Veterans health care legislation introduced by a pair of Republican senators on Monday could further complicate congressional plans to move quickly on sweeping reforms for the Department of Veterans Affairs as another funding deadline looms.
The measure, sponsored by Sens. Jerry Moran of Kansas and John McCain of Arizona, would create a new community care program for the department to allow more veterans to seek care outside the federal system at taxpayers’ expense.
It’s similar in concept to legislation floated by VA officials earlier this fall and another plan passed by the Senate Veterans’ Affairs Committee last week. It also follows a measure under consideration in the House Veterans’ Affairs Committee with similar goals.
All the proposals come as administration officials work on fulfilling their promises to make veterans health care more convenient and timely without sacrificing quality. President Donald Trump made that idea one of the central tenets of his pledge to clean up the federal bureaucracy both during his 2016 election campaign and in the months since inauguration.
Roughly one-third of veterans’ medical appointments are already held outside VA facilities, but critics have long lamented that veterans still face lengthy waits and unfriendly bureaucracy when trying to get health care from the federal government.
Meanwhile, veterans groups have warned against “privatizing” the system by sending too many patients into the private sector, where military-specific injuries may be overlooked or mistreated.
Currently, VA boasts a series of separate community care programs, including the VA Choice program, which allows veterans to seek private-sector appointments with federal officials paying the bill.
VA Secretary David Shuklin has said he wants to consolidate those offerings into a more streamlined process, with more flexibility for doctors and patients.
Moran’s plan — which he tried to attach to the Senate committee’s measure during mark-up last week — would go further than the other legislative plans in giving veterans a freer hand in choosing when to seek private-sector care over VA offerings.
It delineates specific triggers making veterans eligible for the outside care, which include when VA facilities have significant wait times or gaps in specialty coverage. It also would allow veterans to enter the program “when veterans and their VA provider agree it is in the best medical interest of the veteran to receive community care.”
The committee-passed measure — approved 14-1 with only Moran opposing — also does that, but with more flexibility for VA officials to interpret the guidelines and maintain a primary role as care coordinator for veterans. Moran said the measure is too timid of an approach to reforming veterans care.
“(This bill) explicitly arms the VA secretary and clinicians with objective, demand-driven data that determines the capabilities of VA facilities and whether care in the community is necessary rather than relying on the VA bureaucracy to determine eligibility criteria without specifying the tools they should use to do so,” Moran said in a statement.
McCain said past work on the issue by Congress has been a positive starting point for reforms, but “much more needs to be done to provide all veterans a choice in when and where they receive care.”
The bill also omits a $3.4 billion plan to expand the VA caregivers program to families of all eras. Currently, the program is restricted to veterans who served after September 2001.
Congressional Democrats have been cool to ideas like Moran’s proposal so far, instead supporting other Republican-backed plans that give VA physicians more power to remain the gatekeeper of patient care plans.
They have also loudly condemned more ambitious plans to turn VA into an insurance voucher program or a full competitor with private-sector hospitals, arguing that those moves amount to dismantling a key safety net for veterans.
Moran’s proposal before the Senate Veterans’ Affairs Committee received no votes besides his own but some interest from lawmakers for future discussion.
Now, he and McCain hope that it can become the main vehicle for reform talks in the Senate. Whether it will overtake the committee-passed measure or become a secondary talking point remains unclear.
Either way, VA officials expect to run out of money for the Choice program by the end of the year. All of the plans under debate include several billion to extend that program into 2018 as a bridge to the overhauled community care system.
Without a clear path on those bills, lawmakers will have to pass a separate stopgap measure to ensure thousands of veterans using the Choice program don’t see their appointments disrupted or cancelled.
That could come as part of broader budget negotiations in coming weeks, although those debates are also still uncertain. A continuing resolution governing federal spending runs out on Dec. 8. Lawmakers are discussing a two-week extension in hopes of completing a full fiscal 2018 appropriations plan before Christmas.
Veterans groups are hoping their programs aren’t overlooked in that broader debate. Officials from the American Legion, AMVETS and Concerned Veterans for America endorsed Moran’s measure on Monday.
“This measure addresses funding, implements ongoing patient surveying in conjunction with community care teams, and devises re-evaluation of both VA and private sector care,” AMVETS National Executive Director Joe Chenelly said in a statement. “Both need oversight. All veterans have a right to receive the quality health care they have earned.”