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 Photographs
WATERLOO, Iowa — John-Paul Sager appreciates the care he has acquired at Division of Veterans Affairs hospitals and clinics, however he thinks it ought to 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 generally should make a number of telephone calls to acquire approval to see an area chiropractor. “It looks like it takes completely too lengthy,” he mentioned.
Many veterans reside hours from VA amenities, 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 typically hesitates to take action.
Republicans controlling Congress intention to streamline the method of acquiring what is called neighborhood care.
Two Republican senators have launched laws that might make it simpler for rural veterans to hunt care at native hospitals and clinics. The proposals would construct on VA neighborhood 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 personal care amenities 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 may get hold of at native hospitals and clinics.
“My essential concern is for veterans, not for the VA,” Sen. Kevin Cramer (R-N.D.) instructed KFF Well being Information. “I do not consider we now have an obligation to maintain the paperwork.”
John-Paul Sager, a veteran of the Marine Corps and Military, is handled for persistent again and shoulder ache by chiropractor Matt Gronewold in Waterloo, Iowa, on June 20, 2025. The Division of Veterans Affairs’ neighborhood care program pays for Sager’s remedies at Vanderloo Chiropractic Clinic in Waterloo.
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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 amenities, in response to knowledge supplied by the division.
Cramer sponsored a invoice that might enable veterans who reside inside 35 miles of a rural, “important entry” hospital to make use of VA advantages to cowl care there or at affiliated clinics with out referrals from VA employees.
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 jap border, which is greater than 400 miles by automobile from elements of western North Dakota.
Many North Dakota veterans drive previous a number of neighborhood 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 neighborhood hospitals and clinics.
However he mentioned veterans nonetheless should fill out an excessive amount of paperwork and procure approval from VA staffers to make use of non-VA amenities.
“We won’t 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 outdoor look after some veterans. However he contends Republicans are going overboard in shifting the division’s cash to help non-public well being care amenities.
The VA offers specialised care that responds to veterans’ wants and experiences, he argues.
“We should forestall 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 neighborhood.”
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 needs 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 acceptable, well timed providers at VA hospitals and clinics, he mentioned.
However Disabled American Veterans does not wish to see VA amenities weakened by having an excessive amount of federal cash diverted to personal hospitals and clinics.
Retzer mentioned it is true that sufferers generally anticipate VA care, however so do sufferers at many non-public hospitals and clinics. Most delays stem from employees shortages, he mentioned, which afflict many well being amenities. “This can be 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 be sure that the VA is the first supplier of that care,” he mentioned.
Veterans Affairs Secretary Doug Collins has pledged to enhance the neighborhood 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 neighborhood care choice to pay for remedy of a again damage stemming from his navy service.
Total, Lewis mentioned, the neighborhood care program has grow to be simpler to make use of. However the utility course of stays difficult, and individuals should repeatedly get hold of VA referrals for remedy of persistent 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 presents 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 lots of people simply do not wish to combat the system,” he mentioned. “They do not wish to undergo the additional hoops, and they also’ll leap within the van, they usually’ll journey alongside.”
Rep. Mike Bost (R-Ailing.), 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 neighborhood care program in 2026. Though spending on this system has gone up and down lately, the appropriation represents a rise of about 50% from what it was in 2025 and 2022. The Senate included comparable figures for subsequent yr in its model of a navy spending price range that handed Aug. 1.
Bost additionally co-sponsored a Home invoice that might spell out necessities for the VA to pay for neighborhood care.
John-Paul Sager developed persistent again and shoulder ache throughout his navy service, together with his function as an Military drill sergeant at Fort Sill, Oklahoma, the place he took this picture 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 energetic 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 alternate options for veterans who reside removed from these amenities or who want care the VA cannot promptly present.
The native VA does not supply chiropractic care, so it pays for Sager to go to the non-public clinic. However each few months, he must get hold of recent approval from the VA. That always requires a number of telephone calls, he mentioned.
Sager is one in every of a few dozen veterans who use the neighborhood 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 personal insurance coverage, however the paperwork is extra burdensome. She mentioned leaders of the chiropractic follow thought of pulling out of the VA program however determined to place up with the hassles for a superb trigger. She needs veterans did not have to leap via so many hoops to acquire handy care.
“After what they’ve accomplished for us? Please,” she mentioned.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF.
