The Newly Passed VA Access to Care Act is a Mixed Bag

The bill is a series of half measures and risky "�reforms' that do little to actually address the capacity of the VA to deliver earned healthcare and benefits.One the positive side, it will help fund much needed programs including critically needed TBI research and treatment, improved access to treatment for men and women with PTS stemming from military sexual assault, $2 billion for new VA facilities and $5 billion to hire more doctors, nurses and mental health providers who actually deliver veteran-specific care. This spending goes directly to addressing unacceptable wait times for VA appointments by adding capacity.On the negative side, the bill funds $10 billion for "outside care" or a veterans' choice fund. This may look beneficial in theory but it is a dangerous step toward privatization that would harm veterans in the long term. First, the VA already has the authority to offer enrolled veterans fee-for-care services at outside facilities. More importantly, while the management and bureaucracy of the VA can be maddening, an entity which provides veteran-specific care to veterans throughout their lifetime is extremely effective, particularly for service-related injuries, PTS, TBI, MST, the myriad conditions related to Agent Orange exposure, and the like. While we lose specialized care available from a central caregiver who understands the service-connection, the wider market will not be equipped to deal with the growing treatment needs of veterans.More damning is the fact that the Congressional Budget Office estimates that this experiment will actually cost roughly $500 million in 2014, $16 billion in 2015, and $28 billion in 2016 (www.cbo.gov/publication/45453). Meanwhile, we lose the value of specialized care and go down the dangerous road to privatization. On the performance side "� the bill takes some aim at preventing misfeasance by VA staff. The bill calls for termination, suspension and/or civil fines for falsifying appointment data. This is a no-brainer and one would hope that falsifying any data would result in swift discipline or termination. The formula written into the law; however, sidesteps union procedures designed to protect workers from unscrupulous supervision. We see the lengths that hospital leadership went to in this scandal to protect themselves at the expense of underlings and patients. We should ensure that accelerated discipline and termination offers transparency and fairness.The manipulation of wait lists and cover-ups created impetus for Congress to act "� but that inexcusable behavior stemmed from financial bonuses tied to impossible performance measures. Why Congress then decided continue to allow the VA to hand-out $360 million in bonuses annually is beyond comprehension. We can only hope that at least those bonuses will be awarded with more scrutiny and only to those who truly go above and beyond in the hard work delivering quality healthcare and research.Finally, much goes unaddressed to increase access to care, as the bill does not touch on the benefits side of the equation. It is there that the veterans' service connection and thus, eligibility is determined. Veterans who wait for months or years for their claim to wend its way through the backlog and error rates languish without any care at all. In essence this is the waiting list they must wait on before they even get to the wait for their actual appointments.Much more needs to be done before Congress may congratulate itself for its service to veterans.Amy Fairweather, Policy DirectorAmy Fairweather directs Swords to Plowshares Institute of Veteran Policy (IVP) which conducts public policy research regarding veterans' health, access to benefits and socioeconomic well-being. She has worked in the field of public health policy, in particular, with and for trauma survivors, since 1999. Ms. Fairweather serves as the chair of the California Governor's Inter-Agency Council Health Committee.Amy Fairweather received her undergraduate degree from Mills College and her Juris Doctor from the Hastings College of the Law. She is a member of State Bar of California.Feature image from VA blog