VA commission health care report — contentious until the end

The release of a report next week on the future of Veterans Affairs health care is not likely to end debate over what is the right mix of services provided to veterans by VA medical facilities or the private sector.

The Commission on Care is expected to release recommendations Wednesday that call for VA to strengthen its performing hospitals and clinics, shut its underutilized facilities and establish nationwide networks of private providers that veterans could use instead of going to VA.

But some panel members say the commission’s deliberation process has left them without a voice, charging that chairwoman Nancy Schlichting has quashed opposing views by refusing to call for a vote on the final report or allowing any supplements or addenda.
Speaking for himself and two other commissioners, Darin Selnick, a former VA employee and management consultant who chaired a task force on VA health care organized by the Concerned Veterans for America, said the members would like their objections included.

“We don’t have a problem with the recommendations so much, it’s just that we don’t think they go far enough or solve the problem,” Selnick said. “There is more that needs to be done.”

The dispute is not surprising in what has become an 18-month heated discussion over the future of VA care. Proposals floated by commissioners, Congress and veterans advocacy groups range from closing all VA facilities and turning the Veterans Health Administration into a health insurance management organization, expanding the Veterans Choice program to all veterans and turning VHA into a not-for-profit corporation overseeing specialty medical centers and managing payments to private providers.

Most of the proposals that include some variation of private care have raised the hackles of major veterans groups, and in mid-June, VA employees joined the fight, holding rallies outside VA hospitals to protest proposals to shut down facilities and expand private care.

On June 22, Senate Veterans' Affairs Committee Chairman Johnny Isakson, R-Ga., and House Veterans' Affair Committee Chairman Jeff Miller, R-Fla., wrote Schlichting asking for a vote by commissioners on the final report and emphasizing that they want to hear all commissioners' opinions on the matter.

They said they expected the report to include a tally of commissioners’ votes as well as supplemental material with any opposing views.

“We write to urge you to ensure that the individual viewpoints of each commissioner be accurately and transparently reflected in the commission’s final report,” they wrote.

Schlichting defended her approach to the final report in an email to commissioners. She said she is trying to show consensus among the group and noted that the final report acknowledges differences within the body of the text.

She added that commissioners could opt not to sign the final version but added that the “strength of the report relies on consensus.”

“Emphasizing again the importance of the consensus we have reached in open meetings, the hard work invested in getting to that consensus, and the charge that this be a 'commission report,' I hope you will understand my decision not to include supplementary views or other additional statements in the final report,” she wrote.

The Commission on Care was created in 2014 under legislation that established the Veterans Choice program. It is expected to provide Congress with a framework for designing the Veterans Health Administration for the next 20 years.

VA officials say transformation of the VA health care system is underway and they have asked Congress for legislation that would allow them to consolidate its numerous community care programs, including the Veterans Choice program, downsize its real estate holdings and shut 12 to 15 underused facilities.
Members of Congress also have pitched their own VA health care reform proposals. Sen. John McCain, R-Ariz., has introduced legislation that would make the Choice program permanent and available to all veterans, and Rep. Cathy McMorris Rodgers, R-Wash., has put forth a proposal to consolidate VA health facilities under a government-chartered, not-for-profit corporation with a board of directors and to give all new veterans access to private health care.

Whether lawmakers will act on the commission’s final report is unknown. Isakson and Miller said that the commission’s work will provide a framework but it is “just the beginning of the work that Congress, VA and the American people must do to increase access to care for our nation’s veterans.”

Selnick said he wants the commission’s final report to reflect the panel’s discussions and rise above the political debate on privatization that has colored debate on the issue.

“Would you call Tricare system privatization? We are not trying to privatize. We are trying to make sure that VHA itself is a good provider, and we also want to make sure that veterans have other sources that meet their [health care] needs,” he said.