Marine Corps veteran Nancy Brown qualifies for a program that allows her to see a private doctor because she lives about 60 miles from the nearest VA hospital in Richmond, Virginia, but she was turned down recently when she sought an appointment to treat her ailing knee.
“There are no more referrals,” said Ms. Brown, 57, of Fredericksburg, Virginia. “They’re denying it now, telling people they can’t see you. What are veterans to do?”
The popular Veterans Choice Program, created after the 2014 health care scandal in the Department of Veterans Affairs, is designed to give veterans more treatment options if they can’t get an appointment at a VA facility within 30 days or they live more than 40 miles from the nearest VA hospital. But the program is running out of money.
The VA initially projected that Veterans Choice would be running a surplus of $1.1 billion by Aug. 7. But VA Secretary David J. Shulkin surprised lawmakers last month when he revealed that the money is expected to run dry by mid-August because of unexpectedly high demand.
“On financial projections, we have to do better,” he said. “We do not want to see veterans impacted at all by our inability to manage budgets.”
Mr. Shulkin has ditched a proposal to shift money from an account funding disability benefits for about 225,000 elderly and disabled veterans after an outcry from veterans groups, and Congress is preparing an emergency spending measure to make up the budget shortfall in the Choice program.
House Veterans’ Affairs Committee Chairman Phil Roe, Tennessee Republican, plans to introduce legislation next week that would extend funding for six months, with offsets elsewhere in the VA budget.
The committee held productive discussions Tuesday night on the issue, Mr. Roe said.
“We would like to proceed with a fully paid-for six-month [extension],” he said, adding that it would buy time for the committee to address other issues related to veterans’ care. “I think we will come out hopefully with a better product and more time for understanding and more input from other sources.”
Facing the shortfall, the VA has been instructing its medical centers to limit the number of veterans sent to private doctors. Some veterans have been sent to VA facilities at greater distances from their homes or to Defense Department hospitals. The agency also was delaying spending by its regional offices on some medical equipment.
For veterans like Ms. Brown, the delay has been frustrating, especially since President Trump signed legislation in April extending the Choice program instead of allowing it to expire next month.
“I shouldn’t have to worry about this because Trump signed the approval,” she said. “I do need this Choice referral.”
A veterans group that advocates for more private health care options said Congress should use this opportunity to empower veterans with more choices for treatment in their communities.
“While Congress must quickly move forward on a temporary fix for the VCP budget shortfall, the Choice program must ultimately be overhauled, expanded and permanently reformed,” said Dan Caldwell, policy director at Concerned Veterans for America.
Mr. Shulkin is promising to expand the program under the VA’s budget for fiscal 2018, which begins Oct. 1. Mr. Trump has proposed $2.9 billion in additional funding for Choice next year and another $3.5 billion in fiscal 2019. The VA is one of the few federal agencies to be targeted for increases in spending.
The revised Choice program would eliminate the 30-day and 40-mile requirements and allow VA personnel to perform a “health risk assessment” to determine whether the VA or a private doctor is the better option for a patient.
“This will give veterans real choice in getting the care they need and ensure it is of the highest quality,” Mr. Shulkin told the Senate Committee on Veterans’ Affairs. “At a minimum, where the VA does not offer a service, veterans will have the choice to receive care in their communities.”
Veterans have described difficulty in obtaining timely appointments, and health care providers say it takes too long to get paid under the Choice program. The VA was relying on a third-party vendor to handle payments but started to pay claims directly this summer.
Mr. Caldwell said his organization intends to work with Congress on other reforms for veterans, including more health care options if Veterans Health Administration facilities are not meeting their needs.
“Giving veterans more health care choice will incentivize VHA facilities to become higher-performing health care providers through competition,” he said.
The group also is pushing for more transparency from the VA about costs.
“In the last six months under Secretary Shulkin, the VA has already made great strides in increasing transparency by releasing more information on wait times and quality of care within the VHA,” Mr. Caldwell said. “Congress should ensure that in any VA choice overhaul legislation that the VA will continue to release more information about the quality of its care, wait times and health care costs and that the data being provided to the public is accurate. This will further empower veterans to make better health care choices with their VA benefits and increase accountability for the VA.”
Mr. Shulkin said at a forum last month that his other priorities include legislation to overhaul the disability claims appeal process and to expand the VA’s program to provide financial assistance to caregivers for veterans.
The agency also is trying to save money by closing about 1,100 vacant or underused buildings nationwide over the next two years, which Mr. Shulkin has estimated would save taxpayers about $23 million annually.