Sen. Marsha Blackburn, R-Tenn., speaking Tuesday, Jan. 28, 2025, during a meeting of the Senate Veterans’ Affairs Committee. She has introduced legislation that allows veterans to directly schedule their own appointments for private health care at non-VA facilities. (Eric Kayne/Stars and Stripes)
WASHINGTON — Legislation that would allow veterans to bypass pre-approval to get their health care outside the Department of Veterans Affairs is gaining traction in Congress.
The Veterans Health Care Freedom Act would make it easier for veterans to obtain medical services from doctors in private practice by removing eligibility requirements for non-VA care.
Introduced by Rep. Andy Biggs, R-Ariz., in December, the bill has collected 24 co-sponsors in the House.
Sen. Marsha Blackburn, R-Tenn., also introduced a companion bill in the Senate that would enable veterans to make an appointment with a clinician in private practice without the VA first determining the medical service is not readily available at a VA health facility close to the veteran’s home.
Though similar legislation was introduced a few years ago, it did not gain momentum in Congress. But interest by lawmakers in easing the rules for community care has grown along with the demand by veterans for the health coverage.
About 40% of veterans care is now provided outside the VA, according to the agency. Demand for community care keeps rising each year, lawmakers said.
The Senate bill, co-sponsored by Sens. Tommy Tuberville, R-Ala., and Roger Wicker, R-Miss., is designed to give veterans more control over how and where they receive their health care.
“Streamlining the VA community care program is a common-sense way we can increase access to care and cut through red tape,” Tuberville said.
Passage of the Mission Act in 2018 for the first time enabled veterans to receive health care coverage outside the VA for service-connected illnesses and injuries. The VA covers the cost of care delivered by private clinicians registered with the agency’s health care network.
But veterans must meet specific conditions to receive care from a clinician in private practice. The VA pre-approves the service before an appointment is made.
Veterans must first show that they face long delays for treatment or a specialty medical service that they need is unavailable at a VA facility close to home.
Navy veteran Marie Smith, 60, of California said she often experiences two- to six-month waits for VA appointments for cardiology, ophthalmology, neurology and pain management. But Smith said the VA rarely informs her of the options for care in the community.
“The VA is very reluctant in most cases to give referrals for community care. I think it has to do with the costs,” said Smith, a former corpsman who served in the Navy from 1987-1988 and was honorably discharged after injuring her back and neck in a vehicle accident.
This legislation would take the VA out of the referral process, Blackburn said, enabling veterans to have the final say about where and how they get their health care.
Blackburn also said she and other lawmakers increasingly hear from veterans frustrated by the requirements.
The legislation would authorize a three-year pilot program allowing veterans to go to a doctor in private practice without first receiving a referral from the VA. The goal is to expand the program to all veterans after the pilot program ends, lawmakers said.
The pilot program would be funded through the existing VA budget, which is $369 billion in fiscal 2025.
“This bill will remove the barriers many veterans face in accessing care closer to home or at higher quality facilities in their local communities,” according to Concerned Veterans for America, a conservative nonprofit veterans advocacy organization that supports the legislation.
Under the legislation, veterans would have the same access when making appointments with primary care doctors, specialists and mental health counselors as they now have when seeking urgent care in a community setting, supporters said.
Smith said she is eager to see less involvement by the VA in administering community care because of the delays that she encounters. She has had problems with follow-up from the VA in tracking and verifying authorizations and then delivering reimbursement after the medical treatment.
“Everything seems to fall into a blackhole at the VA. If they don’t lose the approval paperwork, it gets shuffled to different people. There are delays to getting notified, when you’re approved for community care,” Smith said.
Blackburn said she believes the VA effectively discourages veterans from seeking community care with “layers of bureaucratic red tape and a lack of accessibility to their local medical providers.”
Wicker added: “Veterans must have access to community health care facilities. This legislation gives them more choices for medical care and helps avoid long wait times at VA facilities.”
