The U.S. Senate followed the House of Representatives in passing sweeping legislation to overhaul the beleaguered Veterans Affairs Department.
The Democratic-controlled Senate on Tuesday evening voted 91-3 in favor of the bill, with three Republicans opposing it. The passage came a day after the Republican-led House overwhelmingly approved the bill and a day before Congress was set to break for August recess. President Barack Obama is expected to sign the measure into law.
The legislation was the product of a deal brokered between Rep. Jeff Miller, R-Florida, and Sen. Bernie Sanders, I-Vermont, chairmen of the House and Senate veterans' affairs committees. It comes two months after Eric Shinseki resigned as VA secretary over a scandal involving dozens of vets who died while awaiting treatment after being placed on secret wait lists.
"This bill keeps our commitment to the men and women who put their lives on the line to defend our country," Sanders said in a statement after the vote. "It makes certain that we address the immediate crisis of veterans being forced onto long waiting lists for health care."
The bill calls for $16.3 billion in spending to expand community healthcare options for veterans who face long wait times and commutes; hire more doctors, nurses and other health-care workers; and improve accountability by making it easier for the agency secretary to fire executives.
The Senate this week unanimously confirmed Robert McDonald, 61, a West Point graduate and former chairman of the consumer products giant Procter & Gamble Co., to replace Acting Secretary Sloan Gibson as Veterans Affairs secretary.
"I recognize that the last few months have been difficult -- and the days ahead will not be easy," McDonald said Thursday in a message to employees. "In fact, many tasks that we must accomplish will be difficult, but I assure you that I will be with you each step of the way."
McDonald takes over an agency facing daunting bureaucratic challenges, including a backlog in disability claims, delays in adopting electronic health records and other technology programs, and instances of preventable deaths at some facilities. The problems were grating on lawmakers, especially Republicans, even before news of the wait-list scandal broke.
Following whistleblower reports of the scandal, investigators in May confirmed that a VA hospital in Phoenix maintained a secret list of patients waiting to get appointments and that dozens of them died before getting a chance to see a doctor.
The agency's own investigators confirmed 35 deaths linked to the Phoenix list and concluded that VA hospitals across the country systematically manipulated data to conceal appointment backlogs. The public – and lawmakers – were outraged.
The investigation into fraud continues. Agency executives and other managers routinely received bonuses based in part on appointment figures they submitted to headquarters. If investigators conclude certain officials deliberately altered patient records, they'll face criminal charges.
Republicans led by Miller pushed for a provision in the legislation authorizing the secretary to fire any employee of the Senior Executive Service or equivalent Title 38 medical professional. The language isn't as severe as that of the House's version of the bill and gives affected parties an option to appeal the decision.
As the scandal escalated with the revelations out of Phoenix and elsewhere, Shinseki resigned and Gibson took over as acting secretary. It was Gibson who, in mid-July, told lawmakers the agency needed $17.6 billion to end the problem of delayed care.
While Sanders was quick to accept Gibson's calculation, Miller was not. The Republican said nothing shown to him by the agency justified the figure. As the two met in conference negotiations to hammer out a deal, the budget request emerged as the toughest issue to resolve.
The overhaul package includes $10 billion for a "Veterans Choice Fund" so vets experiencing delays in getting care at a VA facility or who live more than 40 miles from one can go to hospitals and clinics outside the system. These may include qualified community-based hospitals or clinics of federally funded facilities, including those on military bases and in the Indian Health Service.
Another $5 billion will be used to hire more doctors, nurses, mental health workers and other medical staff, while another $1.3 billion will pay for expanding the agency's healthcare footprint by entering into leases with 27 medical centers in 18 states and Puerto Rico.
The legislation also calls for the creation of a commission to review VA's ability to provide long-term healthcare long term, and to determine what changes, if any, should be made in services.
In addition, it funds an assortment of veterans-related programs, including providing services to victims of military sexual assault, extending post-9/11 GI Bill benefits to the spouses of fallen troops, and guaranteeing in-state tuition to veterans, surviving spouses and eligible dependents regardless of where they attend school or their home of record.
What’s more, it will also help extend a rural healthcare program that provides rehabilitation therapy, quality of life and community integration services to vets suffering from traumatic brain injury.
In a shift from the way Congress has previously handled spending bills, the veterans' legislation is funded mostly by new dollars, without matching offsets typically demanded by GOP lawmakers. Only the $5 billion going toward hiring additional medical staff is to be offset by cuts elsewhere in the budget.
The three Republicans who opposed the bill – Sens. Tom Coburn of Oklahoma, Bob Corker of Tennessee and Jeff Sessions of Alabama – did so in part because of its cost.
Coburn noted the agency's budget has surged 40 percent in recent years, while the number of veterans seeking care has increased just 17 percent. Approving the measure would amount to "borrow[ing] $12 billion from our children and rewarding poor behavior, and charging it to our children," he said.
Sen. John McCain, R-Arizona, who helped craft the original Senate version of the bill, conceded Coburn's criticisms of VA mismanagement, but said the crisis at the VA is an emergency that needs to be addressed.
"This is so important to me that I believe it deserves our support," McCain said. "Can we leave here for five weeks and not address this issue? ... This is not perfect legislation, but for us not to pass it at this time sends a message to the men and women who have served the country that we have abandoned them."
Last Friday, it appeared the House and Senate were going their separate ways. Miller called for a conference committee meeting – attended by only one Democrat – during which he put forth his idea for a final bill. Shortly thereafter, Sanders and the Democrats went before reporters to unveil his plan for a bill.
After talking through the weekend, the two lawmakers held a joint press conference Monday to announce a deal. Miller said he was confident he could sell the bipartisan pact to the GOP-dominated House, and he delivered on that Wednesday.
Miller complimented the Sanders and his Senate colleagues for taking action on the legislation.
"We are now just one signature away from making government more accountable and providing veterans with real choice in their health care decisions," he said in a statement. "I am confident the president will do the right thing and sign this bill into law."
-- Bryant Jordan can be reached at firstname.lastname@example.org