Veterans Choice Act Fails To Ease Travel Burdens For Vets In Need Of Care

Mar 11, 2015
Originally published on March 11, 2015 11:27 am

Veterans who need to see a doctor often have to travel long distances – 40 miles or more – to get to a Department of Veterans Affairs facility. So last year, after scandals involving long wait times for vets, Congress tried to make getting care easier.

The Veterans Choice Act gives veterans the option of using a doctor outside the VA system if VA facilities are more than 40 miles away, or there's more than a 30-day wait for an appointment.

While the rule seems simple, making it work hasn't been as easy. In Indiana, for example, veterans are still having to go far to get the care they need.

John Birdzell is a retired Army vet who volunteers to pick up other veterans at their homes and bring them to the Adam Benjamin Jr., VA Medical Clinic in Crown Point, Ind. On this cold, early morning, Birdzell waits in the facility's empty parking lot while 30 mile-an-hour wind gusts swirl the lake effect snow coming off of Lake Michigan.

"I guess I've driven in worse conditions," he says. "It just gets to be a challenge on days like this."

It sounds odd, but for 30 to 40 veterans a day, the clinic in Indiana is actually a bus terminal for vets to catch a shuttle to the Jesse Brown Medical Center in Chicago. It's more than 40 miles and at least an hour away – a lot longer depending on city traffic.

One of the people Birdzell was scheduled to take home called while she was still in Chicago. She needed an X-ray and was running late; she asked if he could pick her up on a later shuttle. Birdzell said yes, though it meant more than a 10-hour day for both of them.

"It's kind of mind boggling to me that they get on a bus to Chicago to have things such as blood work or simple X-rays done," he says.

There's a reason vets from Indiana go all the way to Chicago. They usually need to see specialists who aren't available at the clinic in Crown Point. And because the clinic itself is considered their nearest VA facility, they are disqualified because of the the 40-mile rule.

The Veterans Choice Act has only been operating since November, but it is struggling out of the gate. The non-profit organization Veterans of Foreign Wars, recently surveyed more than one thousand vets who thought they were eligible. But 80 percent of them reported the VA didn't offer them the option of going outside the VA system.

Rep. Peter Visclosky, D-Ind., has been pushing the VA to make it easier for veterans to go outside the VA for care.

"We owe it to veterans not to burden them further as far as this travel," he says. "But it has been long-standing and it remains to be addressed."

One thing he and dozens of other legislators want the VA to clarify: How does it measure 40 miles? Right now, the VA draws a straight line from the veteran's home to the nearest clinic. But Visclosky doesn't think that's realistic because no one drives in a straight line. He also wants the VA to take into account another factor that costs time: traffic.

On a recent day, the 40-plus mile drive back to Indiana through Chicago's midday congestion took about an hour and 10 minutes. Upon entering the Crown Point clinic's parking lot, not only was the bus stop visible, but so was Southlake Methodist, one of the area's largest hospitals.

The question now for the VA is whether to allow more veterans to trade their long bus ride for a trip to the local hospital.

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RENEE MONTAGNE, HOST:

Veterans who need to see a doctor often have to travel long distances, 40 miles or more, to get to a VA hospital. Last year, after scandals involving long wait times for vets, Congress tried to make getting care easier. So it gave the option of going outside the VA to vets who'd have to wait more than 30 days for an appointment or who live more than 40 miles from a VA facility. It seems pretty simple, but making that rule work has not been all that easy. Steve Walsh of Lakeshore Public Media in Merrillville, Ind. tried to find out why.

STEVE WALSH, BYLINE: I met John Birdzell recently, at five in the morning in the empty parking lot of the Adam Benjamin VA Clinic in Crown Point, Ind. Birdzell is a retiree and a vet who volunteers to pick up other veterans at their homes and bring them to the local VA clinic. The day we met was a balmy 19 degrees. Thirty-mile-an-hour wind gusts swirled the lake-effect snow coming off of Lake Michigan.

JOHN BIRDZELL: Yeah, I guess I've driven in worse conditions. It just gets to be a little bit of a challenge on days like this.

WALSH: Under VA rules, I couldn't drive with him. So I met him the next morning at a nearby cafe.

BIRDZELL: Well, it was kind of a typical day in a way. I had two that were scheduled to go to Jesse Brown.

WALSH: That would be the Jesse Brown Medical Center in downtown Chicago. It sounds odd, but for 30 to 40 veterans a day, the Crown Point clinic is little more than a bus terminal for vets to catch the shuttle to the medical center in Chicago, just over 40 miles and at least an hour away - a lot longer depending on traffic. One of the people Birdzell was scheduled to take home called while she was still in Chicago. She needed an X-ray and was running late. She asked if he could pick her up on a later shuttle. Birdzell said yes, though it meant more than a 10-hour day for both of them.

