Congress delivered a victory to President Donald Trump by expanding private care for veterans as an alternative to the troubled Veterans Affairs health system.
The Senate cleared the bill on a 92-5 vote Wednesday, also averting a disastrous shutdown of its Choice private-sector program. The program is slated to run out of money as early as next week, causing disruptions in care.
The sweeping measure would allow veterans to see private doctors when they do not receive the treatment they expected, with the approval of a Department of Veterans Affairs health provider. Veterans could access private care when they have endured lengthy wait times or VA medical centers do not offer the services they need.
The bill's approval comes despite concerns from some Democrats that the effort would prove costly and be used too broadly by veterans in search of top-notch care even when the VA is able to provide treatment deemed sufficient for their needs.
The White House said Trump applauded passage of legislation that would transform VA "into a high-performing and integrated health care system for the 21st century and provide veterans with more choice in their health care options, whether from VA doctors or from the community."
The VA secretary will have wide leeway in implementing the legislation, which leaves it up to VA to determine what is "quality" care. Trump said last week he will nominate acting VA secretary Robert Wilkie to permanently lead the government's second largest department serving 9 million veterans. Democrats say they intend to question Wilkie on whether he plans to "privatize" or degrade the VA health system, an issue that former VA Secretary David Shulkin says led to his firing in March.
Sen. Johnny Isakson, the Republican chairman of the Senate Veterans Affairs Committee, lauded the bill as a big step toward providing veterans with "more choice and fewer barriers to care."
Sen. Jon Tester, the top Democrat on the veterans panel, said the plan will also boost VA health care by paying off higher amounts of student loan debt for doctors who agree to work in high-need VA positions, requiring improvement plans in communities with few hospitals and creating a pilot program that would send medical personnel to help fill shortages.
"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.
Trump has made clear he will sign the bill if it reaches his desk before Memorial Day. The House passed it on a 347-70 vote last week.
The Senate supported the bill that would create a presidentially appointed commission to review the closure of underperforming VA facilities. House Democrats had 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.
The $51 billion bill provides for a newly combined "community care" program that includes Choice and other VA programs of outside care. It 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 a growing price tag, putting the VA at risk of unexpected budget shortfalls next year.
Sen. Bernie Sanders, I-Vt., a former chairman of the Senate Veterans Affairs Committee, criticized the bill as moving the VA "too far in the direction of privatization." He noted that it would not provide any money to fill more than 30,000 positions at the VA that the Trump administration has left vacant.
"My fear is that this bill will open the door to the draining, year after year, of much needed resources from the VA," he said.
The measure 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 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 legislation 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. Currently, more than 30 percent of VA appointments are in the private sector.
A broad array of veterans' groups supported the bill. The American Legion, the nation's largest veterans group, says the plan will "strengthen veterans' health care for future generations while ensuring that veterans' caregivers of all generations get the support they deserve."
The conservative Concerned Veterans for America, a long-time advocate of expanding private care for veterans, called the measure a "very big deal." Still, executive director Dan Caldwell stresses the "top priority for the VA secretary is ensuring it will be implemented properly."