Healthcare access has long been an issue for our nation’s veterans, and the MISSION Act — signed into law on June 6, 2018 — was a step toward reducing barriers to quality care for former service members. Aimed at strengthening the Department of Veterans Affairs (VA) healthcare system, the law expanded community care provisions to help ensure veterans can find appropriate medical care within a reasonable distance and/or timeframe.
Despite the significant contributions veterans make to society during and after service, they can face challenges navigating bureaucracy around VA healthcare & benefits. Additionally, they may experience disparities in local VA facilities, long wait times for appointments, or a lack of providers specializing in veterans’ needs.
As we look at the progress made since the MISSION Act was passed, we’ll also break down the current roadblocks to the law’s effectiveness and answer the following questions:
What is the MISSION Act?
The MISSION Act was signed into law on June 6, 2018, to establish a new community care program for the VA healthcare system, among other provisions. Its aim is to strengthen nationwide VA healthcare overall, and a few key objectives are to:
improve the VA’s ability to recruit and retain clinicians;
increase veteran access to community care providers;
provide “Anywhere to Anywhere” telehealth support across state lines;
reduce wait times for appointments at VA healthcare facilities;
ensure veterans can get care within a reasonable driving distance; and
expand urgent care benefits within the VA’s network of urgent care providers.
The Veterans Health Administration (VHA) is a branch of the VA that oversees and carries out its healthcare program. The VHA system provides care to over 9 million veterans enrolled in VA healthcare at 1,298 healthcare facilities, including 171 VA medical centers and 1,113 outpatient sites.
A major step in reaching the goals of the MISSION Act was centered on revising the department's private-sector healthcare programs for veterans by consolidating a number of non-VA affiliated healthcare options into a single community care program. This was intended to provide more healthcare options to veterans while still having the costs covered by the department.
Today, the renewed and expanded VA community care program is making strides, but there’s much work to be done in ensuring veterans have access to quality healthcare within a reasonable timeframe or distance. The availability of comprehensive mental health support is among the crucial needs that have yet to be sufficiently met.
For instance, veterans faced nearly 20 million canceled or delayed appointments during the COVID-19 pandemic. On top of that, the fallout from the U.S. withdrawal from Afghanistan in August 2022 reportedly contributed to a spike in crisis hotline calls, as former service members “struggled to process the unfolding events.”
This underscores the need for comprehensive medical care that includes proper mental health care.
In fact, a study from the RAND Center for Military Health Policy Research shows that less than half of veterans in need of mental health services receive treatment. And of those who do, less than one-third get evidence-based care. The Center’s research also found that deployment “increases risks of mental health conditions and related problems among veterans who have served since the September 11, 2001, attacks.”
In light of this, the VA must work to improve veteran access to medical care and mental wellness support by increasing the number of trained mental health providers; creating initiatives to educate and inform veterans about treatment options; standardizing performance measurements for VA community care facilities; and providing evidence-based treatment and therapies for veterans with mental health conditions. Additionally, Congress must put in place measures to see to it that the MISSION Act’s aims are being fulfilled by the VA, with clear-cut plans to resolve the current gaps in veteran care.
Who is eligible to benefit from the MISSION Act?
Veterans enrolled in the Department of Veterans Affairs (VA) may be eligible for at least basic VA healthcare coverage and therefore benefit from the care improvements outlined in the MISSION Act. The Basic Medical Benefits Package includes preventive, primary, and specialty care, as well as diagnostic, inpatient, and outpatient care services.
And under the newly-established Veterans Community Care Program — an outcome of the MISSION Act — veterans can work with their VA healthcare provider to see if they are eligible to receive care outside the VA’s system. In most cases, eligibility is based on one or more of the following criteria:
Needing a service not available at any VA medical facility.
Living in a U.S. state or territory without a full-service VA medical facility. (e.g., U.S. territories, Alaska, Hawaii, etc.)
Qualifying under the “grandfather” provision related to distance eligibility according to the Veterans Choice Program.
Verification that the VA cannot offer care within certain designated access standards.
Having the veteran and referring doctor agree it is in the best medical interest of the veteran to receive community care.
Having the VA determine that an affiliated provider is not offering care that complies with the VA’s quality standards.
Though these provisions and clarifying updates are a step in the right direction, there are many veterans who may be left out of the improvements to VA healthcare benefits.
According to the U.S. Census Bureau, there were a reported 16.5 million veterans across the country as of 2021. And with just over 9 million veterans enrolled in the VA healthcare program, nearly half of all veterans are unaffiliated and therefore not able to benefit from the MISSION Act’s agenda.
Part of the issue is a lack of understanding of VA coverage and unclear roadmaps for enrollment as service members transition from military to civilian life. Veterans can easily become overwhelmed navigating the complexities of VA healthcare.
According to feedback in the Journal of Veteran Studies, many former service members expressed a desire to see the VA change its broad approach to transition assistance. In their opinion, this would include putting more emphasis on ways to secure practical needs like healthcare and mental health services.
