What Is Wrong with the Veterans Choice Program? (by Hai Nguyen)

Introduction

For the past seven years, I have been an employee of the Portland Veterans Affairs Medical Center, working as a CNA (Certified Nursing Assistant) on the graveyard shift. Besides my CNA work, I am also a volunteer for the hospital. I never realized the limited access our veterans have with the VA health care system. During my time volunteering at the Portland VA Medical Center, I learned that there are currently 128 active drivers out of 180 helping veteran patient getting to and from their doctor appointments. There are two main VA hospitals in Oregon, one in Roseburg and the other in Portland. Many times, veterans in Oregon have to go across the bridge to get to the Vancouver VA hospital for their care. I learned from my fellow volunteers that the government recently passed the Veterans Choice Program in November 2014 which helps veterans getting access to non-VA health care.

In the wake of the wait-list scandal that exposed systemic failures and mismanagement within the VA in Phoenix, Arizona last spring, congress came together with the President and signed The Veterans Access, Choice, and Accountability Act of 2014 (Choice Act). The Choice Act created the Veterans Choice Program (http://www.va.gov/opa/choiceact/) which was designed to give veterans the option to receive non-VA health care rather than waiting for a VA appointment or traveling to a VA facility. Veterans are also eligible for service if they are told by their local VA medical facility that they will need to wait more than 30 days from their preferred date or the date medically determined by their physician. The veterans are also eligible for service if their current residence is more than 40 miles from the closest VA health care. It’s a 10 billion dollars short-term program that President Obama’s 2016 budget asked Congress to establish to help former troops who are struggling to obtain care at vastly over strapped VA clinics.

Although it is liberating to have the Veterans Choice Program, the program also has some major flaws. One of the flaws is the program’s exclusion of the veterans who live within 40 miles of a VA facility. This program does not care even if the nearest facility does not provide the type of care the veterans need. With that said, the VA misguided the interpretation of the 40-mile rule when it comes to whether a VA facility offers the care a veteran needs. This limitation is nonsensical and prevents the veterans from receiving the care they need and deserve. By choosing to take into account only the distance of a VA medical facility from a veteran’s home and not whether that facility can actually provide the services the veteran needs, the VA has left many of our most vulnerable veterans out of the program that was designed to help them.

Also, the VA measures the 40 miles “as the crow flies” and not the actual distance that the veterans would have to travel. The VA is not using its authority to allow non-VA care for those who face a geographic challenge in accessing care, including long drive times or health conditions that make traveling difficult. The impact of such an interpretation excludes many of the Veterans from the care that Congress had aimed to make health care more accessible for them. For the veterans in remote and rural areas with limited transportation access, this could mean the different between 30 minutes and half a day of travel. Rural veterans are being forced to choose between traveling hours to a VA medical facility, paying out of pocket, or going without care altogether.

According to the Veterans of Foreign War National, as for February 5, 2015, a survey shows that 8.6 million Veterans Choice Cards have been issued. Of those numbers, 458,769 calls have been placed by the veterans to the call centers. Also, 26,662 veterans have requested non-VA care and 24,288 veterans have received appointments. It’s a fraction of the 9 million veterans who depend on the delay-plagued VA health-care system, the largest network of health centers and hospitals in the country.

In order to improve the Veteran Choice Program, the VA needs to modify how it will determine the required 40-mile distance between a veteran’s residence and VA facility. The program needs to change the 40-mile rule to refer to driving distance rather than a straight-line, “as the crow flies” measurement. The program also has to make sure that it accounts for the population density based on the differences the veterans face when traveling to VA medical facilities. It is very important that the program takes into consideration that all non-VA care authorities must be used when the VA cannot readily provide care due to the lack of available specialists, long wait time, or geographic inaccessibility.

With that said, there are many ways to help to improve the Veterans Choice Program. First, one can volunteer at the local VA medical center. Second, one can proactively talk about the program to the veterans and let them know there are programs that can help them with their health care needs. Third, you can also join groups at the Veterans of Foreign Wars (VFW) or Military and Veteran Association and be an advocate by blogging and spreading out current information. Personally, I think the only way we will effect change in the VA is to rally, speak out, and share our thoughts and writing so that others will understand they are not alone. Also, you can go to local new or national news and talk about the program. With the advance of today’s technology, one can easily use social media such as Facebook, Twitter, LinkedIn, Instagram and etc. to spread information about the Veteran Choice Program.

When our men and women in uniforms completed their military services, they have fulfilled their solemn vows and commitments to our nation. It is our duty to honor our commitments to them by providing quality medical care to our nation’s veterans. The Veteran Choice Program not only allows veterans greater access to care, but it gives the VA an overdue incentive to improve services.

 What the Research Says

Here are some articles that have helped me better understand the issues regarding veterans’ access to health care:

http://libproxy.pcc.edu/login?url=http://go.galegroup.com.libproxy.pcc.edu/ps/i.do?id=GALE%7CCX1337704534&v=2.1&u=pcc&it=r&p=GVRL&sw=w&asid=88132cab6dae4953687580a3ec4bd2fb

Batten, Donna. “Veterans’ Rights.”Gale Encyclopedia of American Law.3rd ed. Vol. 10. Detroit: Gale, 2010. 224-226. Gale Virtual Reference Library. Web. 24 May 2015.

