The Tibor Rubin Veteran Affairs Medical Middle in Lengthy Seashore on Wednesday, July 31, 2019.
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Scott Varley/MediaNews Group/Torrance Every day Breeze/Getty Photos
WATERLOO, Iowa — John-Paul Sager appreciates the care he has acquired at Division of Veterans Affairs hospitals and clinics, however he thinks it must be simpler for veterans like him to make use of their advantages elsewhere.
Sager, a Marine Corps and Military veteran, makes use of his VA protection for non-VA remedy of again accidents stemming from his navy service. However he mentioned he typically should make a number of cellphone calls to acquire approval to see an area chiropractor. “It looks like it takes completely too lengthy,” he mentioned.
Many veterans dwell hours from VA services, or they want well being providers that are not available from the VA. In such circumstances, the division is meant to supply a referral and pay for personal care. Some veterans’ advocates say it usually hesitates to take action.
Republicans controlling Congress goal to streamline the method of acquiring what is named group care.
Two Republican senators have launched laws that may make it simpler for rural veterans to hunt care at native hospitals and clinics. The proposals would construct on VA group care packages that began below Democratic President Barack Obama and have been expanded in Trump’s first time period.
Critics fear that steering veterans to non-public care services drains federal cash from the VA hospital and clinic system. However supporters say veterans should not be pressured to journey lengthy distances or wait months for the remedy they might get hold of at native hospitals and clinics.
“My foremost concern is for veterans, not for the VA,” Sen. Kevin Cramer (R-N.D.) advised KFF Well being Information. “I do not imagine we’ve an obligation to maintain the paperwork.”
John-Paul Sager, a veteran of the Marine Corps and Military, is handled for power again and shoulder ache by chiropractor Matt Gronewold in Waterloo, Iowa, on June 20, 2025. The Division of Veterans Affairs’ group care program pays for Sager’s therapies at Vanderloo Chiropractic Clinic in Waterloo.
Tony Leys/KFF Well being Information
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Tony Leys/KFF Well being Information
A 400-mile drive to a VA hospital
About 9 million veterans are enrolled within the VA well being system. Final yr, about 3 million of them — together with 1.2 million rural veterans — used their advantages to cowl care at non-VA services, in line with knowledge offered by the division.
Cramer sponsored a invoice that may permit veterans who dwell inside 35 miles of a rural, “vital entry” hospital to make use of VA advantages to cowl care there or at affiliated clinics with out referrals from VA workers.
Cramer, who serves on the Senate Veterans’ Affairs Committee, famous his state has only one VA hospital. It is in Fargo, on the state’s japanese border, which is greater than 400 miles by automotive from elements of western North Dakota.
Many North Dakota veterans drive previous a number of group hospitals to get to the VA hospital for remedy, he mentioned. In the meantime, many rural hospitals are determined for extra sufferers and revenue. “I saved considering to myself, ‘This does not make any sense in any respect,'” Cramer mentioned.
Cramer mentioned earlier legal guidelines, together with the VA Mission Act, made it simpler for veterans to make use of their advantages to cowl care at group hospitals and clinics.
However he mentioned veterans nonetheless should fill out an excessive amount of paperwork and acquire approval from VA staffers to make use of non-VA services.
“We will not let the VA itself decide whether or not a veteran is certified to obtain native care,” he mentioned.
U.S. Rep. Mark Takano of California, who’s the highest Democrat on the Home Veterans’ Affairs Committee, mentioned he sees the necessity for out of doors look after some veterans. However he contends Republicans are going overboard in shifting the division’s cash to assist non-public well being care services.
The VA offers specialised care that responds to veterans’ wants and experiences, he argues.
“We should stop funds from being siphoned away from veterans’ hospitals and clinics, or VA will crumble,” Takano mentioned in an announcement launched by his workplace. “Veterans can’t afford for us to dismantle VA direct care in favor of shifting extra care to the group.”
Defending the VA
Some veterans’ advocacy teams have additionally expressed issues.
Jon Retzer, deputy nationwide legislative director for the Disabled American Veterans, mentioned the group desires to make it simpler for veterans to search out care. Feminine veterans and veterans residing in rural areas can have a very robust time discovering applicable, well timed providers at VA hospitals and clinics, he mentioned.
