Thursday, December 2, 2021

The punitive nature of bureaucracies

Veterans Affairs bureaucrats are keeping vets from using health care outside its troubled system


Once again, Department of Veterans Affairs bureaucrats are making a concerted effort to prevent veterans from using our health-care benefits at community-based providers outside the VA system — despite a law requiring them to do so.  

Seven years ago, while suffering from excruciating pain, I attempted to make a primary-care appointment at a VA hospital. In the week between Christmas and New Year’s, no one at my Durham, N.C., VA facility answered the phone. In January, it took two weeks to get a new provider assigned and an appointment scheduled. The earliest they could offer was April 15, 90 days out.   

At that point, inflamed joints throbbing, I asked if I could use my Choice card, which had arrived in November with the promise it gave me access to private, local health care in the event “the Veteran is told by his/her local VA medical facility that he/she will need to wait more than 30 days from his/her preferred date or the date medically determined by his/her physician.”  

No dice.The Veterans Choice Program was enacted by law in the wake of the 2014 VA wait-time scandal. Nevertheless, the VA denied me the Choice option until after my appointment in 90 days. 

A sample of a VA myChoice card show that the card does not provide pre-approval.
A sample of a VA myChoice card show that the card does not provide pre-approval.
Veterans Affairs

With the team at Concerned Veterans for America, I worked hard to help pass that bill and believed the program would make a difference. Alas, faceless bureaucrats undermined its implementation every step of the way.

So we went back to work.

In 2018, Congress passed and President Donald Trump signed the VA Mission Act, which bolstered veterans’ health-care options, providing access standards that shortened the requirements for veterans seeking private care to those who could not get a VA appointment within 20 days or who had to drive more than 30 minutes to a VA facility.

It was a positive reform. But again, we see VA bureaucrats working, despite the law, to limit veterans’ ability to access care.  

In 2020, some Trump administration officials expressed public doubts about using community care during the COVID pandemic. That was all career bureaucrats needed to hear. It’s been on the rocks ever since.

After a lawsuit filed this year, the VA finally responded to Freedom of Information Act requests that it account publicly for wait times and veterans’ ability to access community care. 

President Trump
In 2018, Congress passed and President Donald Trump signed the VA Mission Act, which bolstered veterans’ health-care options.
CNP/startraksphoto.com

The results were startling and add to concern about the 20 million appointments that have been canceled, denied or delayed since the pandemic’s start.

The FOIA documents revealed the VA’s failure to follow the law and its own regulatory requirements as it refuses to refer eligible veterans for community care, possibly cancels appointments without patient consent and dissuades veterans from seeking community care in call scripts.

In January 2020 at the Prescott, Ariz., facility, for example, 10.3 percent of veterans were listed eligible for primary care in the community when in fact 68 percent were eligible. The VA is also denying veterans community care due solely to cost. That’s not part of the law, and getting veterans the care they need should always be the top priority.

The Biden administration has sent clear signals it intends to accede to the bureaucrats’ wish to end community care.    

The Mission Act page on the VA Web site was recently removed. The VA has ceased providing veterans easily accessible information about the program. And the department is dismantling the community-care office, integrating it into the general patient-management system. It’s blocked referrals to community care at every opportunity. 

Exterior of the Veterans Affairs Department hospital
Healthcare worker walks into the Department of Veterans Affairs Medical Center. 
AP / David Zalubowski

Last month, it issued a call for input on access standards. Parts of the request for information are technical, but question No. 6 asks: “What are Veterans’ experiences with, and feedback on, the VA access standards established in 2019?” Might this be the first step in dismantling the program and ensuring that veterans cannot seek VA-sponsored care in their communities?

“During the pandemic I had an appointment with the VA urologist as a follow-up because of elevated” prostate-specific antigen levels, a New York veteran posted on the My VA Story Web site. “The VA canceled and rescheduled it four times until I asked why and was told they were only seeing patients on an emergency basis. My condition was probably not an emergency but I felt it was urgent enough that I transferred my records to a civilian urologist.” 

The VA didn’t refer him. He paid out of pocket to get the care he needed — the care he’d earned. 

All veterans deserve quality, timely care. When I was in pain, access to community care would have solved my situation sooner. Don’t let the VA take it away.

John Byrnes is a Marine Corps and Army National Guard veteran who served combat tours in Somalia, Iraq and Afghanistan and education director for Concerned Veterans for America. 

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