In mid-April, U.S. Sen. Jon Tester, a Montana Democrat, and Sen. Jerry Moran, a Kansas Republican, sent a letter to Secretary of Veterans Affairs Denis McDonough demanding to know why the agency was wounding itself. 

Specifically, they worried about a series of seemingly contradictory eligibility and staffing policies. In March, the VA handed down a directive that expanded healthcare eligibility to millions of veterans who were exposed to toxins and other hazards while serving in the military. And yet not long after, the department paused hiring for most positions, with plans to cut as many as 10,000 full-time staff in 2025 and then another 10,000 in 2026. 

“They’re cutting front-line people who see patients in the clinic,” an anonymous VA official vented to CNN, which broke the news of the Congressional letter. “We have no idea why they are making this move.”

Moran and Tester expressed similar surprise, deriding the VA’s staffing reductions as both “drastic” and “shortsighted.” Their condemnation was at once politically advantageous and deeply disingenuous. Moran and Tester, after all, are Washington’s two most powerful veterans’ policymakers. Not only are they both acutely aware of the forces squeezing VA staffing levels, but they also played leading roles in creating this crisis. As they dashed off their pointed questions to McDonough, both Moran and Tester had on their desks a VA Red Team report, written by independent experts on veterans’ care, that provided precise details of what’s gone wrong with VA budgets and staff — and how to fix it.

The report makes clear that VA is not struggling with these issues due to some dangerous or self-defeating instinct, but simply because Tester, Moran, and their Congressional colleagues have waged a campaign to redirect public dollars from VA care into the private sector.

This work was launched in earnest exactly a decade ago, with the passage of the 2014 VA Choice Act, and solidified four years later via the VA MISSION Act. These twin laws, boiled down to their essence, outsource care to the private sector when the VA cannot offer services under a set of arbitrary and often illogical conditions. (If, for instance, an appointment cannot be confirmed within 28 days, a VA patient is given a referral to the private sector, even when the wait time there is ultimately longer.)

Tester and Moran were key supporters of both bills and have stuck by them even as serious issues around cost, contractor negligence, and quality care issues have emerged. In 2017, for instance, a reporter at Montana Public Radio pointed to Choice’s myriad problems before asking Tester why the program should not simply expire.

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“Because I think there’s a role for community care to fill in the cracks around the VA care,” Tester replied. That same year, Moran ignored similar problems with Choice. He introduced legislation to reform the program, but it was overwhelmingly focused on how to allocate more money for private care and to more seamlessly pay private providers

Since then, leaders in both parties have allowed private care spending to spiral out of control – repeatedly employing the rhetoric that private providers are vital to filling in gaps while, in reality, allowing them to cannibalize the VA’s care budget. The Red Team report crystalizes this worrying trend, noting that 40 percent of VA patients were provided private care in Fiscal Year 2022 – fueling a surge in private care costs which is now over $30 billion annually. 

“This could create a self-perpetuating cycle in which increased community care spending results in less direct care funding that negatively impacts direct care capacity, leading to increased community care reliance, and a continuous ‘downward spiral’ for VHA’s direct care system,” the report concludes. An evident sign of this spiral is the VA’s belt-tightening for staff that now has lawmakers up in arms. 

The contents of the report were first reported by The American Prospect. Its six authors include Kenneth W. Kizer, a Navy veteran and nationally known leader in healthcare quality and hospital management, who, as VA Under Secretary for Health, led the transformation of the modern VHA under President Bill Clinton.  Also on the Red Team is Dr. Jonathan Perlin, who served in the same role under President George W. Bush and is now the President and CEO of The Joint Commission Enterprise.

Despite their diverse backgrounds, the authors came to the unanimous decision thatVA urgently needs to take action to control community care utilization and spending if the direct care system is to continue to be available to serve the diverse, specialized, and often highly complicated health care needs of enrolled veterans.”

Were Tester and Moran to meaningfully engage with this report, they would find solutions to the staffing problems they’re publicly fuming about. The authors urge leaders, for instance, to highlight VA’s superior care compared to that delivered by the private sector. They also ask Congress to adequately provide the resources needed to build the VA’s internal treatment capacity.

“Absent additional new funding to pay for rising VCCP costs,” the authors concluded, “VHA will likely be forced to consider eliminating VHA direct care services or closing VA facilities.”

The letter from Tester and Moran is ultimately frustrating but unsurprising. Throughout the VHA’s history, Congress has established a predictable pattern of failing to adequately fund and support the VA, followed by cynical political attacks on issues that stem directly from this underfunding. Lawmakers are also now facing lobbying not only from veteran service organizations(VSOs) but private companies involved in this outsourcing campaign. In this election cycle alone, David McIntyre, the founder and CEO of TriWest Healthcare Alliance, which earns billions administering the VA’s private care network as one of its two third-party administrators (TPAs), has given $4,950 and $3,000 to Tester and Moran, respectively, according to federal election records. 

When McIntyre has appeared before the Senate Veterans Affairs Committee, he’s generally received a warm reception. More recently, when McDonough came before the committee, Tester vaguely ordered him to make more investments in staffing without acknowledging Congress’ vital role as holders of the purse strings and drafters of the policies. 

“Hopefully your VISN Directors will take a look and say, ‘Hey, we’ll put pressure on you to get more docs in here because we need them,’” Tester said. “Otherwise, the community care issue is going to continue to grow and grow and grow.”

A senior Hill staffer fumed that lawmakers are engaging in “willful ignorance,” refusing to draw a connection between VA budgetary issues and outsourcing. Also unacknowledged is the fact that VA care is safer, faster, and more effective than private options. “The real interest is not quality of care, it’s shoveling taxpayer dollars into the pockets of TriWest and other VA contractors,” the staffer contended. 

Indeed, the major veterans policy package being pushed for passage ahead of Election Day contains two poison pill proposals aimed at further loosening eligibility rules for private care. These actions will demand even more money. By contrast, insourcing efforts recommended by the Red Team could save the VA billions of dollars annually. “The lay of the land now is simple,” the Hill staffer concluded. “Conservatives really want to open the door to even more outsourcing, and Democrats are too spineless to stick up for the VA as an institution.” 

If Tester and Moran really want to serve veterans, they should be carefully reviewing the Red Team report and pushing VA to immediately implement its findings. Without swift action, the Red Team’s authors warn, the VA will continue “eliminating choice for the millions of veterans who prefer to use the [VA] direct care system for all or part of their healthcare needs.”

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