On June 17, 2022, the New York City Council Committee on Veterans held an oversight hearing on veterans’ access to health care. NYHealth Program Officer Derek Coy delivered the following testimony highlighting the importance of ensuring high-quality care and services for veterans through both the VA and community providers:
Thank you, Chairperson Holden and members of the Committee for the opportunity to provide testimony at today’s hearing focused on how veterans access health care in New York City.
My name is Derek Coy, and I am a Program Officer at the New York Health Foundation, a former sergeant in the United States Marine Corps, and veteran of the Iraq War. The Foundation is a private, independent, and statewide charitable organization dedicated to improving the health of all New Yorkers—including the more than 200,000 veterans who call New York City home.
We have used grants, policy analysis, convenings, and advocacy to build a robust network of community-based services and prepare health care providers to understand veteran culture and meet their unique needs. Understanding and addressing the health-related needs of New York’s veteran population and strengthening and expanding community resources for veterans throughout the State is a core part of my role at the Foundation.
I also have direct experience accessing health care from a variety of sources since transitioning out of the United States Marine Corps in 2008 after four years of service on active duty. As a service-connected disabled veteran who received an honorable discharge and has had some level of private insurance coverage after leaving the military, I am fortunate to have access to Veterans Administration (VA) facilities in addition to private options. I have used them both.
Living a stone’s throw away from the Bronx VA for nearly a decade, while working equally close to my non-VA primary care provider, has allowed me to choose whichever provider was most convenient at the time. Having options about where to get my care has given me more control over my health care decisions.
My experience is reflective of what most veterans prefer. Multiple studies show that most veterans choose between VA and private providers based on practical reasons: their family already receives care at one location, one option is more convenient, or they prefer the quality of one provider compared with another. We also know that post 9/11 veterans are split nearly evenly down the middle when given the option between accessing care at a VA facility or at a non-VA community provider.
Despite this desire for options among veterans, a number of factors create challenges and barriers. I’ll share a few factors that offer important context for today’s hearing:
- According to recent reports, only about half of the veteran population is enrolled in the VA health care system because of a variety of archaic and evolving eligibility standards.[1] And about two-thirds of those eligible will actually use this care each year. This is also true in New York, where only about 225,000 of the 370,000 New Yorkers who are eligible for VA care will receive services there in any given year.[2]
- It is well established that the quality of care at VA is often on par or better when compared with private providers.[3] VA facilities nationwide outperform community hospitals in key areas of patient experience, according to a survey conducted by the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems.[4]
- Studies have also shown that veterans who use VA health care still rely on private options for 70% of their health care needs.[5] And VA outsources nearly 1 out of 3 of its appointments to the private sector.[6]
- Finally, choosing a private provider can come at the risk of receiving services that do not take the military and veteran experience into account. Research by the RAND Corporation, funded by NYHealth, shows that less than 3% of private providers in New York State meet the qualifications for providing high-quality, culturally competent care to military veterans.[7] Because of evolving health needs in the veteran community, lacking this experience can have grave consequences.
Veterans deserve both a strong VA and high-quality community-based options so that they receive the best care possible, regardless of where they choose to access care. Providing health care should not be the responsibility of one sole entity—be it VA or private providers. The onus should be shared, considering the veteran community relies heavily on both for their health care needs. Providing veterans with options is the right thing to do and is reflective of what this community has expressed that it prefers. Veterans themselves need to have a prominent seat at the table in ongoing research and discussions. Regardless of the final results, the restructuring process simply cannot be successful if the voices of veterans—whose health care will be directly impacted by these decisions—are not heard and listened to.
We respect and share the Council’s commitment to New York City’s veterans. I hope you will look to the New York Health Foundation as a resource for your important work. Thank you.
Watch the video of the hearing (Derek Coy’s testimony begins at 1:33:02).
[1] RAND Corporation, “Balancing Demand and Supply for Veterans’ Health Care,” June 2016, https://www.rand.org/pubs/research_reports/RR1165z4.html.
[2] Department of Veterans Affairs, “New York State Summary,” September 2017, https://www.va.gov/vetdata/docs/SpecialReports/State_Summaries_New_York.pdf.
[3] RAND Corporation, “Balancing Demand and Supply for Veterans’ Health Care,” June 2016, https://www.rand.org/pubs/research_reports/RR1165z4.html.
[4] U.S. Department of Veterans Affairs, “Hospital Assessment of Healthcare Providers and Systems Patient Survey Report,” March 2022, https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5773.
[5] RAND Corporation, “Veterans’ Health Insurance Coverage Under the Affordable Care Act and Implications for Repeal for the Department of Veterans Affairs,” 2017, https://www.rand.org/pubs/research_reports/RR1955.html.
[6] Congressional Budget Office, “The Veterans Community Care Program: Background and Early Effects,” October 2021, https://www.cbo.gov/publication/57583.
[7] RAND Corporation, “Ready or Not? Assessing the Capacity of New York State Health Care Providers to Meet the Needs of Veterans,” 2018, https://www.rand.org/pubs/research_reports/RR2298.html.