This report shows Veterans rights includes the legal rights and benefits extended to those who served on active duty in and have been honorably discharged from one of the U.S. Armed Services. Veterans are generally required to enroll with the VA in order to be eligible for Health Care benefits. Some veterans are exempted from the enrolment requirement if they fall within certain categories, such as those who have a disability of 50 percent or more caused by service of duty and those who seek care only for a disability suffered as a result of service. This report connect to my question because it show, in order to determine whether a veteran is eligible for benefits due to financial need, the VA calculates the annual income and net worth of the veteran and then compares this amount with the “means test”, a financial threshold calculated on an annual basis. If the veteran income and net worth fall below the means test, then the veteran may be eligible for health care benefits.

http://libproxy.pcc.edu/login?url=http://go.galegroup.com.libproxy.pcc.edu/ps/i.do?id=GALE%7CCX3232000609&v=2.1&u=pcc&it=r&p=GVRL&sw=w&asid=300a71b3684f56d19026d742abcad67d

Wells, Ken R. “Veterans Affairs Hospital System.” The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers. Ed. Jacqueline L. Longe. Vol. 5. Detroit: Gale, 2009. 1826-1829. Gale Virtual Reference Library. Web. 24 May 2015.

The Veterans Affairs hospital system is part of the U.S. Department of Veterans Affairs, a cabinet-level agency. There is at least one medical center in each state, the District of Columbia, and Puerto Rico. The VA medical system operates clinics in all states and territories along with a clinic in the Philippines. More than 5.3 million people received care in 2005 in VA health care facilities, a 29% increase from 2001. That number was expected to increase due to the wars in Iraq and Afghanistan that were ongoing as of 2008. Projections are that in 2009, the VA system will treat about 6.8 million people. It is the largest health care system in the United States. This article related to my question because the VA is the one who have the authority of the Veteran Choice Program.

http://www.military.com/daily-news/2015/04/24/10b-veterans-choice-program-even-more-underused-than-thought.html

Caruso. David B. “$10B Veterans Choice Program Even More Underused Than Thought.” Associate Press. 24 April 2015. Web

This article is about a new program that supposed to get patients off waiting lists at Veterans Affairs Medical Centers by letting them switch to private-sector doctors is proving to be an even bigger disappointment than initially thought. The Choice plan is supposed to be open to patients who live more than 40 miles from a VA hospital or clinic or who have been told they would have to wait more than 30 days for VA cares. As of April 1, there were nearly 432,000 appointments pending in the VA’s scheduling system involving a wait that long. But after a hurried rollout that has led to confusion as to exactly who is eligible and what they need to do to coordinate treatment, officials now say only 37,648 medical appointments have been made through April 11. This article related to my research question by providing statistic current number of veteran enrolling with the Veteran Choice Program.

http://www.legion.org/veteranshealthcare/225102/veterans-choice-card-not-free-pass

Callaghan, Marty. “Veterans Choice Card is not a free pass.”The American Legion. 13 November 2014. Web

This article talked about VA has signed contracts with two private health-care companies to help administer the Veterans Choice program: Tri West (http://www.triwest.com/en/veteran-services and Health Net (https://www.hnfs.com/content/hnfs/home/va/home/veterans-choice.html). This article related to my question by explaining detail what the Veteran Choice Program really is, how to qualify for the program. It also gave good information for veterans who want VA health care.

https://www.fas.org/sgp/crs/misc/R42747.pdf

Panangala, Sidath Viranga “Health Care for Veterans: Answers to Frequently Asked Question” Congressional Research Service. 30 April 2015. PDF

This report provides responses to frequently asked questions about health care provide to Veterans through the VHA (Veteran Health Administration). It is intended to serve as a quick reference to provide easy access to information. This report related to my question by provides the legislative background pertaining to the question about the Veterans Choice Program.

Advertisements

2 comments

  1. Chelsea

    You bring up an extremely important point Hai. What good is care if it is to accessible. If a vicinity for affordable care and programs is 40 miles away and you cannot drive, how is that really good care when one cannot access it. I work at a bank and all too often I see our veteran clients who come in and make their withdrawals struggle to even make it to the bank or to the hospital, they spend a whole day commuting to a doctors appointment on the other end of town. I could not imagine being in a situation like that without support.

    I want to congratulate you on working as a CNA in that area. I did that the summer after I graduated high school here in Portland at 18 and it was extremely difficult work, but also very rewarding. I am looking to go back into the field and just want to commend you for everything you do. You bring a new and unique voice to the issue through this blog.

  2. Malissa

    Hai,
    Thank you for writting about and caring about this topic. My husband is a former Marine, and I have seen first hand how disfunctional the VA is, but I didn’t even know about the Choice Act or the Veterans Choice Program. It does not supprise me to learn that there are so many problems with them. We have resigned ourselves to relying primarily on our private health insurance because the VA is so inefficent. You provided a lot of good resources for me to learn more about this, as I probably should. Thank you!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: