowledged to the House committee: “I think we are sending more people to the community than we probably should be.”

This was a serious problem since, as the House report states,“community providers are ill-prepared to treat the high volume of veterans expected to be pushed to the private sector as a result of the Mission Act.” A VA spokeswoman said the department has since fixed the tool.

While the VA has already signed contracts with roughly 5,000 urgent care providers to treat veterans, House and Senate staffers said the VA’s Office of Community Care hasn’t provided Congress with the parameters or requirements of these and other contracts, despite multiple requests.

In response to questions from the Monthly, a VA spokeswoman insisted the “premise of your inquiry is false.” She pointed to a recent op-ed from Wilkie defending the Mission Act’s implementation. The spokeswoman further contended that it was House staffers, not the VA, who stopped engaging in MISSION implementation and oversight talks. A House staffer disputed this claim as “wholly inaccurate,” and said it was the VA that stopped giving them updates, beginning in June.

In many ways, these problems are eerily similar to what happened the last time lawmakers pushed veterans care into the private sector—through the VA Choice Act in 2014. That August, a scandal was exposed at a VA hospital in Phoenix, Arizona, where administrators were rigging scheduling data as part of a widespread effort to cover up wait times that averaged 115 days.

Immediate reform was called for in Congress, and a bipartisan agreement quickly emerged. The final package, called the Veteran’s Choice Program, allocated $10 billion to pay for private care and only $5 billion for the VA to hire more doctors and staff. An additional $1.3 billion was used to lease space at 27 facilities in 18 states to expand coverage options.

The act was billed as a three-year temporary measure, a band-aid that would last until more permanent improvements to the department’s capacity were achieved. But this work has never been completed. Instead, Washington has let the VA’s vacancies balloon to over 45,000.

Moreover, since its inception, Choice has been plagued by administrative failures that often complicated care for veterans. Many of these were carried out by two federal contractors tasked with scheduling appointments and coordinating medical records between the VA and private providers. In the first year of the Choice program, these two companies, Health Net Federal Services and TriWest, notched a 13 percent success rate in scheduling out-of-network appointments. The Inspector General later found that 82 percent of veterans who sought care through the Choice Act did not receive an appointment within the promised time frame. (TriWest has continued to coordinate private sector appointments under MISSION through a sprawling series of contracts worth more than $1 billion.)

TriWest’s performance seems to be similarly dysfunctional under the Mission Act. A VHA source told the Monthly that a large West Coast outpatient clinic has referred more than 600 veterans to the TriWest Community Care Network mental health care clinic since June. Nearly three months later, only 157 have received an appointment. Many of the rest have grown tired of waiting and have given up. Others have returned to the VA clinic because they couldn’t find another community provider.

Robert Anderson, a Vietnam veteran, has faced similar problems with TriWest in New Mexico. For three months now, Anderson says he has been seeking a second opinion on his back issues to little avail. “The outsourcing to Tri West is a joke,” Anderson told the Monthly. “They have called me no less than four times to ask the same questions about preparing an appointment time with the University of New Mexico health center.”

Worse yet, he added, “cutbacks have left the staffing of our medical center like a ghost town with vets coming and going but no one home really. The dental lab has probably 20 hygienists’ little rooms but only three staff for all the thousands of vets needing dental care … Vets are suffering and paying the price right now of privatization.”

The understaffing of departmental facilities combined with the outsourcing of care is quickly resulting in the gutting of the agency. Hospital directors are losing patients across the country. One medical director at a VHA facility in the South told the Monthly it was losing 20 to 30 percent of patients to the private sector.

This outsourcing not only pads the pockets of the private sector, but it can deeply disrupt the kind of care integration and coordination that has resulted in stellar patient outcomes at the VHA. As a nurse practitioner from a Northwest facility told the Monthly, precious time that could be spent on clinical care is now wasted trying to track down patient information from private sector doctors who have no incentive to provide it. This has resulted in massive backlogs—which, according to an August Inspector General Report, are set to “significantly increase” under Mission.

Taken together, the Trump administration is perpetuating a dangerous cycle to further the case for VA privatization. Veterans, now facing fewer clinical resources and delays in care, may themselves clamor under these conditions for the private sector as a seemingly better alternative. But privatization, as we are seeing, will ultimately lead to care that is more expensive, less accessible, and not tailored to the unique needs of those it’s supposed to serve.

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Suzanne Gordon and Jasper Craven

Suzanne Gordon is a senior policy analyst at the Veterans Healthcare Policy Institute, and the author of Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation's Veterans.

Jasper Craven is a freelance reporter interested in overlooked policy changes at the local, state and federal levels. He has written for The Nation, Vermont Digger, The Boston Globe, and the Chicago Tribune, among other outlets.