Veterans Affairs Secretary Robert McDonald told Senate lawmakers Wednesday that Congress' inaction threatens to undermine the department's reform efforts.

During testimony before the Senate Veterans Affairs Committee, McDonald said that VA embraces 15 of 18 proposals set forth by a congressional advisory panel and wants to create a health care system that incorporates public facilities and private health networks to treat veterans. 

"We've made tremendous progress with Veterans Choice," McDonald said, referring to the program created in 2014 to provide care to veterans who can't get an appointment within 30 days or who live more than 40 miles from a VA facility. "There are about a million veterans who rely on the Choice program. There about 5,000 veterans who only use the Choice program, which is a strikingly low, small number that demonstrates most veterans want a hybrid."


McDonald said VA asked Congress earlier this year for legislation to initiate some of the recommendations suggested by the Commission on Care panel, to include expanding the department's networks of private providers, and closing underutilized or underperforming facilities.

But Congress has failed to act, he said.

"VA is not the hold-up on expanding community care. We’re doing that, too. We submitted a plan to streamline and consolidate our community care programs last October — almost a year ago. What happened to it? ... We’ve submitted over 100 proposals for legislative changes in the president’s 2017 budget. No result," McDonald said.

The secretary rejected suggestions that VA programs should be privatized, saying those who support the concept are "ideologues who think in the simplest, laziest terms: Big government is bad and private industry is good."

"Let's face it: Privatization would put more money into the pockets of people running healthcare corporations. It's in their interest, so of course it makes sense to them, even if it's not what veterans need or want," he said.

The Commission on Care, a congressional panel appointed after revelations that VA failed to provide its patients with timely and quality care, released a report in June recommending creation of a consolidated health care system in which veterans can access public facilities and private networks. It also recommended establishing a board of directors to oversee the new system and allowing veterans to choose where they want to receive care.

The commission estimated that its plan would cost between $65 billion and $85 billion to implement.

David Shulkin, VA's undersecretary of health, said this proposal is cost prohibitive, a return to the "late '80s and '90s, where there was just runaway costs."


VA's plan, by contrast, would cost an estimated $17 billion.

Senate Veterans Affairs Committee Chairman Johnny Isakson, R-Ga., said some of the department's needed authorizations are included in the Veterans First Act, an omnibus bill introduced in April that includes new accountability and hiring rules for VA employees and the expansion of some services.

The bill does not include provisions that would allow VA to consolidate its community care program, nor does it include reforms for the disability claims appeals process.

Isakson said the legislation would improve veterans' health services by allowing VA to enter into agreements with community providers and expanding benefits for those who care for veterans at home.


The bill has faced significant opposition, however.

Some lawmakers, including Sen. John McCain, R-Arizona, have said it does not go far enough to hold VA employees accountable for malfeasance.

About Patricia Kime

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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