Disadvantaging the VA: How VA Staff View Agency Privatization and Other Detrimental Policies
I use the VA as I am eligible for it. I need to apply for my two+ years in and out of Camp Lejeune. Just have not done. My disorder comes and goes and Rituxan seems to put it into remission. There are others there who have far more serious issues than I. The VA does offer good care in spite of what you hear. These reports as shown here are not made up. If you have some time, read patient comments.
When President George W. Bush launched the “War on Terror,” Republicans almost immediately pushed for deep and poorly timed VA budget cuts. In 2003, the House tried to slash nearly $15 billion worth of veterans’ programs. At risk, according to the Boston Globe, was “money for disabilities caused by war wounds, rehabilitation and health care, pensions for low income veterans, education and housing benefits, and even— nice touch—burial benefits.”
Democrats eventually thwarted this effort but were unable to bolster the overall VA budget so the agency could address current and future needs. In fact, that very same year, the VA announced it was forced to start turning away many middle-income applicants applying for new medical benefits.
Not long after, the Bush administration killed a bipartisan Congressional effort to add $1.3 billion for VA hospitals to the war and reconstruction budget. In 2004, Congressionally chartered Veterans Service Organizations (VSOs) like AMVETS, Disabled American Veterans, Paralyzed Veterans of America, Veterans of Foreign Wars, and Vietnam Veterans of America unsuccessfully pleaded for $3.7 billion more for the VA than the administration was requesting. Even Bush’s own VA Secretary, Anthony Principi, publicly complained that the President was not adequately funding the agency. He testified:
“I asked OMB for $1.2 billion more than I received,” he testified.
“We are facing a crisis today because we have underfunded VA healthcare,” former Texas Congressman Chet Edwards said in 2005 remarks while serving on the House Committee on Veterans Affairs. “We should correct it before Congress takes one more day of recess or vacation.
A Survey of VA Employees
In the spring of 2022, the Veterans Healthcare Policy Institute (VHPI) sent a survey to ~90,000 VHA and VBA employees represented by the American Federation of Government Employees (AFGE). Within AFGE, this survey was supported by the National VA Council (NVAC), which works to improve VA employee wages and working conditions—and by extension quality of care and benefit services—through contract negotiation on the AFGE-VA Master Agreement and administration of that agreement at locations with represented members across the country.
VHPI posed questions about how employees and veterans are being impacted by a series of policies, including the VA MISSION Act, the VA Accountability and Whistleblower Protection Act, a Trump-era Human Resources Modernization project, VBA productivity standards, and the outsourcing of medical exams related to VBA disability claims.
More than 2,000 employees (VHA = 1,680; VBA = 359) completed the entire survey. Roughly 30 percent of all respondents served in the military. Every one of the VHA’s 18 Veterans Integrated Service Networks (VISNs) had at least 50 respondents. They spanned a wide spectrum of clinical, administrative, and support roles including physicians, nurse practitioners, physician assistants, registered nurses, nursing assistants, physical therapists, diagnostic radiologic technologists, police officers, plumbers, groundskeepers, clerks, and dozens of other occupations. Specifically:
- 33 percent were nurses
- 3 percent were physicians
- 25 percent were other health professionals
- 23 percent served in various administrative and other support jobs
- 16 percent were “other” positions, including VBA claims processors and other administrative support staff.
Our queries were framed as multiple-choice questions. Respondents were invited to provide supplementary written comments, and hundreds did so. Our comprehensive survey data is expressed through graphs in Appendix A (for VHA) and Appendix B (for VBA). In these two appendices, we dropped “Not Applicable” answers when tabulating final percentages.
The survey results, which are contextualized and analyzed in this report, reveal a series of mounting challenges. Most relate to the outsourcing of care to the private sector through the VA MISSION Act of 2018 and Choice Act of 2014, which is hurting staff morale and negatively affecting veterans’ health.
Many employees have concerns about the VA Human Resources Modernization project, launched during the Trump administration and continued under President Joe Biden. Many also expressed concern and opposition to VA Secretary Denis McDonough’s March 2022 recommendations to close dozens of facilities and units as part of the Asset and Infrastructure Review Commission (AIR) process, another MISSION Act mandate.