Moreover, the Military Family Advisory Network (MFAN) 2021 survey of more than 8,000 veteran and military families found that access to the VA healthcare system was one of the respondents’ top concerns. Specifically, the MFAN report reveals negative experiences with providers, poor quality of care, trouble scheduling appointments, and a lack of available appointments were issues frequently cited among the feedback on VA healthcare and mental healthcare services.
As we reach another anniversary of the MISSION Act’s passage, it’s an opportunity to assess how well the law’s guidelines are being implemented. We must ensure that veterans are not only aware of the healthcare benefits that are available to them but that they are experiencing tangible improvements while navigating the VA healthcare system.
What progress has been made since the MISSION Act was signed?
The passage of the MISSION Act in 2018 was an important step toward providing comprehensive, quality healthcare for veterans. Since then, the expansion of community care options and revised urgent care benefits were among the most significant changes. This has helped establish clear eligibility criteria for veterans to receive care outside of the VA system and allowed for quicker access to treatment through the updates to urgent care services.
Although progress has been made, there is still much to be done to ensure former service members can access the care they need.
Current roadblocks to the MISSION Act’s effectiveness reflect a lack of congressional oversight and assurance of the VA’s adherence. For instance, USAToday reports that “VA administrators are overruling doctors’ judgments and preventing them from sending their patients outside the VA health care system.” The allegations are based on a review of thousands of medical records and department documents, along with interviews with dozens of patients, providers, and veterans healthcare advocates.
Lengthy appointment wait times are especially an issue for veterans living outside of urban areas.
Despite 4.7 million veterans — close to a quarter of all veterans — living in rural communities, there are significant healthcare disparities in these areas.
A February 2023 report by the Government Accountability Office (GAO) explains how VHA officials confirmed “veterans living in rural areas face unique barriers to accessing mental health care” and that it’s often due to “staff shortages in rural facilities and transportation issues.” Based on the VHA's 2021 data, GAO found that rural veterans used outpatient care at a much lower rate than urban veterans, with only 21% of rural veterans obtaining services at these facilities compared to 79% of urban veterans.
With proper congressional supervision and clear roadmaps to achieve the goals of the MISSION Act, we can see much-needed progress on veterans healthcare barriers going forward. There have already been a few promising legislative steps to improve veterans healthcare over the past year, including:
Support for Veterans in Crisis: The Biden administration announced in January 2023 that veterans in suicidal crisis can receive free emergency medical care at any VA or private care facility.
The HEALTH Act: Introduced in April 2023, this bill aims to “protect and expand access to care for veterans, safeguard veterans’ ability to choose their own providers and require VA to improve the quality of care veterans receive.”
The Protecting Veteran Community Care Act: Montana Rep. Ryan Zinke introduced this legislation in May 2023, with the goal of streamlining current veteran community care options and allowing for expedited residential healthcare options where appropriate.
VA Mobile Application Launch: The VA launched a mobile application in August 2022 named “VA: Health and Benefits,” intended to centralize veterans' health and benefits information and streamline navigation of VA services.
The PACT Act: The VA expanded benefits eligibility to over 3.5 million veterans after the PACT Act was passed in August 2022. It provides compensation and medical care to veterans who were exposed to toxic substances during their service.
What else should Congress and the VA do to improve healthcare for veterans?
Congress and the VA play an essential role in ensuring veterans have access to quality healthcare. Congress must see to it that the VA is implementing the MISSION Act standards properly. The VA must focus on right-sizing VA inequities in underserved areas, reducing wait times for connection to VA providers, improving mental health support, and increasing community care provisions — as outlined in the law.
And since navigating the healthcare system can be difficult or overwhelming for retiring or transitioning veterans, clear roadmaps are needed for service members transitioning to civilian life. Hence, the VA can also help meet the goal of strengthening its healthcare system by better explaining veteran benefits prior to service members’ military separation.
Making sure veterans can receive evidence-based mental health in a timely manner must be prioritized as well.
A February 2023 Mission Roll Call veterans poll asked if former service members with mental health challenges should be able to access the provider of their choice regardless of whether they are affiliated with the VA system. Out of 7,200 responses, 94% said yes — emphasizing the pressing need for strategic, timely community care expansion.
Finally, lawmakers and the VA should plan effective initiatives to increase VA enrollment among eligible veterans, as nearly half of the estimated 16.5 million veterans in our nation are unaffiliated with the VA. Overall, Congress must ensure the VA adheres to the MISSION Act’s access standards by establishing ongoing oversight of the progress made toward strengthening veteran healthcare.
Conclusion
The MISSION Act has presented opportunities for Congress and the VA to foster better healthcare standards for our veterans — and it’s what they deserve. The brave men and women who have served our country shouldn’t be met with hurdles to basic medical needs, nor should they be faced with disparities in their local communities. As we reflect on the progress made since the MISSION Act became law, let’s also remember and advocate for what still needs to be done to ensure no veteran is without access to proper healthcare and support.