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White House weighs in on stalled VA Choice reform

The Department of Veterans Affairs (VA)

White House officials issued guidance to senators this week meant to resuscitate negotiations on Department of Veterans Affairs health care reform after legislation has languished in the House and Senate for months.

The guidance calls for clearer rules about when veterans can go into the private sector for health care and asks senators to remove proposals to implement a hiring quota at VA facilities and expand caregiver benefits that are only available now to veterans injured after 9/11. White House officials also want plans on how to offset costs.

Sen. Johnny Isakson, R-Ga., chairman of the Senate Veterans’ Affairs Committee, said he hoped the guidance could be a catalyst to overcome divisions among senators on reforms to Veterans Choice, a program created in 2014 to get veterans faster access to care by sending them to private sector doctors.

Sen. Jon Tester, D-Mont., the ranking Democrat on the committee, is reviewing the guidance and working with Isakson to reach a compromise, said Marnee Banks, Tester’s communications director.

“He believes there is a lot of common ground and is encouraged by the open lines of communication,” Banks said.

Though more veterans are using the Choice program, VA officials and lawmakers have criticized it as bureaucratic and complex, with arbitrary rules governing which veterans are eligible to receive non-VA health care. They’ve been working for about a year to develop a complete overhaul of the program but recently hit an impasse over funding and eligibility concerns.

The Senate committee voted in November to send a bipartisan bill, the Caring for Our Veterans Act, to the Senate floor. The legislation offered flexibility concerning veterans’ eligibility for private-sector care, making it a decision between veterans and their VA physicians. In a report released this month, the Congressional Budget Office estimated the legislation would cost nearly $50 billion.

But Sen. Jerry Moran, R-Kan., a member of the committee, disagreed with some aspects of the bill and introduced his own legislation that he said better lays out in what instances veterans can seek private-sector health care, rather than leaving those choices to the VA.

Isakson asked the White House for help to restart negotiations.

Officials with President Donald Trump’s administration went through the Caring for Our Veterans Act and highlighted changes.

White House officials asked senators to remove a measure requiring private-sector medical providers to follow VA guidelines on prescribing opioids. The agency began cutting back on opioid prescriptions in 2010 because of the growing number of veterans becoming addicted. The White House stated it supports safe use of opioids but the requirements would impose a “burden” on community providers and veterans.

They also suggested senators nix a measure requiring non-VA providers who participate in the Choice program to meet certain standards for treatment of post-traumatic stress disorder, military sexual trauma and traumatic brain injuries. White House officials said the idea was “unworkable” and would increase VA costs.

White House officials also described a proposal requiring the VA to fill all vacant jobs in mental health and primary care within 180 days after the bill is enacted as “unrealistic.” As of the end of June, the VA reported 34,000 vacancies across the VA health care system.

One White House suggestion, to remove the expansion of caregiver benefits, drew the ire of the Elizabeth Dole Foundation.

The foundation, along with Disabled American Veterans, the American Legion, Veterans of Foreign Wars, Paralyzed Veterans of America, strongly supported the expansion of caregiver benefits to veterans injured before 9/11. In December, they presented lawmakers with a petition containing more than 182,000 signatures from people supportive of the expansion.

Under the bill, caregiver benefits would become immediately available to veterans injured before May 7, 1975. Two years after the bill is enacted, veterans injured between 1975 and 2001 would be eligible. The Congressional Budget Office estimated the measure would cost $3.4 billion over five years to implement.

“Removing the provision would upset the months of negotiations and good faith compromises that led to this bipartisan legislation,” the foundation wrote in a statement this week. “It’s an injustice that some military caregivers are left without needed assistance and support simply because their veterans served in the ‘wrong’ era.”

Moran said he agreed with part of the White House’s guidance that urges senators to create clear access standards for which veterans can receive non-VA care. White House officials said those standards should be published in the Federal Register and clearly posted on the VA’s website. Moran has previously cited concerns about giving the VA too much discretion to create their own rules, for fear the agency would limit veterans’ access to the private sector.

“Too many past examples to count have demonstrated that when Congress passes legislation that leaves any room for interpretation by the VA bureaucracy, our veterans are the ones who lose,” Moran said in a written statement. “I will continue working to make certain the future of VA community care relies on objective, demand-driven standards, not the VA’s burdensome regulations that thwart the intent of Congress.”

The conservative group Concerned Veterans for America also applauded that part of the White House guidance.

“Like CVA, the president clearly recognizes there should be clear standards for when a veteran can access care in the community, and that vague guidelines can easily be undermined by bureaucrats hostile to increased choice,” CVA Executive Director Dan Caldwell said in a statement.

It was uncertain Friday when senators might reach a compromise.


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