McDonough was forced to retreat, at least temporarily, from these plans when key senators refused to confirm President Biden’s AIR Commission nominees and Congress voted to defund the Commission. Nevertheless, the resulting job insecurity, and stress, has led many to reconsider their careers at the agency.
The survey’s major findings, which were summarized in an interim report published in the summer of 2022, are as follows:
- The VHA workforce is experiencing serious underfunding and understaffing. Tens of thousands of vital jobs are going unfilled. Sixty percent of respondents reported losing key resources, especially staff, over the last four years. Ninety-five percent said their facilities needed more frontline staff. Seventy-five percent said they needed more administrative/support staff. Seventy-seven percent said that there are vacant positions for which no recruitment is taking place.
- Sixty-six percent of VHA respondents reported that beds, units, or programs have been closed in their facility due to staffing and budget shortages, even when there is patient demand for such services.
- Almost 30 percent of VHA respondents have shifted a portion or a majority of their work to monitoring and coordinating private sector care. Fifty-five percent said they have less time to deliver direct patient care and support services because of outsourcing duties.
- More than 40 percent of respondents said that, despite efforts to seamlessly coordinate private care with VHA services, staff often don’t receive patient medical records from private sector providers. VHA respondents also report that private care is less integrated and more fragmented than VA care.
- The VHA’s Human Resources Modernization project—which was ostensibly designed to streamline the hiring process and improve working conditions—is failing. Forty-eight percent of respondents said the modernization project has increased delays in hiring. Respondents said facilities are hemorrhaging staff, with too few being replaced. More than 90 percent said that interested candidates were lost because of HR delays.
- In scores of comments, VBA employees reported job dissatisfaction and burnout, due mostly to understaffing and unrealistic performance standards. Nearly 80 percent of VBA respondents said they faced work quotas, which in their comments, they described as entirely unrealistic. Of those, 83 percent said these quotas impeded their ability to assist veterans. Forty-seven percent said outsourced Compensation and Pension exams—which create crucial medical evidence for claims—make it more difficult for them to rate veterans. That’s because they are often incomplete, incorrect, biased, or illegible.
- Sixty-two percent of VBA respondents are considering leaving their jobs in the next few years. Their frustrations predated the passage of the PACT Act, which is now increasing their workloads and likely adding additional job frustration.
- One of the survey’s most important findings confirms what Secretary McDonough and countless VA patients have consistently noted: the VA workforce remains deeply committed to caring for veterans and fulfilling the VA’s many missions. These sentiments suggest that, should the VA’s serious challenges be addressed, VA workers will not only feel less frustration and burnout but will be able (and be enthusiastic) to provide even higher quality care and services to veterans.
The first section of the report discusses working conditions at the VHA. It begins with a description and analysis of the legislative and policy history that has produced adverse working conditions at the VHA. It then presents and analyzes the survey responses, along with selections from the hundreds of comments offered. The report then shifts to conditions inside the VBA.
In addition to survey data and written responses, this document includes profiles of patients and agency staff. (Additional patient profiles are in the appendix.) These stories make it abundantly clear why the majority of veterans, when surveyed, say they are satisfied with VA care. They do not want the VA to be privatized.
Our findings echo smaller surveys from VA staff—like the Association of VA Psychologist Leaders (AVAPL), the Nurses Organization of Veterans Affairs (NOVA), and the VA’s Chiefs of Staff Advisory Council. It also mirrors findings published in peer-reviewed research papers, Congressional reports, VA Inspector General investigations, and VHPI’s own extensive reporting and analysis, which are all summarized in the report.
The report concludes with an alternative agenda for the VA—a series of commonsense policy solutions to address staffing shortages, improve and expand services, end the outsourcing of VA work to the private sector, and ensure the integrity and vitality of both the VHA and VBA for generations to come.
Earlier Findings of a Study
A 2018 study of VA patients being cared for in the private sector noted that “recent federal policy changes’ attempt to expand veterans’ access to providers outside the [VA] may increase the risk for unsafe prescribing, particularly in persons with dementia.”
These dangers were further highlighted in a 2020 JAMA article on VA outsourcing: “Without well-defined mechanisms for 2-way flow of information, it is unclear how easier access to private sector care, potentially at the expense of increased fragmentation, could translate into safer higher-quality care, regardless of the cost implications.
Make sure you look at the report itself. This post is just a portion of it. Disadvantaging the VA