Veterans Network

VA Purposely Denied Veterans Access to Choice Program Use… but Why?!

Written by AJ Powell

In 2014, the Veterans Access, Choice and Accountability Act[1] – effectively called the “Choice Act” – was signed into public law for the purpose of providing Veterans the ability to seek medical care at facilities other than Veteran Administration Medical Facilities due to prolonged waiting times for care, distance from a VA facility properly equipped to handle specific care needs, and/or even geographical burdens in attempting to get to a VA facility.[2] While the new law was intended to help and aid Veterans to get the care they rightfully needed and deserved, the VA to date has effectively refused to allow Veterans to take advantage of the new law by purposely restricting Veterans’ ability to use the program. The United States Department of Veterans Affairs (VA or DVA) is a government-run military Veteran benefit system with Cabinet-level status in the federal government and an annual operating budget authorized by Congress of over $150 billion USD as of 2014. The sole mission for the VA? To take care of Veterans… So one would have to ask then, why exactly would the VA refuse to allow Veterans to use a program passed by Congress that actually helps them receive the medical care they need? To answer that, we need to start by looking at a little bit of history as to why the Choice Act was enacted in the first place.

The Choice Act was created due to response from years of massive VA corruption at nearly all levels. The Veterans Administration for decades refused to acknowledge evidence of Agent Orange Toxicity connection with Veterans illnesses and deaths caused by exposure. The VA for decades refused to compensate and treat Veterans who claimed service connected medical disabilities caused by health issues directly related to Agent Orange Exposure. The VA for decades refused to acknowledge the existence of Gulf War Syndrome in Veterans cause by exposure to Sarin Nerve Gas. Both the VA and other departments within the government for decades refused to acknowledge evidence that Sarin Nerve Gas exposure actually occurred and was directly linked to Gulf War Syndrome. [3], [4] The VA for decades refused to compensate and treat Veterans who claimed service connected medical disabilities caused by health issues directly related to Gulf War Syndrome induced Sarin Nerve Gas exposure… The VA to this day refuses to acknowledge Veteran and Veteran Family medical issues directly related to illegal chemical storage, storage failures, substance destruction, and dumping that contaminated water supplies, wells, rivers, soil, and the air throughout the entire area at Ft. McClellan.[5] To this day, the VA refuses to acknowledge medical disabilities caused as a direct result of exposure to toxic chemicals by all – Veteran and Family Member alike – who even stepped foot on the base. To this day, the VA refuses to compensate or treat those with medical issues caused as a direct result of exposure to toxic chemicals, or even acknowledge the deaths of those who suffered from medical issues caused by exposure while at the base – Veteran and Family Member alike… These are the major cases, and there are hundreds upon hundreds of minor cases little or less known. However, the last few years have shown the nation that the VA has yet to end corruption within its own offices.

Recently, evidence came out from whistle blowers across the nation as VA facilities refused to comply with federal level requirements for care provision within appropriate times. While in only a few locations it has been documented that appointment wait times were a systemic problem caused by limited staff, ill-equipped facilities, and simply not enough space, there are other locations that had no such excuses. Further, instead of openly admitting the problems, multiple VA facilities across the nation chose instead the hide the evidence.[6] The corruption – which extended all the way to the VA’s highest levels – involved placing new appointment requests onto secret waiting lists, kept separate from each locations actual appointment list, in order to create the false image that those facilities were in compliance with federal requirements.[7] Shocking still is the fact that the VA has been caught lying to congress countless times[8], stonewalling the investigation[9], and whistleblowers have alleged insider cover-ups of the evidence by altering patient records.[10] To date, investigative reports have proven that hundreds of Veterans – and perhaps thousands more yet to be accounted for – have died as a direct result of waiting for appointments to receive the care they needed, but that never came.

This is the history of the nations Veteran care system’s corruption, and the very reason why Congress passed legislation to overhaul Veterans’ access to care last year by creating the Choice Act. Naturally, giving Veterans the ability to choose not to use a VA facility and go to a civilian doctor of their choice in their local area, while still being covered for medical care, would be beneficial for everyone. It would decrease the stress on a VA system trying take care of more patients than any one facility can effectively care for, it would remove the iron grip of VA care restricted solely to VA facilities and allow care provision to Veterans in quicker times, and it would even remove many – though not all – of the factors that have contributed to VA abuses in the first place by giving Veterans the freedom to see a doctor of their choice, at a local facility of their choosing, while still remaining fully covered.

