House Panel Advances Bills to Overhaul VA-Funded Private Care, Shutter Facilities and Enable Marijuana Research

A House panel on Tuesday overwhelmingly advanced a measure to expand veterans access to private sector health care, while also agreeing to shutter some government-owned facilities.

Just two Democrats on the House Veterans' Affairs Committee voted against the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act (H.R. 5520), which consolidates the department’s array of community care programs into one. The bipartisan support for the bill was a significant accomplishment for the committee, which has worked for years to strike an acceptable balance between easing veterans access to private care while assuaging concerns that the process would lead toward the privatization of the department.

Rep. Phil Roe, R-Tenn., who chairs the committee and authored the bill, called the measure a “transformational, once-in-a-lifetime opportunity to reform VA.”

“This compromise is one that we can all be extraordinarily proud to support,” Roe said.

Rep. Tim Walz, D-Minn., the top Democrat on the committee, was one of two members who voted against moving the bill forward. He said he supported 95 percent of the measure, but had concerns about how its provisions would unfold in future years. The VA MISSION Act, for example, would fund the new private sector health care program through the regular discretionary budgeting process. While Walz supported that funding stream, he issued an amendment to shield it from potential cuts when budget caps are reinstated.

Roe said the bill resulted after 18 months of negotiations and it was too late to make major changes.

“Any amendments to the bill, no matter how worthy they may be, violate the terms of those negotiations and put us right back at square one,” the chairman said. He added that the changes Walz requested were merely to “appease the unions.” The American Federation of Government Employees, which represents 230,000 VA employees, has expressed significant apprehension about the measure, saying it would endanger the department by shifting resources toward the private sector. All three of Walz’s amendments were rejected.

The 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. It would also 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.”

Acting VA Secretary Robert Wilkie applauded the committee's approval of the measure. It also has support from the White House, which is calling on Congress to pass the bill by Memorial Day.

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. The bill would avoid that pending crisis by providing $5.2 billion for the program before sunsetting it permanently in one year.

The measure includes 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.

The measure received a major boost earlier this week when 37 veterans service organizations and other stakeholders sent a letter to Congress urging lawmakers to support it. The groups have cautioned members against taking too aggressive an approach in boosting private sector care, but said Roe’s bill represented “a balanced approach to ensuring timely access to care while continuing to strengthen the VA health care system.”

The House committee’s counterparts in the Senate helped negotiate the compromise and appear poised to also advance the measure. Congress could run into trouble as VA is currently without permanent leadership and lawmakers could therefore have concerns about how the department would implement the bill. President Trump has yet to nominate a new VA secretary since his previous pick, Rear Adm. Ronny Jackson, withdrew his name from consideration. Walz said he tried to contact the administration to get its approval for his suggested changes but VA was in “chaos.”

“I don’t know who’s in charge of the VA, really, with an acting secretary,” Walz said.

AFGE has asked Congress to pause its movement on choice reform until VA has a permanent leader.

The House committee also approved the 2018 VA Medicinal Cannabis Act (H.R. 5520) on Tuesday, a bill that would enable VA to research the impacts of marijuana on veterans suffering from post-traumatic stress disorder and chronic pain. The measure would promote such research by clarifying it is “well within the authority of VA” and requiring the department to report to Congress on how it plans to exercise that authority.