The Senate voted 92-5 Wednesday to approve landmark legislation to transform how the Department of Veterans Affairs delivers health care, but not before concerns were raised that funds have yet to be found to pay the estimated $55 billion price tag.
"It's not paid for," Sen. Mike Enzi, R-Wyoming, said in the brief floor debate on the VA Mission Act to expand private health care options for veterans. "I believe we should care for our veterans in a fiscally responsible manner" and not have to borrow to fund the bill.
Sen. Johnny Isakson, R-Georgia, chairman of the Senate Veterans Affairs Committee, and Sen. Jon Tester, D-Montana, acknowledged at a Senate news conference Tuesday that funding for the bill was lacking, but both expressed confidence that the money would be found for a bill crucial to veterans care.
The Mission Act would replace the current Veterans Choice Program over the course of a year and expand the options for the nine million veterans served annually by the VA to choose private and community care when it's in their best interests.
President Donald Trump has pledged to sign the bill quickly; a signing ceremony is expected on Memorial Day.
Isakson said before the vote that the bill puts "the needs of veterans first by giving them the option of seeking care when and where it makes the most sense for their needs, and we're creating a force multiplier for the VA to better utilize its resources and provide even better care to veterans."
"It's long overdue," he said of the bill, which he predicted will give veterans "more choice with fewer barriers to care."
The bill, in some cases, would give veterans an opportunity to choose their own doctor, but the VA would remain the "gatekeeper," Tester said at the news conference Tuesday.
Veterans could pick a private doctor for care so long as that doctor is qualified and registered with the VA, he said.
About one-third of veterans receive health care in the private sector, but Tester dismissed concerns that the VA Mission Act would ultimately lead to the "privatization" of VA health care.
"The best defense against any effort to privatize the VA or send veterans in a wholesale fashion to the private sector is to make sure the VA is living up to its promise," he said.
The bill includes provisions to expand the VA caregivers program for the families of disabled veterans who were injured or wounded in the line of duty. The program had been limited to those disabled after the 9/11 attacks, but the bill expands the caregivers program to veterans of all eras.
Some leaders of veterans service organizations initially had reservations about the rapid expansion of private care pushed by political appointees at the White house and within the VA. But they concluded that the bill would provide better care while preserving the VA's primary role.
"This historic legislation is the result of years of negotiating what role the private sector should play in providing care to America's veterans," Keith Harman, national commander of the 1.7-million member Veterans of Foreign Wars, said in a statement. "It helps improve the VA health care system while relying on the private sector when needed, striking the right balance in order to make sure veterans have the best care possible."
"On behalf of our two million wartime veterans, we thank all the members of the U.S. Congress who worked with us to enact this important legislation," said Denise Rohan, national commander of the American Legion.
From his home in Arizona, where he is battling brain cancer, Sen. John McCain, a Republican and the chairman of the Senate Armed Services Committee, applauded passage of the bill.
He said he was "deeply humbled" to have the bill named for him along with "my friend and colleague" Rep. Sam Johnson, R-Texas, who was a POW with McCain in Vietnam, and the late Sen. Dan Akaka, D-Hawaii, a World War II veteran.
"Once this bill is signed, Congress must exercise strong oversight of the Department as it begins to implement these changes so it can successfully carry out its mission to deliver timely and quality care to those who have served," McCain said.
The responsibility will fill to acting VA Secretary Robert Wilkie, who has been nominated by Trump to the permanent post.
Last Friday, at an unrelated White House event, Trump said that Wilkie had done "an incredible job" as acting Secretary and followed with the surprise announcement of his nomination.
There was a concern that an acting Secretary cannot succeed to the permanent post under a section of the U.S. Code, but Isakson and Tester said Tuesday that they expected to work around the potential problem before his confirmation hearing.
Wilkie was not Trump's first choice to succeed former VA Secretary David Shulkin, who was fired in March amid scandals over his travel expenses and his charges that he was being undermined by Trump administration political appointees.
Trump at first nominated his personal physician and head of the White House medical unit, Rear Adm. Ronny Jackson, but Jackson withdrew his name amid charges that he lacked managerial experience and allegations -- never proven -- that he drank on the job.
Last week, the House voted 347-70 to pass the VA Mission Act, and the 92-5 vote in the Senate showed overwhelming bipartisan support, but the union representing 260,000 employees at the VA renewed charges that overreliance on private care would ultimately work to the detriment of veterans health care.
The American Federation of Government Employees joined with the AFL-CIO and 15 other labor organizations in a letter charging that the "privatization" section of the bill "outsources primary care to the private sector, authorizes the outsourcing of entire service lines, and fails to address the chronic and prolonged issue of understaffing that is currently plaguing the VA."
-- Richard Sisk can be reached at firstname.lastname@example.org.