"Congress is going to need to pass legislation that fixes Choice and community care programs," Caldwell told Modern Healthcare. "There are still hundreds of thousands of veterans needing medical care. We believe the legislative language that was going to be included in omnibus would have gone a long way to reduce access issues."
But Pelosi came out swinging in her statement on Shulkin's ouster, blasting the recent effort on Choice as she called the secretary's dismissal "a troubling step in the Trump administration's ultimate goal of VA privatization."
"From day one of this administration, the president has openly encouraged and embraced Koch brothers-led forces as they work around Congress and behind closed doors to dismantle veterans' healthcare," Pelosi said.
Fuentes said though no side will get everything it wants, his advice to Congress from a veterans service organization is to keep promoting the draft.
"When you're considering veterans who don't have access to care, you need certainty, and there is urgency," Fuentes said, noting that since September Congress has simply punted on authorizing the Choice program permanently by adding stopgap funding. The last batch of funding is projected to run out in June. "It's about getting together to mitigate any differences and chart the way forward."
Fuentes added that VA matters traditionally have been bipartisan. "I hope that continues," he said.
The top Democrat for the Senate VA Committee added his voice to the chorus of lawmakers asking to finish up a bill. "Moving forward, the VA needs a strong leader at the top who will listen to veterans, strengthen the VA, and work with Congress to implement bipartisan reforms," Sen. Jon Tester (D-Mont.) said.
Yet as lawmakers and stakeholders jostle, one key item is missing from the debate: how the expanded role of private providers would actually work.
On March 1, the RAND Corp. released a survey looking only at New York state healthcare providers and their readiness to accept veterans as patients. Researchers studied offerings of "culturally competent care" that take into consideration conditions and medical history common to veterans.
Analysts said that of the 92% of New York providers accepting new patients, only 2.3% met all the researchers' designated criteria "for effectively serving the veteran population."
That echoes concerns some in the provider community have expressed.
More than 800,000 veterans, half of whom are under 65, live in New York. Nearly half of the VA's $6.3 billion annual expenses in the state is spent on healthcare. Fewer than 5% of the healthcare providers surveyed by the researchers said they were part of VA Community Care. Mental health professionals, a necessity for veterans dealing with traumatic issues, were the least likely to be enrolled in the program.