What the new VA health care bill means for Alaska’s veterans

WASHINGTON — A new bill is headed to President Donald Trump's desk that Alaska's U.S. senators hope will ultimately offer the state's veteran population greater access to health care in and near their homes, and bring new doctors to the state.

The so-called V.A. Mission Act of 2018 will set the Department of Veterans Affairs down a multiyear path to expand private-sector treatment programs for veterans. Alaska's senators said a 2014 law unintentionally limited treatment options for the state's veterans, in part because the federal VA failed to issue payments to doctors.

All three members of Alaska's congressional delegation voted in favor of the bill. It passed the House 347-70 last week and passed the Senate by a vote of 92-5 on Wednesday. Trump is expected to sign it.

"For a state where our veterans cynically refer to the Choice Program as 'No Choice at All,' it's imperative that the VA take the failures of the Choice Program to heart and work to ensure we don't repeat them," Alaska Sen. Lisa Murkowski said in a statement.

Alaska has the highest per-capita rate of veterans in the country — roughly 10 percent of the state's population, which amounted to 73,276 veterans in 2015. About half were authorized for VA benefits that year, according to congressional testimony at the time. Many of Alaska's veterans live in rural and remote areas, meaning they have extra obstacles to receiving care, in cost, distance and availability.

The new legislation is seen as a step forward in revamping the Veterans Choice Program, which was widely unpopular in Alaska. Alaska veterans complained that they were being saddled with expensive bills and difficulties getting appointments, which went through call centers in the Lower 48, where workers didn't understand the geography of Alaska.

Some of what the new bill does to fix the program nationally has already begun in Alaska. The bill will cement them into the federal statute.

The bill funds the Veterans Choice Program, which was slated to soon run out of money, for one more year, and sets up programmatic changes that will take effect in several years. Alaska's tribal health system should continue to be available to the state's veterans under the bill, both Murkowski and Alaska Sen. Dan Sullivan said.

Murkowski made a point of entering that understanding into the record on the Senate floor in what is known as a "colloquy." A colloquy is a scripted floor discussion between members — in this case, Murkowski and Senate Veterans Affairs Committee Chairman Johnny Isakson, R-Ga. — designed to record in the congressional record an agreed understanding about an amendment or a provision of a bill.

Similarly, Alaska will keep its other fixes to the 2014 "choice" law. At the time, veterans' health care providers weren't getting paid, so they sent bill collectors after veterans. The VA now has a 30-day time limit, and the new bill makes that a statutory requirement.

The VA wasn't getting around to paying providers in Alaska for services rendered. Eventually tired of waiting, the providers started turning to the veterans for payment — sometimes sending collections agents after them for huge bills that remained unpaid. "If you've ever had a collections agency ride you … it's quite stressful," Sullivan said.

The repeated lack of payment caused some local health care providers to drop out of the VA plan in Alaska, Sullivan said.

"It was a total meltdown of our system," Sullivan said.

The Veterans Choice Program also initially outsourced the process of making appointments to the Lower 48, which was problematic for Alaska veterans, who were faced with staffers with no understanding of the state's geography.

Alaska veterans will continue to be eligible for the community care program that allows them to access health care from nearby providers, since there is no VA hospital in Alaska.

Scheduling services will remain in Alaska. Those who provide services to veterans will be reimbursed at rates that reflect the high cost of health care in Alaska.

The bill also has provisions meant to encourage telemedicine, and to add doctors to the state VA programs.

The latter was a provision Sullivan helped add to the bill, he said. Sullivan worked with Montana Democratic Sen. Jon Tester to get a pilot program into the bill that would encourage doctors to perform their residency in the state by paying back a larger percentage of their student loans.

Alaska has no medical schools (neither does Montana), Sullivan said. And often doctors stay in the state where they do their residency, he said.

The Veterans Choice Program was implemented in 2015, a rushed response to scandals of yearslong wait times for care within the VA. But in Alaska, "the entire system was collapsing," Sullivan said Wednesday.

In response, Sullivan brought then-undersecretary of health David Shulkin (who ultimately became VA secretary before being dismissed by Trump) up to Alaska to see it firsthand, and face veterans at public meetings. The result was "what we then called the 'Alaska Plan,' " Sullivan said.

For all aspects of the new legislation, oversight will be "critical," Sullivan said. "Right now, the VA has essentially no leader." The agency has had four secretaries in four years, and the role of VA secretary is widely acknowledged to be the most difficult job in Washington. Trump last week said he would nominate acting VA Secretary Robert Wilkie to lead the agency.

Another aspect of the bill that Sullivan said will require great oversight is a massive expansion of an in-home care payment system that used to be available to veterans of wars after Sept. 11, 2001. The program pays family members who offer full-time care for veterans.

While it's a nationwide provision, it could be "uniquely impactful" in Alaska "given how many veterans we have," especially in rural areas, Sullivan said.

But it will require oversight to make sure it isn't abused.

"This will be costly," Sullivan said. "The money will be appropriated, I believe. But that's another issue that we've got to focus on."