The Veterans Choice Act came sweeping into law with a House vote of 265-160, a Senate vote of 93-3, and was signed into law on the 7th of August 2014. The bill was estimated to cost nearly $2 billion USD, of which, approximately $500 million USD is to be used for the hiring of more doctors and nurses to work in VA facilities[11], and the program is designed to last for 3 years or until funds for the program have been exhausted. Finally, the program would allow Veterans who fit the criteria for seeking outside care the ability to see health care providers who maintain the same or similar credentials and licenses as VA providers, and to whom agree to provide both proof their credential and license currency annually, as well as provide the VA with electronic copies of any and all medical records related to care and services provided to Veterans under the program.

In order to assess the feasibility of the program within budgeting constraints, the Congressional Budgeting Office (CBO) prepared the analysis of the Choice Act, and estimated that the act itself would create an increase in direct spending by roughly $35 billion USD across a 10-year period from 2014 through 2024[12], and the reason for this is simple… a very large number of Veterans today who are eligible for VA care do not trust the VA, and as such, have never signed up for VA services. The VA’s current health care enrollment figures sit around 8.4 million, meaning that the nations remaining 13 million Veterans are not involved with the VA. Out of that remaining 13 million figure, the CBO estimates that 8 million more Veterans are eligible for VA health care enrollment and services, but to this day, have refused to enroll in the VA system. The logic here is that these additional 8 million might choose to enroll if they could receive care by a private doctor outside of the VA while still receiving coverage by the VA system, and this is where the cost increase over time would come from. The VA currently spends about $44 billion USD of its $150 billion USD annual budget on providing health care services to those enrolled, and of course, that number is only representative of short-term costs. It does not include long-term care programs, paying for care providers, or even programs designed to end Veteran homelessness[13], so it’s understandable that the drafting of the law required extensive research into assessing how the budget would be affected over the long-term. Yet, despite this careful analysis, there seems to be one thing that Congress clearly forgot to consider, and that is who would be the right person to take charge of implementation of the program itself.

Congress mistakenly gave the VA control over implementing the very policy enacted because of the VA’s track record of corruption. Of course, the first thing the VA did was draft internal policy based on its own narrow interpretations of the law that restricted actual use of the program by any Veteran who attempted to take advantage of it. The VA chose to ignore the aspect of what actually constitutes correct levels of care, or the provision of care specific to individual needs, effectively allowing the VA to by-pass entire sections of the law that authorizes Veterans to use the program. They did this by defining any VA facility within the 40-mile radius of a Veterans listed home of address as constituting the presence of VA care within acceptable distance of the Veteran – regardless if whether or not that facility was equipped to provide the actual care required.

“Veterans are being told they cannot use their Choice Cards because they live within 40 miles of a VA facility, even though that facility does not offer the care they require. The VA is denying the access the law was intended to provide and forcing veterans to choose between traveling hours to a VA medical facility, paying out-of-pocket or going without care altogether.”[14], stated Senator Moran (KS), “Veterans simply want what they were promised in the Choice Act: the choice to access the care they deserve in their community. In my hometown of Hays, Kansas, a veteran is forced to drive 200 miles several times a month for routine cortisone shots because the VA outpatient clinic just 25 miles from his home does not offer the shots he needs. One would think this veteran could use his Choice Card to visit a local physician or local hospital to get the shots he needs – but the VA is denying access to this care. Thousands of veterans across the country are facing this same frustration.”

As if that isn’t bad enough, now the VA is looking to end the program with Obama’s help. Not less than 6 months after the act became law, and only 3 months after Veterans started receiving their Choice Cards, now the VA is collaborating with Obama in trying to use the Presidential Office to force relocation of the program’s budget. The VA drafted a report based on the programs budgeting figures alone and presented it as evidence that the funding was not being used. The VA’s single sided evidence came with a statement that Veterans are not interested in seeking medical care from local physicians, that Veterans are not interested in seeking care outside of the VA, and that the proof was in the numbers.[15] But this is nothing more than yet another VA lie. “I was proud to sponsor the Veterans Access, Choice and Accountability Act of 2014 (the Choice Act), and deliver good news to veterans: They would have a choice when it comes to accessing health care they deserve, and many would have the option of seeing their local physician.”[16], Stated Sen. Moran, “Now, the VA is trying to take that choice away.” The Senators words bring up a very important question that must now be considered… why would the VA do this?

