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One of President-elect Joe Biden’s many transition task forces is charged with advising him about the federal government’s second largest agency, the Department of Veterans Affairs (VA), which operates the nation’s largest public healthcare system.
The appointees on this particular “agency review team” include doctors, lawyers, consultants, researchers, administrators of hospitals and a homelessness program, a small business owner, and the founder of a non-profit animal rescue shelter. According to Biden, all were recruited because “they not only reflect the values and priorities of the incoming administration” but also a “diversity of perspectives crucial for addressing America’s most urgent and complex challenges”—to wit, “ensuring a smooth transfer of power.”
Although ten of its 14 members have been past VA administrators or advisors, the resumes of some raise questions about their commitment to undoing the main Trump-era damage to the agency, which took the form of costly and unnecessary out-sourcing of patient care to the private sector. Of even greater concern to Veterans Service Organizations (VSO) is that their members have been totally excluded from the initial line-up of VA task force members. All major VSOs—like the American Legion and AMVETS– have been sadly complicit with incremental privatization of veterans’ healthcare under the Trump and Obama Administrations. But they do represent millions of veterans, including many of the nine million who receive VA care.
“This is really unprecedented,” says Rick Weidman, Executive Director for Policy and Government Affairs of the Vietnam Veterans of America (VVA). “It’s also alarming that there is no one on the transition team representing the Vietnam veteran generation, even though Vietnam veterans make up half of VA patients, and many of our needs are not yet addressed.” Because of such concerns, Biden transition officials have reached out to various VSOs to arrange meetings this week between their representatives and members of the VA task force.
Regardless of who is in the White House, VSO officials consider the VA to be “their” agency, just like union leaders view the Department of Labor (DOL) as their ally and defender when Democrats are in power. Throughout their history, veteran organizations have helped former soldiers pursue individual and collective claims for better compensation and fair treatment, just like unions and associations of injured workers have always done on behalf of their members. Under Trump, the traditional missions of the VA and DOL were both subverted by right-wing political appointees. But organized labor now has six representatives on Biden’s 23-member team charged with getting the DOL back on track, while equivalent advocacy groups at the VA have none.
Workers, like the veterans among them, are also impacted by the functioning of other federal agencies. That’s why Biden, to his credit, has named 20 other union leaders or staffers to serve either on his overall transition advisory board or individual teams assessing 14 other departments whose policy-making affects workers—from Social Security to the Postal Service and Departments like Energy and Transportation. Three teacher union reps are part of the team of 20 that’s developing plans to help the Department Education recover from the de-regulatory damage done by Trump-appointed Betsy DeVos. But, again, Student Veterans of America, the voice of 900,000 GI bill beneficiaries and a leading critic of DeVos’s failure to regulate for-profit schools that defrauded some of them, is not included on a committee top-heavy with foundation officials, academics, and education think tankers.
Also missing from the VA task force is any representative of unions, like the American Federation of Government Employees and National Nurses United, which have more than 100,000 members serving VA patients. AFGE and NNU activists have been outspoken critics of VA privatization efforts and have tried to build “Save Our VA” coalitions with veterans’ organizations. Many of the VA’s unionized frontline care-givers are veterans themselves—and might have a different perspective on transition issues than the former VA managers and program directors tapped by Biden.
Who Did Get Picked
According to their bios, three of the VA review team’s members are veterans themselves. One particularly well qualified to serve is former Army sergeant Kayla Williams. She is the author of two memoirs about her military service, one of which deals with the challenges of being the spouse and caregiver of a badly disabled fellow Iraq veteran. Both Williams and her husband are VA patients. In her frequent opinion pieces, Williams has been an eloquent defender of the VA’s unique services for veterans and additionally important role during pandemics. Under President Obama, Williams directed the VA’s Center for Women Veterans where she made major strides in making women veterans feel more welcome in the VA. She was eventually forced out under Trump and now works for The Military, Veterans, and Society Program at the Center for New American Security.
Another VA Task Force member with a good grasp of VA healthcare is Dr. Shereef Elnahal, now a hospital CEO in New Jersey. He served as Deputy Under Secretary for Health when Dr. David Shulkin was fired as Trump’s first VA Secretary, after being undermined by the pro-privatization Concerned Veterans of America (and its political appointees at the VA). Along with Shulkin, Elnahal co-edited a 440-page book about veterans’ healthcare system innovation called Best Care Anywhere. This collection of clinical case studies so contradicted the reigning CVA narrative about VA “dysfunction” and “failure” that the White House suppressed its distribution by the Government Printing Office.
