House unveils VA Choice compromise bill

(Updated May 4)

A key House committee on Thursday released compromise legislation to move forward with long-stalled VA Choice reforms.

House and Senate lawmakers and administration officials for months brokered a package that would require VA facilities to meet certain standards or release veterans to community providers; it would also will launch a mandatory review of the VA's medical assets. Congressional and administrative aides view the House introduction as the quickest way forward for the legislation. The House Veterans' Affairs Committee is scheduled to debate the package May 8.

President Donald Trump wants to sign the package into law by Memorial Day and has urged swift movement on Choice over the last few weeks. Hours before House VA Committee Chair Phil Roe (R-Tenn.) released the legislation, the president took to Twitter to discuss it again.

"This spring marks 4yrs since the Phoenix VA crisis," Trump tweeted. "We won't forget what happened to our GREAT VETS. Choice is vital, but the program needs work & is running out of $. Congress must fix Choice Program by Memorial Day so VETS can get the care they deserve. I will sign immediately!"

The legislation is called the Maintaining Internal Systems and Strengthening Integrated Outside Networks, or Mission, Act.

The White House fully backs the Mission Act, an aide told Modern Healthcare. The Trump administration has maintained steady pressure on lawmakers to keep working even amid the fallout from the firing of VA Secretary Dr. David Shulkin and through allegations about his proposed replacement, Dr. Ronny Jackson, who ultimately withdrew his name from consideration.

It isn't clear how quickly the package could move through the House and Senate. A GOP Senate VA Committee aide told Modern Healthcare that the committee majority supports the legislation but did not respond to a question on timing.

A spokesperson for Jon Tester of Montana, ranking Democrat on the Senate VA Committee, did not respond to a request for comment on his position. Tester supported the earlier draft version of the VA Choice reform bill that Congress failed to pass with the March spending omnibus. He had urged his fellow lawmakers to pass the reforms for months.

A spokesperson for House Minority Leader Nancy Pelosi (D-Calif.) said her office is still reviewing the legislation.

The Mission Act includes provisions from a bill Sens. Jerry Moran (R-Kan.) and John McCain (R-Ariz.) introduced in December 2017. Moran wanted to set into law certain access standards that VA medical clinics must fail to meet before releasing a patient to community care.

As part of the Moran provision, the VA must also set quality measures as determined from surveys of veterans that show their satisfaction with timeliness, safety, efficiency and quality of care at VA medical clinics or centers within the past two years. Another provision from Moran-McCain mandates a deep study of the VA's and community providers' caring capacity as well as demand versus capacity at VA medical centers across the country.

Moran pushed these measures with the committee and had a public altercation with Shulkin over what he viewed as Shulkin's reluctance to support codifying the access standards into law. On Thursday, Moran came out with strong support for the current package.

"I have long been a vocal advocate for giving veterans greater choice and flexibility in their health care," Moran said in a statement. "After months of extensive debate and negotiations, I am pleased Rep. Phil Roe introduced legislation to reform VA healthcare and fund the Choice Program until the new program created by this bill is up and running."

The GOP members of the House VA Committee noted that the Mission Act largely reflects the compromise legislation lawmakers and the administration had quickly hammered out in March in order to try to include it with the $1.3 trillion spending omnibus. House Democrats blocked it, however, saying that rather than streamline the Choice program the partial agreement created uncertainty in the VA budget, "opened the floodgates to privatizing VA's mental health services and beyond," and removed congressional oversight of the VA's infrastructure.

In addition to expanding community care, the Mission Act includes a $5.2 billion boost to keep the current Choice program running until the VA can implement the new one. VA Choice is expected to run out of money and shut down by mid-June if Congress does not appropriate additional funding.

Lawmakers, aides and veterans groups that have worked closely on the legislation believe that the uncertainty around future leadership of the VA won't stop the package from smooth sailing to the president's desk.

Acting VA Secretary Robert Wilkie promised he "will work with House and Senate leaders to get this done on President Trump's timetable."

Trump has not yet nominated another candidate to replace Shulkin, while rumors continue to rumble around Washington over whom he will pick. Ascension President and CEO Anthony Tersigni; former Florida GOP Rep. Jeff Miller, who served as House VA Committee chair; and even Trump's chief of staff, John Kelly, have all been floated as possible nominees.

An edited version of this story can also be found in Modern Healthcare's May 7 print edition.