Eugene Downs, a 93-year-old Navy veteran who served during World War II, the Korean War and the Vietnam War, has received nearly all of his care over the past 27 years from the Department of Veterans Affairs. He’s a regular at the Washington VA Medical Center, where he has “no gripes.”

“I get the best damn care anybody can get,” he says.

[Veterans are being denied this GI Bill benefit if they work in cannabis]

VA health care is a comfort for veterans like Downs, who appreciate the special attention, knowledge and camaraderie they often find within VA hospitals. But the VA also routinely faces scrutiny when the quality of care falls, or if veterans are unable to see a doctor for weeks or months at a time.

The concerns crystallize an inherent tension surrounding the VA, which operates more than 1,200 hospitals and outpatient clinics across the country. Many veterans prefer the VA to private doctors, but bureaucratic delays and staffing shortages often get in the way.

[Kyrsten Sinema invokes memory of John McCain in maiden speech]

A new Veterans Community Care Program that launched June 6 permits veterans to see private providers if their drive time to a VA facility is longer than a certain threshold, or if wait times for VA appointments extend beyond a certain number of days.

Congress passed an earlier version of the program after a 2014 secret wait-list scandal at the Phoenix VA, where dozens of veterans allegedly died waiting to see doctors. But the Veterans Choice Program, as it was known, did not always reduce wait times.

The new program, created under the VA Mission Act, combines and expands the VA’s private care options. The law also aimed to improve recruitment and retention at VA facilities by boosting pay and debt forgiveness for medical professionals.

While outsourcing care to the private sector can alleviate some problems with the VA, critics fear it’s a slippery slope that could lead to wholesale privatization if the VA deprioritizes funds for its own facilities.

VA Secretary Robert Wilkie points to funding boosts and statistics that show veterans increasingly prefer the VA as proof the Trump administration isn’t pursuing a secret privatization agenda. Veterans request appointments with private doctors at a rate of around 30 percent, says Wilkie, compared with the historical average under different programs of around 40 percent.

Last September, President Donald Trump signed the largest VA budget ever, with $86.5 billion in discretionary funds. The department is on track to get yet another historical funding boost for 2020, with House lawmakers appropriating $94.3 billion in discretionary spending.

Choice concerns

Even the VA’s staunchest defenders acknowledge its limitations — lengthy wait times, seemingly arbitrary restrictions on medical supplies or the difficulty in obtaining a second opinion. But extending care to the private sector opens up other problems, like billing errors or delays in approving claims and reimbursing doctors. The bill sometimes ends up in the veteran’s lap.

Curtis Schmitt, a 35-year-old Army veteran from Milwaukee, is battling a $1,200 private hospital bill for a February liver test that was mistakenly placed in his name instead of the VA’s. The bill landed in collections.

A Milwaukee VA Medical Center spokesman says the staff reached out to Schmitt following a CQ Roll Call inquiry.

Tom Wheaton, a 52-year-old Navy veteran from Golden, Colo., faced a similar issue when he got a kidney ultrasound from a private facility years ago. The hospital charged Wheaton hundreds of dollars before sending the bill to a VA facility in Pennsylvania rather than the one in Denver.

“That six months was a lot of hassle that I wasn’t expecting,” he says.

The VA has tried to iron out some of those kinks, but the experience left a lasting impression on Wheaton.

A paraplegic hit by a drunken driver in 1988 during active duty in Australia, Wheaton is the national treasurer for Paralyzed Veterans of America. He works with the VA’s spinal cord injury team and worries that expanding private care could undercut the agency’s highly regarded specialty services. Wheaton feels like he is a priority at the VA, and worries that might fade if too much care is outsourced.

“My biggest concern is that if the wave of privatization goes so well for the general veteran who has minimal health care needs, I would hate to see all the specialized services gobbled up with that and politicians just saying, ‘Wow, this is so great for veterans, we’re just shutting down the VA altogether,’ ” he says.

For disabled veterans, private hospitals and doctors’ offices are sometimes difficult to navigate. Tammy Jones, national vice president for PVA and a 52-year-old Air Force veteran from San Antonio, says many places lack wheelchair-accessible rooms or interpreters for the hearing-impaired.

A paraplegic with limited use of her hands, Jones says the VA could mitigate issues by requiring partnering providers to meet accessibility requirements. That could include things like ensuring doors are wide enough for wheelchairs and other things that make the VA “think about where they’re sending us.”

“That’s where I think the happy medium can be,” she says.

Wheaton and Jones acknowledge the benefits that expanded access can have for veterans with less severe injuries, or who live further away from VA facilities.

“I have learned that for the vast majority of veterans who maybe do not have these disabilities, this is going to be a great thing for choice,” Wheaton says.

Bureaucratic hassles

Delays in care of any kind can have catastrophic consequences, but the danger is especially acute when it comes to mental health.

Schmitt, who served in Iraq and Afghanistan, sometimes struggles to get to see his mental health doctor. If he doesn’t schedule regular appointments, it can take months to get back in. While that would qualify him to see a private doctor, it’s difficult to forge a new connection with a stranger.

“Once you establish a relationship with somebody, you’re not trying to go and spill the beans with someone else,” he says.

For some, a break from the bureaucracy would be a relief.

Dillon Cannon, a 33-year-old Army veteran from Sugarland, Texas, is paralyzed from the waist down with limited use of his hands. Four days after Christmas in 2006, Cannon’s truck was returning to base in Iraq when word of a roadside bomb stalled it.

Cannon, the gunner, was reaching for a cigarette when a sniper’s bullet struck him.

He now works for a racetrack and takes his own Camaro ZL1 — adapted to drive with his hands only — out on the track during his break.

“It’s my escape,” he says.

To get into the driver’s seat, Cannon must lift himself from his wheelchair and into the car, pulling the chair in after him. When a problem arose with his chair, Cannon reverted to his 35-pound backup chair — which was nearly impossible to lift.

The VA initially refused to replace the chair. The problem wasn’t resolved until Cannon visited then-VA Secretary David Shulkin with conservative advocacy group The Independence Fund in 2017.

While Cannon calls the VA’s quality of care “pretty decent,” he hopes the new program will let him use a private hospital for an upcoming procedure. That isn’t guaranteed since the decision largely rests with the physician.

In the end, the site of care matters less than the care itself.

“Just as long as we’re getting them taken care of,” Schmitt says.