House passes VA Choice expansion

The U.S. House of Representatives passed the long-delayed VA Choice reforms Wednesday night, potentially teeing up a vote in the Senate before funds for the current Choice program are expected to run out at the end of May.

The bill folds all the community care options for veterans into the Choice program and opens up private provider options if Veterans Affairs facilities don't meet certain access standards and quality measures—an effort to address issues of long waits and poor quality care.

It's unclear when the Senate will vote. A GOP Senate aide close to talks said it could be early next week.

The Senate VA Committee's top Democrat, Jon Tester of Montana, didn't give a date, only saying he thought they could get it done by Memorial Day. "That would be good," he said.

Over the past few months, Tester has said he hopes the bill could clear the upper chamber quickly through a vote of unanimous consent, but that would depend on universal support from Democrats.

The Trump administration has pushed the reforms, which lagged after the Senate and House Veterans Affairs committees passed different versions. Sen. Jerry Moran (R-Kan.) opposed the bill his chamber's committee produced and drafted his own that included provisions supported by the White House. The Senate, House Republicans and administration officials hammered out a deal they wanted to pass with the March spending omnibus, but House Democrats objected.

Policy disagreements between the House Republicans and Democrats on the committee remained even after the bill passed out of the House VA Committee.

In the committee vote, the two top Democrats, Ranking Member Tim Walz of Minnesota and Rep. Mark Takano of California voted against the bill, blasting the White House for derailing certain provisions House Democrats hoped to add, such as yearly VA review of the agency's decision to send veterans to community providers as well as exempting Choice funding from potential sequester cuts; the funding would move from mandatory to discretionary spending under the legislation.

Walz also opposed the measure on the House floor.

Heather O'Beirne Kelly, who leads the American Psychological Association's military and veterans policy team tweeted a congratulatory message to Walz, saying her organization opposed the Mission Act because of the bill's lower standards for mental health services.

While VA healthcare enjoys bipartisan support from Congress when it comes to funding, analysts from the nonpartisan Committee for a Responsible Federal Budget are warning lawmakers about the price tag.

The legislation's move to change the program's funding from mandatory to discretionary could result in "significant" new discretionary or future mandatory costs for the government, according to the analysts.

The Congressional Budget Office has projected that the community care program alone will cost about $5 billion to $6 billion each year. The total cost of the care would be $10 billion to $15 billion per year.

An edited version of this story can also be found in Modern Healthcare's May 21 print edition.