Senate Passes Bill That Would Allow More Vets Access to Private Health Care

This story has been updated.

More veterans would have access to private health care under a bill the Senate passed on Friday.

The bipartisan legislation would allow vets access to health care outside of the Veterans Affairs Department when the nearest VA facility within 40 miles driving distance does not provide the care the vet needs. The bill amends the so-called “40-mile rule” included in the 2014 Veterans Access, Choice and Accountability Act, which allows certain vets to receive health care temporarily outside the VA if the department is unable to schedule an appointment for the veteran within 30 days, or the veteran lives more than 40 miles from a VA facility.

S. 1463 would ensure that the 40-mile rule “applies only in the circumstance where a veterans facility provides the service the veteran needs,” said Sen. Jerry Moran, R-Kansas, the bill’s sponsor, on the Senate floor Friday. So if a vet lives within 40 miles of a VA facility, but that facility does not provide the care the vet needs, then the veteran is eligible for the Choice program.

The 2015 Access to Community Care for Veterans Act now heads to the House, but Moran said he hoped that Senate passage of the bill would push the department to “correct this problem on its own volition” as soon as possible.

This is the latest tweak to the 40-mile rule included in the 2014 law. On April 24, VA published an interim final rule in the Federal Register, effective immediately, that changed the interpretation related to a veteran’s distance from the nearest VA facility. Instead of calculating geographic distance based on a straight line or, “as the crow flies,” the department now determines eligibility based on the actual driving distance between the veteran’s home and the nearest VA medical facility. VA is using geographic information system (GIS) software to calculate driving distance.

The department came under pressure from veterans, lawmakers and veteran advocates over its original interpretation for how to calculate the 40-mile distance, which led to the change. VA defended its original interpretation saying the conference report accompanying the final bill stated: “In calculating the distance from a nearest VA medical facility, it is the conferees’ expectation that VA will use geodesic distance, or the shortest distance between two points.” VA then pointed out in the interim final rule explaining the April change that “the shortest distance between two points is a straight line, so VA concluded that a veteran who is outside of a 40-mile radius of a VA medical facility would be eligible under this provision.” 

Moran and other lawmakers have said S. 1463 is necessary because there are still too many veterans, especially in rural areas, who are not able to get the health care they need despite the Choice program. Senate Veterans’ Affairs Committee Chairman Johnny Isakson, R-Ga., on Friday said that “if for some reason the House does not adopt the language, we will take it up immediately in the Senate when we have our next markup meeting in the Veterans’ Affairs Committee and take care of it.” Moran said lawmakers would make sure the language would be included in “every bill related to veterans affairs that is on its way to the White House” if his stand-alone bill isn’t enacted or the VA doesn’t make the change through regulatory action.

The Choice program is a key component of the 2014 Veterans Access, Choice and Accountability Act, which President Obama signed into law last summer. The department began sending Choice cards to eligible veterans at the end of last year, mailing them out in three phases. But the roll-out created confusion, and many vets who believed they were eligible for the Choice program were turned away.

It runs through Aug. 7, 2017, or until the $10 billion fund is exhausted. The administration’s fiscal 2016 budget proposal recommended shifting any potential excess money from the Choice program into other areas, but lawmakers quickly shot down that idea in February saying it could end the program prematurely. House Veterans’ Affairs Committee Chairman Rep. Jeff Miller, R-Fla., called the proposal a “non-starter.”

The department anticipated that the change related to calculating distance would double the number of vets eligible for non-VA care under the program; presumably, Moran’s legislation would allow access to even more vets.

Moran said that the non-partisan Congressional Budget Office’s “preliminary estimate of the mandatory effects of S. 1463 gave a net zero effect over the five-year and 10-year projection period. But according to a May 25 Associated Press report, VA said it could cost billions each year to make the change.

VA spokesman Randy Noller said that while the department could not comment on pending legislation "we at VA strive to care for our veterans who have served our nation and earned veterans benefits. We continue to look forward to working with our Senate and House committee partners to best implement the Choice Program and serve our veterans."