Some privatization of veterans health care has already been initiated.
The privatization fight
The turmoil has been replaced with an intense focus on the Mission Act, which includes an overhaul of VA caregiver support rules, plans for a base-closing-style commission for VA facilities and the new outside care rules. The measure was signed into law by Trump just a few weeks before Wilkie was sworn in as the department’s 10th secretary.
The caregiver rules and facility review will come later this year. But revising the outside care rules has been the primary challenge facing VA leadership since Wilkie walked into VA headquarters, located less than a block away from the White House.
Currently, taxpayer-funded private-sector medical appointments are available to veterans who live 40 miles from the nearest VA facility or face a wait of up to 30 days for care. The new rules, developed by Wilkie’s team, would extend eligibility to veterans who face a 20-day wait or a 30-minute care ride to a VA facility.
“It is not what it has been purported to be, and that is what I would call ‘libertarian choice,’” he said. “You don’t give a veteran a card and say, ‘thank you very much, the private sector is wide open to you.’”
“I’ve heard some people say that the changes in access standards and availability standards were arbitrary, capricious. Well, if they have that charge, they need to go to the members of Congress who wrote the Mission Act. Because the Mission Act gave me very clear instructions on how I come up with access standards.”
But critics are unhappy with more than just the rules as written. They say that Trump’s team is working to undermine VA health care as a viable enterprise, by promoting outside care as a better solution for veterans’ medical needs.
Groups such as Veterans of Foreign Wars and Disabled American Veterans has voiced concerns that the messaging of the changes emphasizes convenience of care over quality. Outside doctors, they note, don’t necessarily have experience diagnosing post-traumatic stress disorder or burn pit illnesses. They’d rather see efforts put into improving VA access options.
For Wilkie, it’s not an either-or option.
“Our spending on tele-health has gone up at an exponential rate in the last few years,” he said. “We’re on the cutting edge of using it for mental health issues. It also reaches into rural areas and, importantly, we’re allowed to [provide it across state lines], what the rest of the country can’t do.”
Asked if VA will be promoting outside care over VA care to veterans, Wilkie did not provide a direct answer.
“The Mission Act says up front that it’s the veterans’ health interest that is first and foremost. So that veteran will have a care team at VA who will speak with him and talk about the options for him.
“Nine times out of 10, he’s been probably going to stay with the people that he knows and the community he knows … The pull of the culture on people to be where they share experiences with others is very different from any other segment of the country.
“And as I said even as VA has had hiccups — and we’ve overcome those hiccups — we’ve actually seen the number of veterans asking to go into the private sector drop.”