In a feat of crisis management last year, Congress, in a nearly unanimous vote, approved a $16.3 billion overhaul of the Veterans Affairs Department. The bill set aside $10 billion in emergency funding for a three-year pilot program allowing patients to seek private medical care under certain circumstances.
Now, a leading Senate Republican who has consistently questioned how VA is utilizing the effort, is proposing legislation that could be a seismic change to the department’s healthcare system and allow any veteran enrolled in the agency’s insurance network to seek private care any time they’d like.
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The proposal by Sen. John McCain (R-AZ), rolled out on Wednesday, would make permanent the “choice card” pilot program and lift the restrictions in the 2014 law, of which McCain was a key architect. Most notably it would get rid of criteria such as if a patient has faced a long wait time to get an appointment at their local facility or lives more than 40 miles from a VA facility.
“This would help remove uncertainty from within the VA, among providers, and especially among our veterans, while sending a strong signal to all Americans that this program is here to stay,” McCain said in a statement. “More than a year after the VA scandal first came to light and a year since VA reform legislation was signed into law, wait times are still too long and veterans are still not getting the care they have earned and deserve.”
The bill, unveiled just before the Senate left town for a month, surprised many in the veteran’s community and raised the possibility that the GOP-controlled Congress might look to put more of a burden on the VA to pay for private health care for veterans.
VA spokeswoman Walinda West said the agency was reviewing the proposed bill.
“It would, however, be premature to take a definitive position until we have had the opportunity to thoroughly review it,” she said.
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The measure, should it gain traction once Congress reconvenes next month, could have huge implications for the VA’s budget.
The department used $43.4 billion in discretionary spending in fiscal 2014 for direct and non-VA related healthcare. Congress enacted $45.2 billion for those efforts in fiscal 2015.
President Obama in his fiscal 2016 asked for $48.7 billion for medical treatment inside and outside the VA. The figure could change as House and Senate lawmakers have pared down the department’s discretionary spending account in their appropriations bills.
An official for one of the country’s top veteran’s service organizations warned that McCain’s bill “could be a very, very expensive proposition.”
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Raymond Kelley, legislative director for the influential Veterans of Foreign Wars, said that while his organization is “not opposed to the idea of some version of permanent access” to outside medical care, many of the restrictions written into the 2014 law were designed to keep the pilot effort’s cost down and therefore more palatable to House conservatives.
If McCain’s bill were enacted, he predicted, lawmakers “would have to back and give them more money. There simply will not be enough if they do that broad of an expansion.”
Kelley predicted such a move would increase the payouts VA makes to outside providers, even at the lower Medicare rater, by billions over time.
He also took issue with McCain’s timing.
“The problem is right now we’re working on a pilot program,” Kelley said. “The pilot should be just that, it should help us make good decisions about how to move forward.”
McCain’s legislation is sure to renew debate on Capitol Hill over whether or not the medical treatment provided by the VA should be privatized, something that has been advocated for by conservative veterans group Concerned Veterans for America.
Speaking at an event in Washington on Thursday, VA Secretary Bob McDonald, quickly dismissed the idea that such a shift would ever occur.
“We are not in favor of privatizing the VA,” he said.
