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Veterans who have trouble getting timely mental health care from Veterans Affairs hospitals and clinics should also have access to thousands of health care providers who care for military personnel and their families, says the Republican chairman of the House Committee on Veterans Affairs.
The proposal by Rep. Jeff Miller, R-Fla., borrows from the playbook of Republican Mitt Romney, who raised the idea of tapping into the military's Tricare network of doctors during the course of the presidential campaign.
"We can double overnight the number of providers for those who are in need," Miller said in an interview. "Eighteen veterans a day commit suicide in this country. Nobody thinks that is acceptable."
The VA has beefed up its mental health staff over the years to try to keep up with the needs of soldiers returning from Iraq and Afghanistan, but a critical inspector general's report last year found that about half of those seeking care for the first time waited about 50 days before getting a full evaluation. The VA had been reporting that the vast majority of those patients were getting care within 14 days.
Shortly before that report was released, the VA announced it would be adding 1,900 mental health professionals to its staff. VA officials said the department has made good progress on the hires, but they couldn't provide specific numbers yet.
Miller says tapping into Tricare's network of psychologists and psychiatrists would allow many veterans to get care closer to home, particularly those who live in rural communities. He doesn't have an estimated price tag yet, but says that whatever it is, that's part of the cost of war. His proposed expansion would only apply to mental health care.
Still, even a modest increase in spending could make Miller's proposal a tough sell at a time when Congress is focused on cutting the federal debt and dealing with the threat of across-the-board spending cuts to defense and discretionary programs.
Asked about Miller's proposal, VA spokesman Josh Taylor said the department is "committed to providing high-quality, comprehensive care directly to veterans, instead of leaving veterans to navigate complex, unconnected providers who might not be experts in veterans' unique healthcare needs."
Miller acknowledged that veterans groups are traditionally wary of relying on health professionals outside the VA system because they view it as the first step to tearing it down. The congressman said he agrees veterans get excellent care from the VA — when they can access it.
"We simply want to expand a very capable system," Miller said.
In some instances, the VA already contracts with local doctors in rural settings to treat VA patients, but that represents a tiny fraction of the patient visits that occur each year. The number of veterans getting mental health treatment from the VA has been steadily rising: from 927,052 in 2006 to more than 1.3 million in the fiscal year that ended Sept. 30.
Nearly 22 million veterans live in the United States, but fewer than half are enrolled in the VA system. It's generally reserved for those who have a disability or illness stemming from their service. Also, all returning Iraq and Afghanistan veterans are eligible for VA care during their first five years back from deployment.
The Tricare program serves those currently in the military, their families and those who retire from the military. The two health systems are quite different. The doctors at VA-run facilities are government employees paid a fixed salary for the work they do. Doctors in Tricare agree to participate in a managed care program and are reimbursed at a rate set by the insurer. Under Miller's proposal, the VA would pay that rate without additional costs to the veteran.
Days after Romney proposed giving veterans access to Tricare for mental health treatment, President Barack Obama issued an executive order that requires the VA to set up a minimum of 15 pilot projects focused on contracting with local providers to meet the mental health needs of veterans.
Miller's proposal is more sweeping. Sen. Bernie Sanders, an independent and the new chairman of the Senate Committee on Veterans' Affairs, said he's open to the idea.
"While we must do everything that we can to greatly expand the VA's mental health capabilities, I am open to exploring options outside of the VA for contracting services with public and private mental health providers, including Tricare," Sanders said.
Veterans groups are noncommittal at this early stage. They traditionally prefer beefing up the VA's capacity rather than going outside the system.
"It's a fantastic system," Joe Davis, a spokesman for Veterans for Foreign Wars, said of the VA. "For contracted-out care, we will only concede to that for extremely rural areas, or for specialized care, when that type of care is not readily available at the VA."
With that caveat, Davis said the suggestion is worth a look.
Dr. James Tuorila, a clinical psychologist in St. Cloud, Minn., who also advises the VFW on mental health issues, said he's afraid many of the doctors who see Tricare patients still don't have the specialized training the VA offers its psychiatrists and psychologists for treating such illnesses as post-traumatic stress disorder.
"Being a veteran myself, there was an affinity to working with other veterans. The VA needs to step up on training and on offering internships so it can hire more of these professional veterans in the mental health area," Tuorila said.