- Associated Press - Thursday, March 22, 2018

WASHINGTON (AP) - President Donald Trump is holding out the promise of better health care for veterans through an imminent expansion of private-sector services outside the Department of Veterans Affairs system. The problem: His campaign priority remains deadlocked in Congress as his VA secretary struggles with rebellion inside the agency.

During the presidential campaign, Trump repeatedly pledged to fix the VA by expanding access to private doctors and firing bad employees, criticizing the department as “the most corrupt.” Last year, Trump promised to triple the number of veterans “seeing the doctor of their choice.”

But the plan remains in limbo after lawmakers declined this week to include it in a spending bill.

Meanwhile, VA Secretary David Shulkin, under investigation by VA’s internal watchdog for possible spending abuses, didn’t tell the full story when he insisted to Congress that Trump’s proposed budget would give that office all “the staffing they need.”

A look at the statements and their veracity:

TRUMP: “Choice is coming. Choice - where the veterans can actually, instead of waiting on line for weeks and weeks and weeks, they can actually go and see a doctor and have it taken care of, and we pay. And that’s going to be the big one.” - remarks Tuesday to the National Republican Congressional Committee.

THE FACTS: Trump’s claim of fast service under the Veterans Choice program is not echoed by his VA secretary. The program allows veterans to see doctors outside the government-run VA system at taxpayers’ expense. Trump suggests that veterans using the program don’t have to wait “for weeks and weeks” as they do at VA. But Shulkin told an American Legion veterans gathering last month that the VA is “often 40 percent better in terms of wait times” compared with the private sector.

Choice was put in place after a 2014 wait-time scandal that was discovered at the Phoenix VA hospital and elsewhere throughout the country. It allows veterans to go to private doctors if they endure long waits for VA appointments.

According to the Government Accountability Office, Congress’ investigative arm, Choice suffers wait times potentially as high as 81 days. Last summer, an unexpected budget shortfall in the program forced VA to limit outside referrals, leading to additional delays in medical care.

Trump’s statement that an improved Choice program “is coming” is also highly uncertain.

Shulkin originally had hoped for a long-term overhaul to be approved by Congress in December, but proposals have stalled due to disagreements over cost and how much access veterans should have to private doctors. Shulkin also has complained about internal drama at the agency, pointing to a half dozen or so political appointees there who were rebelling against him.

This week, key Republicans and Democrats had signed off on inserting in an overall government spending bill a Choice plan to outsource more routine veterans’ care to private providers. But House Democrats balked at moving that quickly. Some veterans’ groups worry that an aggressive Choice expansion could lead to unwanted “privatization” of VA.

The failure to include Choice in the spending bill could make it tougher to implement major VA fixes anytime soon as a politically divided Washington lurches toward congressional mid-term elections in November.

Due to the complexity of the proposals, the delay so far also means that a long-term Choice plan won’t be fully implemented until 2019 or later.


DEMOCRATIC SEN. PATTY MURRAY, questioning Shulkin about his department’s Office of the Inspector General: “I was really concerned to see your budget asks for a large decrease in the office of inspector general. I know how important that role is. I know you yourself were subject of investigation, but I have really grave concerns about under-resourcing an office that really plays a vital role in our oversight of VA …I want to know why this budget doesn’t provide the OIG with the full funding that they need.” - Senate hearing Wednesday on VA budget.

SHULKIN: “We are supportive of the role of the OIG as well. And in fact this budget actually does provide them the resources. …They do have the staffing they need.” - Senate hearing Wednesday.

THE FACTS: Neither is entirely correct.

The Trump administration’s proposed budget would provide $172 million to VA’s internal watchdog office for the budget year beginning Oct. 1. That is a technical increase from the administration’s $159 million budget level in 2018, but a decline from the office’s actual spending of roughly $174 million due to increased demands to investigate reported problems at VA. The inspector general’s office spent an additional $15 million in leftover money from previous years to fill the gap, cash that is now largely used up.

To maintain current staffing levels, the IG’s office is seeking $181 million for the next budget year, or $9 million above what the Trump administration is proposing. Without that money, it says it will have to cut the equivalent of 30 full-time staff positions, most of them directly involved with the IG’s core criminal investigations, auditing and health inspections work, and could fall short on payments to cover equipment and office leases.

The IG office, with a total of about 850 full-time staff, is charged with keeping watch over the government’s second largest department, whose 360,000 employees provide medical care and other benefits to 9 million military veterans in more than 1,700 health facilities across the U.S.

In recent months, the watchdog has put out blistering reports concluding that Shulkin violated ethics rules during a 11-day trip to Europe and that systemic leadership problems at VA put patients at risk. Shulkin is now being investigated over allegations that he used his security detail to run personal errands for him; he has denied wrongdoing.


Associated Press writer Calvin Woodward contributed to this report.


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