Tammy Duckworth, the Illinois senator and retired army lieutenant colonel, lost both her legs in 2004 during the Iraq War.
It happened when the UH-60 Black Hawk helicopter she was co-piloting was hit by a rocket-propelled grenade.
Since that fateful day, Duckworth has dedicated her life to helping her fellow veterans.
And recent events in the White House have left her worried about the future of the U.S. Department of Veterans Affairs (VA).
She’s particularly concerned about secret meetings held recently by Trump administration officials to discuss the possibility of merging the VA — which handles healthcare for some 9 million veterans — with Tricare, the primary health system for all active-duty troops and their families.
“A proposal of this magnitude, which could fundamentally change how tens of millions of service members and veterans get their healthcare, is not something that should be rushed or negotiated in secret behind closed doors,” Duckworth told Healthline.
Tricare, which enables soldiers, sailors, and Marines to visit a private doctor, works reasonably well by most accounts.
But efforts by the VA to allow veterans to see a private doctor have been less successful.
The Veterans Choice Program, for example, was initiated in 2014 to allow some veterans to see private doctors if they’re too far from a VA clinic or their wait time to see a doctor is too long.
However, the program has been mired in red tape and hasn’t appealed to many private sector doctors.
In interviews with Healthline, more than a dozen veterans, veterans advocates, and elected officials agreed that VA should fix and broaden the scope of public-private partnerships for veteran care.
But the concern shared by the people Healthline interviewed is that those who most vociferously support the idea of more public-private partnerships at the VA actually want to do away with the agency completely.
Proponents of the merger idea deny this.
But the fear among many veterans advocates is that if VA and Tricare join forces, it’ll lead to a situation where VA hospitals and clinics will suffer and even shut down.
Meanwhile, the advocates say, the private sector will take over and make a financial killing while veterans lose many of the unique services provided by the VA.
“If the Trump administration is serious about this [merger], they need to be transparent about how this would impact the quality of care our heroes have earned — and they need to immediately involve those who would be impacted by any changes,” Duckworth said.
The VA, she adds, is “specifically designed to provide unique services to meet the total needs of veterans. Any attempt to privatize it, to move veterans further away from VA as the primary coordinator of care, or undermine the integrity of VA hospitals and clinics, is unacceptable.”
Would this be the end for the VA?
Thomas Bandzul, a longtime veterans advocate in Washington, D.C. and legislative counsel for Veterans and Military Families for Progress, insists the president and some members of Congress are simply embracing greed over what veterans want and need.
He says they want to take corporatization of the VA too far.
“If this merger happens, it would be the beginning of the end for the VA,” said Bandzul. “Instead of the money going to the VA or the Choice program, it would go to the Department of Defense and the people administering Tricare. And that would be a disaster for veterans.”
Rep. Tim Walz (D-Minn.), the top Democrat on the House Veterans’ Affairs Committee and a war veteran, agrees.
Walz recently told “Talking Points Memo” that the VA-Tricare meetings are evidence that “the White House was taking steps to force unprecedented numbers of veterans into the private sector for their care.”
Walz concluded, “The fact that the Trump administration has been having these secret conversations behind the backs of Congress and our nation’s veterans is absolutely unacceptable.”
The VA responds
Curt Cashour, a spokesman for the VA, told Healthline that the White House meetings are only discussions at this point that are meant to explore options that would benefit veterans.
“We are simply exploring in preliminary terms the general concept of partnering between the VA and [Department of Defense] healthcare systems to provide better care for veterans at lower costs to taxpayers,” Cashour said.
One example of partnering the VA and Tricare that’s being discussed, Cashour explained, is “by sharing provider networks and, potentially, services like credentialing and claims processing. This has nothing to do with VA healthcare delivery system reform.”
VA Secretary David Shulkin said last month there’s no clandestine effort to sneak through major changes in veteran healthcare.
“In no way should this be interpreted as privatizing or taking down the VA system,” he told the Military Times. “This is nothing more than good business discussions.”
Cashour reiterated Shulkin’s message, telling Healthline that “if there are efforts where we could do things better, we want to look at all those ideas and the potential synergies. But there is no plan here. There is no draft. We are simply having early discussions.”
Corporatizing veteran care
But it’s not just the VA-Tricare merger that has many veterans advocates worried.
It’s also some of the people Trump is hiring at VA, and some of the people from whom the president is seeking advice on veterans’ health issues.
