In a shift from their past opposition, veterans groups are supporting an effort to increase the healthcare delivered to veterans by private-sector providers under contract with the federal government.
Legislation that passed the House Veterans Affairs Committee last month allows the Department of Veterans Affairs to contract for hospital care and other healthcare services when VA facilities cannot furnish those services economically.
In the Senate, meanwhile, a bill that awaits committee action would allow the VA to pay private-sector providers to give primary and preventive care to veterans who live farther than 50 miles or one hour of traveling time from a VA facility.
The department supports the House version of the legislation because it matches a Clinton administration proposal.
Current law only allows the VA to contract with private providers for specialized or scarce medical resources. On those grounds, the General Accounting Office, a congressional watchdog agency, already has challenged a VA program that aims to increase the number of community-based primary-care access points largely by contracting with private-sector physicians or clinics (April 29, p. 12).
Veterans groups, which in the past have decried proposals to increase private-sector contracting because it would weaken the system, now say the move is necessary to make sure VA care continues in meager budgetary times.
Under congressional balanced-budget resolutions, spending in VA discretionary accounts-those, including healthcare, that are subject to year-to-year appropriations-will stay about the same or decline slightly over six years. In the House, VA discretionary spending falls from $19 billion in fiscal 1996 to $18.5 billion in 2002.
"We're more concerned with the quality of care that veterans get than we are with building a lot of new hospitals," said James Jewell, field representative with the Veterans of Foreign Wars.
Jewell cautioned, however, that the VA shouldn't contract with the private sector to provide healthcare services if it will cost more or be of lower quality than if the department provided those services.
While they recognize the need for increased contracting authority, organizations representing disabled veterans warned that they oppose increased contracting if it endangers specialized programs serving veterans with various disabilities.
Contracting "could weaken the healthcare system itself," said Richard Schultz, national legislative director for Disabled American Veterans. "Once the healthcare system goes away, you lose a lot of the specialized care."