Struggle in Congress to Revive VA Choice Program Extension

The House and Senate scrambled Tuesday to come up with a bill that could pass bipartisan muster on extending the Veterans Choice Program on private health care before it goes broke next month.

Rep. Phil Roe, R-Tenn., chairman of the House Veterans Affairs Committee, is "actively talking with his Senate and minority counterparts about the path forward" following the stunning defeat on the House floor Monday night of the $2 billion Choice extension bill he sponsored, according to an HVAC spokeswoman.

"He is committed to getting this done so veterans can have the certainty and access to care they've earned and deserve," the spokeswoman said.

In a statement following defeat of the bill, Roe suggested he had been blindsided by Democrats. "Last week, during a bipartisan member meeting, members of both parties came together and agreed to fund the Choice program for six months while Congress worked on other reforms," he said.

"This was a bipartisan agreement, and I'm disappointed the concerns raised on the House floor today were not mentioned during what I thought was an open and honest conversation," he said.

Congress is up against two deadlines in finding an alternative. The House is expected to go on August recess next week, and funding for Choice allowing veterans to seek federally paid health care in the private sector could run out as early as Aug. 7, according to Roe.

Without an extension, thousands of veterans would be cut off from referrals to private care and third-party administrators would go unpaid.

Roe said the proposed $2 billion Choice extension "would have ensured the Choice program remained funded for the next 6 months -- solving our most pressing issue and preventing yet another access crisis like the one that led to the creation of Choice three years ago."

He referred to the wait-times scandals at the Phoenix VA in 2014 that led to enactment of the Veterans Choice Program, making veterans who live more than 40 miles from a VA facility or have to wait more than 30 days for an appointment eligible for private or community care.

The program has become a victim of its own popularity. It was originally set to expire in August 2017, but VA Secretary Dr. David Shulkin initially thought there would be enough money left over from the $10 billion authorized to keep it going into fiscal 2018. By then, Congress would have had time to make needed reforms and extend the program.

However, demand for Choice among veterans, which was up by 30 percent for the first six months of 2017, exhausted the funding.

Roe's extension bill was brought to the House floor for a quick vote under a suspension of the rules normally reserved for non-controversial legislation such as the naming of Post Offices. The suspension required a two-thirds vote for approval, but the bill fell short on a vote of 219-186.

Lobbying against the bill by eight Veterans Service Organizations (VSOs) was a main factor in its defeat and demonstrated their political clout.

"I appreciate and understand that some Veterans Service Organizations raised concerns with this legislation to fund Choice, and my door is always open to hear their concerns and ideas to make VA work for veterans," Roe said in his statement.

The bill was opposed by the Veterans of Foreign Wars, AMVETS, Disabled American Veterans, Iraq and Afghanistan Veterans of America, Military Officers Association of America, Military Order of the Purple Heart, Vietnam Veterans of America and Wounded Warrior Project.

The VSOs saw the House bill as an aggressive move to favor private care over improvements to the VA health care system, and they objected to the diversion of funds from other VA programs to pay for the proposed $2 billion extension.

The bill would have extended pension reductions for Medicaid-eligible veterans in nursing facilities and continued collecting fees on housing loans guaranteed by the VA. The cuts were put in place in 2014 and were set to last until Sept. 30, 2024. The bill would have moved the end-date to 2027.

In a joint statement following defeat of the House bill, the eight VSOs said there is now an opportunity for "the House and Senate to work together in a bipartisan, bicameral manner to rapidly reach agreement to continue funding the Choice program uninterrupted in the short term -- without forcing veterans themselves to pay for it."

"We thank all those members who voted to reject this unacceptable legislation and call on them and all members of the House and Senate to work together, and with us, to quickly find a reasonable solution that we can all support."

Rep. Tim Walz, D-Minn., the ranking member on HVAC, said, "The House majority did not build the necessary consensus among Democrats, Republicans, and our nation's well-respected veterans service organizations, who almost unanimously opposed this legislation, to pass the bill."

Rep. Annie Kuster, D-New Hampshire, voted against the bill, though New Hampshire lacks a full-service VA hospital and veterans there are more reliant on private care. She said, "Unfortunately, the legislation considered this evening would not have improved the Veterans Health Administration at a time when we need to be bolstering support for our veterans."

On the Senate side, Sen. Johnny Isakson, R-Georgia, chairman of the Senate Veterans Affairs Committee, has been working to reach a compromise. His office and that of SVAC did not immediately respond to requests for comment.

Sen. Jon Tester, D-Mont., the ranking member on SVAC, introduced a bill earlier this month that would provide equal levels of extra funding for Choice and VA programs.

Currently, more than 30 percent of VA appointments are in the private sector, up from fewer than 20 percent in 2014, as the VA's more than 1,200 health facilities struggle to meet growing demands for medical care.

If funding for the Choice program runs out, veterans will wait longer for appointments and won't be able to return to their private-sector providers for care, Dr. Poonam Alaigh, acting VA undersecretary for health, told the House Veterans Affairs Committee in June.

-- Richard Sisk can be reached at Richard.Sisk@Military.com.