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Future Unclear for Veterans Choice Program After House Bill Falters

Nicholas Fandos | NY Times

WASHINGTON — Congressional lawmakers struggled on Tuesday to reach an agreement to prop up a popular multibillion-dollar health care program that allows veterans to see a private doctor at government expense.

This was supposed to be a relatively easy task, meant to buy lawmakers time as they debated the future of the program. As recently as last week, Republican leaders were considering using a bill temporarily funding the Veterans Choice Program as a vehicle to raise the debt ceiling, a perennially bitter pill for Republicans.

Instead, House Republicans put forward a plan that would pay for the visits by diverting funds from elsewhere in the department and would not allocate additional funds for in-house care. In doing so, they galvanized enough opposition among Democrats and a raft of veterans groups fearful of creeping privatization that the bill unexpectedly failed Monday night to clear the necessary threshold on the House floor.

The defeat left House leaders scrambling for an alternative, with only a handful of legislative days left before the chamber is scheduled to begin its extended summer recess. Money for the Veterans Choice Program is expected to run out early next month.

Lawmakers in the Senate, where legislation would need to pick up some Democratic support to come to a vote, never appeared likely to take up the House measure. Behind the scenes, leaders of the veterans committees in both chambers had opened negotiations to find a compromise that could pass muster among their members, as well as among the veterans groups. (The Senate has said it will stick around for the first two weeks of August.)

Created in the aftermath of a 2014 scandal over the manipulation of patient wait times at Veterans Affairs Department facilities, the Choice program was intended to give veterans facing long wait times for care an option to see private doctors in their communities. It came with additional time and money for the department to retool. Three years later, both parties and most veterans groups are in agreement that the program has done some good but needs major repairs.

The present funding crisis largely stems from the program’s rapid growth in popularity and miscalculations by the department of how quickly the program would run out of money.

As patient visits through the program have increased — they were up more than 30 percent in the first quarter of the 2017 fiscal year — resources have been depleted more quickly than expected, catching lawmakers off guard.

The veterans groups opposing the House legislation — including Disabled American Veterans, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Vietnam Veterans of America — wield considerable influence in Washington, and their opposition is taken seriously on Capitol Hill.

They sent a stern letter to lawmakers on Saturday objecting to the bill’s terms and spent the weekend lobbying congressional staff members. They say the plan, which provides $2 billion to cover Choice program expenses for six months without adding any funds to departmental programs, would push veterans out of the latter without addressing the systemic problems that prompted the creation of the program in the first place.

“You just can’t give money to send people out of the system while neglecting to put money into the system to fix the capacity problem that is there,” said Garry Augustine, the Washington director for Disabled American Veterans. “We believe that is a slippery slope to dismantling the V.A.”

To be sure, the opposition from veterans groups was not unanimous. Several large groups declined to stake out a position, and at least one, the Concerned Veterans for America, embraced the plan. This small conservative advocacy organization linked to the free-market activist billionaires Charles G. and David H. Koch has long made it its mission to offer more private sector choices for veterans’ health care.

During a debate preceding the vote on Monday afternoon, Representative Phil Roe, Republican of Tennessee and the chairman of the House Veterans Affairs Committee, said he valued the veterans groups’ feedback but disagreed that the short-term measure would push the department toward privatization. He also said he did not agree that departmental programs were lacking for funds. A spokesman for Mr. Roe, Tiffany Haverly, said he was committed to finding a solution to ensure veterans did not lose access to care through the program.

Mr. Roe and Republican leaders had been confident enough in the bill’s chances that they chose to pass it under an expedited process — usually reserved for uncontroversial measures like post office namings — that requires a two-thirds majority. It backfired after Democrats began to slip away in recent days.

The committee’s top Democrat, Representative Tim Walz of Minnesota, had implored House leaders to delay the vote to give both chambers time to strike a deal and took issue with how the $2 billion extension was funded. Rather than require that the extension funds be offset, he said, Congress should grant the funding on an emergency basis.

Such changes, along with funds for in-house care, are now likely to get fuller consideration among Senate leaders who face a more moderate Republican caucus and the task of winning over some Democrats. A spokeswoman for Senator Johnny Isakson, Republican of Georgia and the Senate committee’s chairman, declined on Monday to comment on the negotiations.

The standoff could be a bad omen for lawmakers who are in the early stages of a major rewriting of the Choice program and several other programs that currently pay for veterans’ care outside of Veterans Affairs facilities. It is also likely an indication of where lawmakers, who are in broad agreement about the need for such care, may clash as they proceed: where to spend new money and how to pay for the programs.

Democrats and many of the veterans groups generally want to see more money allocated to the department to strengthen in-house care on top of money for modest increases for the Veterans Choice Program. They are also suspicious that Republicans, empowered by their control of Congress and the White House, will try to tip the scales toward privatization. Republican lawmakers deny that, though they tend to prefer an expansion of community care and are averse to additional dollars for the Department of Veterans Affairs.

Still, for now, the acrimony has been the exception to the rule for the veterans affairs committees, which have enjoyed a run of bipartisan productivity in recent months. Even as the parties split Monday on Choice program funding, the House voted overwhelmingly in favor of a new G.I. bill that would expand education benefits for veterans by lifting a 15-year limit on their use, restore benefits to those who attended now-defunct for-profit schools and extend them to groups who were previously excluded. Similar legislation under consideration in the Senate is expected to win passage — easily.

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