Veterans aren’t happy about the latest pronouncements from the Department of Veterans Affairs.

The Hill reports that David Shulkin, Veterans Affairs secretary, is talking about broadening the role of private sector health care in providing care for veterans, with the eventual goal of eliminating of the need for veterans to go through the VA to approve or coordinate their care.

Shulkin, who previously worked as CEO of a private health care system, is quoted saying in a Wall Street Journal report, “The direction I’m taking this is to give veterans more choice in their care, and be the decision maker for their care, which I fundamentally believe is a concept that has to be implemented.”

But veterans’ groups disagree, with a spokeswoman for the Veterans of Foreign Wars being critical of his plan and telling The Wall Street Journal that the organization has not heard from the secretary about his health care concept. Other critics warn that it is a step toward privatization, which would limit funding to government-run facilities.

According to the Journal, inserting private sector providers into veterans’ care could take years.

But that’s not the only hornet’s nest that Shulkin is stirring up. ABC News reports that as part of its effort to expand private health care, the VA is also exploring the possibility of merging its health system with the Pentagon’s. While the VA says it will cut costs, veterans’ groups say it could threaten the viability of VA hospitals and clinics.

Without providing any details, VA spokesman Curt Cashour called the plan a potential “game-changer” that would “provide better care for veterans at a lower cost to taxpayers.” Others aren’t so sure, with Griffin Anderson, a spokesman for the Democrats on the House Veterans Affairs Committee, saying that the proposal, which was produced without Congressional input, would amount to a merger of the VA’s Choice and the military’s TRICARE private health care programs. Committee Democrats independently confirmed the discussions involved TRICARE, the report says.

Veterans’ groups were alarmed at the news, saying that they had not been consulted. In addition, congressional Democrats criticized the plan, pledging to oppose any VA privatization effort that forces veterans “to pay out of pocket for the benefits they have earned with their heroism.”

“Today, we see evidence that the Trump administration is quietly planning to dismantle veterans’ health care," House Minority Leader Nancy Pelosi, D-CA, is quoted saying. Pelosi adds, “House Democrats will fight tooth and nail against any efforts to diminish or destroy VA’s irreplaceable role as the chief coordinator, advocate and manager of care for veterans.”

They’re not the only ones expressing concern over the quietly discussed possibility. Health care experts have expressed surprise that the VA would consider a TRICARE merger to provide private care for millions of active-duty troops, military retirees and veterans, since each serves a unique patient group—with the VA treating older, sicker veterans, while TRICARE cares for generally healthier service members, retirees and their families.

In addition, the way the two systems work is different: TRICARE is insurance paid by the government using private doctors and hospitals, while the VA provides most of its care via medical centers and clinics owned and run by the federal government, though veterans can also see private doctors through the VA’s Choice program with referrals by the VA if appointments aren’t readily available.

“My overarching concern is these are very dramatic changes in the way health care is delivered to veterans,” Carrie Farmer, a senior policy researcher on military care at Rand Corp. who has conducted wide-ranging research for the VA, says in the report. Farmer adds, “There haven’t been studies on what the consequences are in terms of both costs and quality of care.”

Louis Celli, director of veterans’ affairs and rehabilitation for The American Legion, says in the report that any attempts to outsource services away from VA medical centers and clinics would be financially unsustainable and likely shift costs unfairly onto veterans with service-connected disabilities.

Celli points out that a similar change was made to TRICARE; military retirees were promised free care from military base hospitals. But then TRICARE began offering insurance to use private-sector care, and TRICARE beneficiary copays are now rising. “The precedent the TRICARE model sets is not something we would accept on the VA side,” Celli says in the report.

The VA is seeking a long-term legislative fix for Choice by year’s end.

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VA seeks greater role for private health care, merger with TRICARE

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