Donald Trump claims 'tremendous progress' in improving care for veterans. Here's the truth

In bountiful tweets and self-praise, President Donald Trump plays up "tremendous progress" in improving care for veterans in his first year. His claims fall short of reality.

Trump's initiatives have yet to show meaningful impact, and his campaign promises of expanding access to doctors and adding mental health specialists are unfulfilled.

Several of the 2017 accomplishments highlighted in a Trump tweet this week are largely symbolic — proclamations routinely signed by presidents or initiatives that haven't taken full effect or were later acknowledged by the Department of Veterans Affairs to be largely unneeded. In the meantime, wait times for veterans seeking treatment at VA medical centres haven't improved much, as Congress remains deadlocked over a long-term fix aimed at expanding access to doctors, in part due to rising costs.

The VA also admits it fell short of adding 1,000 new mental health professionals last year, even after Trump singled out mental health as especially in need of attention during the campaign and pledged a hiring surge.

Trump speaks often about his commitment to veterans, a group that backed him by nearly 2-to-1 over Democrat Hillary Clinton in the 2016 election.

A look at his rhetoric on veterans and White House statements marking his first year in office:

The facts: The video with catchy music overstates the impact of these steps.

Of the eight achievements cited, two are ceremonial proclamations recognising National Veterans and Military Families Month and National Pearl Harbor Remembrance Day.

Two are pieces of legislation that extended the troubled Veterans Choice program on a temporary basis. This became necessary because the Trump administration repeatedly miscalculated the amount of taxpayer dollars available to pay for care from private doctors outside the VA system when veterans had to endure long waits for treatment at VA medical centres. The department's poor budget planning caught lawmakers off guard.

A fifth claim involves "telehealth," a step letting doctors practice medicine across state lines using digital technology. Announced in August, it has yet to take full effect because a proposed VA regulation hasn't been completed. The VA wants authority to practice across state lines to come from legislation, not a regulation. On Wednesday, the Senate approved a telehealth measure that now goes to the House.

A sixth claim refers to legislation that streamlines the appeals process for disability compensation claims within the VA. This step has had limited impact so far because it applies to new disability claims, not the 470,000 pending claims.

The other two initiatives mentioned make it easier for the VA to discipline employees. The department has pointed to more than 1,300 employees who have been fired under Trump's watch. Because their infractions are not detailed in public documents, the impact on veterans' care is not fully known.

During a rally on 8 December, in Pensacola, Florida, Trump said: "The VA was a mess." Before, "you couldn't fire anybody at the VA, if they were sadists, if they were horrible people. ... Now we look at them, they're no good — we say, 'You're fired. Get out of here."'

The facts: It's wrong to say VA employees were never fired before Trump took office. In fact, more were fired in President Barack Obama's last budget year than in Trump's first.

In fiscal 2017, covering Obama's last three months and Trump's first nine months, 2,061 VA employees were removed for discipline or performance. About 1,419 firings took place since January 2017, when Trump took office, to present. That's down from 2,662 in the previous fiscal year, according to Office of Personnel Management information on the agency's data archive FedScope.

However, it's true that it often took longer for terminations to become final under an appeals process that has been shortened under Trump. Because a new accountability law making it easier to fire VA employees did not take effect until late June 2017, about 500 of the firings last year occurred under the former appeals system, which remains in place at other federal agencies. The new law shortens the length of time to challenge a disciplinary action and lowers the burden of proof needed to fire VA employees.

In a tweet on 31 December, Trump said: "Why would smart voters want to put Democrats in Congress in 2018 Election ... People are much better off now not to mention ISIS, VA ..."

The facts: He's entitled to his politics, but the tweet masks the fact that each veterans' bill signed into law by Trump won approval with strong support from Democrats as well as Republicans.

House Democrats did block one VA Choice emergency funding bill after major veterans groups complained it focused too much on private care without also investing in core VA programs. The bill was revised to add the money, was overwhelmingly approved and was signed by Trump on 12 August.

The bipartisan display began with David Shulkin, a holdover from the Obama administration confirmed unanimously by the Senate to serve as VA secretary in February. Trump calls Shulkin the "100-to-nothing man" because of that vote, since he is the only Trump Cabinet member to achieve that.

In a press release on 9 November, the White House said: "Secretary Shulkin has expanded access to urgent mental health care to former service members with other-than-honorable discharges."

The facts: This claim glosses over VA's difficulty in hiring mental health professionals and providing counselling support to higher-risk veterans, due in part to a tightening VA budget. Trump cited mental health care as a top priority for fixing VA during the presidential campaign and pledged a hiring surge. But the VA only netted about 258 new personnel as of late November, far below the 1,000 additional mental-health specialists it had targeted for 2017.

In March, Shulkin announced an initiative to expand urgent mental health care to those with other-than-honourable discharges with much fanfare, but soon after, he revealed he wouldn't be asking Congress for additional money to pay for it. The programme provides mostly emergency care, something that had been offered already to any veteran, not preventive services.

To reduce suicide rates, VA is seeking to establish "telehealth" hubs in rural areas to provide veterans with mental health assistance. It has launched a new predictive model to analyse veterans' health records to identify those at risk. Roughly 20 veterans take their lives each day.

In a press release, on 22 December the White House said: "President Trump signed the VA Choice and Quality Employment Act of 2017 to authorise $2.1 billion in additional funds for the Veterans Choice Program." — 22 December press release.

The facts: The money was quickly used up. Weeks after Congress approved the $2.1 billion in emergency funding to keep the VA Choice private-care program running, the VA acknowledged in September the program would again run out of money earlier than expected. The VA asked Congress to approve a long-term fix to its VA Choice program that could cost as much as $54 billion over five years, but divided lawmakers in December decided instead to approve another stopgap measure of $2.1 billion, punting the bigger issues until later.

The delay means that a larger overhaul of VA Choice — which Shulkin says will help significantly reduce wait times at VA medical centres — isn't likely to be fully implemented until 2019 or later.

The VA Choice program was put in place after a 2014 wait-time scandal that was discovered at the Phoenix VA hospital and elsewhere throughout the country. Veterans waited weeks or months for appointments while phony records covered up the lengthy waits. The program allows veterans to go to private doctors if they endure long waits for VA appointments, but it has suffered extended wait times of its own.

Last year, Shulkin said veterans were waiting more than 60 days for new appointments in about 30 VA locations nationwide.

AP