The House voted Wednesday to give veterans more freedom to see doctors outside the Veterans Affairs health system, a major shift aimed at reducing wait times and improving medical care despite the concerns of some Democrats who cast it as a risky step toward dismantling the struggling agency.
The plan seeks to fulfill President Donald Trump's promise to expand private care to veterans whenever they feel unhappy with VA health care.
The long-awaited bill would change how veterans receive their medical treatment by allowing them to go to a private physician when they felt government-run VA medical centers couldn't provide the care they needed, with the approval of a VA health provider. Veterans could access private care when they endured lengthy wait times, or the treatment was not what they had expected.
The VA would decide in many cases when a veteran sees an outside doctor, based on conditions it sets that determine what is inadequate care.
The White House said in a statement that Trump applauded passage of the bill and urged the Senate to send it to his desk for his signature by Memorial Day. "The President encourages members of the Senate to put the needs of our nation's veterans over partisan politics," it said.
The House passed the bill by a 347-70 vote, with the program to be implemented later next year as the VA works to add private doctors to its network of outside referrals.
The wide-ranging plan would avert a catastrophic shutdown of the VA's troubled Choice private-sector program, which would receive $5 billion to continue operating for another year before it is made a longer-term fixture at the VA. The program will run out of money as early as May 31, causing disruptions in care.
The $51 billion bill has the support of nearly 40 organizations, including The American Legion and Veterans of Foreign Wars. The program could be expanded based on veterans' demand for private services and when VA care is deemed inadequate. The VA would be able to determine how quickly the program grows.
Rep. Phil Roe, the chairman of the House Veterans Affairs Committee, praised the measure as keeping "our promise to give veterans more choice in their health care."
The program could face escalating costs due to growing demand from veterans seeking the convenience of seeing private physicians. Some House Democrats warn the VA won't be able to handle the costs of the newly combined "community care" program that includes Choice and other VA programs of outside care, putting the VA at risk of unexpected budget shortfalls next year.
Rep. Tim Walz, the top Democrat on the Veterans Affairs Committee, cautioned that outsourcing more care to the private sector would lead to devastating cuts to VA hospitals, which many veterans see as best-suited to treat battlefield injury such as traumatic brain injury. "I am deeply concerned about the long-term health and stability of VA health care," he said.
House Minority Leader Nancy Pelosi, D-Calif., attacked the bill as failing to do enough to keep veterans in the VA, instead opening "the doors to VA privatization."
The bill builds on legislation passed in 2014 in response to a wait-time scandal at the Phoenix VA medical center, where some veterans died while waiting months for appointments. It comes as the VA is without a permanent leader after David Shulkin was ousted as VA secretary in March. Trump has yet to name a new secretary after his first nominee, Ronny Jackson, withdrew last month.
The legislation aims to steer more patients to the private sector to relieve pressure at VA hospitals, thus improving veterans care at VA facilities and with private providers alike. Patients could also access private walk-in clinics, such as MinuteClinics, to treat minor illnesses or injury if they used VA health care in the last two years.
The bill would create a presidentially appointed commission to review the closure of underperforming VA facilities, which House Democrats opposed when the plan was drafted in March. Democrats sought restrictions on the commission but were rebuffed by House Republicans and the White House.
It would also expand a VA caregivers program to cover families of veterans of all eras, not just the families of veterans who were seriously injured in the line of duty since Sept. 11, 2001.
Veterans would be able to access private care when VA does not offer the services they need or a veteran and his VA health provider agree it is best to receive care with a private doctor. It would loosen Choice's restrictions that limit outside care only when a veteran must wait 30 days for an appointment or drive more than 40 miles to a VA facility.
"This is a great victory for those want to see the VA reformed and fixed," said Dan Caldwell, executive director of the conservative Concerned Veterans for America. "This will hopefully ensure veterans aren't trapped in failing VA hospitals."
Currently, more than 30 percent of VA appointments are in the private sector.