A major Veterans Affairs reform has passed the Senate by 92-5 and is on its way to the White House. The $55 billion bill will change how the VA pays for private care, expand a VA caregiver program and start a review of the VA's aging infrastructure. President Trump has said he will sign it — and it's sure to be touted among his biggest legislative achievements.
All three main planks of the VA Mission ACT have been knocking around Capitol Hill for years and have come close to passage several times in just the last 6 months. It took a June deadline of money running out for the current VA Choice program to help push the bill over the finish line.
The most controversial part of the bill revamps the way VA reimburses veterans for private care appointments — replacing the seven different complicated systems currently in use. VA doctors will decide when a vet will benefit from seeing a private doctor because the nearest VA facility is too far away or appointments aren't available.
In most regions, VA care performs as well or better than private care and is less expensive. Critics fear the new system could bleed resources away from VA care, and start a spiral that weakens VA care, pushing more and more vets into the private sector.
Carlos Fuentes with the Veterans of Foreign Wars supports the bill.
"It strikes that balance between improving internal care and relying on the community when necessary," says Fuentes. "We truly believe the VA delivers great care, but the VA can't be everything to everyone."
Dozens of veterans and military service organizations endorsed the bill, promising to closely monitor how it is implemented.
The bill also expands a popular stipend program for family caregivers, currently only available for post-9/11 vets. Now veterans from the Vietnam era and before would be phased in within two years. After another two years vets of all eras could apply.
Finally, the bill initiates a review of the VA's aging and underutilized infrastructure, with the aim of closing down facilities that aren't worth their upkeep. Critics have compared this measure to BRAC - an often politically delicate process of closing down unneeded military bases. But supporters of the bill say VA facilities don't have nearly the same economic impact on the communities around them. Congress and veterans organizations says they will closely monitor any decisions to close down VA buildings.
ARI SHAPIRO, HOST:
Congress has passed a major bill overhauling the Department of Veterans Affairs. President Trump has promised to sign it. The bill dedicates $55 billion to expanding a VA program for caregivers, reviewing the VA's infrastructure and funding private care outside the VA system. It's taken years for all three measures to work through Congress. And in the end, they got deep bipartisan support, three words we don't say very often. NPR's Quil Lawrence covers veterans and joins us now. Hi, Quil.
QUIL LAWRENCE, BYLINE: Hey, Ari.
SHAPIRO: Tell us more about what's in this bill.
LAWRENCE: Well, it expands a popular caregivers program that we've done a lot of reporting on. It pays a stipend to family members who are taking care of a disabled veteran. At the moment, that's only open to post-9/11 veterans. But this will expand it to all eras over - and within a couple of years. And that is huge for families of, for example, Vietnam vets.
There's also a review of VA infrastructure. VA facilities are - most of them are 50 years old or more, and it costs millions just to keep the lights on in some of the unused buildings. The big issue, really, is private care. This bill will consolidate and streamline the seven different confusing programs that VA uses to pay for outside care.
SHAPIRO: It's remarkable. Even popular items often don't get the kind of broad bipartisan support that this one did, just because politics gets in the way. So how did this get such a strong vote from Republicans and Democrats?
LAWRENCE: Well, bipartisanship is really almost the norm among the veterans affairs committees. But these issues have been hammered out over several years. In fact, I was told by - I was told that this would pass Memorial Day two years ago. So people have been thinking about these and hammering out the details for a long time.
There was a deadline that helped. Some - money was going to run out for the main program that VA uses now to pay for private care. That program's been burning through money. And this new law will fund it but also replace it by next year. And there are some ambiguities in this bill that I think maybe both sides of a policy fight are hoping to exploit.
SHAPIRO: Tell us more about those ambiguities.
LAWRENCE: Well, it's all really down to who determines when a veteran gets to go outside the VA to get private care, which is more expensive and not always better than VA care. The fear is that if the secretary of the VA interprets that too broadly, it could bleed resources away from VA and start sort of a spiral where VA care gets weaker, and you need to spend more on private care. And so even some of the senators who supported this bill, like Washington Democrat Patty Murray - told me she has serious concerns about privatization.
PATTY MURRAY: We are going to work very hard to make sure that doesn't happen. Our veterans deserve the care they need at our VA facilities. But we also need to make sure they've got the ability to see doctors when they need it and, importantly in some of our rural areas, where they can.
LAWRENCE: Yeah. So those who do want to see the VA rely more on the private sector, they're going to be hoping that this will be implemented more in their direction.
SHAPIRO: And this is going to be implemented by President Trump's next secretary of Veterans Affairs. He's nominated the acting secretary Robert Wilkie. Where does that stand?
LAWRENCE: Well, we're expecting him to get a hearing after Memorial Day. Wilkie's been making the rounds with Congress, veterans organizations, getting good reviews. He's got experience on Capitol Hill and the Pentagon under various Republican administrations. He's run a large government bureaucracy before.
And he's - there are still some questions, though, about the internal fights within the White House over this policy. Many of these questions revolve around the use of private care. And you'll remember, that question was part of what got the previous secretary, Dr. David Shulkin, pushed out. So at the moment, Robert Wilkie is acting. And there's even some confusion about that because now that he's nominated, he might legally be obligated to step down from being the acting secretary.
SHAPIRO: That's NPR's Quil Lawrence, who covers Veterans Affairs for us. Thanks so much, Quil.
LAWRENCE: Thank you, Ari.
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