The House is expected to vote this week on a bill aimed at ending the political infighting that has riven the leaderless Department of Veterans Affairs by overhauling the way the VA pays and provides for the health care and benefits of the nation's veterans.
Passage of H.R. 5674, the "VA Mission Act," would mark a major victory for the White House in the long-running battle over the Choice program, which allows veterans to opt for community care.
To improve its chances for passage, the Mission Act included an extension of benefits under the family caregivers program to veterans of all eras. A separate bill, expected to be voted on together with the Mission Act, would expand Agent Orange benefits and care to an estimated 90,000 "Blue Water Navy" veterans of Vietnam.
Both the blue water Navy and caregivers provisions have long been advocated by the major Veterans Service Organizations (VSOs).
Acting VA Secretary Robert Wilkie last week urged quick passage of the bill to avoid having the VA run out of funding for the existing Choice program at the end of May.
Wilkie echoed the White House in stating that the bill "will transform the [VA] into a modern, high-performing, and integrated health care system that will ensure our veterans receive the best health care possible from the VA, whether delivered in the VA's own facilities or in the community."
He added, "Veterans are counting on Congress to approve this vital legislation by Memorial Day [May 28]" and send it to President Donald Trump, who has pledged to sign it immediately.
Political Infighting Leaves VA Secretary's Post Empty
Wilkie's position as acting head of the VA is itself emblematic of the disarray and backbiting at the VA over the core mission of its 360,000 employees in providing health care to nine million veterans annually.
In addition to lacking a permanent secretary, the VA until Tuesday had vacancies in the critical posts of undersecretary of benefits and undersecretary of health. On Tuesday, the VA announced that Paul Lawrence, a former Army captain and Kaiser Associates vice president, had taken the post of undersecretary for benefits.
Dr. David Shulkin was undersecretary of health before becoming secretary and eventually the only holdover from the Obama administration in Trump's Cabinet.
Shulkin won Trump's praise at the outset but eventually fell victim to charges that he was slow-rolling the expansion of the Choice program, in addition to two damning reports in quick succession from the office of the VA Inspector General.
Shulkin favored the extension and expansion of Choice while pledging that the "privatization" of VA health care, one of the VSOs' main concerns, would not happen "on my watch."
Shulkin at first denied the allegations on his expenses, but then agreed to reimburse the government for his wife's airfare. He also went public with charges that he was being undermined -- "subversion" was his word -- by political appointees at the White House and within the VA over the Choice program.
In March, Shulkin was either fired or resigned. (The White House said he resigned; he said he was fired.)
While Trump considered a replacement, Wilkie, who was at the Pentagon and settling in as under secretary for personnel and readiness, was named acting VA secretary.
Trump surprised again with the choice of his personal physician and head of the White House medical unit, Rear Adm. Ronny Jackson, to become the new secretary.
Jackson withdrew from consideration amid concerns that he lacked managerial experience to head the government's second-largest agency after the Defense Department, and allegations -- never proven -- that he drank on the job and was careless in prescribing drugs.
Jackson has since returned to the White House medical unit, but Trump's nomination of him for two-star rank has been on hold.
Rocky Road Ahead for New VA Secretary
The failure of Jackson's nomination left in doubt how long Wilkie would remain as acting secretary, or whether Trump might decide eventually to leave him in place.
In a short video to all VA employees when he took over in early April, Wilkie said he was cognizant of the challenges he faced in a department in turmoil. "Anyone who sits in this chair and tells you he has the answers is in the wrong business," he said.
He also alluded to the prolonged fight over the Choice program within the VA. Wilkie said he wanted VA employees and department heads to reach the stage where they were "not talking at each other, but with each other."
Former Rep. Jeff Miller, R-Florida, who was head of the House Veterans Affairs Committee before retiring, has been interviewed by the White House staff as a potential VA secretary nominee, but reportedly has not met with Trump himself on the job.
