The Washington PostDemocracy Dies in Darkness

It was meant to reduce wait times, but veterans say new choice cards are causing more problems

Secretary of Veterans Affairs Robert McDonald speaks during a news conference  Sept. 8, 2014, in Washington, D.C. (Alex Wong/Getty Images)

Veterans and some VA doctors say that the new “choice card” program, meant to reduce long patient wait times, is confusing and causing more stress.

The choice card issued by the embattled Department of Veterans Affairs was meant to end long wait times for veterans after last summer’s scandal revealed that those who fought for their country were dying while waiting for care.

The card gives veterans who have been waiting more than 30 days for appointments or who live more than 40 miles from a VA facility the chance to see a private doctor.

But instead, some veterans say that when they attempted to use their card, the VA told them they had to live more than 40 “miles in a straight line, or as the crow flies,” from their VA rather than Google maps miles, which makes the card harder to use. Several VA doctors e-mailed The Washington Post saying they themselves don’t understand how to use the program

Another reader wrote in saying that her stepfather, Charles Schuster,  who died in 2009, recently received a card in the mail, a symbol of an agency still seemingly in disarray. “Gave me a good laugh,” she wrote.

So far, 27,000 veterans have made appointments for private care with their cards, the VA said last week. It’s a fraction of the 9 million veterans who depend on the delay-plagued VA health-care system, the largest network of health centers and hospitals in the country.

“As far as I can tell, the choice card has created more confusion and aggravation than improving access to clinical care, though it did gain political points,” said one VA primary care doctor, who says he’s on the front lines of doing intakes. He spoke on the condition of anonymity because VA employees are not allowed to speak to the media without permission. But he said he and other doctors “are confused by the choice card system and don’t understand how to implement it.”

Another problem that veterans pointed to is that all veterans, whether eligible or not, get the card. Some are showing up in private emergency rooms and try to use the card only to find out it’s not valid.

During a recent House hearing with VA Secretary Robert McDonald, Rep. Tim Huelskamp (R-Kan.) said the program needs to be totally revamped. The 40 mile “as-a-crow-flies” distance is a huge problem for his district, which has 63 rural counties and no VA hospital. Huelskamp co-sponsored a bill that would require the VA secretary to expand the Veterans Choice Act eligibility to better assist rural veterans by changing the 40-mile requirement to be based on actual driving distance  instead of radius.

Additionally, the 40-mile criteria would apply directly to the type of care requested by the veteran – which means having a Community-Based Outpatient Clinic (CBOC) in the area would no longer prevent a veteran from choosing care at a local hospital if the local CBOC can’t provide the necessary service.

He also reported that there are approximately 70 rural community hospitals in Kansas willing to fill that void, but under current VA restrictions, many veterans are unable to use those facilities.

“Refusing to allow these men and women to choose their local hospital and doctor and forcing them to drive huge distances in simply unacceptable – they deserve better,” Huelskamp said.

He also said that when veterans were calling their hospitals for appointments, they were not asked for or advised to check whether they could use their cards.

Other political leaders and veterans advocacy groups are questioning how hard the VA is really selling the choice card.

The VA’s release of the choice chard numbers is at the heart of a controversy over President Obama’s 2016 budget, which asks for authority to reallocate funds from the temporary $10 billion program that Congress established last year to help veterans struggling to obtain care at strapped VA clinics. VA officials say they want the “flexibility” to fund other projects, such as reducing the claims backlog.

House Veterans Affairs Committee Chairman Jeff Miller (R-Fla.) has roundly rejected the plan, calling it a “complete non-starter, which I will not support.”

Pete Hegseth, CEO of the conservative advocacy group Concerned Veterans for America, has told the media that veterans get the run-around when they call the VA for permission to use the choice card.

“The VA is making a concerted attempt to undermine anything that looks like choice,” he said.

Retired Lt. Col. Jack Martins, who has hearing loss from Vietnam, said that he couldn’t use his card because, even though his nearest facility in Virginia is 60 miles away, that mileage is using Google Maps, not “mileage in a straight line.”

“I called twice, just to verify this information. Makes you wonder why they sent out the mailing before fixing this problem,” said Martins.

Former Army private Ian Albright receives VA benefits and medical care, and his father, Tim Albright, is helping him access his care. He said veterans are scared to use the choice card for various reasons, including too much paperwork, delays getting approval by VA physicians and fear of never being reimbursed.

“It all sounds like governmentese, for no one is going to approve payment of your care ahead of time. It’s a bunch of booby traps and trap doors,” he said. “There’s nowhere you can go to get quick answers from the VA. And I see this as a life-and-death dilemma for vets and family members who really have no clue how the system works.”

While he has nothing but praise for the staff and management of the VA Medical Center in Saginaw, Mich., where his son receives treatment, he wishes getting to that treatment was easier.

Albright worked for the federal government in Social Security for 34 years and offered a solution, which he e-mailed about and left a message on McDonald’s cellphone.

The idea, he said,would involve issuing temporary Medicare cards to veterans who meet the “choice criteria.”  The benefits of this plan include “little or no paperwork for veterans and the VA would save additional administrative and personnel expense since the Medicare claim system is already in place.”

“How are private doctors going to send these choice card bills in? You are talking about training tens of thousands of people, but if you use Medicare — everyone knows how to handle Medicare,” he said. “All energy and efforts should be to provide immediate medical care to those in backlogs or on waiting lists.”