See more of the story

– The Department of Veterans Affairs is preparing to shift billions of dollars from government-run veterans’ hospitals to private health care providers, setting the stage for the biggest transformation of the veterans’ medical system in a generation.

Under proposed guidelines, it would be easier for veterans to receive care in privately run hospitals and have the government pay for it. Veterans would also be allowed access to a system of proposed walk-in clinics, which would serve as a bridge between VA emergency rooms and private providers, and would require copays for treatment.

Veterans’ hospitals, which treat 7 million patients annually, have struggled to see patients on time in recent years, hit by a double crush of returning Iraq and Afghanistan veterans and aging Vietnam veterans. A scandal over hidden waiting lists in 2014 sent Congress searching for fixes, and in the years since, Republicans have pushed to send veterans to the private sector, while Democrats have favored increasing the number of doctors in the VA.

If put into effect, the proposed rules — with many details remaining unclear as they are negotiated within the Trump administration — would be a win for the once-obscure Concerned Veterans for America, an advocacy group funded by billionaire industrialists Charles and David Koch and their network of donors, which has long championed increasing the use of private sector health care for veterans.

For individual veterans, private care could mean shorter waits, more choices and fewer requirements for copays, and it could prove popular.

But some health care experts and veterans’ groups say the change, which has no separate source of funding, would redirect money that the existing veterans’ health care system — the largest in the nation — uses to provide specialty care.

Critics have also warned that switching vast numbers of veterans to private hospitals would strain care in the private sector and that costs for taxpayers could skyrocket. In addition, they say it could threaten the future of traditional veterans’ hospitals, some of which are already under review for possible consolidation or closing.

President Donald Trump, who made reforming veterans’ health care a major point of his campaign, may reveal details of the plan in his State of the Union address later this month, according to several people in the administration and others outside it who have been briefed on the plan.

The proposed changes have grown out of health care legislation, known as the Mission Act, that was passed by the last Congress.

“Most veterans chose to serve their country, so they should have the choice to access care in the community with their VA benefits — especially if the VA can’t serve them in a timely and convenient manner,” said Dan Caldwell, executive director of Concerned Veterans for America.

Critics, which include nearly all of the major veterans’ organizations, say that paying for care in the private sector would starve the 153-year-old veterans’ health care system, causing many hospitals to close.

“We don’t like it,” said Rick Weidman, executive director of Vietnam Veterans of America. “This thing was initially sold as to supplement the VA, and some people want to try and use it to supplant.”

Members of Congress from both parties have been critical of the administration’s inconsistency and lack of details in briefings. At a hearing last month, Sen. John Boozman, R-Ark., told Robert Wilkie, the current secretary of Veterans Affairs, that his staff had sometimes come to Capitol Hill “without their act together.”

Although the Trump administration has kept details quiet, officials inside and outside the department say the plan closely resembles the military’s insurance plan, Tricare Prime, which sets a lower bar than the Department of Veterans Affairs when it comes to getting private care.

Health care experts say that, whatever the larger effects, allowing more access to private care will prove costly. A 2016 report ordered by Congress, from a panel called the Commission on Care, analyzed the cost and warned that unfettered access could cost well over $100 billion each year.