James Jones is a 54-year-old disabled Army veteran. After four years of active duty and four in the reserves, Jones says he has a “multitude” of health care problems.
“There’s PTSD, a right arm injury, my right shoulder, chronic rhinitis from toxic exposure during the Gulf War, dental,” he says. That’s why he depends on the Department of Veterans Affairs (VA) health system, the nation’s largest.
Jones, a federal employee from Wakauga County, North Carolina, is also one of the 25 percent of vets who live in rural areas. And care for these rural veterans is now at serious risk as Republicans push to cut rural health care and privatize the VA.
The VA MISSION Act of 2018, passed under President Trump’s first term, established a parallel private network, the Veterans Community Care Program (VCCP). The VCCP now sees 60 percent of VA patients and eats up over $30 billion a year that could go to hiring more staff and improving the VA’s aging infrastructure.
This year, VA Secretary Doug Collins asked Congress for a 50 percent increase in VCCP funding and — in an unprecedented move — a reduction in VA funding. The private sector, backers insist, can provide rural veterans with high quality, convenient care without the delays they may face at the VA. But Jones and other rural veterans say this is a lie.
“I prefer to go to the VA, even if I have to drive longer to get there,” Jones says. But even if he wanted to take advantage of non-VA providers, there are simply not enough near his home — or anywhere else in rural America — to accommodate the needs of the 4.7 million rural veterans like himself.
That’s precisely what the Veterans Healthcare Policy Institute (VHPI) found. In a study, which one of us (Suzanne) authored, VHPI discovered that rural veterans seeking care in the private sector face even greater barriers than those in the VA.
While these providers may be well-intentioned, few have enough expertise to recognize veterans’ complex health care problems, much less treat them. This was also the conclusion of not one but two RAND Corporation studies of private sector providers.
Bob Anderson, an 81-year-old Vietnam veteran in Albuquerque, has been very frustrated by these providers: “When I went to the private sector cancer doctor, my appointment was late in the afternoon on a Friday, and they prescribed pain meds that I had to pick up at the VA which was all the way across town,” he said. “It was very difficult to get the pain medicine I needed.”
Anderson says there was no effort to coordinate or follow up his care. In the VA system, by contrast, “You’d always get a call from a nurse or nurse practitioner the next day to see how you were doing.”
But for many rural veterans, the problem isn’t just finding a provider who understands their needs — it’s finding any provider at all. Of the less than 1,800 rural hospitals remaining, 432 are considered “vulnerable to closure.”
In fact, the majority of rural Americans already live in so-called health deserts. In states with large rural populations like Georgia, North Carolina, and Texas, nearly every rural county — and many urban ones — falls under this designation.
Worse still, President Trump’s new budget will decimate rural hospitals and discourage even more medical and mental health professionals from practicing in rural areas.
If millions of veterans are steered out of the VA and into crumbling rural health care institutions, they’ll be forced to compete with their loved ones, friends, and community members for increasingly scarce rural health care resources. That’s bad for all concerned.
Fortunately, opposition is forming to the administration’s VA priorities and other efforts to dismantle the federal government. James Jones is part of that opposition. What he and his fellow veterans want is not more costly and unnecessary outsourcing but improvements in the VA itself.
Suzanne Gordon is a journalist, editor, and author of Our Veterans: Winners, Losers, Friends, and Enemies on the New Terrain of Veterans Affairs. Steve Early writes about politics and labor. This op-ed was adapted from a long-form story at Barn Raiser.
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