House Chairman Unveils Bill to Overhaul VA-Funded Private Care and Shutter Department Facilities

A key lawmaker in the House on Thursday introduced a measure to expand veterans access to private health care on the government’s dime while also instituting a process by which the Veterans Affairs Department would begin closing underutilized facilities.

The Veterans Affairs Maintaining Systems and Strengthening Integrated Outside Networks (VA MISSION) Act would provide veterans access to private sector care when the services they are seeking are not offered at VA, there is no full-service medical facility in their state, they previously were eligible for outside care under the Veterans Choice Program or VA cannot meet its own standards of care in providing care to an individual veteran. Perhaps most controversially, in a bill that seeks to bridge an array of divisions on one of the thorniest issues on Capitol Hill, the measure would allow a veteran and doctor to mutually agree that private care was in the patient's “best medical interest.”

The VA provider would have to first assess the distance the veteran must go to receive care from the department’s network of more than 1,200 medical facilities, the nature of the services required, the frequency of treatment, the timeliness of available appointments and other “excessive burdens to care.”

The bill is still a far cry from fully privatizing the Veterans Health Administration, as some in Congress have proposed, or giving all veterans eligible for VA care a card or vouchers that enable them to receive private care at any time, as President Trump advocated on the campaign trail (the proposal is still live on his campaign website). The health care provisions of the measure are largely in line with a proposal outlined by since-dismissed VA Secretary David Shulkin last year.

Rep. Phil Roe, R-Tenn., who introduced the measure and chairs the House Veterans' Affairs Committee, said his bill represented a “bipartisan, bicameral agreement reached last month.” Lawmakers nearly attached that agreement to the must-pass omnibus spending bill Trump signed into law in March, but House Democrats—whose votes were necessary in order to approve the larger appropriations package—balked at the proposal. House Republicans can likely move a standalone bill without Democratic support, and Sen. Jon Tester, D-Mont., the top Democrat on the Senate's veterans committee, has expressed an openness to a similar bill in the past.

“This legislation must be passed, and if Congress fails to act veterans will pay for that failure,” Roe said. He plans to hold a committee vote on the bill next week.

Rep. Tim Walz, D-Minn., the top Democrat on Roe’s panel, has not yet taken a position on the bill as he and committee Democrats “are still actively engaging veterans and stakeholders in the community,” according to a spokesman.

The choice program, which Congress established after the 2014 scandal involving department employees manipulating patient data to hide long wait times, is set to run out of funding later this month or in early June. Roe’s bill would avoid that pending crisis by providing $5.2 billion for the program before sunsetting it permanently in one year. The looming deadline caused VA acting Secretary Robert Wilkie to call for “decisive action” through a “permanent choice program.”

“Without community care, VA’s ability to provide timely, high quality health care to veterans will be dramatically diminished,” Wilkie said last week. “The VA, along with the White House, commend Congress’s dedication to finding a long term solution to the choice program.”

He added: “We cannot wait any longer.”

Wilkie on Thursday endorsed Roe's bill. 

The VA MISSION Act would include another controversial provision to put VA through a process similar to the Defense Department’s Base Realignment and Closure Commission. The measure would require the VA secretary to assess the department’s current capacity to provide health care in each of its networks and ultimately recommend facilities to close, modernize or realign. The secretary would then pass those suggestions along to a presidentially-appointed, Senate-confirmed commission. That panel would submit its recommendations to the president, who would then have to approve of the plan in full, in part or reject it altogether. Congress would then have 45 days to vote down the plan or it would automatically go into effect.

Roe previously pushed those provisions through his Asset and Infrastructure Review Act. A third provision of the bill would expand veterans access to home caregivers.

The bill quickly earned endorsements from an array of stakeholders. Veterans of Foreign Wars, called on its 1.7 million members to contact their representatives in Congress and urge support for the measure.

“Passing this bipartisan and bicameral bill is critical to ensuring veterans have timely access to the care they have earned and deserve,” said Keith Harman, VFW’s national commander.

Concerned Veterans for America, a libertarian-leaning group with ties to the Koch brothers that has often clashed with traditional, congressionally chartered veteran service organizations like VFW, also threw its support behind Roe’s bill.

“The MISSION Act would go a long way towards resolving problems with the VA’s existing community care programs and stabilizing the VA’s health care system,” said Dan Caldwell, CVA’s executive director. “We’re also encouraged that the MISSION Act mandates a long-overdue review of the VA’s infrastructure across the country. With more than half of VA facilities over 50 years old, it’s critical that we begin working to modernize the VA’s infrastructure to serve a new generation of veterans.”

While CVA has led the charge in calling for expanded private care for veterans, VFW and most other veterans groups have supported a more cautious approach. The bill seeks to assuage concerns about privatizing VA in part by keeping VA in charge of scheduling private appointments and maintaining robust access and quality standards for the private facility network. VA would generally pay Medicare rates to providers, with some adjustments, and guarantee the costs veterans incur would not increase compared to what they would pay at VA.

While the bill strives to strike a delicate balance, it would not leave everyone satisfied. The measure would allow VA facilities to offer up private sector care for up to three categories of medical services—not to exceed 36 offerings nationally—drawing the ire of the American Federation of Government Employees. Marilyn Park, a legislative representative at AFGE’s VA council, which represents 230,000 VA workers, said the bill amounted to “pretty unfettered use of service clinics to replace integrated care.”

“The VA is starving for staff, the VA is starving for new facilities and to protect the ones it has,” Park said. She added that VA employees are struggling to “help the veterans every day who are being lost in the system by choice.”

While Roe is pushing for an expedited schedule, Park said Congress should “take a pause” and await permanent leadership at the department. Trump has yet to nominate a new VA secretary since his previous pick, Rear Adm. Ronny Jackson, withdrew his name from consideration. Veterans groups and VA itself have said it is struggling to “restore regular order” amid all the recent leadership turmoil. Still, the White House and VA have set Memorial Day as the goal for passing a new choice bill.

“You’ve got a deal that’s been brokered between the House and the Senate already, and the White House,” Darin Selnick, who served as the White House’s top VA policy person until April, recently told Government Executive. “Why not give it one last shot of money, fix it, and be done with it?”