Trump was lauded for retaining and promoting Shulkin, an Obama appointee and medical doctor.
But in July, when the president picked Thomas Bowman to be second in charge to Shulkin, some longtime VA observers weren’t pleased.
Bowman, a retired marine, was chief of staff for former VA secretaries Jim Nicholson and James Peake in President George W. Bush’s administration.
The VA under Bush and Vice President Dick Cheney was accused of profiteering, underfunding veteran programs during two wars, and being hostile to veterans with disability claims.
“The future of VA under President Trump unfortunately looks a lot like that past,” Bandzul said.
Bandzul said that during those years Bowman was at VA, programs were cut, funds disappeared, and inspector general reports pointed out failure after failure of VA.
He added that things “just kept getting worse” the longer Bowman was there.
“Bowman scares me,” Bandzul said. “I see shades of what happened under Secretary Nicholson happening again. Bowman was the architect of the collapse of VA under Nicholson and Peake. This was the worst period for veterans in the history of the organization.”
QTC making billions from veterans
When Peake was hired to run the VA in 2007, he was working at a private company called QTC Management, Inc.
The firm is now the largest provider of disability-focused medical examination and diagnostic testing services for the U.S. government.
Peake was the second person to run the VA during the Bush administration who came from QTC, which was acquired by Leidos in 2016.
The first secretary was Anthony Principi, who was president of QTC before he ran the VA. He returned to the firm after he left VA to become chairman of the board. He’s reportedly a QTC lobbyist to this day.
The Los Angeles Times reported that while Principi oversaw the VA, his company collected about $246 million in fees.
Multiple sources also told Healthline that the denial rate for veteran disability claims went up enormously after QTC took over the exams process.
QTC is still collecting billions, and with little oversight or accountability, sources say.
In August, the company was awarded another contract for $6.8 billion.
According to Bandzul, Bowman’s connections to QTC date back to a time when the company was called SAIC, then split into separate entities.
“Bowman worked for SAIC,” Bandzul said. “It would be logical there were stock deals made as compensation. I just don’t see how he would not profit from the revenue stream at QTC.”
The same month that Trump nominated Bowman to return to the VA, the president also promised to triple the number of veterans “seeing the doctor of their choice.”
Bandzul says QTC would “flourish under this merger. They would be positioned to take even more veterans healthcare to their facilities. Instead of building up VA facilities, it would go to a QTC facility or their care providers.”
In 2007, Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America (IAVA), told Salon that it was “a little bit troublesome that a company may be a farm team for the VA. I want to know why [Peake] and Principi both came from QTC. I want to know how directly they are involved in VA contracts. If you are bringing people from the private sector, is that because you feel they are going to bring a greater level of efficiency — or is it because you want to move toward privatizing care?"
QTC didn’t respond to requests for comment for this story.
Empowering those who would abolish VA
Trump’s election has given new energy to the already existing trend among some conservative members of Congress and Concerned Veterans for America (CVA) — a Koch Brothers organization — to push legislation that privatizes the VA, diminishes its role, and in some cases, bypasses it entirely.
But the pushback from many veterans organizations has been fast and furious.
Stars and Stripes reported that Veterans of Foreign Wars (VFW), one of the nation’s oldest and largest veterans service organizations, criticized legislation introduced by a Colorado congressman last month that would allow veterans to skirt the VA and receive treatment from private sector doctors with taxpayer money.
The Veterans Empowerment Act, forwarded by Rep. Doug Lamborn (R-Colo.), is identical to a proposal from CVA that would create a government-chartered organization to operate a new veterans health insurance system.
This past week, Senators John McCain (R-Ariz.) and Jerry Moran (R-Kan.) introduced the Veterans Community Care and Access Act of 2017.
The senators insist that this new bill, which is supported by both the CVA and the American Legion, would transform the VA and increase veterans’ access to quality care.
But Bandzul said McCain’s legislation “would mean the outsourcing of all of the Veterans Health Administration, and the veteran service organizations don’t even realize it. Sheep to the slaughter.”
Who’s steering Trump’s agenda on veterans?
When it comes to his agenda on veterans, Trump evidently relies heavily on the advice of the Koch Brothers and their many associates, who for years have preached the gospel of privatization and corporatization of the VA.
There are, in fact, 44 members of Trump’s White House who have direct ties to the Kochs, according to a recent report by Public Citizen.
The billionaire brothers recently launched their biggest push yet for privatizing veterans care.
