WASHINGTON — President Donald Trump's expansion of a program aimed at steering more veterans to private healthcare is getting an $8.9 billion boost as part of the massive government spending bill approved by the House, setting up a potential battle over the direction of the Veterans Affairs Department.
The deal provides $81 billion for VA medical care to treat 9.3 million veterans, including the $8.9 billion for private care under a law passed last year expanding the Veterans Choice program. Another $11.3 billion is on tap for private care in 2021.
Major veterans groups have cautioned against "cannibalizing" VA programs to pay for Choice, which they worry could lead to privatization of VA.
The program gives veterans wider access to private care when they have endured lengthy wait times or the treatment was not what they had expected. The price tag could soar as the expanded program takes hold, putting the VA at risk of future budget shortfalls.
Democratic presidential contenders including Vermont Sen. Bernie Sanders and Massachusetts Sen. Elizabeth Warren have urged reinvestment in the VA over expanded private care options. Former Vice President Joe Biden and Pete Buttigieg, a mayor of South Bend, Indiana, have said they will roll back or change some of the Trump administration's rules on Choice.
"As the increasing need for medical care by wounded, ill and injured veterans and their family caregivers is being forced to fit under tight budget caps, we are concerned necessary resources could be shifted away from the VA healthcare system, which independent research has shown provides higher quality care than the private sector," said Joy Ilem, national legislative director for Disabled American Veterans.
"While community care programs are vital to fill and supplement VA in many locations, we believe the value to veterans and the taxpayer of every dollar spent in the VA healthcare system is greater than if it were spent in the community," she said.
House Democrats had pushed for Choice money to be exempt from budget caps, to avoid the risk of cuts to core VA programs as costs grow in the coming years. Ultimately, however, the money was kept under budget caps after the White House resisted.
The added money for Choice is part of a 6% increase to the total VA budget for the fiscal year ending next September. It also includes $9.4 billion for mental healthcare. About 20 veterans die by suicide each day, a rate unchanged during the Trump administration.
The spending bill, which still needs Senate approval, also requires the VA to report to Congress within 30 days the reasons for a two-year delay in announcing whether it plans to provide healthcare coverage for additional Vietnam War veterans exposed to Agent Orange.
Former VA secretary David Shulkin in 2017 tried to get additional diseases such as Parkinson's on a VA list of conditions that are tied to Agent Orange, but the White House opposed that recommendation. A National Academies report in 2016 said there was suggestive evidence to link some of the diseases to herbicide exposure.
"The VA and the Office of Management and Budget now have 30 days to deliver a plan detailing how they'll get veterans suffering from Agent Orange exposure the coverage they need," said Senate Minority Leader Chuck Schumer, D-N.Y., who pushed the provision.