Press Release

February 27, 2015
Cardin, Mikulski, Bipartisan Group of Senators Urge Improvements to Veterans Choice Program

WASHINGTON – U.S. Senators Ben Cardin and Barbara A. Mikulski (Both D-Md.) were joined by 40 colleagues in writing to Secretary of Veterans Affairs Robert McDonald with serious concerns about the implementation of the Veterans Choice Card program. Veterans living in Western Maryland and on the Eastern Shore in particular have seen no change in their care options since the program was implemented.


The Veterans Choice Card program was established by Congress last year in response to the nationwide crisis of veterans’ access to care, but has yet to be implemented as Congress envisioned. The program allows veterans who live more than 40 miles from the closest VA facility, or who face a significant delay in scheduling an appointment, to access non-VA care.


“The VA is construing the eligibility criteria as it relates to the 40-mile rule so narrowly that it is excluding too many who are far away from the care that they need,” wrote the senators. In addition, the Veterans Administration has said that it plans to propose reallocating funds for the Veterans Choice Program to other VA accounts. The senators urged Secretary McDonald to make certain that funding provided by Congress is being used to implement the Veterans Choice Program to the fullest extent possible.


“When we promise better health care access for those who have risked their lives in service to our country, we must deliver on it. Our veterans have come through too much for us not to come through for them,” said Senator Cardin. “We simply cannot allow bureaucratic technicalities to get in the way of quality health care for our veterans.”


“Veterans in rural communities across Maryland and America who have fought for our freedom shouldn’t have to fight the red tape of bureaucracy for the care and benefits they have earned and deserve,” Senator Mikulski said. “It’s past-time these bipartisan reforms be enacted so veterans can access  the care they need from a doctor in their own community. Promises made to our veterans and military families must be promises kept.”


The letter is signed by Senators Cardin and Mikulski, Susan Collins (R-Maine), Jerry Moran (R-Kans.), John McCain (R-Ariz.), Angus King (I-Maine), Chuck Grassley (R-Iowa), Ed Markey (D-Mass.), Joni Ernst (R-Iowa), David Vitter (R-La.), Joe Manchin (D-WV), Deb Fischer (R-Neb.), Amy Klobuchar (D-Minn.), Jeff Flake (R-Ariz.), Mark Warner (D-Va.), Mike Crapo (R-Idaho), Ron Wyden (D-Ore.), Orrin Hatch (R-Utah), Barbara Boxer (D-Calif.), Pat Roberts (R-Kan.), Tim Kaine (D-Va.), John Barrasso (R-Wy.), Sherrod Brown (D-Ohio), Mike Enzi (R-Wyo.), Heidi Heitkamp (D-ND), Marco Rubio (R-Fla.), Thom Tillis (R-NC), Pat Toomey (R-Pa.), Martin Heinrich (D-NM), Shelley Moore Capito (R-WV), Steve Daines (R-Mont.), Jim Inhofe (R-Okla.), Richard Burr (R-NC), Lamar Alexander (R-TN), John Thune (R-SD), Tom Cotton (R-Ark.), John Hoeven (R-ND), Ted Cruz (R-Texas), Jeff Merkley (D-Ore.), Ron Kirk (R-Ill.), Claire McCaskill (D-Mo.), Tim Scott (R-SC), and Brian Schatz (D-Hawaii).


The full text of the letter is below.


The Honorable Robert McDonald

Secretary of Veterans Affairs

U.S. Department of Veterans Affairs

810 Vermont Avenue

Washington, DC  20420


Dear Secretary McDonald:


Since November 1, 2014, the Choice Card, as provided under the recently enacted Veterans Choice, Access, and Accountability Act of 2014, has been distributed to approximately 8.5 million Veterans nationwide, yet less than one percent of recipients – 0.37 percent – have been authorized to access non-VA care through this program.   With this in mind, we write to convey serious concerns regarding your implementation of the Choice Card Program with respect to funding for the program in connection with the Fiscal Year 2016 Presidential Budget Request and your interpretation of the 40-mile rule as provided under the Act.  We ask you to address both of these concerns immediately.   


First, we were dismayed to learn from the President’s Fiscal Year 2016 Budget Request that the Department of Veterans Affairs intends to submit a legislative proposal that would reallocate part of the funding for the Veterans Choice Program to other programs within the VA.  It is deeply disturbing that the Administration would try to reduce funding for this program before this program has even been allowed to work – being in existence for only a few short months – and as barriers to care continue to exist.  Instead, the Department should make certain that funding provided by Congress is being used to implement the Veterans Choice Program to the fullest extent possible.


Second, the VA is construing the eligibility criteria as it relates to the 40-mile rule so narrowly that it is excluding too many who are far away from the care that they need.  As you know, the Choice Program provides Veterans with the option to receive non-VA health care rather than waiting for a VA appointment if there is a significant delay in scheduling an appointment or a Veteran has to travel more than 40 miles to receive VA care.  While many Veterans are satisfied with care provided through the VA Health Care System, trips to VA medical centers can be difficult for rural Veterans, especially those who are elderly or ill.  Because long drive times are a hardship for these individuals and can present a significant barrier to accessing care, many Veterans anticipated using their Choice Cards when Congress established the Choice Program last year. 


The VA’s definition of the eligibility criteria is too narrow in two important respects. First, the VA does not consider the type of care available within 40 miles of where a Veteran lives.  In many areas across the nation, the effect is that those who need services only available at a VA medical center, but who live near a Community-Based Outpatient Clinic, are prevented from using the Choice Card to access specialty care in their local community.  While the Clinic may be within 40 miles, the VA hospital offering the required care is often more than 40 miles and hours of travel time away.


Second, the VA measures the 40 miles “as the crow flies” and not the actual distance that the Veteran would have to travel.  Congress’ intent was to establish a pilot program that would allow Veterans to access non-VA care when they face an obstacle to care, whether it be an unacceptable distance to care or wait time for care.  Given the clear intent of Congress to reduce barriers to care, it is perplexing that the VA is not using its authority to allow non-VA care for those who face a geographic challenge in accessing care, including long drive times or health conditions that make travel difficult.  The impact of such an interpretation is to exclude from the program many of the Veterans for whom Congress aimed to make health care more accessible.  For Veterans in remote and rural areas with limited transportation access, this could mean the difference between 30 minutes and half a day of travel. 


As Secretary, you already have the authority to modify the way that the distance criteria is calculated so that the Choice Program is implemented as Congress intended, and we urge you to rectify the overly narrow definition without delay.  Additionally, we urge you to stop any attempt to propose a reallocation of funds designed to kill the Choice Card program in its infancy.