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AP FACT CHECK: Trump’s overhaul of vets care is no quick fix

June 7, 2018
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President Donald Trump speaks during a bill signing ceremony for the "VA Mission Act" in the Rose Garden of the White House, Wednesday, June 6, 2018, in Washington. The bill will expand private care for veterans as an alternative to the troubled Veterans Affairs health system. (AP Photo/Evan Vucci)

WASHINGTON (AP) — President Donald Trump is setting up veterans for likely disappointment as he tells them they have freedom to get quick medical care from private doctors when they’re unhappy with government-run health care.

He is casting a bill that he signed into law Wednesday as an immediate cure-all to long wait times for medical treatment. But he glosses over the fact that the private-sector program often takes longer to provide care than Department of Veterans Affairs medical centers. Trump also neglects to mention that the White House is opposing a plan to fund the newly expanded Choice program, which could see escalating costs as more veterans seek the flexibility of picking their own doctors.

A look at his claims at the bill signing :

TRUMP: “In the campaign, I also promised that we would fight for Veterans Choice. ... It seemed like if they’re waiting on line for nine days and they can’t see a doctor, why aren’t they going outside to see a doctor and take care of themselves, and we pay the bill? It’s less expensive for us, it works out much better, and it’s immediate care. And that’s what we’re doing.”

THE FACTS: The care provided under the Choice private-sector program is not as immediate as Trump suggests, nor does it always work out much better. Currently only veterans who endure waits of at least 30 days — not nine days — for an appointment at a VA facility are eligible to receive care from private doctors at government expense. Under a newly expanded Choice program that will take at least a year to implement, veterans will still have to meet certain criteria before they can see a private physician, such as when a local VA facility does not offer the services required or veterans face an “unusual or excessive burden” to getting the care they need.

Waits for a private doctor are not always shorter. VA has said its medical facilities are “often 40 percent better in terms of wait times” compared with the private sector.

There also is little evidence that providing private care to veterans compared with treatment at one of VA’s 1,300 clinics and hospitals will be “less expensive.” Experts generally agree that VA care is less costly due to economies of scale. A congressional commission in 2016 determined that giving veterans more flexibility to see doctors outside the VA system would probably increase costs, due in part to growing demand from veterans who are drawn by the idea of picking their own doctor.

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TRUMP: “This bill speeds up the claims process, increases the health services, expands access to walk-in clinics, and fights opioid addiction.”

THE FACTS: It’s not clear if a newly expanded Choice program will speed up the claims process.

A Government Accountability Office report released this week found that despite the Choice program’s guarantee of providing an appointment within 30 days, veterans waited an average of 51 to 64 days; the process took as long as 70 days. Investigators faulted bureaucratic inefficiency and understaffing at VA, which contributed to delays in making referrals and scheduling appointments. They warned of continuing problems of long waits under a newly expanded Choice program until the VA is able to more easily exchange veterans’ medical records with outside physicians; the VA has said achieving that could take years.

Pointing to faulty data, government investigators said the VA “cannot determine whether the Choice program has helped to achieve the goal of alleviating veterans’ wait times for care.”

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TRUMP, on expanding the Choice program: “This has been for years; for 30, 40 years, they’ve been trying to get this done, and they haven’t been able to. And we got it done.”

THE FACTS: It’s not done. Trump signed into law a bill that would loosen restrictions for veterans seeking medical care outside the VA system, but it’ll take at least a year to implement and its actual scope in expanding choice to veterans will depend on the next VA secretary, who has yet to be confirmed by the Senate. A successful expansion of private care will also depend on an overhaul of electronic health records at VA to allow for a seamless sharing of records with private physicians. That overhaul will take at least 10 years to be complete.

Limited money for the program could also hamper its effectiveness. A group of senators is seeking to pay for the law by adding new funds to cover the VA private care program, but the White House has been quietly working to block that plan, saying it is “anathema to responsible spending.” The White House is insisting that added costs of the newly expanded private care program be paid for by cutting spending elsewhere at the VA, something that major veterans groups generally oppose.

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TRUMP: “My administration has also taken action to ensure veterans can seamlessly transition their medical records from the Department of Defense into the VA. ... It was almost impossible to do. It took years to do. We’ll do it immediately now. We’re set up.”

THE FACTS: No, it’s not set up. The VA last month signed a $10 billion contract with Cerner Corp., the same company that is overhauling the Pentagon’s electronic health records. But a full rollout of the new VA health records is expected to take at least 10 years.

The contract, one of the largest in VA’s history, has also drawn concern from lawmakers that it could be plagued with problems and ultimately prove ineffective.

A report released last month from the Pentagon’s director of operational test and evaluation found that a partial rollout of Cerner’s electronic health record for the Defense Department is “neither operationally effective nor operationally suitable.” The report cited, in part, inaccurate data and a confusing layout of the records.

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