While Trump considers a nominee, Rep. Phil Roe, R-Tennessee, chairman of the House Veterans Affairs Committee, has pressed ahead with the VA Mission Act, a consensus bill aimed at expanding private-care choices while easing the VSOs' concerns about "privatization."
The bill passed in the committee by a vote of 20-2 last week and is expected to go to the House floor as early as Thursday.
Veterans, and doctors, have complained about late or missing payments under the current Choice program. Roe said the Mission Act is intended to "streamline the department's duplicative community care programs into one cohesive program."
The bill would also provide $5.2 billion to extend the current Choice program for one year while the reforms are underway. "This legislation must be passed and, if Congress fails to act, veterans will pay for that failure," Roe said in a statement.
Sen. Johnny Isakson, R-Georgia, chairman of the Senate Veterans Affairs Committee, and Sen. Jon Tester, R-Montana, the ranking committee member, have expressed support for the Roe bill.
Isakson sponsored a similar bill in the last Congress, but it was left out of the $1.3 trillion omnibus spending package for all government agencies reluctantly signed by Trump in March.
In a joint statement, Isakson and Tester said the bill would "authorize and appropriate funding for the VA to continue the Veterans Choice Program for one year while the new, streamlined Veterans Community Care Program is implemented."
In a separate statement, Tester said, "Congress must act now to reform the broken Choice Program," but also "address the VA's crippling workforce shortages, protect rural health clinics, and ensure we do right by veterans and their caregivers."
For the moment, the VSOs have dropped their concerns about the privatization of VA health care and backed the VA Mission Act.
In a statement, Denise Rohan, national commander of the more than two-million member American Legion, said the bill would provide "necessary and critical improvements to [VA] current community care programs."
"When VA care is unavailable, we support the use of non-VA providers," Rohan said, but "we also believe the [VA] must remain the gatekeeper for health care and that veterans should not be expected to pay for care related to their service-connected disabilities."
Garry Augustine, executive director of the Disabled American Veterans' Washington headquarters, also backed the overall bill but stressed the inclusion of the caregivers provision.
Currently, family caregiver benefits are restricted to post-9/11 veterans; the bill would open them to veterans of all eras.
Regional Directors Move Ahead to Improve Private Care
Anticipating passage of the bill, VA regional directors have already begun working with the private sector on streamlining options for veterans to choose community care.
In Grand Junction, Colorado, last week, the VA's Rocky Mountain Network, which covers Colorado, Utah, Wyoming, Montana and Oklahoma, met with private health care providers on improving partnerships for veterans health care.
"I think the important theme is the VA can't do it alone. It takes a community partnership for us to provide care to our veterans who have earned the benefit," Rocky Mountain Network Director Ralph Gigliotti said, according to a report in the Daily Sentinel newspaper of Grand Junction. "The community needs to know what we can offer."
"A forum like this helps us better understand each other so we don't duplicate services," said Grand Junction VA Medical Center Director Michael Kilmer.
On Wednesday, Curt Cashour, a VA spokesman, disputed that the VA was "leaderless" without a permanent secretary in charge. He also disputed that the VA was in "disarray" while working to make changes to align with President Trump's vision for the department.
In an April 25 statement, Cashour said that acting secretary Wilkie was providing solid leadership, while also noting that a number of VA staff had to be let go over disagreements on the direction of the department.
"Under VA's new leadership, which is now firmly aligned with President Trump and his priorities, the department's operations have improved in many ways," Cashour said.
"In a number of cases, employees who were wedded to the status quo and not on board with this administration's policies or pace of change have now departed VA," he said.
"Under Acting Secretary Wilkie's leadership, senior VA officials are now on the same page, speaking with one voice to veterans, employees and outside stakeholders, such as Congress and Veterans Service Organizations, and are focused on a number of key priorities in the short term," he said.
Editor's Note: This story has been updated to clarify that Agent Orange benefits for blue water Navy veterans are not part of the Mission Act and that the VA has recently named a new undersecretary for benefits. A VA spokesman's response to the story has also been added.
-- Richard Sisk can be reached at Richard.Sisk@Military.com.