WATERLOO, Iowa \u2014 John-Paul Sager appreciates the care he has received at Department of Veterans Affairs hospitals and clinics, but he thinks it should be easier for veterans like him to use their benefits elsewhere. <\/p>\n
Sager, a Marine Corps and Army veteran, uses his VA coverage for non-VA treatment of back injuries stemming from his military service. But he said he sometimes must make several phone calls to obtain approval to see a local chiropractor. \u201cIt seems like it takes entirely too long,\u201d he said.<\/p>\n
Many veterans live hours from VA facilities, or they need health services that aren\u2019t readily available from the VA. In such cases, the department is supposed to provide a referral and pay for private care. Critics say it often hesitates to do so.<\/p>\n
Republicans controlling Congress aim to streamline the process of obtaining what is known as community care.<\/p>\n
Two Republican senators have introduced legislation<\/a> that would make it easier for rural veterans to seek care at local hospitals and clinics. The proposals would build on VA community care programs that started under Democratic President Barack Obama and were expanded in Trump\u2019s first term.<\/p>\n The proposals would build on VA community care programs that started under Democratic President Barack Obama and were expanded in Trump\u2019s first term.<\/p>\n Critics worry that steering veterans to private care facilities drains federal money from the VA hospital and clinic system. But supporters say veterans shouldn\u2019t be forced to travel long distances or wait months for the treatment they could obtain at local hospitals and clinics.<\/p>\n \u201cMy main concern is for veterans, not for the VA,\u201d Sen. Kevin Cramer (R-N.D.) told KFF Health News. \u201cI don\u2019t believe we have an obligation to sustain the bureaucracy.\u201d<\/p>\n About 9 million veterans are enrolled in the VA health system. Last year, about 3 million of them \u2014 including 1.2 million rural veterans \u2014 used their benefits to cover care at non-VA facilities, according to data provided by the department.<\/p>\n Cramer co-sponsored a bill<\/a> that would allow veterans who live within 35 miles of a rural, \u201ccritical access\u201d hospital to use VA benefits to cover care there or at affiliated clinics without referrals from VA staff.<\/p>\n Cramer, who serves on the Senate Veterans\u2019 Affairs Committee, noted his state has just one VA hospital. It\u2019s in Fargo, on the state\u2019s eastern border, which is more than 400 miles by car from parts of western North Dakota.<\/p>\n Many North Dakota veterans drive past multiple community hospitals to get to the VA hospital for treatment, he said. Meanwhile, many rural hospitals are desperate for more patients and income. \u201cI kept thinking to myself, \u2018This doesn\u2019t make any sense at all,\u2019\u201d Cramer said.<\/p>\n Cramer said previous laws, including the VA Mission Act<\/a>, made it easier for veterans to use their benefits to cover care at community hospitals and clinics.<\/p>\n But he said veterans still must fill out too much paperwork and obtain approval from VA staffers to use non-VA facilities.<\/p>\n \u201cWe can\u2019t let the VA itself determine whether a veteran is qualified to receive local care,\u201d he said.<\/p>\n U.S. Rep. Mark Takano of California, who is the top Democrat on the House Veterans\u2019 Affairs Committee, said he sees the need for outside care for some veterans. But he contends Republicans are going overboard in shifting the department\u2019s money to support private health care facilities.<\/p>\n The VA provides specialized care that responds to veterans\u2019 needs and experiences, he argues.<\/p>\n \u201cWe must prevent funds from being siphoned away from veterans\u2019 hospitals and clinics, or VA will crumble,\u201d Takano said in a statement released by his office. \u201cVeterans cannot afford for us to dismantle VA direct care in favor of shifting more care to the community.\u201d<\/p>\n Some veterans\u2019 advocacy groups have also expressed concerns.<\/p>\n Jon Retzer, deputy national legislative director for the Disabled American Veterans, said the group wants to make it easier for veterans to find care. Rural and female veterans can have a particularly tough time finding appropriate, timely services at VA hospitals and clinics, he said. But the Disabled American Veterans doesn\u2019t want to see VA facilities weakened by having too much federal money diverted to private hospitals and clinics.