WASHINGTON -- House lawmakers on Tuesday advanced major reforms for the Department of Veterans Affairs that include an extensive overhaul of the agency's private-sector care programs -- a deal delayed by intense negotiations for more than a year.
The House Committee on Veterans' Affairs voted 20-2 to send the legislation to the full House. The bill, titled the VA Mission Act, would alter eligibility criteria for veterans to access private-sector health care, extend benefits for veteran caregivers and initiate a review of VA infrastructure, among other changes. The bill would cost $51 billion over a five-year period, according to preliminary estimates from the Congressional Budget Office.
The vote marked the first significant step forward for long-debated changes to the VA Choice program, which was created after the VA wait-time scandal in 2014 to ease demand on VA services. The program faces funding challenges, and rules governing who is eligible to access private-sector doctors through Choice are considered by many people to be bureaucratic and restrictive.
The bill has the support of the VA, White House and major veterans organizations.
"I think this is a once-in-a-lifetime, transformational bill," said Rep. Phil Roe, R-Tenn., the committee chairman.
Democrats on the committee balked that some of their provisions failed to make it into the final draft of the bill. Republicans shot down several amendments that Democrats offered Tuesday. Rep. Tim Walz of Minnesota, the ranking Democrat on the committee, was concerned about potential funding issues for the VA's private-sector care programs. He was one of the Democrats to vote against the measure.
"Put simply, the VA Mission Act, a policy designed to create a permanent solution for VA community care, lacks a sustainable source of funding to ensure that care is provided and protected in the long term," Walz said following the hearing.
Roe argued Tuesday that the "time for negotiations has come and gone."
"It's a really good bill," he said. "Is it everything I want? No. We did this so we could get a four-corners agreement and get it to the president's desk and get the uncertainty done with."
There's a sense of urgency to push the bill through Congress by May 28, which is Memorial Day.
VA Acting Secretary Robert Wilkie sent a letter to lawmakers Monday, calling on them to quickly pass the legislation because of another looming funding shortfall in the VA Choice program. He warned lawmakers that the program would run out of money as early as May 31. Once the funds run out, veterans won't be able to secure private-sector appointments through the program.
"This will have a dramatic, negative impact on our veteran population," Wilkie wrote.
The Mission Act includes $5.2 billion for the VA Choice program, intended to keep it running until May 2019 when new rules for private-sector care would be implemented.
In a tweet May 3, President Donald Trump also urged Congress to pass the bill by Memorial Day.
"I will sign immediately!" Trump wrote.
The Mission Act would require the VA to grant veterans access to the private sector if they and their VA doctor agree it's in their best interest. A host of issues could be considered when making that decision, including whether the veteran faces an "unusual or excessive burden" to accessing a VA facility.
The bill also introduces the possibility of veterans receiving access to the private sector if their closest VA is determined "deficient" compared to other VA and non-VA facilities.
If a veteran's request for private-sector care is rejected, they could appeal it through the VA's clinical appeal process, the bill states.
Leaders of 38 veterans organizations signed a letter of support for the bill Monday, calling it a "balanced approach" to handling private and VA health care.
"Since the access and waiting list crisis exploded in 2014, Congress, VA and veterans leaders have debated how best to strengthen and reform the delivery of veterans health care to ensure timely and seamless access for enrolled veterans," they wrote to lawmakers. "The legislation before the committee would take a major step towards that goal."
Besides revamping private-sector cares programs, the VA Mission Act contains a gradual expansion of caregiver benefits to veterans injured before the 9/11 terrorist attacks.
Through a VA caregiver program implemented in 2010, benefits such as monthly stipends, health insurance, medical training and access to home health aides are available to family caregivers of post-9/11 veterans.
Caregivers to veterans injured before 9/11 see it as an unfair discrepancy, and along with veterans organizations, they've been fighting for a change for years.
Under the bill, caregiver benefits would become immediately available to veterans injured before May 7, 1975. Two years after the bill is enacted, veterans injured between 1975 and 2001 would be eligible.
A process to take stock of VA infrastructure problems is also included in the VA Mission Act.
The bill would create a commission tasked with reviewing VA buildings nationwide and recommending which ones to keep and where the VA could invest.
Getting rid of old and underused facilities was one of former VA Secretary David Shulkin's priorities for the department. Under his watch, the VA began the process last year of disposing of or finding another use for 430 vacant or nearly vacant buildings. The VA was also reviewing another 784 buildings that are still in use.
If the measure is approved, the asset-review commission would conduct its work in 2022 and 2023.
Roe intends to have the bill named after Sen. John McCain, R-Ariz., and retired Rep. Sam Johnson, R-Texas, to honor their military and civil service. Both men were prisoners of war in Vietnam.