The House Committee on Veterans Affairs held an Oct. 24 hearing on pending draft legislation to reform how veterans access care at non-Department of Veterans Affairs (VA) facilities. VA Secretary David Shulkin, MD, also testified regarding a VA proposal released Oct. 16, titled the “Veteran Coordinated Access and Rewarding Experiences (CARE) Act.”
In his opening statement, Committee Chair Phil Roe, MD, (R-Tenn.) reiterated “this effort is in no way, shape, or form intended to create a pipeline to privatize the VA healthcare system.” Of importance to VA’s academic affiliates, Dr. Roe’s draft legislation affirmatively retains authority for direct health care resource contracts under 38 U.S. Code § 8153, often referred to as sole-source affiliate contracts. The VA’s CARE Act also appears to make no changes to this authority.
Reps. Mark Takano (D-Calif.) and John Rutherford (R-Fla.) both questioned Dr. Shulkin about the effectiveness of the VA’s GME service obligation proposal to recruit the most competitive medical residents. Rep. Takano also submitted for the record a letter from Deborah Deas, MD, dean of the School of Medicine and CEO for Clinical Affairs, University of California Riverside, expressing similar concern. Likewise, the Disabled American Veterans noted in written testimony, “While we support the intent of creating new incentives to bring clinicians into the VA health care system, we believe that further discussion and consideration of alternate incentives should occur before moving forward with this provision.”
Dr. Shulkin responded to these concerns, “The best asset that the VA has is its academic partners, thanks to General Bradley in 1946 and his vision of establishing these teaching relationships. So you're going to have the very best medical schools and residency programs in the country, expanding spots and medical students deciding whether they want to apply for those spots or not, even if they are tied to giving back service to the VA. So I believe it will be an experiment whether they are competitive.”
Rep. Ann Kuster (D-N.H.) also questioned why the VA could not use the existing VA GME expansion program. Dr. Shulkin noted that VA is “only allowed to pay for the time the resident is in the VA, so the academic partners have to come up with their own money to at least match that and they're capped out at the Medicare rate.”
Dr. Shulkin and Rep. Rutherford also discussed whether increasing student loan repayment programs would be a less expensive and more effective recruitment incentive. Rep. Rutherford Oct. 25 introduced a bill (H.R. 4132) that would establish a “residency loan payback program” that would provide $160,000 for four years of VA commitment.
The committee is expected to mark up its final legislation in November. The Senate VA Committee is also expected to introduce new VA reform legislation, building on bills discussed in July [see Washington Highlights, July 14].