Tricking Veterans: Using Suicide and Mental Health Struggles as a Guise for Privatizing the VA

Yahoo

2 days ago

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While attention remains focused on the looming crisis of Department of Veterans Affairs employees facing termination, an even more ominous threat to veterans' health care advances unnoticed through the halls of Congress.
Three pieces of legislation are gaining momentum, each crafted to systematically dismantle VA-delivered care under the guise of sympathy for veteran suicide and mental health struggles. These bills could deliver the decisive blow in a long-standing campaign by proponents determined to privatize VA health care, collapsing the system by pulling funding it needs to care for veterans.
Despite promises of greater "freedom," "autonomy" and "choice," unfettered private-sector funding threatens to narrow -- rather than expand -- veterans' actual options. As resources steadily drain from VA facilities and units disappear, millions of veterans who rely on VA services -- particularly those with service-connected conditions -- will lose access to the system they prefer. Instead, those funds will go into the coffers of private health care companies.
Lawmakers have repeatedly introduced legislation to grant veterans unrestricted access to privatized care, known as the Veterans Community Care Program, or VCCP. A particular emphasis has been on mental health care, where legislation has aimed to eliminate VA referral requirements entirely. None of these potential laws has made it very far, until now. Three bills are proceeding through Congress. One, the No Wrong Door for Veterans Act, secured House approval last month. The Senate Committee on Veterans' Affairs (SVAC) is actively weighing whether to follow suit. Should it do so, or if the other bills gain traction, the foundational structure of the VA system could crack.
Even without legislation, we're seeing a shift underway. In the VA secretary's new budget, VA medical care funding would be cut by 17% while VCCP private-sector resources would receive a 50% boost.
Veterans genuinely appreciate the convenience of community care referrals close to home, but they remain largely unaware of the devastating long-term consequences these legislative changes could bring. If veterans truly grasped the scope of what's being planned, they'd likely reject them. When the Veterans of Foreign Wars surveyed 10,000 members, an overwhelming 92% wanted the VA preserved as the primary health care source -- not dismantled in favor of insurance cards for private providers. A Common Defense poll last week found that two-thirds of veterans oppose downsizing the VA. The Disabled American Veterans is so alarmed by the prospect of unchecked outsourcing that it published a 2023 report with the stark warning title, "A Broken Promise: What if the Veterans Health Administration Goes Away?"
That question cuts right to the core. If the VA does not remain the sole authorizer of care, and receive sufficient funding to meet patient demand, the system -- which research consistently shows equals or exceeds community care in critical quality and outcome measures -- faces dismantlement. The VA will likely end up instead as a sprawling assortment of outpatient clinics. If that sounds familiar, it's the plan envisioned in the Project 2025 blueprint.
The ripple effects will also reach into America's broader health care landscape. The VA serves as the primary training ground for the nation's health care workforce. Furthermore, VA research -- for countless mental and physical conditions that help both veteran and civilian populations -- would suffer crushing consequences. The VA's role as the nation's health care safety net during public health emergencies would also be severely compromised.
The drive for privatization -- shifting governmental responsibilities and funding to private-sector entities -- has deep roots in anti-government politics. Over the past decade, libertarian advocates have forged a powerful alliance with health care corporations seeking lucrative access to billions of taxpayer dollars, joined by veterans' organizations positioning themselves as preferable alternatives to VA care.
The strategy crystallized at a June 2014 gathering of conservative activists, where Concerned Veterans for America, backed by the Koch brothers, unveiled a plan to discredit and steadily privatize VA health care. This vision gained legislative traction two months later when Congress enacted the VA Choice Act, expanding private-sector use. The VA Mission Act of 2018 accelerated this shift through the Veterans Community Care Program, which has experienced explosive growth of 15% to 20% annually and already accounts for 40% of all VA-funded patient care.
Despite these legislative changes, one essential safeguard against large-scale VA privatization has remained intact: Veterans must still receive authorization from VA staff to obtain private care. This gatekeeping function serves an indispensable purpose, ensuring the VA can allocate resources efficiently and continue investing in high-quality, innovative care within its own system.
