VA secretary urges extension of troubled Choice program

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WASHINGTON (AP) — Veterans Affairs Secretary David Shulkin urged Congress on Tuesday to act quickly to extend a troubled program aimed at widening veterans' access to private-sector health care, pointing to growing demand for medical treatment outside the Department of Veterans Affairs.

Separately, Shulkin also pledged additional VA efforts to combat suicide, pledging to expand mental health care to former service members who receive "other than honorable discharges" from the military, typically for behavior problems such as violence or use of illegal drugs. Shulkin did not release specific details, but said the VA will act on its own to expand coverage without waiting for legislation. Pentagon data has indicated that thousands of service members have had such discharges in recent years.

"We are going to start doing that now," he said, referring to the expanded mental health coverage. "So many veterans that we see are so disconnected from our system."

Testifying before a House panel, Shulkin acknowledged that a Choice program offering access to private care that was put in place in 2014 following a wait-time-for-care scandal was hastily done, and had problems of its own in providing timely care. But the physician says improvements to the Choice program have resulted in more than 1 million out of 9 million veterans in the VA system now using some Choice care, with data pointing to even greater use this year.

Shulkin, who previously served as VA's top health official in the Obama administration, says Congress must hurry to extend the Choice plan beyond its Aug. 7 expiration date, or the VA will lose nearly $1 billion left over in that account. That money can provide stopgap care until a broader revamp is designed, he said.

"There is no time to waste," Shulkin told the House Veterans Affairs Committee. "Many veterans are using the Choice program today, and it is important to continue to care for and support those veterans."

On Tuesday, Sen. Jon Tester, D-Mont., introduced legislation with Sens. John McCain, R-Ariz., and Johnny Isakson, R-Ga., that would extend the Choice plan until its money runs out, likely in early 2018. The bill also calls for fixes in the program to speed up VA payments and promote sharing of medical records.

"Have no doubt: If we let this program lapse, more than a million veterans will lose their ability to visit a community provider, the VA system will once again become overwhelmed, and veterans will go back to the pre-scandal days of unending wait-times for much-needed care," McCain told the House committee, noting that the VA has said a broader revamp could take two years.

That panel led by Rep. Phil Roe, R-Tenn., was scheduled to consider a House version of the bill Wednesday.

Major veterans' organizations and Democrats are closely watching the VA's planned overhaul of the Choice program, after President Donald Trump's transition team signaled in late December it was weighing a "public-private" option. Under that plan, veterans could get all their medical care in the private sector, with the government paying the bill. Veterans groups generally oppose that as a threat to the viability of VA medical centers.

After Trump selected him to be VA secretary, Shulkin has said he would not privatize the VA. He expressed support for an "integrated model," without sketching the full details.

He says he wants to eliminate restrictions in which veterans may seek outside care only in cases where they had to wait more than 30 days for an appointment or drive more than 40 miles to a facility. But Shulkin also says he wants the VA to handle the scheduling and "customer service" for those outside appointments, something that the Government Accountability Office, Congress' auditing arm, indicated could be problematic.

GAO recently reassigned a "high-risk" rating to VA's health programs, citing in particular problems with its choice program. Randall Williamson, GAO's health care director, said veterans could wait up to 81 days to receive outside care due to bureaucratic problems, in contrast to a stated goal of 30 days or less.

Williamson said the VA also faced significant challenges in overhauling the Choice program, citing the department's outdated information technology systems as well as likely additional costs and staffing needed to administer the changes.

On Tuesday, Shulkin said he hopes to propose a broader overhaul to Congress within six months and said the VA would consider "off-the-shelf" IT programs such as those developed by Microsoft to speed the process. The VA also wants to create a broader network of outside providers, predominantly federally run medical centers by the Pentagon and the Indian Health Service, plus academic teaching hospitals.

Currently, more than 30 percent of VA appointments are made in the private-sector, up from fewer than 20 percent in 2014, as the VA's 1,700 health facilities struggle to meet growing demands for medical care.


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