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VA Secretary David J. Shulkin has used congressional testimony and recent meetings with veterans' service organizations to preview new steps the Department of Veterans Affairs might test for containing costs as it reforms the Choice program to smooth access to VA-paid private sector healthcare.

Shulkin last month said he would ask Congress to scrap driving distance and appointment wait times for determining eligibility to use Choice. But without new screening criteria, VA health costs could soar by as much as $1 trillion over the next decade, congressional auditors have estimated.

So Shulkin intends to test new screening criteria over the next several months. One model under consideration is to give veterans with service-connected injuries or ailments priority to use Choice over veterans seeking care for conditions unrelated to service.

"He's looking at service-connected disabled veterans to have this option first because he thinks the American public looks at those veterans as being most worthy of getting the best treatment possible," said one executive of a major veteran organization who Shulkin had briefed on tentative Choice reform plans.

A second idea under review is to charge other health insurance that a veteran might have, either through employers or even Medicare, for the cost of care that Choice provides through participating private sector providers.

A third notion Shulkin wants tested, he told veteran groups, are new sets of co-payments for Choice. One might be used when VA healthcare is available and a veteran still elects to use non-VA care. In that case, co-pays could be one level for veterans with service-connected conditions and higher for others.

Shulkin told veteran groups he would prefer that Choice stay free to all patients. But if co-pays are needed to contain costs, they might be applied based on whether veterans have service-connected conditions.

He premiered a few of these ideas Tuesday at an evening hearing of the House Veterans Affairs Committee. "Choice 2.0" will have a better title when VA presents a full reform plan to Congress "within six months," Shulkin promised.

Also testifying at the hearing were representatives of the Government Accountability Office and Office of VA Inspector General who presented their latest findings of flaws across Choice, including the disturbing fact that many veterans who opted to use it waited longer for care than those who stuck with the VA system.

Taking a fresh step to try to lower suicide rates among America's veterans, Shulkin said VA will grant access to urgent mental healthcare to otherwise ineligible veterans, those who received other-than-honorable discharges.

Shulkin noted an average of 20 veterans a day take their own lives, and 14 of the 20 average are not enrolled in VA health care. Many are combat veterans denied VA access because of the character of their discharge. Some received the "bad paper" because of misconduct due to post-trauma stress or traumatic brain injury which perhaps their service branch failed to diagnose.

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