Community options are unquestionably an essential backup for veterans living far away or facing lengthy waits for VA appointments. However, excessive private-sector use risks destabilizing the VA system and jeopardizing its viability. A "Red Team" of independent health care experts concluded last year that the metastasizing growth of private-sector referrals placed the system in an "existential crisis." These allocations are draining resources from VA facilities, threatening to eliminate services and close facilities. This precarious situation is already evident under current eligibility requirements. Further statutory expansions of veterans' eligibility -- especially unfettered access -- for private-sector care would be financially unsustainable for VA direct care.
Champions of privatization have introduced numerous bills designed to eliminate the requirement for VA authorization before veterans can access private care. These advocates have strategically seized upon veteran suicide and mental health crises as leverage points, exploiting the genuine sympathy these urgent issues generate to advance their broader privatization agenda that bears little connection to improving veterans' mental health.
The underlying statistics certainly warrant concern: Veteran demand for mental health services has continued to climb relentlessly for years, outstripping the VA's funded capacity, while the veteran suicide rate remains persistently entrenched at levels approximately 50% higher than that of the general population.
However, the proposed solutions reveal an inconvenient contradiction. Expanding outsourced mental health care would move veterans away from higher-quality, more timely treatment toward a fragmented private system ill-equipped to address their needs.
The VA is widely considered the gold standard for treating psychological wounds. Compared to VA mental health clinicians, VCCP providers are far less likely to utilize evidence-based psychotherapies, receive mandatory training in military sexual trauma and suicide prevention, or seamlessly integrate mental and physical health care. Even the VA Mission Act recognized this disparity, citing VA mental health providers as possessing unique "special expertise" that distinguishes them from their civilian counterparts.
Similarly, the VA's suicide prevention initiatives exceed private-sector efforts. Each of the VA's 170 medical centers employs dedicated suicide prevention coordinators who collaborate with VA clinicians to oversee suicide risk screening, expedited mental health appointments, follow-up after missed appointments, safety planning, and medical record flagging. Annual suicide prevention and lethal means safety training is mandatory for all VA providers. Veterans receiving all their care through community programs experience higher suicide rates than those treated exclusively within VA facilities.
The privatization push also wasn't driven by the private sector's capacity to deliver care more quickly. Most American counties lack a single psychiatrist, while 45% of rural counties have no psychologist. Veterans wait longer for mental health appointments through the VCCP than within the VA system itself.
The VA system still has plenty more work to get done. Veterans currently wait an average of 17 days for a mental health appointment, while those requiring more intensive care face a 16-day delay from initial screening to admission into residential rehabilitation programs.
In 2017, Jeff Miller, the recently departed chairman of the House Committee on Veterans' Affairs (HVAC), began working as a lobbyist for billionaire Steven Cohen, founder of the Cohen Veterans Network mental health clinic chain. Cohen objected to the VA's policy requiring prior authorization before reimbursing for private care. He sought to eliminate this regulation, allowing veterans to walk into his clinics, receive services, and send the VA the bill afterward -- no approval needed.
Miller and Cohen Network representatives met with HVAC committee members and drafted legislation abolishing the VA's authorization requirement for mental health care. These efforts gained movement when then-Rep. Mike Gallagher, R-Wis., agreed to introduce their bill.
The legislation faced immediate and unified opposition from major veterans service organizations. These groups recognized that the bill would undermine not only the VA's mental health services but also threaten the integrated health care system's overall structure. Faced with this resistance, the bill was quickly withdrawn.
Talking to ProPublica, a former VA official presciently warned at the time, "If you start trying to carve into government money in veterans' care to feed things like the Cohen Veterans Network, that's actually privatization. It's going to be death by a thousand cuts."
In 2019, veteran suicide statistics seemed to portray a devastating picture. Despite a decade of well-conceived efforts, the numbers simply weren't budging. Twenty veterans took their lives each day, 14 of whom were not using the VA for services. The unyielding problem begged for fresh approaches.
This recognition sparked genuine bipartisanship on Capitol Hill. In the Senate, John Boozman, R-Ariz., and Mark Warner, D-Va., joined forces, while Representatives Jack Bergman, R-Mich., and Chrissy Houlahan, D-Pa., did the same in the House. Together, they crafted the IMPROVE (Incorporating Measurements and Providing Resources for Outreach to Veterans Everywhere) Wellbeing for Veterans Act -- a three-year pilot program to provide federal grants to community organizations already working on the ground to identify at-risk veterans disconnected from VA health care and furnish preventive services before suicidal crises emerged.