The duo has reportedly already made hundreds of millions of dollars off of veterans addicted to painkillers by partnering with drug companies.
The Kochs have also made millions more by selling oil and toilet paper to the Department of Defense.
Discussions have been going on for years
Ben Krause, a war veteran and attorney who represents veterans who have a disability claim at the VA, says privatization of the VA didn’t begin with Trump.
“John McCain is involved. Democrats and Republicans are involved. Outsourcing of VA expanded greatly under Obama and would continue under Clinton or Trump,” contended Krause, who authors a news blog about the VA that’s popular among veterans.
As far as the move toward more VA privatization, Krause said, those gears have been in motion since President Bill Clinton’s National Partnership for Reinventing Government was established in 1993.
“Veterans want and need choice in healthcare because of VA’s multi-decade-long bungling of healthcare administration and any attempts to reform bad practices through accountability,” he said. “The agency still engages in intentional cover-ups for bad healthcare providers, while spending millions each year to convince veterans and the American public VA is doing a good job.”
But Bandzul doesn’t believe veterans would have been nearly as bad off with Democrat Hillary Clinton as they will be with Trump.
“The demise of VA will happen far more rapidly and deviously under the existing president because he has the people in place to quietly destroy the agency,” Bandzul said.
Veterans groups against merger
The move to merge Tricare and the VA is strongly opposed by many but not all of America’s best-known veterans groups and advocates.
Bob Wallace, executive director of the VFW, told the Military Times that his organization “would oppose any effort to erode the system specifically created to serve the healthcare needs of our nation’s veterans by reducing VA’s role to a payer of care for veterans.”
A spokesperson for IAVA, the largest post-9/11 veterans organization, didn’t wish to discuss a possible merger between VA and Tricare, specifically, because it’s mere speculation at this point.
But in a statement for Healthline, IAVA was unequivocal in its support for keeping the VA fully intact in the future.
“IAVA stands shoulder-to-shoulder with other leading Veteran Service Organizations in opposition to any moves toward privatization of the VA,” the IAVA statement read. “The majority of IAVA members surveyed do not support privatization of VA, and IAVA will hold the line to ensure it does not happen.”
Watchdog says merger could work
But Jim Strickland, a respected VA watchdog, says a VA-Tricare merger could be an improvement for veterans healthcare.
It all depends on how it’s implemented.
“I’m hearing a lot of support for a merger of Tricare and VA healthcare. It’s a sensible idea, one that really shouldn’t be that hard to do, but probably can’t be done,” Strickland told Healthline.
“We don’t have veterans colleges. We have the GI Bill that helps vets pay for college,” he explained. “We don’t have Veteran-Land, a tract housing project where veterans can buy homes and live the good life. We have the VA loan that helps veterans to achieve home ownership. So why do we have VA hospitals? Because veterans are a captive audience for doctors who are in the early years of doctoring. We can’t sue the doctor who errs. We can try to sue the government, but they have a lot of lawyers there.”
Strickland said the downside of trying to merge a Pentagon program and a VA program is spelled out in the history of the single electronic health record (EHR) that would supposedly provide a seamless record of care from day one of entry into military service to the grave.
“It all sounds good, but can it be made to happen? Based on the EHR, probably not,” Strickland said. “The egos and politics that separate VA and [Department of Defense] aren’t going to allow this to be easy. The [Department of Defense] doesn’t want any part of the VA and its well-known problems.”
Bandzul agrees that a VA-Tricare merger could conceivably be a good thing if certain criteria are met.
“If they actually allow veterans to access military bases and it is truly the Tricare model, where if they don’t like their base they can go somewhere else, and they can get their own doctor, that is fine. I am for that,” Bandzul said.
He adds that the Choice program currently doesn’t work because it pays less in reimbursements to doctors than Medicare, whereas Tricare pays the full insurance rate of reimbursement.
“The real reason Choice isn’t working is because doctors don’t want it. The reimbursement rates are simply too low,” he said. “If they roll this merger out and do these reduced payments to the medical people, I’m against it.”
Despite all the issues, IAVA remains optimistic about the future of veteran healthcare.
But they’re keeping a close eye on both the White House and Congress.
“It’s been three years since the national scandal at the Phoenix VA,” IAVA said in a statement to Healthline, “and IAVA members continue to cite VA care and reform as a top concern, which is why we have included it as one of IAVA’s top priorities. And we will continue to pressure Congress to fund VA and see that veterans care is brought into the 21st century.”