Just when it was starting to look like Montana’s veterans could expect a little more stability from the federal agency charged with providing their health care, another major shakeup at the Department of Veterans Affairs has placed the future of their care in doubt.
Of course, the VA has long stood on shaky ground. However, the current push toward privatization, if successful, could completely erode the foundations of this critical agency and leave millions of veterans — and tens of thousands of Montanans — without the support they earned in service to our country.
The VA’s experiment with privatization through the Veterans Choice Program provides a good example of the potential risk. The program was created in 2014 in response to audits that found many veterans faced long waiting periods before they could see a physician. Some even died while they were waiting for an appointment, and some VA employees fudged the data to make it appear they had met the official 14-day target.
Congress passed the Veterans Choice bill to fix the problem by creating a new program that would allow veterans who live more than 40 miles away from the nearest VA clinic to see health care providers in their own community. Obviously, this held a lot of appeal for veterans in rural states like Montana. But U.S. Sen. Jon Tester, D-Montana, a ranking member of the Senate Veterans’ Affairs Committee, favors scrapping the program and replacing it with a different system.
The bill provided roughly $2 billion to hire more physicians and nurses, build more facilities and expand services for underserved populations, such as women and those seeking mental health care. Unfortunately, from its inception, Veterans Choice has relied on third-party administrators to manage the program, and their track record has shown a lot of room for improvement. One of the health insurance companies awarded a major contract, Health Net, was severely chastised just last month in a letter from Tester and Sen. Mike Crapo, R-Idaho.
"Our home state providers deserve better than the miserable customer service provided to them by Health Net, who appears to be devoting even less attention to the Choice Program as its expiration nears,” wrote the two senators, who also noted providers’ complaints that the company has not paid them on time, and when they attempt to collect their payments, Health Net either puts them on hold or ignores them altogether.
In March 2016, Health Net was acquired by an even larger company, the publicly traded Centene Corporation, for a reported $6.8 billion. Any hopes that the acquisition would lead to improved services were soon dashed when, last year, a whistleblower alerted authorities to Health Net’s complete failure to schedule appointments for some veterans in New Hampshire, some of whom had to wait for longer than six months to schedule an appointment despite the fact that they suffered from life-threatening conditions.
That scandal, among others, helped prompt President Donald Trump to sign an executive order providing better protections for whistleblowers within the agency and establishing a more streamlined system of accountability.
Montana is still working through its own whistleblower scandal. A dentist with the Montana Veterans Affairs Health Care System in Billings, Kelly Hale, reported that veterans faced long wait times due to problems with the clinic’s management. The report was confirmed through an internal investigation that found problems dating back to mid-2016. After the investigation, the head of dental services, Robert Bourne, resigned but was rehired on a fee basis so he could continue providing dental services.
The Montana VA then put Hale through a misconduct review and tried to terminate his employment. That action is on hold while the Merit System Protection Board weighs whether it was taken in retaliation for Hale’s whistleblowing. Meanwhile, Hale remains a paid staff member but is not allowed to see patients, meaning that for many months in 2017, patients were referred to the nearest VA dental clinic — in Sheridan, Wyoming. This past February, the VA finally hired another dentist, but Hale’s case is still pending.
Also in February, the Montana VA issued a press release explaining how it is working to overcome an ongoing shortage of primary care providers. In Montana, the system is required to have about 37 full-time-equivalent positions, but only about 34.5 were filled at last count. Further, providers accounting for 5.5 of those positions have announced they are either leaving or reducing their hours.
The VA responded by explaining that it has already scheduled 8.5 to be filled by the end of May, which would bring it above the 37-position threshold. It is actively recruiting to fill vacant positions in Billings and Helena, and will rely on temporary relief from other providers to meet any other needs throughout its network of 15 facilities in Montana.
Last month, the Montana VA learned it will at last be able to move forward with expansion plans at several of these clinics, including the expansion and upgrade of facilities in Missoula and construction of new sites in Butte, Helena and Fort Harrison.
The exact construction costs are not yet known, but it’s likely to cost many millions of dollars. The investment is worth every penny — so long as every one of those pennies goes to providing the best possible care to veterans. Money spent on anything else is money wasted.
In fact, recognition of this value — that private profit off the backs of our veterans is wrong — may have been why former Veterans Affairs Secretary David Shulkin was fired last week. President Trump has already announced that he would like to replace Shulkin with White House physician Ronny L. Jackson.
Shulkin said he suspects he was targeted by supporters of privatization. It likely also had something to do with allegations of ethics violations. An internal investigation found that Shulkin accepted tickets to Wimbledon, and that he not only brought his wife with him on a trip to Europe at taxpayer expense, he directed his chief of staff to go back and change emails in an attempt to justify it. Shulkin denies these accusations.
Nevertheless, his apparent abuse of public dollars for private benefit was soundly criticized, even by his most loyal supporters. It’s a lesson that ought to resound throughout the agency.
The VA is still struggling to overcome major problems. Whoever eventually replaces Shulkin must have the depth of experience and expertise to tackle these problems, and the wisdom to avoid creating new ones — and that includes the misguided push to privatize the VA.