Not many know about the Department of Veterans Affairs’s (VA) so-called “fourth mission.” In 1982, Congress expanded the VA’s role beyond providing care, benefits and burial services to the nearly 9 million veterans it currently serves. Its additional role is to provide a backup health care system in a national emergency — for example, taking on non-veteran patients in the event of a global pandemic.
The agency’s Veterans Health Administration is the country’s largest government-run, integrated health system, with more than 300,000 staffers and 1,200 medical facilities across its sprawling administration. The agency stands ready to deploy 16,500 acute-care beds, including 1,000 isolation units and at least 3,000 ventilators. Such resources could prove crucial as COVID-19 continues to spread, threatening to overwhelm hospital capacity across the nation.
In fact, according to VA Press Secretary Christina Mandreucci, VA staff are actively assisting the Centers for Disease Control and Prevention (CDC) in coordinating its emergency response, including deploying a liaison officer to the Department of Health and Human Services (HHS) secretary’s Operations Center, and deploying 16 nursing assistants to assist the CDC with screening returning U.S. soldiers.
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But even as the agency prepares to fulfill this fourth mission, its leadership under the Trump-appointed Secretary Robert Wilkie threatens to jeopardize its success. Even as criticisms mounted over the agency’s prior failure to release a comprehensive plan for addressing the crisis in late February, Wilkie told legislators that the VA did not need additional resources to fight the outbreak. To make matters worse, the agency quietly deleted any mention of its fourth mission from its Office of Emergency Management page on its website earlier this month.
Yet, lawmakers are quickly recognizing the urgent need for the VA’s resources. As part of the $2 trillion economic stimulus package to combat the economic fallout of the outbreak, Congress has allocated nearly $20 billion in new funding for VA hospital expansion and upgrades, testing kits, protective equipment and other resources.
Despite this funding increase, many veterans and experts familiar with the VA told Truthout they’re worried about whether the agency is up to the task after decades of disinvestment and more recent privatization schemes, including the administration’s unprecedented overhaul of the VA in its 2018 Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act, which has funneled billions toward private-sector care for veterans.
The new stimulus bill includes $2 billion to fund private-sector care for veterans. However, VA officials announced Wednesday that the department would freeze its private care program under the 2018 MISSION Act to prevent private hospitals from being overwhelmed. Experts say that such increased funds and an end to outsourcing will be needed for the VA to do what’s necessary to take on COVID-19.
Still, the agency must fill 49,000 vacant positions — including a permanent deputy secretary position. In fact, five federal public sector unions representing nearly 350,000 VA workers are so worried that they recently urged agency leaders to put better plans and protocols in place.
Such disinvestment, outsourcing and understaffing has put the VA in a poor position to handle its role as an emergency health care provider amid the current crisis, and it remains to be seen whether or not an infusion of $20 billion can get the institution on its feet. As of March 31, the VA said it had administered 14,930 COVID-19 tests nationwide, and was tracking 1,347 positive veteran cases, with 41 confirmed deaths.
Joining President Trump in a White House press briefing last week, Secretary Wilkie said his department has 3,000 medical staff on standby, ready to deploy to areas overwhelmed by the virus. “We’re gaming out emergency preparedness scenarios, and we stand ready when the president needs us to expand our mission,” Wilkie said.
A Vulnerable, At-Risk Population
The staffing shortages and current lack of tests and other supplies at VA facilities could put older veterans — a patient population among the most vulnerable to infection due to many veterans’ service-connected, underlying conditions — at an increased risk.
Denny Riley, 75, an Air Force veteran who regularly receives VA care for his disability, is among the demographic most at risk. If he begins to have symptoms of COVID-19, he will be able to quickly call a VA doctor remotely, using the agency’s Telehealth program, and be directed from there. Even in a worst-case scenario in which Riley becomes critically ill and VA medical providers become quarantined or a VA facility is otherwise inaccessible, he can still use the VA’s Tele-ICU program, which brings remote intensive care physicians into a facility’s ICU rooms via video screens to assist localized staff in treating and diagnosing patients.
Riley understands the necessity of the VA abetting the civilian health care system as the outbreak intensifies, but says he is increasingly worried about being pushed out of the VA system and sent to a civilian hospital if the VA becomes overwhelmed.
He greatly prefers his VA care, but says even at his local VA facility, he has witnessed a reduction in staffing levels. “That’s the kind of cutback they’ve made, is in hiring people, so that staffs seem incomplete,” he told Truthout. “If you defund something so that it doesn’t work adequately for the people, then you can point at it and say, ‘See, it doesn’t work,’ and send these people to private health care, and that’s a total boondoggle.”
