As congressional Republicans continue to grapple with how or whether to repeal Obamacare, outside conservative groups and donors have set their focus on a smaller health care victory—this time at the Veterans Affairs Department.
The VA, which describes itself as the “largest integrated health care system in the United States,” is touted by supporters as a successful example of “socialized medicine.”
Now it appears to be the target of conservative groups that want to shift the system further away from complete government control. The idea of providing more private options to veterans is not new, but with Republicans now running the entire show in Washington, they can conceivably make it a reality.
“Americans who put their lives on the line for our country should have the freedom to choose to use their VA benefits in the private health care market. Giving veterans more health care choice is something that has overwhelming support among veterans and non-veterans alike,” a conservative coalition wrote in an October letter to Congress. Signatories include Concerned Veterans for America, which is reportedly backed by conservative billionaires Charles and David Koch, and Heritage Action for America.
Republicans have resuscitated some efforts to dismantle Obamacare by including language in the tax-reform package to repeal the individual mandate. But the move is still viewed as a political risk, and it is certainly a much smaller victory than they were aiming for earlier this year.
So in the meantime, some Republicans are hoping to score points by shifting the VA away from complete government control, potentially providing the party a rhetorical tool against Democrats who have jumped on board with Sen. Bernie Sanders’s single-payer proposal.
“If Republicans take up the cause of privatizing the VA, it could be the significant blow they strike against single payer and government takeover of health care,” said Michael Cannon, director of health policy at the Cato Institute.
The goal should be to improve the health care for veterans, said Whit Ayres, founder and president of North Star Opinion Research. “If it ends up occurring, that provides a good case study for the broader population,” he said.
Dan Caldwell, CVA’s executive director, pointed out that while it’s not an apples-to-apples comparison between the VA and other health care sectors in the country, there are some lessons to learn from the department. “The VA is a tale of caution for people who want the government to completely take over our health care system,” he said.
Caldwell said that CVA’s proposal is not to privatize the VA but to bring more private-sector options to veterans. The idea would separate VA’s payer and provider functions, creating a new office to administer the payer function and allowing the medical centers and clinics to be managed by a government-chartered nonprofit corporation.
But it remains unclear how far Republicans are willing to go when it comes to incorporating the private sector into the system.
Rep. Phil Roe has sponsored legislation that aims to expand and streamline veterans’ access to private health care services in their community by requiring the VA to establish regional networks of private providers.
“So is it privatizing? It’s using the best of both worlds,” Roe told National Journal. He added: “I think I threaded the needle here. We’ve provided choice, and yet we have kept basically that commitment we’ve made to veterans: ‘You’ll have a special place to get your care.’”
The legislation appears to hit a sweet spot between Republicans and Democrats, as it is cosponsored by every single member of the House Veterans’ Affairs Committee. It has also garnered the support of The American Legion, which represents 2 million members.
It was supposed to be marked up earlier this month, but Roe pulled it from the agenda because he had not received a formal cost estimate from the Congressional Budget Office.
Thomas Miller, a resident fellow at the American Enterprise Institute, said Republicans are cross-pressured on VA issues. “You usually get limited gestures of marketizing some VA care,” he said.
Concerned Veterans for America says the bill contains some positive reforms but does not go far enough. “Under this legislation, the VA will still retain almost complete control over when a veteran can access private health care, which could undermine the better aspects of this legislation,” CVA said in a statement.
The group wants eligible veterans to be able to choose any primary-care physician within their VA integrated care network, regardless of whether they are at the Veterans Health Administration or a contracted community provider, and to make the department a secondary payer for veterans with other health insurance for non-service-connected care.
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