However Disabled American Veterans does not wish to see VA services weakened by having an excessive amount of federal cash diverted to non-public hospitals and clinics.
Retzer mentioned it is true that sufferers typically look ahead to VA care, however so do sufferers at many non-public hospitals and clinics. Most delays stem from workers shortages, he mentioned, which afflict many well being services. “It is a nationwide disaster.”
Retzer mentioned Disabled American Veterans favors persevering with to require referrals from VA physicians earlier than veterans can search VA-financed care elsewhere. “We wish to make sure that the VA is the first supplier of that care,” he mentioned.
Veterans Affairs Secretary Doug Collins has pledged to enhance the group care program whereas sustaining the power of the division’s hospitals and clinics. The division declined a KFF Well being Information request to interview Collins.
Marcus Lewis, CEO of First Care Well being Middle, which features a hospital in Park River, North Dakota, helps Cramer’s invoice. Lewis is a Navy veteran who makes use of the VA’s group care choice to pay for remedy of a again damage stemming from his navy service.
Total, Lewis mentioned, the group care program has grow to be simpler to make use of. However the software course of stays sophisticated, and contributors should repeatedly get hold of VA referrals for remedy of power points, he mentioned. “It is irritating.”
Park River is a 1,400-person city about 50 miles south of the Canadian border. Its 14-bed hospital gives an array of providers, together with surgical procedure, most cancers care, and psychological well being remedy. However Lewis often sees a VA van selecting up native veterans, a few of whom journey 140 miles to Fargo for care they’re entitled to obtain domestically.
“I feel numerous people simply do not wish to combat the system,” he mentioned. “They do not wish to undergo the additional hoops, and they also’ll soar within the van, and so they’ll trip alongside.”
Rep. Mike Bost (R-Unwell.), chairman of the Home Veterans’ Affairs Committee, mentioned veterans in some areas of the nation have had extra bother than others getting VA approval for care from non-public clinics and hospitals.
Bost helped acquire the Home’s approval for Trump’s request for $34.7 billion for the group care program in 2026. Though spending on this system has gone up and down in recent times, the appropriation represents a rise of about 50% from what it was in 2025 and 2022. The Senate included related figures for subsequent yr in its model of a navy spending finances that handed Aug. 1.
Bost additionally co-sponsored a Home invoice that may spell out necessities for the VA to pay for group care.
John-Paul Sager developed power again and shoulder ache throughout his navy service, together with his position as an Military drill sergeant at Fort Sill, Oklahoma, the place he took this photograph in 2014.
John-Paul Sager
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John-Paul Sager
Sager hopes the brand new proposals make life simpler for veterans. The Gulf Conflict veteran lives within the northeastern Iowa city of Denver. He travels about 15 miles to Waterloo to see a chiropractor, who treats him for again and shoulder ache from accidents he suffered whereas coaching Saudi troops in hand-to-hand fight.
Sager, who stays lively within the Military Reserve, additionally visits a Waterloo outpatient clinic run by the VA, the place his major care physician practices. He appreciates the company’s mission, together with its employment of many veterans. “You simply really feel such as you’re being taken care of by your individual,” he mentioned.
He believes the VA can run a powerful hospital and clinic system whereas providing options for veterans who dwell removed from these services or who want care the VA cannot promptly present.
The native VA does not provide chiropractic care, so it pays for Sager to go to the non-public clinic. However each few months, he must get hold of contemporary approval from the VA. That always requires a number of cellphone calls, he mentioned.
Sager is one in every of a few dozen veterans who use the group care program to pay for visits at Vanderloo Chiropractic Clinic, workplace supervisor Linda Gill mentioned.
Gill mentioned the VA program pays about $34 for a typical go to, which is comparable to non-public insurance coverage, however the paperwork is extra burdensome. She mentioned leaders of the chiropractic observe thought-about pulling out of the VA program however determined to place up with the hassles for an excellent trigger. She needs veterans did not have to leap by so many hoops to acquire handy care.
“After what they’ve achieved for us? Please,” she mentioned.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF.
