Introduction to the Issue
WATERLOO, Iowa — 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.
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. “It seems like it takes entirely too long,” he said.
Many veterans live hours from VA facilities, or they need health services that aren’t 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.
John-Paul Sager, a veteran of the Marine Corps and Army, is treated for chronic back and shoulder pain by chiropractor Matt Gronewold in Waterloo, Iowa, on June 20, 2025. (Tony Leys/KFF Health News/TNS)
Proposed Legislation
Republicans controlling Congress aim to streamline the process of obtaining what is known as community care.
Two Republican senators have introduced legislation 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’s first term.
Critics worry that steering veterans to private care facilities drains federal money from the VA hospital and clinic system. But supporters say veterans shouldn’t be forced to travel long distances or wait months for the treatment they could obtain at local hospitals and clinics.
“My main concern is for veterans, not for the VA,” Sen. Kevin Cramer, R-N.D., told KFF Health News. “I don’t believe we have an obligation to sustain the bureaucracy.”
About 9 million veterans are enrolled in the VA health system. Last year, about 3 million of them — including 1.2 million rural veterans — used their benefits to cover care at non-VA facilities, according to data provided by the department.
The Need for Community Care
Cramer co-sponsored a bill that would allow veterans who live within 35 miles of a rural, “critical access” hospital to use VA benefits to cover care there or at affiliated clinics without referrals from VA staff.
Cramer, who serves on the Senate Veterans’ Affairs Committee, noted his state has just one VA hospital. It’s in Fargo, on the state’s eastern border, which is more than 400 miles by car from parts of western North Dakota.
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. “I kept thinking to myself, ‘This doesn’t make any sense at all,’” Cramer said.
Concerns About the Proposal
U.S. Rep. Mark Takano of California, who is the top Democrat on the House Veterans’ Affairs Committee, said he sees the need for outside care for some veterans. But he contends Republicans are going overboard in shifting the department’s money to support private health care facilities.
The VA provides specialized care that responds to veterans’ needs and experiences, he argues.
“We must prevent funds from being siphoned away from veterans’ hospitals and clinics, or VA will crumble,” Takano said in a statement released by his office. “Veterans cannot afford for us to dismantle VA direct care in favor of shifting more care to the community.”
Some veterans’ advocacy groups have also expressed concerns.
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’t want to see VA facilities weakened by having too much federal money diverted to private hospitals and clinics.
Improving the Community Care Program
Veterans Affairs Secretary Doug Collins has pledged to improve the community care program while maintaining the strength of the department’s hospitals and clinics. The department declined a KFF Health News request to interview Collins.
Marcus Lewis, CEO of First Care Health Center, which includes a hospital in Park River, North Dakota, supports Cramer’s bill. Lewis is a Navy veteran who uses the VA’s community care option to pay for treatment of a back injury stemming from his military service.
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. “It’s frustrating.”
John-Paul Sager developed chronic back and shoulder pain during his military service, including his role as an Army drill sergeant at Fort Sill, Oklahoma, where he took this photo in 2014.. (John-Paul Sager/KFF Health News/TNS)
Conclusion
The proposed legislation aims to make it easier for veterans to access community care, but it has raised concerns about the potential impact on the VA hospital and clinic system. While some argue that the VA should prioritize its own facilities, others believe that veterans should have more flexibility in choosing their care providers. Ultimately, the goal is to ensure that veterans receive the best possible care, regardless of where it is provided.
FAQs
Q: What is the community care program?
A: The community care program allows veterans to receive care at non-VA facilities, such as local hospitals and clinics, using their VA benefits.
Q: Why are some veterans having trouble accessing community care?
A: Some veterans are having trouble accessing community care because they must obtain referrals from VA staff, which can be a lengthy and complicated process.
Q: What is the proposed legislation trying to achieve?
A: The proposed legislation aims to streamline the process of obtaining community care by allowing veterans to seek care at local hospitals and clinics without needing a referral from VA staff.
Q: What are the concerns about the proposed legislation?
A: Some are concerned that the proposed legislation could drain federal money from the VA hospital and clinic system, potentially weakening it.
Q: How many veterans are enrolled in the VA health system?
A: About 9 million veterans are enrolled in the VA health system.
Q: How many veterans used their benefits to cover care at non-VA facilities last year?
A: About 3 million veterans, including 1.2 million rural veterans, used their benefits to cover care at non-VA facilities last year.
