House Passes Sweeping Bill to Overhaul VA-Funded Private Care, Shutter Facilities

The House on Wednesday passed 347-70 a major overhaul to veterans health care, voting to expand their access to private sector care on the government’s dime and to bring the Veterans Affairs Department through a process that would close some of its federally run facilities.

The Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act won widespread support in the lower chamber and will now head to the Senate, where it already has bipartisan backing. The massive bill dealing with multiple areas that have for years proven to be political landmines moved quickly through the House, with House Veterans' Affairs Committee Chairman Rep. Phil Roe, R-Tenn., introducing the bill just one month ago. Roe had worked for much of the 115th Congress with Democrats, his counterparts in the Senate, the Trump administration and an array of veterans stakeholders to reach a compromise bill.

The measure this week also won the official backing of the White House, which put out a statement saying the bill would “strengthen the VA’s ability to deliver timely, high-quality healthcare in its own facilities, while ensuring seamless integration with community care providers.” President Trump personally praised the bill in a tweet, saying the Senate should act within the next two weeks.

House votes today on Choice/MISSION Act. Who will stand with our Great Vets, caregivers, and Veterans Service Organizations? Must get Choice passed by Memorial Day!

— Donald J. Trump (@realDonaldTrump) May 16, 2018

The bill would provide veterans with 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.”

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 bill overall would cost $52 billion over five years, according to the Congressional Budget Office.

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.

Thirty-seven veterans service organizations and other stakeholders previously 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.”

A spokeswoman for Sen. Johnny Isaskon, R-Ga., who chairs the Senate Veterans' Affairs Committee and has praised the VA MISSION Act, said Senate Majority Leader Mitch McConnell, R-Ky., would determine when the bill received floor time but the hope was for it to move “quickly.” A McConnell spokeswoman said no vote has yet been scheduled.

The American Federation of Government Employees, which represents 230,000 VA employees, has called on Congress to reject the measure, saying it would endanger the department by shifting resources toward the private sector.