Another demographic at extreme risk are veterans without permanent housing and those who live on the street. Tramecia Garner is associate director for housing and residential programs at the San Francisco-based Swords to Plowshares, a nonprofit that provides housing and other social services to veterans in the California Bay Area.
Garner, who oversees 476 veteran-dedicated housing units, including two VA-funded, short-term transitional housing sites, says most of the veterans she works with are over 60, and many struggle with service-connected conditions and disabilities. The VA has tested at least three veterans involved in the program for COVID-19; all three of their tests came back negative, she said.
“Folks spending time on the streets and being chronically homeless will come to us with a number of challenges already, so of course [COVID-19] doesn’t help the situation,” Garner said. Still, she says, the VA has been responsive and crucial to her clients’ care.
A Nationalized System
Suzanne Gordon, author of Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans says the media’s depictions of the VA as a failing institution are not only unfair but also inaccurate. She points to an increasing body of research showing that VA facilities deliver care equal or superior to that provided by the private sector. Studies have confirmed such quality even after it was revealed that faulty record keeping concealed lengthy wait times at some VA facilities in 2014.
“What I think we’re suddenly realizing, and the media is realizing, after years of bashing the VA, is that it serves a very important function,” Gordon says.
Despite the agency’s dysfunctional leadership, she says, the VA may prove to be one of the few health care institutions in the country with the proper expertise to contain the outbreak. In fact, the VA has a long record of responding effectively to emergencies, including in climate change-fueled crises in Puerto Rico in the aftermath of Hurricane Maria and more recently during the California wildfires.
The VA set up command posts in both situations and actively reached out to every veteran enrolled in its system to make sure they had access to their medications. “[A national health care system] doesn’t just care for you when you book the service and come in and pay the fee. It cares for you throughout, and it reaches out to you,” Gordon says.
The very fact that the VA’s health administration is a government-run system is its biggest strength in a time of crisis, she says, as it doesn’t have to deal with the profit-driven complexities of the private sector. Because of this, its medical providers can quickly shift staff away from certain tasks to address more urgent needs.
Moreover, the VA’s research and development is not proprietary, meaning all its research toward a possible vaccine for COVID-19 is free and accessible to the public. Still, Gordon says, the agency’s health administration can’t perform any of these necessary functions if it remains underfunded, understaffed and overburdened.
“This crisis really underscores the problems, and really folly, of the MISSION Act, because [the Trump administration] paid so much attention to outsourcing veterans’ care to the private sector,” Gordon told Truthout. “You don’t want veterans going to the private sector now.”
It’s not just Trump who deserves scrutiny, however. The MISSION Act was a bipartisan effort, with Democratic Senators Jon Tester and Doug Jones signing on as co-sponsors, and the bill passing with clear majorities in both chambers. Additionally, Gordon is not very confident that 2020 Democratic presidential frontrunner former Vice President Joe Biden would steer the agency toward a better future if he wins in November.
“Biden makes wisecracks about Italy’s single-payer system, and it doesn’t bode well toward his attitude toward the VA. What’s President Biden going to do with the VA if he doesn’t like single-payer systems and doesn’t understand how they work?” Gordon says. “I would hope that the Democrats, if they get back in office after this … would repeal most of the MISSION Act.”
Paul Cox, a Marine Corps veteran and president of the Veterans Healthcare Policy Institute, agrees, telling Truthout that Democratic presidential candidate Sen. Bernie Sanders has a better track record of strengthening the VA as the former chair of the Senate Veterans Affairs Committee. In fact, Cox says, if Republicans hadn’t filibustered Sanders’s omnibus VA bill in 2014, its health administration would be better prepared to handle the COVID-19 pandemic today.
Ultimately, the question of whether the VA sinks or swims as the outbreak intensifies will play a vital role in the larger fight for a Medicare for All system in the United States. If the VA succeeds in helping to stem the pandemic’s impacts, it could serve as a key example of how a single-payer system is uniquely able to address an unprecedented public health crisis.
“The VA is being looked at right now as a sort of model for what a single-payer health care system looks like, and in a lot of ways it does a very good job of that,” says Essam Attia, an Army veteran and activist with Veterans for Peace and Common Defense who gets his care from the VA. “If the VA does get the funding that it needs to be able to respond to this crisis properly, it could be an amazing message to the country as to what a different health care system could look like. On the flip side, if it fails in a major way, it could backfire, and it could be something that is used against the idea of a single-payer health care system…. It’s a double-edged sword.”
Riley, the 75-year-old disabled Air Force veteran, is more hopeful. “I think in this particular situation, the VA will outshine private health care. I think the VA is in a better position to be a star player in this. I may be completely wrong, but I think they are,” he said.