For John-Paul Sager, a Marine Corps and Army veteran, the care he receives through the Department of Veterans Affairs (VA) is valued—but accessing non-VA treatment for service-related back injuries remains a frustrating hurdle.
“It seems like it takes entirely too long,” Sager said of the multiple phone calls required to secure approval for chiropractic care at a local clinic in Waterloo, Iowa.
His experience reflects a broader struggle among veterans, many of whom live hours from VA facilities or need services unavailable through the agency. Now, congressional Republicans are pushing to streamline this process, reigniting debates over the future of VA healthcare.
A Push to Expand Community Care
With Republicans in control of Congress, efforts are underway to simplify veterans’ use of “community care”—non-VA treatment covered by VA benefits. Two GOP senators have introduced legislation aimed at rural veterans, building on VA community care programs launched under President Barack Obama and expanded during former President Donald Trump’s first term.
Sen. Kevin Cramer (R-N.D.), a member of the Senate Veterans’ Affairs Committee, sponsored a bill that would let veterans within 35 miles of a rural “critical access” hospital use VA benefits at those facilities or affiliated clinics without VA staff referrals.
His motivation stems from North Dakota’s reality: just one VA hospital, in Fargo, forcing some western state veterans to drive over 400 miles for care—past local hospitals eager for patients.
“We can’t let the VA itself determine whether a veteran is qualified to receive local care,” Cramer told KFF Health News, emphasizing his priority is veterans, not “sustaining the bureaucracy.”
Tensions Over VA Funding and Purpose
Critics warn shifting veterans to private care could drain resources from the VA’s hospital and clinic system. Rep. Mark Takano (D-Calif.), ranking member of the House Veterans’ Affairs Committee, acknowledges some veterans need outside care but argues Republicans are overreaching.
“We must prevent funds from being siphoned away from veterans’ hospitals and clinics, or VA will crumble,” he said in a statement, adding the VA provides specialized care tailored to veterans’ unique experiences.
Veterans’ advocacy groups share mixed views. Disabled American Veterans (DAV) supports easier access to care—especially for rural and female veterans facing delays in VA services—but opposes weakening VA facilities.
“We want to ensure that the VA is the primary provider of that care,” said Jon Retzer, DAV’s deputy national legislative director, noting staff shortages causing delays are a “national crisis” affecting both VA and private facilities. DAV favors keeping VA physician referrals as a requirement for community care.
Growing Investment in Community Care
Despite debates, funding for community care is rising. The House approved $34.7 billion for the program in 2026—up about 50% from 2022 and 2025 levels—at Trump’s request, with the Senate including similar figures in its August-passed military budget.
Rep. Mike Bost (R-Ill.), chair of the House Veterans’ Affairs Committee, also co-sponsored a bill to clarify VA requirements for covering community care, citing unequal access issues across regions.
Veterans’ Stories: Frustration and Hope
For veterans like Marcus Lewis, a Navy veteran and CEO of North Dakota’s First Care Health Center, community care works—but red tape persists. Lewis uses the program for his own service-related back pain but notes chronic conditions require repeated VA referrals.
In Park River, North Dakota, he sees veterans ride 140 miles to Fargo in a VA van for care available locally, simply to avoid “fighting the system.”
At Vanderloo Chiropractic Clinic in Iowa, office manager Linda Gill echoes the frustration. The clinic participates in VA community care to treat veterans like Sager, but paperwork burdens are heavy. “After what they’ve done for us? Please,” Gill said, urging simpler access.
Sager, a Gulf War veteran with chronic pain from training Saudi troops, splits care between a VA outpatient clinic and the chiropractic clinic. He appreciates the VA’s mission—“you feel like you’re being taken care of by your own”—but hopes new laws will end repetitive approval calls. “The VA can run a strong system while offering alternatives,” he said, “for those who live far or need care faster.”
As Congress advances these proposals, the balance between strengthening VA infrastructure and expanding veterans’ choice remains at the heart of the debate—with veterans’ daily access to care hanging in the balance.
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