What made the Improve Act truly unprecedented wasn't just its community-leveraging framework, but its insistence that renewed funding be based on demonstrated improvements. The bill's architects mandated capturing comprehensive outcome data at multiple points to distinguish which community programs enhanced veterans' mental resiliency over a long-term period and thereby reduced suicide risk.
Meanwhile, Sen. John Tester, D-Mont., SVAC ranking member, was constructing his own comprehensive veterans' mental health bill. During negotiations, he agreed to include Improve Act language in the package, later renamed the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program after a 25-year-old Army sniper instructor who'd recently died by suicide. Tester's bill sailed through Congress, and the pilot Fox Grant Program began funding grantees in late 2022.
The 18-month Fox Program review revealed a bleak picture of widespread ineffectiveness. Organizations were supposed to track participants' suicidal ideation, financial stability, mental health status and social supports before and after providing services, but most didn't do so. Out of all participating entities, only 295 people completed services and filled out at least one of the five required questionnaires. That's roughly, on average, four people per grantee -- a shockingly minuscule number. Even worse, the report failed to break down results by individual organization, making it impossible to determine whether they were helping improve veterans' well-being.
As the three-year pilot approached the time for reauthorization in 2024, House and Senate committees held hearings to chart the program's future. However, applying the original renewal criteria for grantees would create a problem: If grant money was truly reserved for community programs that demonstrated improvement, many grantees would surely lose funding. The solution emerged as a sham workaround -- ensure private-sector money continued flowing by ignoring the requirement that grantees measure outcomes.
Rep. Mariannette Miller-Meeks, R-Iowa, adopted this hands-off approach with her No Wrong Door for Veterans Act. It mandates a one-time initial screening while making no mention of pre and post assessment instruments designed to evaluate program outcomes and inform renewal decisions -- an omission that implicitly renders such evaluations voluntary.
The potential abandonment of required pre and post comparative data troubled several lawmakers. House Democrats offered amendments to ensure continuation of outcomes tracking, but these were swiftly rejected.
The No Wrong Door for Veterans Act contained two additional provisions that will accelerate privatization. One compressed VA access standards, the time limit the VA has to schedule, from 20 days to an unrealistic 3-day window for mental health referrals -- virtually guaranteeing automatic referrals to non-VA providers. Then, once Fox Grant recipients secure this expedited community care pathway, political pressure would inevitably mount to extend identical leeway to all enrolled veterans, draining more resources from VA facilities.
Another provision posed an equally grave threat: The bill expands eligible grant recipients to include "mental health care entities" and permits them to offer non-emergency direct mental health treatment. This expanded scope would duplicate the mental health care provided at nearby VA and VCCP facilities, undermining the very agency it is intended to complement.
A pair of other veterans' mental health bills have entered the legislative pipeline, each creating broad avenues for veterans to access private-sector services independently of VA involvement.
One is the Veterans Health Act, introduced in 2023 by Jerry Moran, R-Kan., then the SVAC ranking member. The legislation includes a pilot program designed to expand access for veterans experiencing mental health and substance use disorders. Under this framework, veterans could schedule appointments directly with community providers, circumventing VA referral systems. Despite its pilot designation, the bill contains a mandate to expand this model across all health conditions throughout the entire VA system after three years. Moran reintroduced the pilot in March 2025 as part of the Veterans Access Act, which is slated for consideration this summer.
The second bill -- the Recover Act -- introduced last fall by HVAC Chairman Rep. Mike Bost, R-Ill., would allocate grants to facilities for mental health services. This Cohen Veterans Network-backed legislation would create a parallel care system beyond services already available through the VA and the VCCP.
This proposed arrangement raises troubling concerns about accountability. The VA would lose ability to oversee treatment furnished through these grants, while recipient facilities would face no requirement to share health records with VA providers -- a fundamental breakdown in care coordination that could leave veterans' treatment fragmented and potentially compromised.
We've reached a critical juncture. The No Wrong Door for Veterans Act cleared the House in late May, leaving the Senate to make a pivotal choice: Advance this legislation or pursue legislation that retains accountability. Both the Veterans Health Act and the Recover Act are teed up for further attention. By the time America celebrates Veterans Day this fall, Washington may have delivered a mortal blow to the system uniquely designed to serve those who answered their country's call.
-- Russell Lemle is a senior policy analyst with the Veterans Healthcare Policy Institute.