<\/p>\n Retzer said it\u2019s true that patients sometimes wait for VA care, but so do patients at many private hospitals and clinics. Most delays stem from staff shortages, he said, which afflict many health facilities. \u201cThis is a national crisis.\u201d<\/p>\n Retzer said the Disabled American Veterans favors continuing to require referrals from VA physicians before veterans can seek VA-financed care elsewhere. \u201cWe want to ensure that the VA is the primary provider of that care,\u201d he said.<\/p>\n Veterans Affairs Secretary Doug Collins has pledged<\/a> to improve the community care program while maintaining the strength of the department\u2019s hospitals and clinics. The department declined a KFF Health News request to interview Collins.<\/p>\n Marcus Lewis, CEO of First Care Health Center, which includes a hospital in Park River, North Dakota, supports Cramer\u2019s bill. Lewis is a Navy veteran who uses the VA\u2019s community care option to pay for treatment of a back injury stemming from his military service.<\/p>\n Overall, Lewis said, the community care program has become easier to use. But the application process remains complicated, and participants must repeatedly obtain VA referrals for treatment of chronic issues, he said. \u201cIt\u2019s frustrating.\u201d<\/p>\n Park River is a 1,400-person town about 50 miles south of the Canadian border. Its 14-bed hospital offers an array of services, including surgery, cancer care, and mental health treatment. But Lewis regularly sees a VA van picking up local veterans, some of whom travel 140 miles to Fargo for care they\u2019re entitled to receive locally.<\/p>\n \u201cI think a lot of folks just don\u2019t want to fight the system,\u201d he said. \u201cThey don\u2019t want to go through the extra hoops, and so they\u2019ll jump in the van, and they\u2019ll ride along.\u201d<\/p>\n Rep. Mike Bost (R-Ill.), chairman of the House Veterans\u2019 Affairs Committee, said veterans in some areas of the country have had more trouble than others in getting VA approval for care from private clinics and hospitals.<\/p>\n Bost helped gain the House\u2019s approval<\/a> for Trump\u2019s request for $34.7 billion for the community care program in 2026. Although spending on the program has gone up and down in recent years, the appropriation represents an increase of about 50% from what it was in 2025 and 2022. The Senate included similar figures for next year in its version of a military spending budget that passed Aug. 1.<\/a><\/p>\n Bost also co-sponsored a House bill<\/a> that would spell out requirements for the VA to pay for community care.<\/p>\n Sager hopes the new proposals make life easier for veterans. The Gulf War veteran lives in the northeastern Iowa town of Denver. He travels about 15 miles to Waterloo to see a chiropractor, who treats him for back and shoulder pain from injuries he suffered while training Saudi troops in hand-to-hand combat.<\/p>\n Sager, who remains active in the Army Reserve, also visits a Waterloo outpatient clinic run by the VA, where his primary care doctor practices. He appreciates the agency\u2019s mission, including its employment of many veterans. \u201cYou just feel like you\u2019re being taken care of by your own,\u201d he said.<\/p>\n He believes the VA can run a strong hospital and clinic system while offering alternatives for veterans who live far from those facilities or who need care the VA can\u2019t promptly provide.<\/p>\n The local VA doesn\u2019t offer chiropractic care, so it pays for Sager to visit the private clinic. But every few months, he needs to obtain fresh approval from the VA. That often requires several phone calls, he said.<\/p>\n Sager is one of about a dozen veterans who use the community care program to pay for visits at Vanderloo Chiropractic Clinic, office manager Linda Gill said.<\/p>\n Gill said the VA program pays about $34 for a typical visit, which is comparable to private insurance, but the paperwork is more burdensome. She said leaders of the chiropractic practice considered pulling out of the VA program but decided to put up with the hassles for a good cause. She wishes veterans didn\u2019t have to jump through so many hoops to obtain convenient care.<\/p>\n \u201cAfter what they\u2019ve done for us? Please,\u201d she said.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n