Veterans, especially in rural Minnesota, look on as lawmakers try to overhaul health care

WASHINGTON – When Phil Klenk injured himself with a shovel during yard work, his wife, Lisa, drove him more than an hour from their home in Winthrop, Minn., to the VA hospital in Minneapolis for urgent care.

It wasn't supposed to work that way. Both veterans, the Klenks had high hopes for a federal program that promised an easier way for rural service members to receive medical treatment close to home.

But Lisa Klenk, the veterans service officer for Sibley County, quickly found the Veterans Choice Program to be so bureaucratic and slow-moving — it took her 2½ months to get a physical therapy appointment near home — that she's reverted to visiting VA hospitals in Minneapolis and St. Cloud, 75 miles away.

"Even though it's an hour and 10 minute drive, it's quicker for me to go there than to go to my local choice program," Lisa Klenk said.

Three years after the Veterans Choice Program began, federal lawmakers are racing to overhaul the troubled, multibillion-dollar effort before it runs out of money. That could happen as early as December, following the approval of $2.1 billion in emergency funding in August.

Stakes are high for elected officials, including President Trump, who repeatedly promised as a candidate that veterans would get better treatment than under the previous administration. In an Op-Ed in The Hill to honor Veterans Day, Secretary of Veterans Affairs David Shulkin noted that he was working with Congress on a replacement called the CARE Act as part of a series of reforms at the agency.

At least a third of the people enrolled in the VA health care system live in rural areas and are more likely to be older and face medical problems that require costlier care.

"It's pretty hard to find a veteran who's happy with the way the Choice Program is working," said U.S. Rep. Rick Nolan, D-Minn., whose sprawling, largely rural northeastern Minnesota district faces the very challenges that the program was supposed to address. "Just colossal administrative snafus and delays and problems have been associated with [it]."

Nolan said he has a neighbor who tried for two years to get an appointment to be treated for a neck injury that the VA system couldn't handle in-house. The congressman recently attended a gathering of about 100 veterans in International Falls to talk about a solution.

"Every time I've had to deal with Veterans Choice there's been a problem," disabled veteran Joe Buzay told the group. "I've spent hours on the phone talking to them, trying to get things straightened out."

Buzay drew applause when he added: "Honestly, I'm glad to see it's going away."

Lawmakers approved the program in 2014, following a scandal over long wait times at the Phoenix VA. The program permits veterans who have to wait more than 30 days for treatment at a VA hospital or live more than 40 miles away to get care from private providers close by.

Members of Congress and Shulkin have been circulating replacement proposals. Shulkin is pushing a plan to allow veterans to seek private-sector care reimbursed by the VA if the government's facilities don't provide what they need, can't provide it in a timely way or don't meet quality metrics compared with community health providers. His proposal would go further than a congressional proposal that would have primary care VA doctors refer patients to a network of private providers when needed.

Shulkin told lawmakers at a hearing last month that streamlining the choice program with other community care programs would save billions over a decade, noting that 13 percent of the choice program's funding went toward "extremely high" administrative costs.

"I'm concerned with how it will be funded," said U.S. Rep. Tim Walz of Minnesota, the senior Democrat on the House Committee on Veterans Affairs, during that hearing. "I continue to believe that veterans do not benefit when we scrape the barrel for money by skimming from some veteran benefits programs to pay for others."

The House proposal would be funded with discretionary funds subject to approval annually, according to Walz's office.

In the southern Minnesota district Walz represents, Mayo Clinic is watching the debate closely; its leaders repeatedly have met with Shulkin in Washington to discuss veteran health care.

Minnesota's most prominent medical system drew some backlash for not participating in the Veterans Choice program, citing high administrative costs to comply. Providers "have to go through a number of hoops" to see veterans for an appointment, and pass through many layers of bureaucracy to set up related tests, said Kathleen Harrington, who heads Mayo's division of policy and government relations. Mayo and other health care providers say the process involves excessive paperwork and extra staffing.

"It's just not very modern," Harrington said. "We're living in an age where time is very, very critical and the burdens slow things down, add additional costs and excessive time, defeating the purpose of getting veterans the care they need in a timely basis."

Mayo has yet to back a replacement program. Harrington said what they've seen so far lacks sufficient details.

At Rainy Lake Medical Center in International Falls, employees routinely discover errors in the authorizations provided by the Veterans Choice program administrator, according to Kris Foss, executive director of clinic operations. The staff finds dates aren't entered correctly, for example, or that veterans aren't aware that the program had approved their appointments until Rainy Lake calls them. The medical center sometimes has to dial the program at 8 a.m. and wait on hold for five hours to clear up problems.

"With us being so remote, sometimes traveling to an appointment isn't an option," said Foss. "Having care close to them isn't a convenience — for some of these veterans who have served our country … it's a necessity."

St. Cloud-based CentraCare Health has had to wait as long as a year for VA reimbursements, according to system director Kathy Parsons, and has to fax or e-mail medical records up to five times to program administrators. She praised the House proposal for mandating that more records be sent electronically and reimbursement go to private providers more quickly.

In her job as county veteran service officer, Klenk knows plenty of veterans face long waits at private providers nearby — undercutting the chief aim of a program meant to bring care to people who live more than 40 miles from a VA facility. She's dealt with veterans contacted by collection agencies because of VA delays in reimbursing private providers.

The paperwork and bureaucracy are so extensive, according to Klenk, "that we're requiring [of] a veteran who served our country … more than we are requiring of a Medicare patient, which is crazy. It boggles my mind."

Last month, Shulkin told lawmakers that the VA would "take back customer service."

But he called on them to act soon, saying, "We need Congress to pass this legislation to avoid the program running out of money and to give veterans a system that works."

Maya Rao • 202-662-7433