The Department of Defense and the Department of Veterans Affairs may be considering merging parts of their two health care programs in a move that could alter how about 19 million military personnel, retirees, dependents and veterans receive care.
In an announcement released Jan. 31, the Defense Health Agency said that an initiative known as DOD VA Health Care Staffing Services has reached the “strategy development stage.” The effort is designed to merge the delivery of health care using facilities run by both agencies to serve the two populations of beneficiaries in a combined fashion, according to veterans’ advocates.
“The idea in itself makes sense,” said Pat Murray, Deputy Director of the National Legislative Service for Veterans of Foreign Wars. “But it’s going to be a lot harder than I think they understand.”
“I think you have the possibility to save,” said Kathy Beasley, Director of Health Affairs for the Military Officers Association of America. “Where there might be excess capacity in one area it may be utilized by beneficiaries in the other,” Beasley said.
In October, the DHA, which oversees the health care system for the 9.4 million participants in the military, sought health-care company feedback on the private industry’s ability to supplement clinical operations in Pentagon and VA facilities. That request also said DHA had “partnered with the VA to determine the feasibility of a joint strategic solution for the delivery of integrated, high-quality health care services to 19 million beneficiaries.”
Although the two health care systems serve populations of roughly similar numbers, they deliver care differently and serve a different clientele: The VA on average treats an older population, while DOD deals more with younger individuals and families.
The move would offload some of the VA’s burden onto the military health care system, according to Murray. VA has struggled in recent years to provide timely care to veterans within its internal systems. Congress overhauled a community care program in 2018 that expands opportunities for veterans to receive government-subsidized care from private providers.
In December, the VA announced the award of the first three of six contracts for its community care program, which will greatly expand the use of civilian providers. Bloomberg Government has estimated that health spending through the private health care program could reach as much as $21 billion annually.
A merger of the two health care systems is likely to be a complex undertaking compounded by political resistance. Both veterans’ service organizations and those that represent military personnel are always concerned that drastic changes to their members’ health systems will have a negative impact on care.
The Trump administration and officials from both departments came under fire in 2017 for secretly considering merging parts of the two health care systems. Lawmakers said any attempt to combine the two would require congressional oversight and significant input from stakeholders.
Political infighting over community care also led to the ouster of then-VA Secretary David Shulkin in 2018. Democrats have promised to stop any further health care privatization attempts at the agency and are already gearing up for a fight over the implementation of the community care overhaul.
Not every stakeholder will resist the idea, however: The proposal could present enormous opportunities for federal contracts both in resolving the technical and logistical barriers to the merger and in the further expansion of the Tricare and community care programs into the private sector.