"I WON’T BE HERE IN SIX MONTHS”: A VETERAN’S BREAKING POINT AND THE ACCESS ACT’S PUSH TO FIX THE VA
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On the sixth night of his deployment to Afghanistan, a rocket-propelled grenade tore through the tent where Army Staff Sergeant Chris Enget was sleeping. It exploded just five feet away from his toes, severing a tendon in his left foot.
Despite the severity of his injury, Enget refused to leave his unit or be medevaced to Germany. So, for the next five and a half months in Afghanistan, the soldier who’d grown up a stubborn kid throwing bales of hay and moving cows in Montana, stuffed his injured foot into a boot and endured constant, stabbing pain in silence.
After returning home, Enget was medically discharged. However, an incorrect surgery, followed by two more unsuccessful attempts to fix his foot, left him with no relief. Soon, the pain began to spread, creeping to his knees, then his hips, back, and finally into his skull, causing debilitating, weeks-long headaches.
The VA kept prescribing him narcotics for the pain, and at one point, Enget was taking 16 different medications. This included six daily doses of an opioid known to be at least twice as potent as heroin, along with medications for anxiety and depression.
Constantly high, Enget wasn’t allowed to drive and couldn’t take care of his kids. He spent two years in his basement as his marriage, his plans, and his life all began to unravel. This continued until he could think of only one option to make it better. Enget tried to kill himself.
When his suicide attempt failed, Enget decided to go to the VA hospital, gathering courage and a deeply buried shred of hope.
“I need to see somebody,” he told them. “I need to talk to a counselor, a therapist, because this isn't working.”
The VA told him he’d have to wait six months.
Sister bills introduced to Congress this session are taking aim at this kind of response to Veterans in crisis. The Veterans' Assuring Critical Care Expansions to Support Servicemembers Act – the ACCESS Act – would require the VA to allow patients to seek care outside the Department if wait times are too long or VA facilities are too far away. This doesn’t solely apply to mental health and substance use issues, but routine and specialty care as well.
Paired with a major reorganization of the Veteran Health Administration announced in December, Rep. Mike Bost, Chairman of the House Veterans Affairs Committee, believes the bill will work to finally solidify Veterans’ access to community care.
Veterans service organizations have expressed support for the legislation. They herald the expansion of choice and continued efforts to make care more timely and convenient. But some worry about the unintended consequences of the proposed changes.
Their concerns hinge not just on outcomes for individuals who have served, but on the potential impact on the VA itself.
Lots of Legislation, Little Change
The ACCESS Act is just the latest legislative effort to chip away at the impediments of a system long maligned as inefficient and overly bureaucratic – sometimes fatally so.
In 2014, whistleblowers at the Phoenix VA blew the lid off a system of secret waitlists meant to conceal the true lengths of time Veterans had to wait for care – a practice eventually revealed to be in use at VA facilities nationwide.
Investigations eventually revealed that 35 Veterans had died while awaiting VA healthcare, and 120,000 others never received medical care due to long wait times. The next year, another effort to tally the toll by the VA’s own Inspector General found 307,000 Vets “may” have died waiting for treatment – a number the VA refuted.
Lawmakers responded by passing the 2014 Veterans Access, Choice, and Accountability Act, which expanded Vets’ eligibility to seek health care in the private sector, especially if they lived in rural or remote areas. But the VA dragged its feet on implementation, which was patchy and imperfect, according to Bost.
Four years later, Congress stepped in again with the VA MISSION Act, which further expanded Veterans’ access to care outside the VA system.
At this point, the VA reported it was “seeing more patients than ever before, more quickly than ever before, and Veterans are more satisfied with their care than they have been previously.” Between 2014 and 2021, community care authorizations jumped 161 percent.
Yet a government review found that the Department’s new Veterans Community Care Program failed to specify allowable wait times. Veteran suicide rates continued to climb, with dozens of Veterans even committing suicide in VA parking lots – a tragic trend that demonstrated the VA’s ongoing inability to get Veterans timely mental health care.
In early 2024, a video surfaced of VA Under Secretary for Health Dr. Shereef Elnahal explaining that his goal was to reduce reliance on community care and instead maximize in-house service provision.
“Let’s press the easy button less,” he said.
A Bill to Finish the Job: The ACCESS Act
Under the ACCESS Act, Veterans would be able to seek care outside the VA if they face wait times of 20 days for primary care or mental health appointments, or if it would take longer than 30 minutes for them to drive there. For specialty care, they can elect to go outside the VA if they can’t be seen within 28 days or if they live an hour or more away.
That’s already true by regulation, but not by law. Bost says the bill is another attempt to accomplish what lawmakers thought they were putting in place with the Choice Act, then the MISSION Act.
“It's the same thing,” he said. “Now this language is clarifying again, for bureaucrats, what our intention is for our veterans, so that they can actually get those services when and where they need them and don't have to drive 9,000 miles, or wait a year.”
Like the Veteran Enget met in Montana, who was diagnosed with cancer but had to wait nine months to see an oncologist. Or the 92-year-old whose eyesight was failing but was directed by the VA to visit an ophthalmologist in Billings – seven and a half hours away.
“It's ironic to me that the people who fought for our freedom are the ones who have the least amount of freedom in their health care,” said Enget, who is now the education director for the conservative nonprofit Concerned Veterans for America.
If the ACCESS Act passes, the VA has to give a reason when it denies a Veteran community care, and it has to do so within two days, plus provide information on how to appeal the decision.
The bill also speeds up the clock on getting Vets who need help into residential treatment centers for mental health and substance abuse. The process, from request to admission, would now be completed within just four days.
Support That Comes With a Lot of Questions
While VA healthcare legislation has historically been bipartisan, the ACCESS Act is not enjoying the same across-the-aisle support. No Democratic members have signed on as cosponsors of the House bill.
