When combat veteran Christine Bailey first discovered the lump in her breast, her first call was like that of any veteran. She dialed up to the VA Montana Health Care System, only to learn that it didn't offer breast care for women.

Bailey's problems compounded when, under the Choice Program, which allows veterans to seek care outside the VA, she was met with a wall of red tape and lengthy delays in trying to get authorization to pursue mammograms and biopsies.

Fighting back tears, the veteran told Sen. Jon Tester on Wednesday that the system needs to change on a number of levels, and Tester agreed.

“I had a cancer scare, and the process seeking authorization seemed to take a long time for someone who thinks they have cancer,” Bailey said. “Going through the Choice Program was a lot of, 'I'll call you back,' and that seemed to be a huge hurdle to get over. Choice kept seeming to put me on the back burner.”

Tester, a ranking member of the Senate Committee on Veterans Affairs, held town hall meetings in Missoula and Billings this week to get feedback from area veterans and providers on what's broken within the VA's well-intended Choice Program.

The program was adopted by Congress in 2014 to cover gaps within the VA Health Care System. Among them, it enabled veterans who were unable to get an appointment within 30 days to receive care from a provider outside the VA system.

The program aimed to address scandalous backlogs in the VA system and, at the time, it served as a win for rural veterans across Montana, where accessing health care and medical specialists is a difficult, if not impossible, task.

But Tester and area veterans say the program has failed to work as intended, and Tester and his fellow committee members in the U.S. Senate are looking to fix the system, so long as President Donald Trump allows it.

“We're going to focus on writing a bill that will determine where Choice is going to go,” Tester said. “Over the next few months – we're talking June and July – we're going to be working on a major Choice bill that will be rolled out sometime in September or October.”

What form that bill takes remains to be seen. During his travels, Tester has heard a number of suggestions, from doing away with the Choice Program altogether and investing the savings back into the VA, to privatizing the entire VA system.

“In the end, what we want is a bill that works for the veterans and, quite frankly, if we're talking about filling in the gaps in the VA, which is what the Choice Program was meant to do, it's got to work for the providers too,” Tester said, adding that he would likely resist efforts to privatize the system, even as that drumbeat grows louder.

“I am not somebody who wants to privatize the VA,” he added. “I think the VA backstop has to be there, and every veterans service organization we heard from back in February said the same thing – don't privatize it.”

Missoula-area veterans share their experiences with the Choice Program. (Martin Kidston/Missoula Current)
Missoula-area veterans share their experiences with the Choice Program. (Martin Kidston/Missoula Current)

The problems with the Choice Program mentioned at the town hall in Missoula ran the spectrum, from too much red tape to a shortage of medical providers working in Montana.

For the private providers who choose to work the VA, the complications are also compounded by difficulties in getting the VA's authorization to provide care, as in Bailey's case, and getting paid back once that care is given.

“Authorizations are the number one issue for us,” said Dr. Dean French, the CEO of Community Medical Center. “We have staff tied up for hours trying to get authorizations done, and it keeps them from doing other work.”

French, who is also a veteran, said the VA owes the Missoula hospital $2.1 million for providing care through the CHOICE program. And that's just the amount that stands 90 days past due.

French said late payments deter providers from participating in the VA program.

“My bean counters ask why we do this and, of course, I say it's because they're veterans,” French said.

French sees other problems with the program as well. While providers outside the VA team up with insurers to improve their patient advocacy – and the health care system in general – he believes that effort is lacking in the VA.

Too often, French and others said, veterans are left to navigate their personal care with little support from a case manager.

“It feels like that's what's missing here,” said French. “If we're going to spend money, why not spend money making sure veterans aren't having to always advocate for themselves, but have people who understand the system that are working that veteran's case day and night.”

Dr. Kathy Berger, the new director of the VA Montana Health Care System, and Tony Giljum, the system's associate director, both said the state is working to address the challenges (see related story). They include filling vacant positions within VA Montana and launching a new in-state medical residency program to bolster providers.

Giljum said VA Montana is also working to improve the Choice Program by working directly with patients and providers in local communities to ensure veterans receive timely care. Doing so would eliminate distant third party providers, he said.

“We have to rebuild the relationship with our veterans and our providers,” said Giljum. “One of the unfortunate outcomes of the situation we're in, if the providers aren't paid, they drop out of the system. It's our intent to start rolling that out and rebuilding those relationships with the veterans and the providers.”

A number of veterans also expressed concern over Trump's proposal to cut monthly stipends to some disabled veterans, along with reducing veterans' cost-of-living adjustments.

“We're robbing Peter to pay Paul,” one veteran said.

Tester responded, “It's not the way the program should work.”

Contact reporter Martin Kidston at info@missoulacurrent.com