Healthcare Business News

House, Senate set to work out differences in VA bills

By Virgil Dickson
Posted: June 12, 2014 - 7:45 pm ET

Stories of long appointment queues for military veterans in Veterans Health Administration facilities and allegations that some died while waiting for care prompted the normally deadlocked Senate to overwhelmingly approve legislation Wednesday to make it easier for veterans to get care in non-VA facilities.

Now the Senate and House, which passed a similar bill on June 10, will seek to iron out the differences. One potential issue is that the Congressional Budget Office offered a preliminary estimate that under the Senate bill veterans would eventually seek a whopping $50 billion in additional care each year, boosting costs to Medicare. “CBO expects that some of the people who are eligible to enroll (in the VA) but not yet enrolled would choose to enroll because of the improvement in access to health care through the VA,” the CBO said in a letter Wednesday to Senate Veterans Affairs chairman Bernard Sanders (I-Vt.).

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The Senate bill would authorize about $35 billion over three years to pay for outside care for veterans, as well as hire hundreds of doctors and nurses and lease 26 new health facilities in 17 states and Puerto Rico.

Budget hawks already have pounced on the Senate bill. “The legislation… includes an unprecedented open-ended mandatory appropriation that basically gives the VA a blank check to spend as it wishes,” warned Maya MacGuineas, president of the Committee for a Responsible Federal Budget.

Still, lawmakers of both parties predicted the bill would pass before the end of June.

Both bills would allow veterans to visit private doctors at VA's expense if they are unable to get an appointment in a timely manner or live more than 40 miles from a VA facility. They each also have language that the federal agency will reimburse no more than Medicare rates for care provided. And both bills would give the VA secretary more power to fire or demote employees for poor performance. Senate Democrats are concerned that the House would remove due process from firing decisions.

The Senate bill would restrict controversial bonuses given to VA employees for meeting certain performance goals. Legislation approved in the House would ban bonuses outright through 2016 and would not include employee safeguards provided in the Senate bill.

Non-VA healthcare providers are bracing for the rush of veterans. While no estimate has been released on how many may seek care in the private sector, a recent VA audit found that more than 57,000 veterans have had to wait at least three months for initial appointments. An additional 64,000 veterans who asked for appointments over the past decade never got them.

On June 10, the American Medical Association announced it is urging state and local medical societies to develop a registry of physicians who are willing to care for veterans. These registries could be provided to local communities and VA facilities to help expedite access to care. “Our nation's physicians can and should be a part of the solution to this national crisis to ensure America's veterans get access to the care they need and deserve,” Dr. Robert Wah, the incoming president of the organization, said in a written statement.

Veterans organizations say congressional leaders have assured them that a compromise bill will be drafted in an expedited manner but that the exact time frame will depend on how the differences are ironed out. Lawmakers either could go the route of a conference committee or have staffers work out the details. The first option takes a little longer on the front end but assures speedy passage once the bill hits the floor. The second is quicker upfront but opens the bill up for amendments once it is put up for vote, said Ray Kelley, legislative director for the Veterans of Foreign Wars of the U.S.

He predicted that the bill will go to conference committee. But the American Legion would prefer that staffers work out a deal, said Louis Celli Jr, legislative affairs director at the organization.

One veterans group warned, however, that in the speedy drafting of the bills some service members have been left behind. Neither bill addresses veterans with specialized healthcare needs such as spinal cord injury or dysfunction, amputation, blindness, or polytrauma, said Carl Blake, acting associate executive director of government relations for Paralyzed Veterans of America.

“The flaw is the presumption that even veterans with specialized needs have a choice, when they do not,” Blake wrote in a June 12 letter to lawmakers. “In fact, the specialized programs of the VA are incomparable services that cannot be duplicated in the private sector.” Blake has launched an aggressive outreach effort to Congress for an amendment authoring funds to hire additional VA providers to serve catastrophically disabled veterans.

Others are concerned that the fiscally conservative House Republicans will gut some of the funding measures in the Senate bill. “The Senate bill has an emergency funding component that will allow VA to receive added funds from Treasury to assist in immediately expanding care,” Kelley said. “It is important that funding be tied to the compromise bill. We believe the quickest way to receive that funding is through the emergency measure that is in the Senate bill.”

The American Legion saw things to like in both bills. It supports the House language that includes 27 new clinics and medical facilities, while backing language in the Senate version that would direct the VA to set timely standards for access to care that are realistic. Celli said that VA should not be held to the “unrealistic standards they portrayed to the public with regard to a 14-day stipulation, which is what the House version currently ties them to.”

Follow Virgil Dickson on Twitter: @MHvdickson

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