Five of 10 bills introduced Tuesday, Dec. 17, 2024, at a hearing of the House Veterans’ Affairs Committee subpanel on health offered plans for expanding coverage for veterans seeking private-sector care. Some of the proposals would waive requirements for veterans to qualify for non-VA care and others offered alternative payment plans for covering veterans care in the private sector. (Stars and Stripes)

WASHINGTON — A day after Congress finalized sweeping reforms to increase health benefits for veterans in the private sector, House lawmakers debated several new bills that push for even more access to care outside the Department of Veterans Affairs.

Five of the 10 bills introduced Tuesday at a hearing of the House Veterans’ Affairs Committee’s subpanel on health offered plans for expanding coverage for veterans seeking private-sector care.

Some of the proposals would waive requirements for veterans to qualify for non-VA care and others offered alternatives for covering veterans care in the private sector.

Rep. Mariannette Miller-Meeks, R-Iowa, the subcommittee chairwoman, said the bills provided creative solutions for helping give veterans greater choice in deciding when and where they get their health care.

The hearing came just hours after Congress finalized the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, sweeping legislation that will increase coverage for aging and disabled veterans to continue living at home and stay out of nursing homes. The bill now moves to the president’s desk to be signed into law.

But concerns about another expansion of private-sector community care were quickly raised at Tuesday’s hearing by VA leaders and the labor union representing VA workers.

“The VA is at a tipping point and [these bills] radically accelerate privatization. We must reverse privatization rather than accelerate it,” said Mary-Jean Burke, first executive vice president of the National Veterans Affairs Council at the American Federation of Government Employees, the largest federal employees union.

The VA employs nearly 375,000 health care workers and support staff.

Burke said the labor union is concerned about an erosion of VA services if coverage for private sector care continues to grow.

Reducing the VA’s role in providing and coordinating care is a common thread of the bills, which the VA “disagrees with on a fundamental level,” said Hillary Peabody, acting assistant under secretary for health for integrated veteran care at the Veterans Health Administration.

Peabody warned greater expansion of non-VA services will diminish the VA and threaten its future. About 40% of veterans’ health care is now delivered outside the VA.

The agency has concerns about “further opening doors to private care without putting at risk the long-term solvency of the VA,” she said.

“Some of the legislation will only push us closer to this breaking point,” said Rep. Nikki Budzinski, D-Ill.

Among the new legislation introduced was the Veterans Direct Access to Primary Care Act, sponsored by Rep. Chip Roy, R-Texas.

The legislation would direct the VA to fund medical savings accounts for veterans to pay for their doctor visits. Medical savings accounts would be tested under a pilot program.

Roy said the medical savings accounts would allow veterans to obtain cash-paid services outside the VA and bypass insurance companies.

“Health savings accounts let patients find a doctor who is not operating under an insurance-constrained health care environment,” he said.

The Veterans Health Care Freedom Act, sponsored by Rep. Andy Biggs, R-Ariz., would enable a veteran to get care from a non-VA doctor without first showing that the VA is unable to provide the same service close to the veteran’s home.

The Veterans True Choice Act, sponsored by Rep. Greg Steube, R-Fla., would allow veterans to enroll in the Tricare insurance program for treatment of military service-connected conditions. Tricare recipients can use a civilian network of providers for their care or Tricare-authorized, non-network providers.

“I do not have a VA hospital in my district,” said Steube, an Army veteran who deployed to Iraq. “This isn’t about dismantling the VA but giving veterans access to the highest quality care.”

Under the Emergency Community Care Notification Time Adjustment Act, requirements would be loosened for veterans to notify the VA after receiving emergency care at a local hospital.

Sponsored by Rep. Brian Mast, R-Fla., the bill would require veterans to notify the VA within 72 hours after discharge from a hospital. Veterans must now notify the VA within 72 hours after an emergency room admission to receive coverage.

Lawmakers also heard testimony about the Complete the Mission Act, sponsored by the Rep. Mike Bost, R-Ill., which would require the VA to inform veterans about non-VA medical services when they are seeking appointments.

It also would codify existing VA standards for making referrals to non-VA care. Under current policy, if wait times for VA medical services exceed 20 days for primary care or mental health services, veterans can choose to see clinicians outside the VA.

The VA covers the cost of care from private clinicians enrolled in the VA network.

“Lawmakers must prioritize creating a robust health care framework for our veterans, ensuring VA has the necessary resources to effectively support its mission and deliver the care that all veterans deserve,” said Patrick Murray, director of national legislative services at the Veterans of Foreign Wars.

Murray told lawmakers that his organization just completed a survey of 2,250 veterans about their preferences for health care delivery. He said most respondents want to see the VA continue as the primary provider of veterans health care.

Cole Lyle, director of veterans affairs and rehabilitation at the American Legion, said the VA’s community care costs have ballooned since passage of the Mission Act six years ago, which authorized private-sector medical services for veterans when the VA could not provide the same care in a timely manner.

“This has naturally resulted in debates on balancing funding with the VA’s direct care system,” he said.

Lyle said his organization has received reports that the VA is denying veterans referrals for private sector care to try to keep them from leaving the VA health system.

“If the VA cannot provide veterans the care they need, when they need it, community providers are the only realistic solution in the best interest of the individual veteran,” he said.