Of course there is zero doubt as to the ethical violations present at this point. The VA is an organization tasked with taking care of the nations Veterans through the provision of health care, earned benefits, and a large array of other programs, yet the largest source of income for the VA itself rests in health care alone. If more Veterans stop using VA facilities and start using other medical service providers, the VA itself may not maintain the numbers it requires to justify the same level (or greater) of funding in the future, and to the VA, that is a threat. With that argument in mind, it seems that the VA purposely designed restrictions into implementation of the Choice Program in such a way so as to make it near completely impossible to use, and for any who jumped through all the hoops just to actually use the program, the experience was so painful that the hope was the Veteran might simply just give up and return to using a VA facility. The issue is that, if the card and the program really were purposely designed to force Veterans back to VA facilities by denying them access to use the program, the ethical violation present is that the VA is – once again – violating public trust and seeking out methods to create gains for itself, while at the same time, actually causing direct harm to Veterans (the one group of people the department exists to serve), and falsely creating an intentionally worthless program for the sake of trying to look good to oversight. Furthermore, since the program is already funded, one only has to ask… just what does the VA intend to use that $169 billion USD – that was intended for this program – for anyway?

What should have happened from the very beginning was the removal of the VA from the system entirely. The VA should have never been allowed to even have a say in the Choice Program, and there do exist several other alternative agencies who very well could have handled the program’s implementation in a responsible and effective manner. To provide just one example, the military’s health insurance agency owned by the Department of Defense and operated by the Defense Military Health System, Tricare – which is used by all active duty service members, their families, national guard and reserve members while on-duty, and to which is even extended to military retirees – could very well have been extended to both cover all those who qualified for VA care but chose this program instead. At the very least, that would have been both a cost saving initiative – by using an already establish network of providers across the nation who readily accept Tricare, by removing the VA’s vastly over-bureaucratic system from the decision-making and operational process, and by allowing additional providers across the nation who are both qualified to provide the care needed, and interested in program participation, to join the network – and an effective alternative policy implementation process that did not allow VA involvement. It could have prevented yet another VA episode of refusing care to the only client they exist to serve.


References:

[1] Choice Act Summary (2014). Fact Sheet: Veterans Access, Choice and Accountability Act of 2014. Department of Veterans Affairs. Retrieved from: http://www.va.gov/opa/choiceact/factsheets_and_details.asp

[2] 113th Congress (2014). H.R. 3230: Public Law 113-146 – 07AUG2014. Library of Congress. Retrieved from: https://www.congress.gov/bill/113th-congress/house-bill/3230

[3] Koeppel, B. (2015). U.S. Nerve Gas Hit Our Own Troops in Iraq. Retrieved from: http://www.newsweek.com/how-us-nerve-gassed-its-own-troops-then-covered-it-317250

[4] Koeppel, B. (2015). The Lies Still Killing Gulf War Vets. Retrieved from: http://washingtonspectator.org/the-lies-still-killing-gulf-war-vets/

[5] Williams, D. (2013). Toxic Vets – The Poisonous Legacy of Ft. McClellan. Retrieved from: http://www.chicagonow.com/uncommon-sense/2013/08/toxic-vets-ft-mcclellan-08072013/

[6] Devine, C. (2014). Bad VA Care May Have Killed More Than 1,000 Veterans, Senators Report Says. CNN. Retrieved from: http://www.cnn.com/2014/06/24/us/senator-va-report/

[7] CNN (2015). Some Vets Waited up to 6 Months for Doctors Appointment. CNN. Retrieved from: http://www.cnn.com/2015/03/24/opinions/moran-va-vets-health-choice/

[8] Flatten, M. (2014). Veteran Affairs IG stonewalls Congress on report over fake appointments list. Retrieved from: http://www.washingtonexaminer.com/veterans-affairs-ig-stonewalls-congress-on-draft-report-over-bogus-appointment-lists/article/2552860

[9] Howley, P. (2014). House Chairman: VA Instructed Employees to Stonewall Investigation. Retrieved from: http://dailycaller.com/2014/06/16/house-chairman-va-instructed-employees-to-stonewall-investigation/

[10] Giblin, P. and Sanders, R. (2014). VA Audit: Staff Falsified Records to Collect Bonuses. The Arizona Republic. Retrieved from: http://www.usatoday.com/story/news/nation/2014/05/31/va-audit-staff-falsified-records-to-collect-bonuses/9812363/

