By Tom Philpott
The ambitious push by Congress and its veteran affairs committees to swiftly solve a health care wait-time crisis for tens of thousands of veterans by granting access to private sector care appears to have run hard aground.
After four weeks, House-Senate conferees, working through their staffs to iron out differences in separate veteran health reform bills, need some major breakthroughs, according to lawmakers and staff.
“I am very concerned that this conference committee will end up taking a step backward for veterans’ health care in this country,” said Sen. Jon Tester, D-Montana. “That cannot happen. Veterans deserve better.”
Worries center on the showpiece of both bills: that VA for two years will make private sector care available to veterans if they face waits for VA care longer than 30 days or live more than 40 miles from a VA care facility.
The trouble goes beyond costs, though they are considerable. Lawmakers negotiating a final deal appear only now to be learning the challenges for veterans to access civilian care, and the need for VA to have the resources to monitor and coordinate expansion of purchased care.
The unease among lawmakers surfaced during a hearing of the Senate Veterans Affairs Committee where Acting VA Secretary Sloan Gibson presented the VA’s longer-term plan to improve access to care.
Sen. Patty Murray, D-Washington, for example, asked about difficulties VA has in getting medical records returned from civilian providers, and monitoring the quality of care veterans receive in the private sector.
“One of the biggest challenges we have with purchased care in the community is maintaining continuity of care for the veteran,” Gibson said. “The ability to get medical record information back and forth is a vital part of this, (to) ensure the quality of care. I will tell you, if the floodgates open, it will present the department with challenges.”
The Congressional Budget Office dropped an anvil of hefty cost estimates on both bills, to the shock of fiscal conservative among supporters.
The Senate voted to treat its bill as emergency legislation, which means not appropriating billions of dollars needed to pay for it; the costs simply would be added to the nation’s debt. House Republicans want the final bill paid for, but need to find budget offsets that colleagues will accept.
With Sen. Bernie Sanders, I-Vermont, chairman of the Senate Veterans Affairs Committee, insisting on emergency funding only, the search is on for ways to lower costs enough to entice House conferees to compromise.
Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: firstname.lastname@example.org