Earlier this year, lawmakers feared they were heading toward an early deadline to pass a funding extension when it appeared that program money was dwindling. Now that isn’t the case, and House VA committee Chair Phil Roe (R-Tenn.) says the bill and the funding can wait until at least early 2018.
While he concedes that the VA needs “certainty and finality” of new legislation paired with appropriate funding, Roe says he wants to wait for the spending caps to lift before he tries to move the bill so he knows how much money he has to work with.
Roe and his committee passed one version of the Choice overhaul, with a price tag estimated at about $39 billion over five years by the Congressional Budget Office; the Senate Committee on Veterans’ Affairs passed another, which would cost about $54 billion over five years per CBO. The two bills, which a Senate committee aide calls “two entirely different policies” would have to be reconciled between the two chambers before a vote could happen.
The House bill would merge all the community provider programs into one and expand veterans’ access; both the House and Senate bill would make sure private providers get promptly reimbursed.
A senior GOP Senate aide said the legislation is on leadership’s to-do list for the end of the year, but didn’t have guidance on whether it would get slated for a floor vote among the myriad other must-pass bills that include a debt ceiling raise.
Roe is focused on the cost of the legislation. He says he thinks the CBO estimate of the House version — which is much lower than the Senate version — is too high based on the program’s actual monthly spending. He also has a vision for transforming the private sector’s role in the program into something resembling Medicare Advantage.
His health subcommittee chair, Rep. Brad Westrup (R-Ohio), said that while he isn’t advocating to privatize the VA’s healthcare, he wants long-term reforms to push more private care where it’s easier to track actual costs and savings.
The House and Senate bills do agree on the funding mechanism. Both would change the program’s appropriation from a mix of mandatory and discretionary to purely a discretionary appropriation. This could spell trouble down the road for continuity of care if it gets caught in congressional budget battles — something lawmakers say won’t happen because of the commitment to veterans — because Congress would have to agree to a spending deal every few years.
Both bills also address payment issues for the private providers who contract with the program.
Since Choice was enacted, community providers including hospitals have received late and deeply reduced payments as reimbursements were managed by third-party intermediaries, according to an American Hospital Association representative. Both versions of legislation put the payment responsibility directly in the hands of the VA secretary with a strict reimbursement schedule.
The third-party contractors often undercut provider reimbursements, the AHA representative said, since they get the difference between the final reimbursement and rate paid out by the VA.
More and more vets are opting for the VA Choice program: As this is likely to continue with expanded access, the reimbursement issue becomes more key, the official said.