The VA Mission Act
Rep. Phil Roe, Twitter

WASHINGTON — Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..

Included in the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act is $5.2 billion for VA’s Choice program to address a funding shortfall. Additionally, the law contains a provision that would set up a commission as part of a process to review VA’s infrastructure for closure, realignment or modernization.

“The veterans have poured out their sweat and blood and tears for this country for so long, and it’s time that they’re recognized, and it’s time that we now take care of them and take care of them properly,” President Donald Trump said in signing the bill.

“This bill will extend and improve the Veterans Choice Program so that more veterans can see the doctor of their choice … and don’t have to wait and travel long distances for VA care,” Trump added. “Some people have to travel five hours, eight hours, and they’ll have to do it on a weekly basis and even worse than that. It’s not going to happen anymore.”

Rep. Phil Roe (R-TN), chairman of the House Committee on Veterans’ Affairs, who was instrumental in shepherding the bill through the House, called the law “a transformational piece of legislation.”

“Moving the VA MISSION Act is the result of over a year of hearings, roundtables and bipartisan negotiations, and I couldn’t be prouder of the final product,” he said.

Sen. Johnny Isakson (R-GA), who chairs the Senate Committee on Veterans’ Affairs, said that the “this is a truly meaningful victory for our nation’s veterans, who will benefit from more choice and fewer barriers to care.”

“The signing of this legislation marks the completion of the final piece in a great mosaic of veterans reforms that we set out to accomplish over the last two years,” Isakson said.

The bill included legislation previously proposed by House and Senate veterans’ affairs committees and is based on a compromise agreement worked out by Roe, Isakson and Sen. Jon Tester (D-MT).

“I can assure you that this was not where we started one year ago,” Roe said of the bill when it was considered by his committee.

Upon passage of the bill by Congress, the White House called it “an important piece of legislation that will transform the Department of Veterans Affairs (VA) into a high-performing and integrated healthcare system for the 21st century and provide Veterans with more Choice in their healthcare options, whether from VA doctors or from the community.”

Issues about funding some of the law’s provisions remained unsettled at press time, however, with the White House at odds with Congress.

The bill also was supported by several veterans’ service organizations (VSOs). American Legion National Commander Denise H. Rohan said after the bill passed that his organization “together with our partners and allies in the veteran advocacy space, have worked tirelessly with the House and Senate to secure the passage of the VA MISSION Act of 2018.”

In addition, a letter of support signed by 38 VSO’s said that the legislation takes “a major step toward that goal by making improvements to and investments in the VA health care system, creating integrated networks so that veterans have access to care when and where they need it, and providing the further recognition and assistance to family caregivers of severely disabled veterans deserve.”

Community Care

VA’s quality of care in outpatient and inpatient settings was assessed using widely recognized performance measures reported across several national surveys during 2013 and 2014. Among the information analyzed were the Healthcare Effectiveness Data and Information Set and the Survey of Healthcare Experiences of Veterans.

Specifically, the law would require access to community care under the following circumstances:

  • if VA does not offer the care or services the veteran requires,
  • VA does not operate a full-service medical facility in the state where a veteran resides,
  • the veteran was eligible for care in the community under the 40-mile rule in the Veterans Choice Program,
  • VA is not able to furnish care within the designated access standards established by VA,
  • or a veteran and the veteran’s clinician agree that community care would be in the best medical interest of the veteran after considering certain criteria.

When it comes to expanding caregiver benefits for pre-9/11 veterans, the law requires only that veterans be unable to perform one activity of daily living, rather than three or more activities which was what Roe originally had proposed.

An infrastructure review called for in the law was advocated for by previous VA secretaries but has proven to be controversial since it might mean the closure of some underused facilities.

Under the law, the timeline for the review would not be immediate. The President would be required to transmit nominations for the commission to the Senate by May 31, 2021.

The law would require VA to assess its infrastructure using criteria that has been published in the Federal Register for public comment. The commission would meet to consider VA’s infrastructure recommendations and hold public hearings on them. The commission then would be required to make recommendations to the president no later than January of 2023.

Controversy Over Bill

The bill faced some opposition before its passage by Congress.

For example, House Committee on Veterans’ Affairs Ranking Member Rep. Tim Walz (D-MN) said the bill “lacks a sustainable source of funding to ensure that care is provided and protected in the long term.” He was one of 70 Democrats who voted against the bill when it was voted for in the House.

The American Federation of Government Employees (AFGE) said it also did not support the legislation.

“We are gravely concerned about the passage of the VA MISSION Act due to the creation a corporate-style, private board that will make decisions about how and when they’d like to dismantle any VA facility in the country,” AFGE National President J. David Cox Sr. declared in a statement.

He added that “by voting to pass S. 2372, Congress is punting on their responsibility to care for the men and women who have served our country and are taking an extremely dangerous step toward privatization.”

Cox had said earlier that the “BRAC-style process should have no place in veterans’ health care.”

“Once a VA medical center or clinic is dismantled through the Commission process, veterans who have lost that vital and preferred source of care will have only one “choice” and that is privatized, fragmented care that is both costly and unaccountable,” he said.