Weekly Column: A Big Win for South Dakota Veterans

South Dakota veterans and doctors who participate in the Choice program received some good news recently. Late last month, President Donald Trump signed into law legislation that includes a provision of a bill I introduced which, in essence, makes the Department of Veterans Affairs (VA) the primary payer for services under the Choice Act.

This is important because now veterans will no longer have to pay higher health care costs when they seek care at a non-VA facility when using the Choice Act. This is especially great news for those who live in rural areas, as it will make sure that their cost of visiting a physician is the same regardless of if they see their own local doctor under the Choice Act or travel to get care at a VA facility. It is also a win for doctors in the private sector who serve our veterans, as it will eliminate the bureaucratic reimbursement process so they can get paid in a timely manner by the VA when they care for veterans under this same act. 

The intent of the Choice Act, which is to provide relief to those facing long appointment wait times and those who live far from VA facilities, had been undermined because of higher out-of-pocket costs to veterans and reimbursement issues for providers. By eliminating the so-called ‘secondary payer clause’ and essentially making the VA the primary payer under the Choice Act, South Dakota veterans will no longer be forced to pay more for health care services they receive in the community than they would for the same care at a VA facility.


In addition to hearing from veterans, our office has heard from doctors who were struggling to be reimbursed for the care they had provided. We heard from one doctor who was waiting up to nine months to be reimbursed by the VA and was owed millions of dollars. In one case, a hospital had refused to accept referred veterans for physical therapy due to non-payment from the VA. They simply can’t afford to see patients when they know there is a strong chance they will not be paid for services rendered. The intent of the law is good, but the manner in which the ‘secondary payer’ provision was originally written failed both our veterans and the private-sector doctors who treat them under the Choice program. I’m glad we were able to fix this section under the extension, and I will work to include the fix as a permanent component of Choice in the future.


My staff and I heard time and again of the hardship caused by the ‘secondary payer’ provision. My interest in introducing this legislation was a direct result of the feedback we received from South Dakota veterans, their families and medical providers in South Dakota. I thank them for alerting us to this glitch in the system, and I look forward to working with the VA on its implementation. Our veterans make incredible sacrifices for our freedoms; they shouldn’t have to worry about reimbursement issues for the care they have earned upon retirement.