Photo via Milwaukee VA - Facebook
VA Outpatient Clinic - Oconomowoc, Wisconsin
The U.S. Department of Veterans Affairs VA Outpatient Clinic in Oconomowoc, Wisconsin
The new Secretary of the Department of Veterans Affairs (VA), former Georgia Congressman Doug Collins, has taken a lot of heat lately from VA patients, their caregivers as well as members of Congress opposed to cuts in jobs and services for veterans at the Veterans Health Administration (VHA) the nation’s largest healthcare system.
According to Collins, even with his plan to have 30,000 fewer VA healthcare staffers by the end of this year, nine million VA-users will have no trouble accessing doctors, nurses, or therapists. They can just go to any private sector provider among the 1.7 million nationwide now being paid more than $30 billion a year for treating eligible veterans outside the VA through the taxpayer funded Veterans Community Care Program (VCCP) .
“VA is providing veterans with more health care choices,” Collins says, “while making it even easier for veterans to get their health care when and where it’s most convenient for them.”
In Wisconsin many VA patients and their caregivers worry that this rosy scenario bears no relation to reality. They’re concerned that cuts in VA staff will not only deprive veterans of choice but of needed care.
Lack of Care
That is, in fact, the conclusion of a 50- state report recently released by The Veterans Healthcare Policy Institute. Entitled “Veterans Healthcare Choice Myth or Reality?” it documented the lack of primary and mental healthcare as well as hospital services in a US healthcare system that is struggling to meet the needs of 322 million non-veterans.
Wisconsin is a perfect example. Wisconsin is home to almost 350,000 veterans and about half of them enrolled in in the VA healthcare system. VA in the state operates two medical centers, 24 outpatient clinics, three Vet Centers, as well two nursing homes and a number of residential treatment programs for those with mental health and substance abuse problems and homelessness. How will more than 170,000 veterans fare if these programs are eroded or eliminated and they have to depend on the private sector? The answer is not well.
Primary care teams are at the heart of VA healthcare and every VA patient has access not only to a primary care provider but to mental health professionals, dieticians, pharmacists, and social workers located in VA primary care clinics. In the private sector, it’s increasingly hard to find a primary care doctor who is accepting new patients. In fact, in 40 of Wisconsin’s 72 counties, there are severe shortages of primary care providers, which means there may be no primary care providers in practice at all. By 2030 Wisconsin will need 22% more primary care doctors, a gap it’s unlikely to be filled because the state’s residency programs don’t have enough primary care slots.
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Over 40% of veterans have mental health problems, yet in Wisconsin, 40 of the state’s 72 counties have severe shortages of mental health professionals and seven have partial shortages. Even in the 25 counties that register no shortages, a third of psychologists and 45% of psychiatrists may not accept insurance of any kind, and six in ten psychologists may not accept new patients.
Lost Services, Worse Care
Rural veterans in Wisconsin may have to drive long distances to get to a VA hospital, but the hospital is definitely open for business. Veterans cannot be sure that rural hospitals in Wisconsin will be there over the next few years. Of Wisconsin’s rural hospitals, 29% have lost services, 21-30% have stopped offering obstetrical services, 13% are at risk of closing, with 6% at immediate risk of closing. Many may close once Trump administration cuts to Medicaid and potentially even Medicare, are implemented.
In contrast, as numerous studies document, if VA remains well funded and well-staffed, the care it delivers is more timely, accessible, and less costly than that provided by private sector providers. Plus, VA care is also of higher quality. That’s because while private sector doctors, nurses and therapists may want to do their bit to take care of veterans, they simply lack the skill, specialized knowledge, to do so.
If the Trump Administration continues to reduce VA staff and divert funding from direct care to costly and unnecessary out-sourcing, veterans in Wisconsin may find themselves in the same long lines and “medical deserts” as their friends, neighbors, and non-veteran relatives. And, due to its incremental privatization, the first choice of most veterans—the VA -- will simply vanish.
Suzanne Gordon is a healthcare journalist and Senior Policy Analyst at The Veterans Healthcare Policy Institute. Mark Foreman, a former Milwaukee art teacher is a Vietnam veteran, VA patient and member of the Save Our VA Campaign.
