As veterans' healthcare moves to the top of the congressional agenda, Democrats and Republicans are offering competing proposals to respond to the scandal at the Department of Veterans Affairs.
Whether to expand the massive — and troubled — VA healthcare system or simply give veterans greater ability to seek private care promises to ignite Congress' customary partisan wrangling and complicate passage of reform legislation.
Republican senators, led by John McCain of Arizona, on Tuesday rolled out the Veterans Choice Act , which would allow veterans facing weeks-long waits at VA facilities to seek care from private doctors, at the VA's expense.
A more sweeping measure sponsored by Senate Veterans' Affairs Committee Chairman Bernie Sanders (I-Vt.) would give veterans who can't get timely appointments with VA doctors the option of going to community health centers, military hospitals or private doctors at the VA's expense. The bill, called the Restoring Veterans' Trust Act, also would authorize hiring more VA doctors and establishing more VA medical facilities.
The measures are among a spate of bills that have been hurriedly drafted in response to a scathing report by the VA inspector general last week. The interim report found a systemic problem in scheduling veterans for healthcare in a timely manner, including instances in which VA staff falsified records to cover up long waits. Investigators found an average wait of 115 days for a sample of veterans at the VA facility in Phoenix.
Although the inspector general's investigation of 42 sites is continuing, Congress isn't waiting to take up reform of the VA's system of 1,700 hospitals and clinics, which handle 85 million appointments a year. But, this being an election year, it won't be easy for lawmakers to reach agreement.
The House recently passed the VA Management Accountability Act to make it easier for the VA secretary to fire or demote senior employees for poor performance.
But that measure has drawn criticism from employee groups, which said it could politicize the VA. "Nothing in the bill prevents a secretary from cleaning house under the guise of performance," the Senior Executives Assn. said in a letter to lawmakers.
Sanders, who caucuses with Democrats, has written his own version of the measure to include protections for employees to prevent "wholesale political firings."
The challenge of getting a VA reform bill through Congress was apparent Tuesday when Republican senators unveiled their bill to allow veterans who "can't schedule an appointment within a reasonable time or live too far away from the VA medical facility" to seek private care.
The bill also would prohibit the VA from using wait times in determining executives' bonuses and would require the VA secretary to establish penalties for falsifying records.
The GOP senators contended that Sanders' bill was too expansive.
The measure would give veterans who cannot get timely appointments with VA doctors the option of going to community health centers, military hospitals or private doctors, and would authorize the VA to lease 27 new health facilities, including four in California (San Diego, Chico, Chula Vista and Redding). It would authorize emergency funding for the agency to hire new doctors and nurses. And it would authorize the National Health Service Corps to forgive college loans for doctors and nurses who go to work at the VA.
"The simple truth is that, with 2 million more veterans coming into the system in recent years, there are many facilities within the VA that do not have the doctors, nurses and other personnel that they need to provide quality care in a timely way," Sanders said Sunday as he unveiled his legislation.
The Republican senators say their bill is more targeted.
"It's not encompassing everything that Congress would like to pass as it relates to VA legislation, but it addresses the urgent things needed right now," said Sen. Richard M. Burr of North Carolina, top Republican on the Senate Veterans' Affairs Committee
But Sanders said in an interview in the Capitol on Tuesday that the GOP bill "doesn't get to the root cause of the problem."
"The problem is that there are VA facilities all over this country who don't have enough doctors, don't have enough nurses, and we need to make sure they get them as quickly as possible," he said.
"It goes without saying that right now, where there are waiting lists, we are going to get veterans the help they need immediately," Sanders said, referring to allowing veterans who face long waits at VA facilities to go to military hospitals, community health centers or private doctors.
A broad veterans bill stalled in the Senate this year amid partisan wrangling. But since then, the VA problems have gained a sense of urgency.
The Senate committee is to consider legislation Thursday. And Senate Democratic leaders have indicated that they will put the bill on a fast track, possibly taking up legislation before the end of the week.
Burr said the Republican bill "empowers the veteran to make the decision, versus relying on a bureaucrat to determine that they want to divert money from the VA facility to outside payment."
In fiscal 2013, the VA spent about $4.8 billion, or about one-tenth of its healthcare costs, on private care, often for veterans who live far from VA facilities or veterans in need of care unavailable at a VA facility.
The idea of expanding veterans' ability to seek private care enjoys strong support in the Republican-controlled House.
House Veterans' Affairs Committee Chairman Jeff Miller (R-Fla.) has said he plans to introduce legislation to offer veterans unable to obtain a VA appointment within 30 days the option of seeking private care at VA expense.
Rep. Jeff Denham (R-Turlock) has introduced the Veterans Need Timely Access to Care Act, which would automatically make a veteran preauthorized for care from a local doctor or clinic outside of the VA if the wait time for an appointment was longer than seven days for primary care and 14 days for specialty care.