This story was first published at 4:33 p.m. on May 4.

The nation's largest veterans groups have lined up to oppose any expansion of the Veterans Affairs Choice program that would allow all veterans who are eligible for VA medical care to use it.

The stand, by the American Legion, Veterans of Foreign Wars and others, places the groups squarely in the corner of VA Secretary Bob McDonald, who has called proposals favoring private care for veterans over VA facilities, a "dereliction" of department duties, and at odds with seven powerful U.S. senators, including Arizona Republican John McCain, who have proposed legislation to lift restrictions on Choice.

Seven veterans organizations wrote the VA Commission on Care on April 29 saying they would oppose any VA health system that allows veterans to see a non-VA provider at any time.

The heads of the organizations, which also included Disabled American Veterans, Vietnam Veterans of America, AMVETS, Military Officers Association of America and Iraq and Afghanistan Veterans of America, told panel chairwoman Nancy Schlichting that giving all veterans access to private health care paid for by VA "would have serious costs, trade-offs and consequences that could endanger or harm the provision of health care to veterans."

"Such unfettered access to the Choice program could result in a decline in the number of veterans using VA programs and facilities, which would threaten the financial and clinical viability of some VA medical programs and facilities," they wrote.

McCain introduced a bill April 27 that would make the Choice program permanent and expand its eligibility to all veterans enrolled in VA care.

The senator said the bill is needed to "tear down bureaucratic hurdles" that deny veterans timely access to quality health care.

The VA, instead, wants to consolidate several community care programs, including Choice, and use the new community care system to supplement health care provided at VA facilities, mainly in areas where services are unavailable or failing to provide timely care for former troops.

The 15-member Commission on Care was tasked by Congress in 2014 to study the Veterans Affairs health system and make recommendations on its future.

It has been working on the effort since last September and is expected to release a final report in June.

But the panel made headlines last month when members discussed the option of closing all VA facilities and moving veterans to a system similar to Medicare, where all eligible veterans would receive treatment from private providers paid for by VA.

That proposal spelled out in a 35-page "strawman" document drafted by seven commission members drew fire from veterans groups that said it represented the intentions of the those who wrote it, including commissioner Darin Selnick, who previously chaired a task force on veterans health care organized by the advocacy group Concerned Veterans For America.

That task force released a report last year calling for the placement of VA medical facilities under a government-funded nonprofit organization and shifting treatment for veterans with nonservice-related health conditions to private health insurance programs.

Critics of the plan, including Democratic presidential candidates Sen. Bernie Sanders, I-Vt., and former Secretary of State Hillary Clinton, have called it a thinly veiled attempt by conservative industrialists Charles and David Koch to privatize the Veterans Health Administration.

News reports have linked the group to the Koch brothers' network of activist organizations, although CVA officials do not discuss their funding sources.

McCain's bill is the second in two years from the senator, who has sought to find "short- and long-term solutions to problems at VA."

A spokeswoman for the senator said Wednesday McCain continues to work with several veterans groups to address ongoing issues at the department, including the recently released bill.

"Senator McCain's Care Veterans Deserve Act ... will accomplish this shared goal through an 'all of the above approach,'" McCain communications director Rachel Dean said. "The 'Care Veterans Deserve' bill expands access to VA facilities through evening and weekend hours and telemedicine,as well as the VA partnering closely with walk-in clinics for veterans seeking same-day appointments."

Other legislation also is wending through Congress to address the VA's Choice program, to give VA flexibility in using Choice funds and improve its processes for reimbursing providers.

But the massive veterans reform bill introduced by the Senate Veterans' Affairs Committee last week does not include language that would allow VA to consolidate various outside care programs that department leaders have requested.

McDonald said Wednesday he would continue to press for the ability to consolidate the outside care programs, and he reiterated the department's stance against shuttering VA facilities in favor of private care.

"They argue that closing VHA is the kind of 'bold transformation' veterans and their families need, want and deserve. I suspect that proposal serves some parties somewhere pretty well," McDonald said, "but it's not transformational. It's more along the lines of dereliction. It doesn't serve veterans well. And it doesn't sit well with me."

The Commission on Care is expected to release its recommendations on VA care in June.

Military Times Capitol Hill Bureau Chief Leo Shane III contributed to this report.

Patricia Kime covers military and veterans health care and medicine for Military Times. She can be reached at 

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

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