Senate Democrats agreed to support a Republican effort to expand veterans' access to private doctors through the Department of Veterans Affairs on the condition that a key provision will expire in eight years.
The Senate Veterans Affairs Committee voted 16-2 to advance the bill Wednesday afternoon, though Democrats characterized their support as provisional based on the expectation of further negotiations on the bill. The bipartisan support stood in stark contrast to the House, where a version of the bill was advanced last week by the House Veterans Affairs Committee on strictly party lines amid Democratic accusations that Republicans are working to privatize the VA.
"It's not designed and not intended, and I wouldn't want it to occur, that we prefer choice or community care over the Department of Veterans Affairs, but I do strongly believe that veterans should have a say," Senate Veterans Affairs Committee Chairman Jerry Moran, R-Kan., said at Wednesday's meeting.
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"I will work with the ranking member, members of this committee and our colleagues to make sure that quality care is provided so that veterans have a choice of good care here or good care there," he added, thanking committee ranking member Sen. Richard Blumenthal, D-Conn., for working in "good faith" on the bill.
The bill, dubbed the Veterans' Assuring Critical Care Expansions to Support Servicemembers, or the ACCESS Act, is Republicans' marquee effort this Congress to solidify and expand the VA's community care program, which allows veterans to see private doctors using VA funding.
One of the key provisions of the bill is codifying that veterans can go to private doctors if they face a wait time for VA doctors of more than 20 days for a primary or mental health care appointment or face a drive of 30 minutes or longer. For specialty care, the standards would be a 60-minute drive or 28-day wait.
Those are the same standards that exist now, but the current standards are regulation, not law.
The original version of the bill would have permanently enshrined the standards in law. But under the bipartisan compromise, the Senate version of the bill would now sunset the legal standards in eight years, leaving them once again to department regulation after that.
Blumenthal backed the bill Wednesday in light of the amendment, but stressed that his support was conditioned on continued negotiations with Moran on the legislation to "make it better than what it is now."
"As we work in a bipartisan way to improve access to quality care for veterans in the community, it's essential that we do the same for care provided by the VA," Blumenthal said.
Other provisions that elicited strong Democratic opposition in the House remain intact in the Senate version, including language saying that the availability of telehealth cannot be a factor in calculating wait times and the creation of a pilot program to allow veterans to get private outpatient mental health and substance abuse treatment without a referral or pre-authorization.
While the Senate's change garnered bipartisan support for the bill, it ruffled conservatives.
Concerned Veterans for America, or CVA, a conservative veterans group, withdrew its support for the bill because of the change. John Vick, the executive director of CVA, said he was extremely disappointed in the senators' decision to limit the codification of the access standards to eight years, adding that the standards were created to comply with the bipartisan 2018 Mission Act.
"From Congress' perspective, they need to be thinking about how best the VA can serve veterans, not how best to preserve the VA in its sort of archaic structure," Vick said in an interview Wednesday with Military.com.
He added that CVA's goal is for "full choice," meaning that veterans can choose to go to a VA facility or select their own community care physician and have it covered by the VA.
"I have no doubt that, as we continue this fight, we're going to achieve that," Vick said. "It's extremely disappointing and, in my opinion, disingenuous to say that eight years from now, we need to reassess whether veterans can choose."
At Wednesday's meeting, one GOP committee member, Sen. Marsha Blackburn of Tennessee, also expressed disappointment the bill would not permanently codify the access standards and noted CVA's opposition. Still, she voted in support of the bill.
While most committee Democrats voted to advance the bill, Sens. Mazie Hirono, D-Hawaii, and Bernie Sanders, I-Vt., who caucuses with Democrats, opposed it.
"Moving us toward privatizing VA care is not the way to go," Hirono said. "We should be focusing on providing this kind of care and increasing the capacity of the VA system to provide all levels of care."
The bill now needs to be voted on by the full Senate and, after that, must be reconciled with the House version, which also still needs to be voted on by the full chamber.
In addition to sunsetting the access standards, the Senate version of the bill has several differences from the House version that would need to be ironed out. For example, the Senate bill would add to the list of factors VA doctors must consider when making a recommendation for community care and expand eligibility for veterans to seek care at private residential mental health treatment facilities -- two provisions that were taken out of the House bill over what Republicans described as cost issues.
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