Veterans Will Have More Access to Private Health Care Under New V.A. Rules

Critics fear that private health care, which tends to have higher costs than government-provided care, will force the department to cut corners elsewhere. Trump has instructed his cabinet secretaries to cut each department’s budget, and a prior budget agreement that lifted caps on spending is set to expire soon, leading many to wonder if Veterans Affairs will be able to pay private providers and maintain its own services.

A congressionally mandated report in 2016, by a panel called the Commission on Care, analyzed the cost of sending more veterans into the community for treatment and warned that unfettered access could cost well over $100 billion each year. That same commission found quality of care at the Department of Veterans Affairs to be very high, one area of agreement between department officials and those who use and advocate the system.

The new standards were developed after V.A. officials studied both the military’s insurance plan, Tricare Prime, which sets a lower bar for access to private care than the department has historically had, and the Medicare Advantage program, which allows Medicare beneficiaries to buy private health insurance plans instead of using government-run fee-for-service Medicare.

The Department of Veterans Affairs will remain at the center of care coordination, and the private providers — who would be paid by the department at rates roughly comparable to the Medicare program — would not be permitted to cherry-pick the healthiest patients, V.A. officials said. About 26 percent of veterans pay a co-payment, and they would have similar co-payments at private doctors.

The department, however, has struggled greatly with its information technology systems in recent years, and studying those systems is now the purview of a House subcommittee. Whether the department can successfully coordinate care with myriad health care providers will be a concern that Congress will doubtlessly follow.

Department officials — including Wilkie — have repeatedly insisted that the department should and probably will remain the provider of choice for most veterans, who prefer the culture of a V.A. hospital to that of the private sector. But a shrinking veteran population over all in the United States and more reliance on private providers could lead to the closings of some government hospitals, some veterans groups and members of Congress warn.

Wilkie insisted that was not the goal of the new policy, and said that fears of full privatization were unfounded.