House poised to expand private care at VA, fix budget crisis

WASHINGTON (AP) — House approval Wednesday of legislation giving veterans more leeway to see doctors outside the Department of Veterans Affairs' health system would help fulfill President Donald Trump's promise of expanded private care.

The long-awaited plan would mean a major change in how veterans receive their medical treatment. With approval from a VA health provider, they could see a private doctor when they felt dissatisfied with government-run VA care, whether the result of lengthy wait times or dissatisfaction with the treatment they had received.

Some Democrats have criticized this shift as a risky step toward "privatizing" the VA.

The $51 billion measure, expected to pass the GOP-run House in an evening vote, also would avert a catastrophic shutdown of the VA's troubled Choice private-sector program by providing it $5 billion to continue operating for another year. The program will run out of money as early as May 31, causing disruptions in care to tens of thousands of patients.

Senators are seeking a vote before their Memorial Day break, and Trump has said he is ready to sign the bill, which has the support of nearly 40 veterans organizations.

The plan would make the Choice program a longer-term fixture, with room for expansion based on veterans' demand for private services and when VA care is deemed inadequate. The VA would be able to determine how quickly the program expands, based in part on how it defines "quality" care.

The program could face escalating costs due to growing demand from veterans seeking the convenience of seeing private physicians. Some House Democrats say the VA will not be able to handle the costs of what would be the newly combined "community care" program that includes Choice and other VA programs of outside care, putting the VA at risk of unexpected budget shortfalls next year.

The bill builds on legislation passed in 2014 in response to a wait-time scandal at the Phoenix VA medical center, where some veterans died while waiting months for appointments.

The measure aims to steer more patients to the private sector to relieve pressure at VA hospitals, reducing wait times and improving the quality of veterans care at VA facilities and with private providers. Patients could also access private walk-in clinics, such as MinuteClinics, to treat minor illnesses or injury if they used VA health care in the past two years.

The bill would create a presidentially appointed commission to review the closure of underperforming VA facilities, which House Democrats opposed when the plan was drafted in March. Democrats sought restrictions on the commission but were rebuffed by House Republicans and the White House.

The legislation would expand a VA caregivers program to cover families of veterans of all eras, not just the families of veterans who were seriously injured in the line of duty since Sept. 11, 2001.

Veterans would be able to access private care when VA does not offer the services they need or a veteran and his or her VA health provider agree it is best to receive care with a private doctor. It would loosen Choice's restrictions that limit outside care only when a veteran must wait 30 days for an appointment or drive more than 40 miles to a VA facility.

Currently, more than 30 percent of VA appointments are in the private sector.