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Published on September 08, 2016

Stutter Steps

Veterans Choice program still working out the kinks

Fred Holdsworth grew up in Philadelphia in the 1950s. He was into baseball and hanging out with his friends from the neighborhood. Every year, he and his family came to Florida to visit relatives in St. Augustine.

When he was in his 20s, Holdsworth was drafted by the Army. He spent nearly two years in Vietnam, and he brought home a souvenir that he still carries with him today – shrapnel in his right arm, which limits his motion and causes intermittent pain, and in his right eye, out of which he can still see, but often has discomfort. He also walks with a permanent limp.

“I was one of the lucky ones,” he said.

His unit, while on routine patrol in a small village, was ambushed by the Viet Cong. Holdsworth dove on top of a South Vietnamese woman and her child to shield them from a grenade that blew up a nearby hut. Many other soldiers didn’t survive that day.

“I got a purple heart, but who wants one?” Holdsworth said. “I thought the doctors and nurses were going to patch me up and send me back out into the field, but they said, ‘No, you’re going home.’ So I’m thankful for that.”

Decades later, Holdsworth, 72, still comes down to Northeast Florida from Philly, along with his wife Rachel, for roughly four months each year. It’s where he often happens to receive health checkups and treatment from the U.S. Department of Veterans Affairs, which has facilities in and around Jacksonville.

“It’s a pain in the you know what,” Holdsworth said. “There are long waits, you have to wait on results. It’s almost always a frustrating experience in one way or another.”

Holdsworth is like many vets for whom receiving health care from the VA has been a struggle. In some cases, patients have died of cancer and other illnesses while waiting for treatment. In other instances, patients have had to drive several hours to reach the nearest VA facility.

A few years ago, after a series of media investigations, the American public was appalled when these issues, as well as poor conditions at several VA hospitals around the country, came to light.


Amid the outrage emerged the Veterans Access, Choice and Accountability Act of 2014 or “Veterans Choice” for short.

In a rare bipartisan effort, Congress hurriedly set aside $10 billion for veterans to receive health care at participating hospitals outside the VA system, with pending renewal of the temporary program slated for 2017. An additional $5 billion was allocated to the VA for hiring physicians and staff and improving infrastructure.

The main requirements to enroll in Veterans Choice are either a VA appointment wait-time of at least 30 days, or living 40 miles or more from the nearest VA facility. Eligible veterans receive a Choice Card, which they use when seeking care from non-VA providers.

In May of this year, St. Vincent’s Medical Center Clay County, along with the entire Ascension network in eligible states, became a participant in the Veterans Choice program.

“We’re here for our veterans,” said James Machado, president of St. Vincent’s Medical Center Clay County, who served 10 years active-duty in the Air Force. “The VA will always have its place, and this program is an extension of the VA to help veterans gain access to the care they need.”

Machado said St. Vincent’s Clay has chosen to prioritize veterans’ health, right down to a handful of parking spots close to the main entrance that are reserved for vets.

Though the program is in its infancy at St. Vincent’s, Veterans Choice has found some success throughout the country, cutting down on wait times in many places and simplifying access. Also, electronic medical records have made coordinated care easy between the VA and affiliated private providers.

“Since we’ve started the program here, I haven’t heard of any negative issues,” Machado said. “We do everything we can to see patients as quickly as possible. It’s vitally important.”


Veterans Choice came about quickly. It was up and running in many places within 90 days of the legislation’s passing.

The initial success at St. Vincent’s Clay notwithstanding, the program has had significant setbacks in various parts of the country. It has been plagued by some of the very issues it was created to solve – namely, the waiting game, with familiarly long waits for appointments, approvals for tests and procedures, and for a Choice Card from the VA.

Also, in some cases, physicians have had to wait as long as a year to be paid for their services through Veterans Choice, causing some providers to drop out of the program.

“Things are moving at government speed, which means very slow,” said Tom Rentz, Service Officer of VFW Post 8255 in Middleburg, who retired from the Army as a Sergeant Major in 2011. “That needs to change. It’s still like any bureaucracy.”

More than 1.5 million veterans live in Florida, including 140,000 in Northeast Florida, according to the U.S. Census Bureau, so demand for veterans’ care in this region is likely to swell.

“Different patients are going to have different perspectives on Veterans Choice,” said Rentz, who spends much of his time helping to facilitate health care and benefits for veterans. “That’s just the nature of it, depending on what condition you may have and how urgent your medical needs are, just like with the VA.

“The thing is, if you know how to navigate online, there are actually a lot of resources there,” Rentz said. “But we’re losing a lot of Vietnam people every day, because many of them aren’t computer literate. It’s really sad. … No matter how young or old you are, the process can be overwhelming with a lot of red tape.”

Rentz emphasized that any veteran who fears that he or she may have an emergent health issue will be accepted at any emergency room. He also recommended using patient advocates to help navigate the Veterans Choice network.

“And you can always call your VA number and dial “0” for a help directory,” he said. “It seems basic, but it’s one place to start.”


Machado’s service in the Air Force, during which he spent time at numerous military hospitals and observed a wide range of health conditions, gave him a unique perspective.

“The thing is, for a lot of military folks, they’re used to the traditional VA structure, so they’re hesitant to go outside of that structure with Veterans Choice,” he said.

Also, fear exists among many vets that privatized care will eventually replace the VA, which, despite its shortcomings, many veterans rely on and trust.

Early last year, American Legion National Commander Michael Helm told Congress, “We applauded emergency legislation to allow veteran patients to use non-VA providers if they were waiting a month or longer to see a doctor or if they lived far from VA facilities. But we oppose privatization or vouchering out of VA care as a long-term solution.”

The setbacks that have dogged Veterans Choice have only stoked skepticism about the program. To prevent the perceived “slippery slope” of phasing out VA care in favor of privatization, many veterans groups have been proactively opposing the expansion of Veterans Choice to cover all vets regardless of VA wait times or distance.

Last November, a poll by the Portland, Ore.-based Vet Voice Foundation, which was jointly conducted by a Republican-backed firm and a Democratic-backed firm, found that two-thirds of veterans oppose privatization of care. Among their reasoning – vouchers may not cover all costs, private insurance companies may prioritize profit over care, and it’s the VA’s responsibility to provide quality health care for veterans instead of pawning them off to private insurers.

Adding to the confusion, when Veterans Choice was instituted, no data-based methods of measuring its success were included with the legislation. Any evidence of its pros and cons, at least to this point, is anecdotal.


The overall effectiveness of Veterans Choice is yet to be determined. It varies widely in different locations. So far, so good at St. Vincent’s Clay, but it only began here four months ago.

As for Holdsworth, he is cautiously optimistic.

“I hope it turns out to be a helpful thing, but we’ll see,” he said.

Renewal of Veterans Choice seems likely, even if expansion doesn’t. But Congress is already feeling pressure over the program’s stumbles.

“It’s meant to supplement the VA, not replace it,” Machado said. “It’s a new program, so it’s going to have some wrinkles that need to be ironed out, but it’s a good first step.

“If you need help, call us or call the VA to get things rolling,” he said. “Don’t wait. Make the call.”

Email Christiaan DeFranco at Follow him on Twitter @cdefranco.

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