WASHINGTON — Lawmakers this week all but assured that the controversial Veterans Affairs Choice program will survive until 2018. But what happens after that will be one of the major legislative fights of the fall.

At issue are philosophical differences in the evolving role of VA, and whether the country’s pledge to cover veterans medical needs is better served by building up the existing system or outsourcing more care to the private sector. Both lawmakers and veterans groups have spent recent weeks lining up on either side of the argument, with an eye towards a post-recess battle.

On Wednesday — just a few hours after the Senate sent a six-month funding plan for the Choice program to the White House — officials from Concerned Veterans for America offered the latest salvo in the debate, releasing a new poll they say reinforces support for extending and improving the VA Choice program.

More than 61 percent of veterans surveyed say VA care is too difficult to access. And 80 percent favor giving veterans “more choices over their health care” outside of the traditional department offerings.

“VA should be the guarantor of care, funding it and making sure veterans have access to it,” said Dan Caldwell, policy director for CVA, which has close ties to conservative donors.

“But keeping VA at the center of providing care, giving them all the say where and how veterans get medical care, that’s not a model that is sustainable. And it won’t provide the best health outcomes for veterans.”

Roughly half of individuals in the poll, which surveyed 1,000 voters including 260 veterans, blamed problems at VA medical facilities on “bureaucracy and mismanagement.” The figures are consistent with past polling done by the group, which Caldwell believes shows strong public support for programs like VA Choice.

The program, created by Congress in 2014 in the wake of VA’s wait times scandal, allows veterans who face lengthy wait times or significant travel hardships to seek private-sector medical appointments at VA’s expense.

CVA and White House officials are pushing to expand the program, removing those time and distance restrictions in favor of permanent, flexible options outside VA. The poll noted that 98 of veterans surveyed “support efforts to reform the health care veterans receive in this country.”

But Democrats remain concerned the flow of money outside the department represents a step towards eroding the VA system and have fought against those plans, noting the Choice program was originally intended to be only a three-year bridge while infrastructure improvements were made within VA.

Last week, veterans groups, including Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America and Disabled American Veterans, successfully forced lawmakers to add about $1.8 billion into the six-month Choice extension deal, to pay for more VA medical leases and personnel hires. CVA and several conservative veterans groups had opposed that part of the plan.

In July, VA Secretary David Shulkin said veterans’ use of department outside care programs for the first half of 2017 VA were up 26 percent over the same period last year.

That totals about 18 million veterans medical appointments being paid for outside of VA facilities, versus about 21 million medical appointments inside the VA system over the last six months.

The CVA survey comes a day after a VA inspector general report warned that veterans using medical care outside department facilities face greater risk of opioid addiction, because of a lack of communication between VA and non-VA providers.

The news was greeted by critics as proof of the shortcomings of private-sector care for veteran-specific needs, but dismissed by Caldwell as simply an area in need of improvements, not an indictment of the entire concept.

Shulkin and VA officials are scheduled to unveil a Choice overhaul this fall, one that will make the program permanent and provide for a consolidation of all VA outside medical care programs.

President Donald Trump has repeatedly cited the growth of Choice program use as a success of his time in office, and on July 25 told a crowd of veterans he would triple the number of veterans “seeing the doctor of their choice” in coming months.

White House officials provided no further details on that proposal, but the remarks drew immediate concerns from critics as further evidence of an intent to privatize VA care.

The Choice extension — expected to be signed into law by Trump in coming days — should keep the program solvent until February. That gives lawmakers just a few months of legislative work when they return in September to find a long-term solution to the outside care issue.


Leo Shane III covers Congress, Veterans Affairs and the White House for Military Times. He can be reached at lshane@militarytimes.com.