WASHINGTON — White House officials want Senate lawmakers to set clearer eligibility guidelines for veterans considering private-sector care and to drop their current plans for an expansion of veteran caregiver benefits, according to a memos sent to congressional leaders this week.
They also want a plan to pay for the massive health care overhaul.
The comments come as legislation to overhaul the Department of Veterans Affairs health care offerings sits stalled in the House and Senate due to a series of budget and eligibility concerns. Senate Veterans’ Affairs Committee Chairman Johnny Isakson, R-Ga., had asked for the feedback from the White House in hopes it would serve as “a catalyst” to restart talks.
The administration memo appears to more closely back a legislative proposal from Sen. Jerry Moran, R-Kan., than bills advanced by the Senate committee or its House counterpart.
It calls for clearer eligibility standards for veterans to seek care outside the VA system, which has become the center of the fight between the dueling proposals.
The White House is backing direct standards for when veterans would be able to see private doctors at VA’s expense, which Moran has said will establish clear rules on who can and who can’t use community care programs. Other plans would allow VA officials more flexibility to interpret broad guidelines based on what they believe is best for patient care, which critics say amounts to limiting veterans’ choices.
But in the memo, White House officials warned that inexact eligibility rules “could inadvertently expand eligibility” and program costs.
President Donald Trump has repeatedly promised to make private-health care more accessible to veterans currently dependent on VA medical centers, arguing that the federal program is too flawed to adequately meet their needs.
VA Secretary David Shulkin has repeatedly pushed back against accusations that those policies amount to privatization of his department’s responsibilities, insisting that the responsible future of veterans health care is a mix of federal and civilian systems.
But the cost of the Senate committee’s Caring for Our Veterans Act — which give veterans in the VA system two walk-in visits at any private-sector practice without co-pay, among other community care options — is estimated at $54 billion over five years.
The White House memo requests offsets for those costs, something the House draft hasn’t dealt with yet either (that plan is expected to cost $39 billion over five years).
One of the ways to lessen the cost of the Senate bill would be to drop a provision to extend benefits to caregivers of veterans from earlier wars, instead of the current policy of limiting them to those who served after Sept. 11, 2001.
Committee members approved expanding monthly stipends and other support services to all caregivers of veterans, to be phased in over time, at a cost of $3.4 billion over the next five years. The White House memo states the administration “cannot support such a costly expansion” without broader debate among appropriators.
The memo also notes concerns about language in the Senate bill that would require more information on opioid prescriptions to veterans (and “the burdens it would impose on community providers) and calls for limits on grandfathering current users of the VA Choice program (those in the system who live 40 miles from a VA facility could stay on).
It’s unclear whether those changes, particularly the potentially expanded pool of veterans eligible for outside care programs, will upset Democrats who had already signed on to the measure. Several have said they worry about an expansion of outside care programs draining needed funds from other parts of VA.
The office of Senate Veterans’ Affairs Committee ranking member Jon Tester, D-Mont., released a statement said they are reviewing the White House memos. “He believes there is a lot of common ground and is encouraged by the open lines of communication.”
Moran in a statement said he was encouraged by the White House memo.
“Too many past examples to count have demonstrated that when Congress passes legislation that leaves any room for interpretation by the VA bureaucracy, our veterans are the ones who lose,” he said.
“The feedback from the White House makes it clear that the administration supports standards, not guidelines — standards that VA must comply with to allow veterans access to community care.”
Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.