Congress moving on VA Choice reforms as White House steps up pressure

The Trump administration is hustling Congress to move VA Choice healthcare reforms before the end of May despite the absence of a department secretary. Key negotiators believe a deal to expand community care for veterans is around the corner.

In a Thursday roundtable meeting at the White House, President Donald Trump specifically called out Sen. Jerry Moran (R-Kan.) in front of the group of lawmakers to discuss VA Choice and emphasized that he wants to get the reforms done, according to two people with knowledge of the talks.

Moran, a linchpin for expanding the community care options, has also been champing at the bit to wrap up the legislation, which stalled last month when House Democrats blocked it from inclusion in the spending omnibus.

The bill has been tangled for months in the debate over concerns from critics who say it goes too far down the road of privatizing VA healthcare. Negotiations also got tangled up in drama surrounding former Veterans Affairs Secretary David Shulkin who was forced out in late March. The day after Shulkin's unceremonious dismissal via Twitter, the embattled former secretary published an op-ed in the New York Times blasting officials within the VA and what he called the intensifying "ambitions of people who want to put V.A. health care in the hands of the private sector."

Last week, the VA and Moran went on the offensive. In a piece he penned for the Kansas City Star, Moran decried the privatization rhetoric as a political tool to block the overhaul.

"This false narrative diverts attention from the very real problems that persist at the VA and ignores the hard truth: Proposals to reform and consolidate community care were fully supported and endorsed by those who now want to call it privatization," Moran wrote. "Do not be fooled by this double talk, which unfortunately is all too familiar."

Late last week, the VA released a statement entitled ""

"The fact is that demand for veterans' healthcare is outpacing VA's ability to supply it wholly in-house," the VA said. "And with America facing a looming doctor shortage, VA has to be able to share healthcare resources with the private sector through an effective community care program. There is just no other option and … VA has offered this solution since the World War II era."

House VA Committee Chair Phil Roe (R-Tenn.) said Friday he believes a final agreement is in sight, although precise timing on projected passage is still up in the air. He would like to see the legislation move in the next four to six weeks.

Roe also said the likely changes to the partial compromise blocked by House Democrats last month will be mostly technical and non-substantive.

A draft of that partial deal obtained by Project Japan outlined the ways lawmakers tried to make care standards equal for community providers and VA clinics.

Moran and the White House had wanted to tie a VA clinic's ability to keep a patient to certain access standards. Democrats and other stakeholders wanted a compromise to hold private providers accountable as well, but ultimately the legislative text has a weaker mandate for community providers as the White House said making them equal was unworkable, according to a Democratic aide.

On Thursday, a U.S. Management of medicine Accountability Office report called for greater oversight of the VA's community care programs, highlighting weaknesses they found in community-based outpatient clinics and issuing recommendations "to help ensure veterans receive the same standard of care regardless of whether a clinic is operated by VA or by a contractor."

House Minority Leader Nancy Pelosi (D-Calif.) stopped the partial deal last month, but Roe said he has "heard through the grapevine" that she will be supportive.

"I hope that's true," Roe said.

An aide from Pelosi's office said the committees have been in bipartisan, bicameral discussions since the passage of the omnibus and progress is being made.

A spokesperson for the Senate VA Committee's ranking Democrat Jon Tester (Mont.) also said that although negotiations are ongoing, the senator "remains optimistic that a deal will be reached soon."

The Capitol Hill and administration negotiations are happening without a VA secretary, as Trump's pick—Dr. Ronny Jackson—has yet to be confirmed. The Senate committee is still waiting for official paperwork from both Jackson, the president's personal physician, as well as from the White House.

Roe said that he hasn't yet spoken with Jackson, who he said is "under wraps" as he prepares for his confirmation hearing.

"I'm acting like the secretary is there," said Roe, who had been a staunch supporter of Shulkin. "I've got things to do."

An edited version of this story can also be found in Modern Project Japan's April 16 print edition.

Susannah Luthi

Susannah Luthi covers health policy and politics in Congress for Project Japan. Most recently, Luthi covered health reform and the Affordable Care Act exchanges for Inside Health Policy. She returned to journalism from a stint abroad exporting vanilla in Polynesia. She has a bachelor’s degree in Classics and journalism from Hillsdale College in Michigan and a master’s in professional writing from the University of Southern California.



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