Democratic Senators agreed to support their version of the bill provisionally, and only if the community care access standards expire after eight years, reverting to regulation instead of law.
And while Veterans service organizations support the ACCESS Act, some of their approval comes with caveats.
“When you analyze the bill, there's a lot of great intentions,” said Jon Retzer, Deputy National Legislative Director for Disabled Veterans of America. “But it comes with unintended consequences and costs.”
One of Retzer’s concerns is that allowing Vets to jump to an external provider doesn’t necessarily mean that they’ll be seen any faster, as they’ll have to compete with the much larger non-Veteran population for care.
Recent studies have found that wait times for community care were no shorter than those at VA medical centers.
Retzer also expressed worry about the ACCESS Act enabling Veterans to bypass the VA’s referral system, which he feared would allow them to disconnect from the VA’s wraparound services.
This is a primary concern for Rep. Mark Takano, Ranking Member of the House Committee on Veterans’ Affairs.
“Leaving veterans in community care without coordination or oversight is dangerous,” he wrote in an email.
“Referrals keep VA providers connected to patients and can save lives. VA already conducts minimal oversight of community-care quality, and this bill fails to fix that,” he said.
Then, there’s the fear that Veterans will opt for community care to shave off wait times or cut down on the commute. But at what cost? For the treatment of issues like PTSD, traumatic brain injuries, or military sexual trauma, getting an appointment close to home or quickly is only helpful if the community provider brings the same expertise that a VA provider would.
It takes Rachel Clark and her husband Charlie, a Marine with a 100% disability rating, four hours to get to the closest VA hospital in South Carolina and back – without traffic.
They go anyway: for mental health appointments with VA psychiatrists after civilian providers flat out said they couldn’t help with Charlie’s combat PTSD.
“We have to keep mental health in the VA,” Clark said. “These men and women that come back with this trauma that have invisible wounds, they need to be able to trust that the person they’re talking to gets military culture … and knows how to really help.”
Enget said for him, the opposite was true.
After he threatened suicide at the VA, they were able to make an appointment for him the next week. But the therapist he was provided moved to a different job after two months, and he had to start over with a new one.
This happened six times.
Eventually, he gave up, stopped going to his appointments, and attempted suicide again.
A friend visited Enget in the hospital and told him he could see a therapist outside the VA system. He hadn’t even known that was a possibility.
“That's one of the things even about the Veterans’ ACCESS Act that I really like,” said Enget. “It's got that provision in there that requires the VA to notify veterans when they qualify for care in the community and why they qualify for it.”
The non-VA psychiatrist Enget met with made him feel like he mattered. Seven years later, Enget still sees him and says his life has been transformed by getting proper and continuous mental health care that was right for him.
A System That Isn’t Ready
Some advocates worry that patients’ health records will get lost in the shuffle if Veterans hop in and out of VA care; lacking a modern infrastructure to share electronic health information, the VA has no reliable way to coordinate care with outside systems.
The Clarks waited for months for the results of Charlie’s last MRI so they could make an appointment for a back ablation – a procedure he needs every six months to a year to deaden nerve pain. Rachel Clark kept calling the VA, trying to figure out what the holdup was.
She finally discovered that the VA hospital had received the MRI report from the community hospital, but not the actual images. VA administrators told Clark that in order to make the ablation appointment, she’d need to retrieve the physical images from the local hospital and hand-deliver them to the VA two hours away.
“Why is there that disconnect?” Clark asked. “I shouldn’t have been the one calling a month later, going, why hasn’t anybody called? We did this, what’s next?”
The lack of records exchange could be especially problematic for Veterans being prescribed opioids and others who rely on a complex balance of medications.
“We understand that veterans need their health care, but it has to be a safe and timely, seamless, transparent, and there has to be a partnership that is all the way around,” Retzer said.
“It's just not there.”
Impacts on the Institution
While individual Veterans might benefit from increasingly flexible community care enshrined in the ACCESS Act, some worry the VA itself could lose out.
“The ACCESS Act is filled with provisions that would accelerate outsourcing, drain resources from VA’s direct-care system, and weaken VA’s integrated and culturally competent care model,” wrote Rep. Takano. “While some veterans will always need community care, it must not replace VA care or erode its quality,” he said.
A 2021 government report noted that increased access to community care might cause some VA facilities to be underused, driving up costs per Veteran unless the VHA closes or consolidates.
If Veterans leave VA care, they’d also pull a lot of data out with them – information currently drawn from medical records, patient surveys, and blood tests that the Department uses for research and to improve health outcomes.
At an estimated $260 billion, the costs associated with the ACCESS Act are consequential and could potentially detract from other VA budget lines. The VA’s 2026 budget funds community care at $33 billion—a 50% increase from 2025 levels. Community care costs are only projected to go up.
John Vick, Executive Director of Concerned Veterans for America, sees the ACCESS Act as a positive push for the VA.
“If you gave veterans full choice in the health care, what you would see is an imperative from the VA to be the most efficient version of itself,” he said.
Enget hopes the bill becomes law. He says that had its provisions been in place when he was ready to give up on life, it would have made a difference.
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BY JENNIFER BROOKLAND
Freelance Journalist at VeteranLife
Air Force Veteran
Jennifer is a USAF veteran and a freelance journalist based in Colorado. She's covered vulnerable children for the Detroit Free Press, veterans issues for North Carolina Public Radio, and her freelance writing has appeared in newspapers around the country.
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Jennifer is a USAF veteran and a freelance journalist based in Colorado. She's covered vulnerable children for the Detroit Free Press, veterans issues for North Carolina Public Radio, and her freelance writing has appeared in newspapers around the country.
