While some believe recent legislation aimed at providing more accessible care for veterans, including at the VA Long Beach Healthcare System, will significantly improve medical service, some critics are skeptical.

The two final regulations of the Mission Act, passed by Congress in 2018, went into effect June 6, allowing the VA Healthcare System to defer community and urgent care cases to private and eligible health care providers in specific circumstances. The Mission Act was signed into law a year prior as an intent to establish a community care program for veterans to make health care more accessible.

VA Expansion Construction Site
Construction is underway at the VA Long Beach Healthcare System to pave way for Outpatient Mental Health Care and Inpatient Mental Health Care buildings and a Community Living Center. The mental health buildings are scheduled for a November 2020 completion date, while the living center is set for November 2021. (Photograph by Brandon Richardson)

Per a public document issued by the U.S. Federal Register last month, private medical entities who have entered a contractual agreement with the VA can provide veterans urgent care – which includes treatment for colds, sore throats and minor skin infections – and community care, which are extended medical services. Eligible veterans have the ability to choose private care if a VA medical provider is not readily accessible, said Richard Beam, VA Long Beach Healthcare System spokesman.

Beam said the Mission Act expands on the Choice Act, signed in 2014, and provides accessible private care for veterans who meet certain criteria. Requirements for private care include cases in which the veteran lives at least an average of 30 to 60 minutes away from the closest VA center, if the wait time for a medical appointment has exceeded a certain number of days – depending on the care – or if a specific medical service is not available at the VA.

In cases where a veteran needs a primary care doctor for something like the flu, Beam said the implementation of the Mission Act limits the possibility of that veteran having to wait 30 days to receive treatment. “That’s somebody who needs access to care or medication or being checked quickly,” he said. “Granted, it’s not necessarily life threatening, but a month out is too far. . . . I think there are main aspects of the Mission Act that are really to the advantage of the veteran. That’s why we exist.”

But the Mission Act isn’t without its share of criticism. Thousands protested nationwide against the VA Healthcare System in disapproval of the legislation. Outside the VA Long Beach on June 5, a group of roughly 100 protestors convened, according to Ryan Mims, legislative political organizer with federal union American Federation of Government Employees (AFGE). According to AFGE, 68 rallies were held nationwide to protest the Mission Act and a new labor contract that would impact 260,000 employees with the Department of Veteran Affairs.

Protestors claimed the VA Healthcare System’s transition to comply with the Mission Act was a sign of privatization, moving services from the public sector into the private sector and deregulating care. In a press release dated June 6, AFGE National President David Cox claimed the act was a “clear double standard that is designed to push veterans out of the VA” and “starve the VA of the resources it needs to continue providing the high-quality care veterans expect and deserve.”

Beam defended the VA’s changes as a way to provide veterans optimal service. “Telling someone that you may come for a same-day appointment and you may have to wait three or four hours to see somebody today is not really the type of care that we want to be providing our veterans,” Beam said. “Why shouldn’t our veterans be able to access care the same way a federal employee can access care using their health benefits? To me, that option is better customer service to the veteran, it’s a better use of taxpayer money and it’s going to keep our veterans healthier.”

Tom Lasser, 73, is a Redondo Beach resident who injured his back in a helicopter crash during his first tour in the Vietnam War on November 26, 1967. Plagued by chronic back pain, Lasser has frequented the VA Long Beach for all his health care needs.

Through the Choice Act, the VA referred Lasser to a private acupuncturist who was less than 10 minutes from where he lived, sparing him about a 20-mile drive to receive care. Lasser said he averaged three to four appointments a month.

When the Mission Act’s regulations went into effect last month, Lasser said he automatically received a voucher for 12 additional acupuncture appointments with his non-VA medical provider. “For me, it works,” he said. “And there’s a lot of logic to how they’re doing this to resolve any backlogs or scheduling issues with the VA.”

Steve Peck, president and CEO of U.S. Vets, said the Mission Act, “on paper,” seems to provide and address all the right things for veterans when it comes to maintaining their standard of care. However, Peck was skeptical of the VA Healthcare System’s finances, which have not publicly disclosed the Mission Act’s influence on the budget. “There was some concern that by outsourcing services to providers in the community, it had the potential to take away from the budget of VA medical centers,” Peck said. “If that is done to a significant extent, it would mean less money for VA medical centers around the country, making that system less effective.”

Beam was unable to locate a national budget projection of the projected costs on the VA Healthcare System. He said the VA Long Beach Healthcare System relies on its local budget to fund the services. Per data Beam provided, VA Long Beach’s community care budget, or non-VA care, was $36,927,135, as of June 2019.

Peck said The Mission Act indicates in its language that the VA’s medical services will not be diminished with the implementation of the new care regulations. “The way it is written, that is reassuring,” he said. “The challenge is, they haven’t quite figured out the budget yet.”

VA Long Beach Expansion Project

In addition to modifying its medical services, VA Long Beach is currently undergoing an expansion to create Outpatient Mental Health Care and Inpatient Mental Health Care buildings and a Community Living Center.

Construction started this year for the three planned structures. The Mental Health Inpatient Building will be two stories, at 78,000 square feet, and will be equipped with 45 beds. The Mental Health Outpatient Building will also be a two-story structure with 80,000 square feet.

The Community Living Center will be the largest expansion. The future 181,000 square-foot building will be three stories and equipped with 120 beds.

Although both mental health buildings are planned for a November 2020 completion date, while the living center is set for November 2021, Beam anticipates that the all projects will be delayed by at least six months. “If we’re lucky, we’re going to try and find some tailwind and make up for the delay,” he said. The recent delays are attributed to an issue with the contractor and miscellaneous expenses, he said.

Both mental health buildings are budgeted at a combined $100 million, while the living center has a flexible fund ranging from $50 million to $100 million, according to Beam. The project will also include new parking structures.

The Community Living Center will serve as a type of rehab center for patients who may have suffered a stroke, are ill or are recovering from surgery. The space will also have hospice care and various forms of therapy. Beam emphasized that veterans admitted to the center must have “rehabilitative potential.” “As long as the patient is improving, we’ll keep working with them until we get them to as close as independent as possible before discharge,” he said.

The Mental Health Outpatient Building will serve as a space for trauma groups, drug and alcohol abuse programs, psychotherapy and telehealth, which is a method of providing health services through technology. Consultations can be arranged through services like Skype and Facetime, Beam said.

The Mental Health Inpatient Building will add 10 new beds for veterans and provide acute care and mental health services for ailments such as post-traumatic stress disorder. “There are many nights when we’ll have somebody come through the emergency room that needs an inpatient psych bed, and we don’t have it,” he said. “Building this … new space, adding beds on the campus gives us a [significantly] better opportunity to serve a veteran from this community.”

Editor’s note: An earlier version of this story incorrectly stated the size of the crowd outside the VA Long Beach, and misidentified the community care budget as the institution’s fiscal year budget. The article has been corrected to address these errors.