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“We have increased by 42 percent the approval for veterans using the Choice program.”
— President Trump, rally in Harrisburg, Pa., April 29

“Already this year, using the Choice Program, veterans have received 42 percent more approvals to see the doctor of their choosing. But that’s just the very beginning of what we have planned. So much more is coming.”
— Trump, remarks signing executive order on improving accountability and whistleblower protection, April 27

This 42 percent statistic jumped out at The Fact Checker, as it seemed to be a significant jump in the number of veterans getting authorized to get their health care outside of the Department of Veterans Affairs health-care system.

The Choice program allows veterans to get health care in the private sector if they face a long wait time or live far from the nearest VA Medical Center. This was a key provision in the August 2014 Veterans Access, Choice and Accountability Act — a bipartisan response to the scandal that erupted over veterans’ delayed access to medical care at VA facilities across the country.

Veteran watchdogs have criticized VA for not acting quickly enough to use the appropriated money to improve patients’ access to medical care. Is it true that veterans have received 42 percent more approvals to get non-VA health care through the Choice program?

The Facts

The Choice program is especially important in the debate over veterans’ access to medical care, because it was designed to give flexibility to those who face the greatest obstacles. Congress created the program so that veterans would no longer face the same type of wait-time problems that surfaced in 2014. (Controversy over those problems led to the resignation of former VA secretary Eric Shinseki.)

Yet even after Congress appropriated the money, veterans groups found their members still faced administrative, technological and logistical challenges that delayed their access to care through the Choice program. VA’s Office of Inspector General found that veterans faced several barriers to getting medical care throughout the first 11 months of the program.

Since 2015, VA and Congress made many changes to the program, which dramatically increased the number of veterans using Choice. In fiscal 2015, there were 380,000 authorizations for Choice care. In fiscal 2016, there were more than 2 million authorizations — quadrupling the number of authorizations in one year, Trump’s VA Secretary David Shulkin testified to Congress in March.

In his testimony in March, then again on May 3 and 11, Shulkin said VA is on track to increase the number of Choice authorizations even more than fiscal 2016. In the first quarter of 2017, there were about 750,000 Choice authorizations — a 35 percent increase over the same period in 2016. Shulkin added that so far in 2017, VA has seen 18,000 more Choice authorized appointments per business day than in fiscal year 2016.

So the actual number that Trump should use — if he is referring specifically to the Choice program — is a 35 percent increase. That’s still significant, but slightly off from 42 percent.

The 42 percent he uses refers to VA’s community-based care programs in general. According to VA, the Choice program comprises a quarter of all of VA’s community-care programs, which allow veterans to receive health care outside of VA medical clinics when the services are not readily available. The White House and VA clarified the difference between the two figures.

Some lawmakers and even some top VA officials use the term “Choice” to refer to all of the community-care options that veterans have. Trump did the same thing in the quotes above, by referring to the 42 percent increase. There’s a difference, but there’s a move to consolidate all community programs into one program. In a recent congressional hearing, Shulkin called for a “new, redesigned, consolidated community-care program.”

“It’s important to distinguish between the different community-care programs because they all function differently and have difference purposes,” said Carlos Fuentes, director of national legislative service for the Veterans of Foreign Wars. “That said, the VFW, Congress and VA all agree that these disparate programs must be consolidated to ensure consistency throughout the VA health-care system and to eliminate confusion among VA staff, private sector providers and veterans as to when and how veterans can receive care from private sector providers.”

While Trump refers to the recent increase in authorizations, they are a result of policy changes that took place before he took office. Still, Trump has taken steps to make sure more veterans get timely access to care. On April 19, Trump signed into law the Veterans Choice Program Improvement Act, allowing Congress to expand the program and fix many of the significant complaints that veterans had with the Choice program.

The Pinocchio Test

Trump gets into technically problematic territory by citing a 42 percent figure that applies to all community-care programs for veterans, while citing one specific (“Choice”) program, which has seen a 35 percent increase. Politicians have often conflated the two, and there is an effort to consolidate all programs into one label to eliminate this confusion.

We prefer the president use more precise language, either by specifying that the 42 percent increase applies to all community care including Choice, or using the 35 percent specifically for the Choice program. (Shulkin, in his testimonies to Congress, used the latter description and used it accurately. But that’s not surprising, given that he was the undersecretary for health at VA while this program took effect.)

While this technical difference means Trump’s statements do not qualify for a Geppetto Checkmark, he is close enough to being right that we won’t issue any Pinocchios. It’s also worth noting that he signed into law a bill that aims to increase Choice authorizations beyond 35 percent.

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“We have increased by 42 percent the approval for veterans using the Choice program.”
during a rally in Harrisburg, Pa.
Saturday, April 29, 2017