A conservative-backed group that has gained more influence since the election is renewing its effort to transfer oversight of Department of Veterans Affairs medical facilities to a government-chartered nonprofit. It's also seeking to expand veterans' private-sector health care options.
Concerned Veterans for America (CVA) has proposed the ideas before, creating consternation among more established veterans organizations that feared too much of an expansion into the private sector would drain the VA of resources.
A bipartisan, CVA-commissioned task force outlined a plan for significant changes at the VA in 2015, and it was unveiled as draft legislation by Rep. Cathy McMorris Rodgers, R-Wash., in June 2016.
The bill, "Caring for Our Heroes in the 21st Century Act," never went anywhere. But since then -- with Trump calling for an overhaul of the department and tapping one of CVA's senior advisers for his transition team -- group leaders say they have more leverage.
"They've already embraced some of the concepts we support," said Dan Caldwell, CVA's director of policy. "I think they are open to these ideas."
CVA leaders will share, in person, their top priorities for VA reform with transition officials, lawmakers and VA leadership.
Other organizations -- including American Veterans, Vietnam Veterans of America, and Iraq and Afghanistan Veterans of America -- requested meetings with Trump during the transition, but never got them.
Besides drastic changes to the Veterans Health Administration, the group is pushing for Congress to empower the VA secretary to discipline and fire employees. CVA also wants to limit bonuses to VA executives more stringently than bonus restrictions passed last year. Lastly, the group is calling on the VA to collect and publicly release more data on health care costs.
Uncertainty about new VA secretary
Trump's transition team did not respond to requests for comment about whether the new administration would consider CVA's ideas. In his 10-point plan for VA reform, Trump said he'd ask Congress to authorize the VA secretary to discipline or fire poor-performing employees, limit bonuses and give every veteran the choice to seek care outside of the VA.
His vision includes "transforming the VA to meet the needs of 21st century servicemembers."
Caldwell said his group is cautious about David Shulkin's nomination as VA secretary. At times during the transition, Trump had considered former Rep. Jeff Miller, R-Fla., an outspoken critic of the VA who had pushed for faster employee discipline. Trump also met with Pete Hegseth about the post. Hegseth is a Fox News contributor who formerly led CVA.
Shulkin is a holdover from President Barack Obama's administration. He worked under VA Secretary Bob McDonald for nearly two years as undersecretary of health.
It's uncertain whether Shulkin will continue on a path set by McDonald to expand the VA's network of private-sector care to certain, eligible veterans while maintaining services within the VA, or make more radical changes, such as what's outlined in CVA's priorities.
"While he's been at the VA, there were continued problems, particularly around wait times and misconduct," Caldwell said. "I think during confirmation hearings, there needs to be discussion about why those problems continued to exist and whether he supported many of the same reforms Secretary McDonald and [Deputy Secretary Sloan] Gibson publicly advocated for, and how he would be different from them."
Other veterans organizations are anxious to hear Shulkin's plans, but are hoping for a different outcome than CVA. More than 25 groups expressed to Trump's team that they wanted to see continuity within the agency, and for the next secretary to build on McDonald's efforts.
"We don't know if he's going to be Bob McDonald-like or something totally different," said Paul Rieckhoff, founder of Iraq and Afghanistan Veterans of America. "We won't know until we hear more of his personal opinions and how he's going to line up, or not, with Trump."
Health care proposal
CVA's plan for health care includes temporarily extending the $10 billion Veterans Choice Program, through which some veterans can receive care now in the private sector with the VA paying the bill. The program is set to expire in August, but Sen. John McCain, R-Ariz., and Rep. Phil Roe, R-Tenn., have introduced legislation extending it until it runs out of funding.
An extension would give Congress time to implement a plan to expand care into the private sector, CVA said.
That plan, according to CVA, should include establishing an independent nonprofit corporation -- the Veterans Accountable Care Organization -- to manage health care within VA facilities and the private market. The corporation would be headed by a board of directors, including the VA secretary, eight members appointed by Congress and two members appointed by the president.
Under the plan, the VA would continue to exist to provide domiciliary care, programs for homeless veterans, research, training for health care staff and support during times of war or national emergency.
In response, the VA issued a statement that private sector care should only supplement VA health care, which is uniquely equipped to serve veterans, and not replace it.
CVA said critics labeling their plan as "privatization" is a misrepresentation.
"It's not a complete dismantling and selling off to the private sector," Caldwell said. "It would still be overseen and funded by Congress."
Firing VA workers
Some movement has already started in this congressional session on one of CVA's priorities: faster discipline for VA employees. The first piece of legislation to pass the House this session was introduced by Rep. Ryan Costello, R-Pa., to require all reprimands against VA employees remain in their files throughout their employment with the department. Currently, reprimands stay in employee files for two years.
Tougher changes are included in legislation Sen. Marco Rubio, R-Fla., re-introduced Wednesday, titled "The VA Accountability First and Appeals Modernization Act."
Rubio first introduced the bill last year, while Miller introduced a complementary bill in the House.
In part, it places a 77-day limit on the appeals process when a VA employee is disciplined or fired. It would also remove the Merit Systems Protection Board from the process of disciplinary action against VA executives. The bill would allow the VA to recoup bonuses and other monetary incentives from poor-performing executives.
On Thursday, Rep. Doug Lamborn, R-Colo., announced his intent to introduce similar legislation in the House.
"After three years of witnessing systemic abuse -- including falsified wait lists, whistleblower retaliation, and abysmal patient care -- this bill will provide real accountability and culture change at the VA," Lamborn said in a written statement.
Caldwell said he's optimistic the legislation will get passed with Trump as president.
"The president-elect has been incredibly clear this is a priority for him," Caldwell said. "I think that, combined with the Senate already introducing this, shows there's a very clear path for these bills passing into law."
The American Federation of Government Employees, which represents about 230,000 VA employees, is preparing to argue against these types of bills this session.
Marilyn Park, who is with the federation, said the measures do away with employees' due process rights.
"I think they're all morale-killers and dangerous to the function of the agency," Park said. "It makes the federal government less and less attractive for the best and brightest. People don't want to go and get beat up every day and be told they don't help the public."
Gibson has also fought against Congress limiting bonuses. In a letter to the House Committee on Veterans' Affairs in December, he asked lawmakers to repeal restrictions on bonuses put in place earlier in 2016. Gibson said the limitations were a hindrance in hiring and retaining high-quality employees.
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