VA running out of money for Choice program

Weeks after a veterans' health initiative received $2.1 billion in emergency funding, the Trump administration says the private-sector Veterans Choice healthcare program may need additional money as early as December to avoid a disruption of care for hundreds of thousands of veterans.

The Department of Veterans Affairs said in a statement that it hoped to move quickly on a proposed long-term legislative fix that would give veterans even wider access to private doctors. The proposal, under review by the White House Office of Management and Budget, would seek money to keep Choice running for much of next year as VA implements wider changes.

On Capitol Hill, the House Veterans Affairs Committee was already anticipating that the emergency funding approved in August may not last the full six months, according to spokespeople for both Republican and Democratic members on the panel. They cited the VA's past problems in estimating Choice program cost. That committee and the Senate Veterans Affairs Committee said they were closely monitoring the situation.

"It's disheartening," said Carlos Fuentes, legislative director of Veterans of Foreign Wars, citing his group's continuing conversations with VA about Choice funding. "Imagine if a veteran has to cease chemotherapy treatment during Christmas."

Garry Augustine, executive director of Disabled American Veterans' Washington headquarters, said recent discussions with VA also gave him little confidence.

"It's always a concern," Augustine said. "Legislative action needs to be done sooner rather than later."

In its statement to The Associated Press, VA said it could not say for certain when Choice funds would be depleted, but acknowledged that it could be as early as December or as late as March. Earlier this year, the VA began limiting referrals to outside doctors as money began to run low and veterans reported delays in care.

The VA proposal for a long-term fix is expected to be released in the coming weeks.

The latest funding woes come amid political disagreement over the future direction of VA and its troubled Choice program, which was passed by Congress in 2014 in response to a wait-time scandal at the Phoenix VA medical center that spread nationwide. Some veterans died while waiting months for appointments as VA employees manipulated records to hide delays. The controversy spurred Congress to establish Choice as a pilot program designed to relieve pressure at VA hospitals.

At a Senate hearing Wednesday, VA Secretary David Shulkin stressed a continuing need to strengthen VA in certain areas of expertise, such as suicide prevention. Noting that most veterans who take their lives had not been connected to VA care, he urged Congress to provide additional money to help recruit mental health professionals and offer counseling for former service members with less than honorable discharges. The VA earlier this year announced plans to hire 1,000 additional mental health professionals but hasn't been able to meet that goal, he said.

"We need the tools the private sector has," Shulkin said.

Choice currently allows veterans to receive outside care if they must wait 30 days or more for an appointment or drive more than 40 miles to a VA facility. But the program has encountered long delays of its own.

In a sign of a political divide, the left-leaning VoteVets ran a $400,000 ad campaign earlier this month in 13 states that warned viewers, "Don't let Trump privatize my VA." The American Federation of Government Employees has been staging rallies to bring attention to 34,000 VA job vacancies left unfilled.

During the presidential campaign, Trump repeatedly pledged to fix the VA by bringing accountability and expanding access to private doctors, criticizing the department as "the most corrupt." At an Ohio event in July, Trump promised to triple the number of veterans "seeing the doctor of their choice."

Signaling a possible fight ahead, some Democratic lawmakers on Wednesday suggested the coming weeks would offer an important sign of the administration's commitment to veterans.

"The president has signed a number of measures dealing with veterans issues — legislation that was long in the works," said Sen. Richard Blumenthal (D-Conn.). "I hope his apparent commitment to those issues will translate into funding, which is really the test."

Sen. Jon Tester of Montana, the top Democrat on the Senate Veterans Affairs Committee, cautioned against a possible commission to close underused VA facilities. Noting that VA facilities in rural areas might be especially at risk due to understaffing rather than poor performance, Tester said if VA proceeded on that path of shuttering VA medical centers, "I guarantee there will be a bipartisan explosion on this committee, which wouldn't be a good thing."

More than 30% of VA appointments are made in the private sector.

Carrie Farmer, senior policy researcher for the RAND Corp., said the Choice debate raises broader questions about the role of government-run healthcare in treating veterans. To many former troops, the VA health system is a "medical home" where patients feel more understood by doctors specially trained to treat battlefield injury, such as post-traumatic stress disorder. Significantly expanding Choice could upend that government role as caretaker, she said.