WASHINGTON — Following suggestions by President Donald Trump that he would move to privatize veterans’ health care, his pick to lead the Department of Veterans Affairs promised major overhauls Wednesday while pledging not to dismantle the agency.
“There will be far greater accountability, dramatically improved access, responsive and expanded care options,” said nominee Dr. David Shulkin during his confirmation hearing. “But the Department of Veteran Affairs will not be privatized under my watch.”
“VA is a unique national resource that is worth saving, and I am committed to doing just that,” he added. He currently serves as the VA’s undersecretary of health.
Shulkin pledged to expand access to health care for veterans who weren’t served by the VA in a timely manner, but he added that most veterans who have received care outside the system prefer VA health care.
He opposed the construction of new VA facilities, citing cost overruns and scheduling delays on recent projects. He instead contended that public-private partnerships for VA health facilities would be more efficient.
Shulkin also pledged to set up a 24-hour crisis hotline for veterans and said he would ask Congress for more money to help modernize the department’s records systems.
The top Democrat on the Veterans Affairs Committee, Montana Sen. Jon Tester, interrogated Shulkin about his conversations with Trump, asking if the president had set any preconditions for his appointment.
“What I told (Trump) is, is that I’m a strong advocate for the VA, that the services that are available at the VA are not available in the private sector, and that my view of where VA needs to go is an integrated system of care taking the best of VA and the best of the community,” Shulkin responded.
If confirmed, Shulkin would be the only member of Trump’s Cabinet who served in President Barack Obama’s administration. There were no major objections to Shulkin’s nomination during the hearing, and he is expected to breeze through the Senate confirmation process.
Shulkin, a son of an Army psychiatrist, has been a private hospital administrator for most of his career. He joined the VA after a series of scandals rocked the department in 2014.
The most damning allegations came from the VA’s Office of Inspector General, which found several veterans had died while waiting for care at a VA hospital in Phoenix. Subsequent investigations found hospitals across the country had accumulated extensive backlogs and many had inaccurately reported the wait times. In this review, wait times at the VA hospital in White River Junction were found to be below the national average.
After the scandal broke, U.S. Sen. Bernie Sanders, I-Vt., who was then chairman of the Senate Committee on Veterans’ Affairs, helped broker the passage of the Veterans Access, Choice and Accountability Act of 2014, a $16.3 billion law that expanded care and oversight of the department.
The package allocated $10 billion to pay for private care and $5 billion for the VA to hire more doctors and staff. An additional $1.3 billion was used to lease space at 27 facilities in 18 states to expand coverage options. The VA cares for 9 million veterans nationwide.
Another key provision of the 2014 law allowed veterans to seek private care if they had to wait more than 30 days for an appointment at a VA center. Veterans who live more than 50 miles from a VA facility were also eligible to seek private care.
A report released Monday by the inspector general for the Department of Veterans Affairs found a number of problems with the rollout of the Choice Act, and Shulkin said Wednesday that the law has brought “disarray” to the VA.
The report found that while the law has seen some success, the third-party administrators responsible for authorizing out-of-network care and scheduling appointments were not doing so in an efficient manner.
In evaluating care at seven VA facilities across the country, the report found that 35 percent of patients were waiting 72 days to even receive an appointment at a private facility from a third-party administrator.
In his testimony, Shulkin said the non-VA contractors scheduling appointments added
“an additional layer of complexity we need to take out.”
He said access to care should be based on the seriousness of the ailment, not proximity to a facility.
“For somebody who needs to see a doctor that day, they should be seen,” he said. “If they can’t be seen at VA, they should be seen in their community.”
Shulkin added that the Choice Act demonstrated that veterans prefer VA care, saying that of the 1 million veterans who received private care through the Choice Act, only 5,000 have sought care solely through private providers.
In his questioning of Shulkin, Sanders made the nominee reiterate his pledge not to privatize the VA before offering his own defense of the organization and calling for more funding of veterans’ health care.
“Without exception, every leader of every major veterans organization — from the American Legion, VFW, (Disabled American Veterans) on down — said once people get into the system, by and large the quality of care is good, very good, excellent,” Sanders said.
Shulkin agreed, saying that independent reports have consistently “found the quality of VA care — particularly when it relates to mental health, primary care measures, screening measures, safety measures, quality measures in general — is actually superior in the VA system to the average of the private health care system.”
Sanders then asked Shulkin about Trump’s recent federal hiring freeze.
Shulkin said there were currently 45,300 job vacancies in the VA and that the White House had exempted roughly 37,000 of those jobs from the freeze.
For good measure, Sanders ended his questioning with a full-throated defense of the VA.
“Primarily for political reasons, the VA has been beaten up a whole lot in recent years, by politicians, by the news agencies and so forth,” he said. “That is not to say that the VA does not have serious problems, but it does say that our entire health care system has serious problems, not just the VA.”
The Choice Act expires this year, and it’s unclear what, if anything, will replace it.
Two Sanders spokespeople did not return phone and email inquiries seeking information regarding Sanders’ legislative plans to address veterans issues.
