Members of the Senate and House veterans' affairs committees met Tuesday to work out a compromise to pass the legislation aimed at reforming the Department of Veterans Affairs.
The Senate version of the bill was passed 93-3 on June 11, but lawmakers remain concerned over the costs and whether the bill adequately holds officials accountable for manipulation of patient appointments that has been linked to at least 35 deaths.
A key provision of the Senate bill would provide veterans facing time delays or long travel times from VA health care facilities the option of going outside the VA system. Veterans would be able to go to a private hospital or clinic taking Medicare, a federally qualified health center, or facilities funded by the Defense Department or Indian Health Service.
The Congressional Budget Office said the expanded route to care could add another $50 billion annually to VA health care costs, a projection that Sen. Tom Coburn, R-Okla., said was wasteful.
"When I hear 'we need more money' [for the VA], I just go nuts," said Coburn, who is also a doctor. "Because what we need [at the VA] is leadership and ... the ability to control growth and manage. And if you don't fix the real problems, you'll be back here again and the commitments to our veterans will be wasted."
Coburn said the VA estimates it sees 6.6 million unique patients each year. Divide that number up among the VA's 11,000 primary care doctors, and 12,000 nurse practitioners and physicians' assistants, he said, and you can estimate that the average health care provider at the VA is seeing 287 people a year.
Private health care providers will see five times that number on average, Coburn said.
"If you cook the books on appointments, you have no idea whether the VA [health care] is good," Coburn said. "We don't know that it's bad, but we don't know that it's good."
Fixing VA, he said, will require making it "totally transparent" and giving VA management the ability to hold people accountable.
Some lawmakers already had questions about VA spending and hospital management when CNN reported in April that the VA Medical Center in Phoenix, Arizona, concealed a large backlog of patients asking to see a doctor by keeping a secret waiting list. The network also reported that up to 40 veterans on the list may have died without getting care.
The VA confirmed the CNN report, saying that 35 veterans on the secret list died, and also found that such manipulation of appointments was systemic throughout the VA.
Sen. John McCain, R-Arizona, and Sen. Bernie Sander, I-Vermont, drafted the Senate bill now in conference committee. McCain reminded conferees that a follow-up report on Monday night includes new allegations about the Phoenix hospital. A whistleblower there told CNN that after its April report, records of some deceased patients were altered so that it would not appear they died awaiting care.
"Frankly, I don't think that is the last shoe to drop," he said.
A point continually raised by lawmakers on Tuesday is that any VA employee or official found to have committed fraud by manipulating data or records needs to be punished. The VA's Inspector General is already investigating 70 hospitals and clinics, and sharing information with the Justice Department for possible criminal prosecution.
The McCain-Sanders bill includes language that will give the VA secretary more authority to fire, demote and transfer employees deemed to be performing poorly, including those in the Senior Executive Service. A bill giving the VA chief that same authority was drafted by House Veterans Affairs Committee Chairman Rep. Jeff Miller, R-Fla., and passed the House in May.
On Tuesday, lawmakers made clear their frustration and anger at the VA for the patient deaths and the evidence of VA officials ignoring complaints of whistleblowers.
The VA has also confirmed what lawmakers were told at least as early as 2012 -- officials looking to get around the VA's standards on patient wait times were receiving bonuses partly based on the numbers.
Sen. Johnny Isakson, R-Georgia, noted that the deaths now under investigation in connection with the Phoenix wait-list scandal are not the only ones that VA has had to answer to. The Atlanta VA Medical Center was the site of three suicides, he said, and changes to staff and policy went into effect only after media attention focused on these.
Isakson said it is important to make sure officials are accountable for their actions.
"Change can take place," he said. "You can take a culture of corruption and make a culture of excellence if [you] let them know somebody is looking over their shoulder."
-- Bryant Jordan can be reached at firstname.lastname@example.org.