BIRDZELL: It's kind of mind-boggling to me to get on a bus to go to Chicago to have things as simple as blood work and simple X-rays done.

WALSH: There's a reason vets in Indiana go all the way to Chicago. They usually need to see specialists who aren't available at the clinic in Crown Point. When Congress passed the Veteran's Choice Act last summer, the idea was to make it easier for vets who live more than 40 miles away from a VA facility to get the care they need. The new law let them use a doctor outside the VA system. The program has only been operating for a few months, but it is struggling out of the gate. The VFW recently surveyed just over a thousand vets who thought they were eligible. But 80 percent of them reported the VA did not offer them the option of going outside the VA system.

CONGRESSMAN PETER VISCLOSKY: We owe it to the veterans not to burden them further, as far as this travel. But it has been long-standing. It remains to be addressed.

WALSH: Democratic Congressman Peter Visclosky of Indiana has been pushing the VA to make it easier for veterans to go outside the VA for care. One thing he and dozens of other legislators want the VA to clarify - how does it measure 40 miles? Right now, the VA draws a straight line from the veterans home to the nearest clinic. Visclosky doesn't think that's realistic. No one drives in a straight line. He also wants the VA to take into account another factor that costs people time - traffic.

GPS-GENERATED VOICE: Continue on I-90 for one-and-a-half miles.

WALSH: I took the drive myself back from the VA in Chicago. Given midday congestion on the Dan Ryan Expressway, I didn't think the traffic was too bad.

Nope - spoke too soon. I was going to say we'd get up to 25 miles an hour, but now we're coming to a halt.

It took me about an hour and 10 minutes to make the 40-plus mile drive back to Indiana from the Jesse Brown VA hospital. When I turned into the parking lot at the clinic in Crown Point, I could see the bus stop where veterans board the shuttle to the city. From the same spot, I could also see one of the area's largest hospitals, South Lake Methodist. The question now for the VA is whether to allow more veterans to trade their long bus ride for a trip to the local hospital.

MONTAGNE: That's Steve Walsh with Lakeshore Public Media in Merrillville, Ind. And he's on the line now to talk more about this. Good morning.

WALSH: Good morning, Renee.

MONTAGNE: And, Steve, you just said that there's a local hospital visible. You could see it right there from the very spot where vets take a bus more than 40 miles to get to Chicago. If the law was supposed to change that, why can't they go to that local hospital?

WALSH: Well, Renee, unless you're experiencing a wait time of more than 30 days, right now the rule is if you're within 40 miles of a VA facility, you don't qualify. The fact that there is a VA clinic makes them ineligible. That's true even if your doctor is in Chicago at Jesse Brown. You're disqualified because there is a clinic, even though it doesn't have all of the services those vets need. That's why this clinic serves basically as a bus terminal for those vets. And they still have to make that long ride to the city.

MONTAGNE: Why did 40 miles become the magic number?

WALSH: OK, so that's the thing. This is all part of a new program called Veterans Choice, which allows veterans to see a doctor outside the VA. The 40-mile rule has nothing to do with convenience. It has everything to do with the VA budget. The Congressional Budget Office said without some limit on mileage, the program would cost $50 billion. That means if they let anyone choose to go to an outside doctor, it would cost the federal government a lot more money. The CBO estimated if they set the limit at 40 miles, the program would cost $10 billion, which was the amount that Congress actually allocated to Veterans Choice.

MONTAGNE: So it sounds like not many vets have taken advantage of the option to use doctors and hospitals outside the VA system so far. Are they more likely to use it, or is this a sign that the private care option just might not work?

WALSH: Well, Renee, it's probably too soon to tell. The program has only really been around for a couple of months. There certainly has been some confusion though. The way the law is written, every veteran receiving VA care received a card whether or not they qualified. The VFW recently issued a report looking at Veterans Choice where they were concerned about how well the VA had trained its own workers to explain the new program. Remember, Congress gave the VA $10 billion to pay for vets to go outside the system. Because demand has been low so far, the VA secretary, Robert McDonald, recently asked Congress for the ability to use some of that money for other VA programs. It doesn't look like the program is going away though. During a recent hearing, the chairman of the House Veterans Affairs Committee made it clear that lawmakers were not ready to give him that authority. So it looks like Veterans Choice will be around for a while.

MONTAGNE: Well, thank you so much for joining us.

WALSH: Thank you, Renee.

MONTAGNE: That's Steve Walsh from Lakeshore Public Media in Merrillville, Ind. We spoke to him as part of our project Back at Base, a collaboration with public radio stations around the country, chronicling the lives of America's troops and veterans where they live. Transcript provided by NPR, Copyright NPR.