- The Senate cleared a House-passed bill on Wednesday making it easier for veterans to see private sector providers by making the Department of Veteran's Affairs program called Veterans Choice permanent.
- The bipartisan legislation, passed 92 to 5, also allows VA providers to offer telemedicine and gives them the ability to partner with community care providers, along with consolidating seven community care programs and expanding support for caregivers. It also gives VA providers the authority to allow patients to receive care from the private sector rather than the VA.
- President Donald Trump is expected to immediately sign the bill, called the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act
With the passing of the MISSION Act, Congress has expanded private sector options for all veterans rather than only those who live far from a VA provider or have to deal with long wait times. Those limitations had been set by the Veterans Choice program, which was set to run out of funding in a few weeks.
The moderate step falls short of the full privatization backed by some in the Trump administration and congressional Republicans.
One survey from a veteran's group found more than 90% of veterans preferred fixing the VA's deficiencies over dismantling the system or a universal healthcare card that would allow them to see any private provider, an idea Trump campaigned on. Also, about 70% of veterans enrolled in the VA already receive most of their care outside the system, according to a 2014 Congressional Budget Office report.
The act allocates $5.2 billion toward the Choice program, originally created through the Veterans Access, Choice and Accountability Act, a bipartisan bill signed by President Barack Obama in 2014 in response to the VA's wait time scandal. The program has allowed veterans the option of receiving care from the private sector if they live more than 40 miles driving distance from a VA facility or if they have to wait more than 30 days to get an appointment.
Lawmakers have been debating the program's potential for giving the private sector more control over veterans' healthcare, but the MISSION Act is largely seen as a compromise.
“The VA MISSION Act removes those arbitrary time and distance requirements that limit eligibility for outside care," Sen. Mitch McConnell, R-Ky., said in a statement. "It replaces those one-size-fits-all policies with a conversation between veterans and their own doctors about what works best."
Despite carrying the support of 38 veterans associations, including The American Legion and Disabled American Veterans, the MISSION Act has been condemned by a number of public sector labor groups concerned with the bill's potential for allowing the private sector to play a bigger role in veterans healthcare. Those groups include National Nurses United (NNU) and the American Federation of Government Employees (AFGE), the union representing VA workers.
"The VA Mission Act is a horrendous piece of legislation that will set the only health care system tailored to veterans on a path of total privatization," J. David Cox Sr., AFGE national president, said in a statement. "Now, an unaccountable, private, corporate-style commission will have the power to decide which facilities to close, which to repair, and which to build."
NNU leadership echoed that sentiment in an open letter, arguing that "farming out primary care to other providers will be a major step to dismantling the VA entirely" and open the door to privatizing services that have historically been provided by VA facilities.
Proponents of the bill argue that those services have not been provided well, if at all, to rural veterans.
"What we're seeing in rural America is a disproportionate number of veterans," Maggie Elehwany, vice president of government affairs at the National Rural Health Association, told Healthcare Dive earlier this year. As many as 25% of veterans, she said, live in rural America. They also tend to be older and experience poverty at a higher rate than urban and suburban veterans.
"We need to get rural veterans some kind of ability to better access care in rural areas. They should have the choice to be able to see their local rural provider," Elehwany said. "We had long fought for that, and for a long time it seemed like the VA was very resistant to that notion."
Trump last week nominated acting secretary Robert Wilkie to head up the VA after White House physician Ronny Jackson withdrew his nomination last month, facing scrutiny over an alleged history of over-prescribing and intoxication on the job.
Wilkie has been serving as acting secretary since Trump fired former secretary David Shulkin, who warned again creeping privatization, in March.