In his contribution to that volume, Elnahal reported on “VA employees’ excitement and burst of energy when they see their great ideas translated into better access and outcomes for the veterans they proudly serve. No operational system, to our knowledge, has achieved the diffusion or consistency of best practices on a scale comparable to what we’re seeing at the VA.”
Less reassuring is Biden’s appointment of Dr. Baligh Yehia and Latriece Prince-Wheeler, both alumni of the VA but now employed by Ascension, one of largest private hospital networks in the country. Having two team members from the same private company hardly reflects a “diversity of perspectives,” particularly since Ascension lobbied for Congressional passage of the VA MISSION Act of 2018. This legislation diverted billions of dollars from the funding of VA direct care to the reimbursement of outside providers like the one Yehia and Prince-Wheeler work for today.
Now Senior VP of Ascension Health and president of its Medical Group, Yehia served under Obama and then Trump, as a VA Deputy Under Secretary for Health. He played a key role in implementing the outsourcing that’s officially called “community care.” As his new corporate bio boasts, Yehia helped assemble a national network of “550,000 partners that deliver outpatient, inpatient, telehealth, and extended care services to more than 2 million veterans annually.” In 2017, when Congress was still weighing the merits of expanded VA outsourcing VA, Yehia assured members of the Senate Committee on Veterans Affairs that veterans would only be referred to “high performing, integrated networks” in the private sector. Yet, within the VA, he was part of the bureaucratic opposition to requiring those private sector “partners” to be as well trained and qualified as VA care-givers themselves.
No Outsourcing Standards?
When West Virginia Senator Joe Manchin asked how the VA planned to ensure that all its outside providers had the necessary “skill sets” to care for patients with complex service-related conditions, Yehia informed him that free continuing medical education (CME) credits would be offered to all approved network physicians. Manchin then demanded to know why such training would only be voluntary, not mandatory. Yehia insisted that that the VA couldn’t require such proofs of competency until private doctors and hospital had a larger volume of veteran patients. “If you put a lot of burdens on the community providers and they’re seeing a handful of veterans, they won’t sign up,” he explained.
Questions about quality standards for VA outsourcing are just as relevant today as they were three years ago. President-elect Biden has yet to determine his position on legislation like The Team Culture Act, introduced by Congresswoman Lisa Rochester Blunt, (D-DE). Opposed by Trump and his VA appointees, this bill would require private sector therapists, seeking referrals from the VA, to first undergo additional professional training on treatment of veterans who are suicidal or suffer from PTSD, military sexual trauma, or traumatic brain injuries.
In his campaign platform dealing with veterans’ healthcare, Biden insisted that he, unlike Trump, did not “under any circumstances support moving to total privatization” nor would he ever “defund the VA,” because, his platform stated, “its patients receive care that is “specialized, supportive, and second to none.”
To help fill many VA hospital vacancies–part of Trump’s legacy of mismanagement–Biden says he will boost salaries for doctors, nurses, and other health care workers who serve veterans. But the President-elect also pledged to maintain “the right balance” between “VA care and purchased care”—which does not signal much intention to roll back the partial privatization that began under President Obama and accelerated under Trump. In a presidential candidate forum hosted by Military Times this fall, Biden even criticized his opponent for not rolling out a big enough “community care network” fast enough!
Hopefully, with the help of task force members like Williams, Biden will be reminded that Trump’s “goal of shrinking the VA by expanding access to community care and closing VA facilities” was “a terrible idea,” That was confirmed earlier this year when COVID-19 cases quickly overwhelmed the U.S. health care system and some VA facilities had to be prepared to accept non-VA patients on an emergency basis. Last March, even Trump’s pro-privatization VA Secretary, Robert Wilkie, was forced to announce a 90-day “strategic pause” in referring veterans outside the VA for non-emergency care, because private doctors and hospitals lacked sufficient capacity to absorb new patients. And just this month, Wilkie acknowledged again that, due to the resurgence of COVID-19 around the country, “a lot of private sector venues that we would use for veterans have just dried up. They’ve stopped taking veterans…” Meanwhile, he reported, “veterans are choosing to come with us at record rates” because “they’d much rather be in a VA [hospital] than in the private sector.”
In the face of on-going healthcare challenges like the pandemic, the incoming Biden Administration has good reason to reassess the desirability of diverting more federal tax dollars from the VA to more costly, less qualified, and, now not even accessible private care-givers. But it certainly would have helped VA patients if the President-elect had picked a VA transition team more favorable to such a course correction.
(Suzanne Gordon is a senior policy fellow at the Veterans Healthcare Policy Institute. Her latest book is Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans. Steve Early is a longtime journalist and health care reform advocate. They are collaborating on a book for Duke University Press on veterans’ affairs. This piece appeared originally in The American Prospect.)