[11] Matishak, M. and Wong, K. (2014). Overnight Defense: Senate passes bipartisan VA fix. The Hill. Retrieved from: http://thehill.com/policy/defense/overnights/209087-overnight-defense-senate-passes-bipartisan-va-fix

[12] 113th Congress (2014). H.R. 3230: Public Law 113-146 – 07AUG2014. Library of Congress. Retrieved from: https://www.congress.gov/bill/113th-congress/house-bill/3230

[13] 113th Congress (2014). H.R. 3230: Public Law 113-146 – 07AUG2014. Library of Congress. Retrieved from: https://www.congress.gov/bill/113th-congress/house-bill/3230

[14] Moran, J. (2015). Will VA Take Choice From Vets? CNN Retrieved from: http://www.cnn.com/2015/03/24/opinions/moran-va-vets-health-choice/

[15] Jordan, B. (2015). VA Seeks to Reallocate Choice Act Funds in $169B Budget Proposal. Military.com. Retrieved from: http://www.military.com/daily-news/2015/02/02/va-seeks-to-reallocate-choice-act-funds-in-169b-budget-proposal.html

[16] Moran, J. (2015). Will VA Take Choice From Vets? CNN Retrieved from: http://www.cnn.com/2015/03/24/opinions/moran-va-vets-health-choice/

About the author

AJ Powell

AJ is a retired U.S. Army NCO who served in both the U.S. Navy and U.S. Army. He is a combat veteran, and has participated in contingency operations around the world. AJ is the CEO of Veteran Leadership Solutions, the Founder and Editor in Chief of The Warfighter Journal, and the Director of Strategic Communications at Mountain Up Hat Company. He is a graduate of Pennsylvania State University with a focus on Sociology and a degree in Organizational Leadership, and is published in the field of sociology. AJ is an inductive analyst, writer of military and leadership articles, aviator, a certified advanced operational diver, professional mentor and adviser, snowboarder, motorcycle rider, world traveler, and enjoys long distance endurance events.

  • Metatron von Bardeleben

    Nothing will happen indeed. The VA itself is a criminal organization
    that may do as it likes and does so. It is allowed as part of normal
    SOP to commit fraud and other crimes, nonfeasance and malfeasance with
    impunity. I am 12 years in a benefits fight, 4.5 years into an appeal,
    and 1.5 years into a remand in which the VBA processors simply removed
    the Army Medical records for my claim and then sent it to the judge.
    When, one points this out VA counsel doesn’t care, the OIG
    does nothing for they are all in it together. I can prove by
    provenance and I maintained those records as well as reordered from the
    NARA myself and all are there. The VA simply took out the diagnosis in
    the Army and other files and then sent to judge to review. The BVA
    doesn’t care and there is no mechanism to get the judge to review this.
    Additionally even through a DRO they just didn’t bother to read at all
    after 12 years they keep telling me that I didn’t have a kind of surgery
    or injury that I did— the surgical diagnosis and narrative are there.
    They just read the preoperative diagnosis. Now, if things were on the
    up and up and they really reviewed the records after 12 years one would
    think that they could have gotten the diagnosis and surgery correct.
    Additionally, finally in July I had a C&P for the remanded
    condition. The C&P examiner was the first nice one that treated me
    like a human and a veteran. She said that I was SC for the condition
    but they won’t give me the report though they used in another condition
    denial inappropriately. Now, they send me another appointment with a
    C&P examiner for the 22nd of this month for the same conditions –
    why? In an effort now to deny again….Now bear in mind too that they
    are supposed to handle older cases expeditiously and without an endless
    pursuit of more and more data, but no. I am going to be f#cked in the
    ass and harassed again. These people are criminals.

  • This article came out in February… I had no idea it existed at the time, however, from the looks of it, even then does the evidence support my conclusions in the last few paragraphs here. And it seems the Veterans Independence Act – and 86% of ALL Veterans – believe the same!

    What are YOUR thoughts?

    http://www.forbes.com/sites/theapothecary/2015/02/26/the-veterans-independence-act-giving-vets-a-way-out-of-socialized-medicine/

  • What are YOUR thoughts on the why the VA handled the Choice program? Do you think a different policy could have prevented some of these issues? What other agencies or systems could possibly have been used to make the program successful instead? Why and how so?

    Let us know your thoughts, we want to hear from you!