Proposal to Expand Private Health Care for Veterans Advanced by House Panel

A bill aimed at giving veterans easier access to private doctors using Department of Veterans Affairs funding has advanced out of a key House panel after stark partisan debate.

Cost issues scuttled a couple of controversial provisions from the GOP-led bill advanced Wednesday compared to the version of the bill that was introduced earlier this year. But the legislation still stoked strong opposition from Democrats accusing Republicans of trying to privatize the VA as Republicans insisted they are trying to give veterans more options in their care.

"Veterans don't need their hands held," said House Veterans Affairs Committee Chairman Mike Bost, R-Ill., who sponsored the bill. "It's their health care."

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The bill, which Bost introduced in January with Senate Veterans Affairs Committee Chairman Jerry Moran, R-Kan., would solidify the VA's existing standards to qualify for community care, the name of the program that allows veterans to seek VA-funded care from private health care providers.

It would also make it easier for veterans to qualify for private care by saying that the availability of telehealth cannot be a factor in calculating wait times and by stipulating wait times cannot reset if the VA cancels an appointment or veterans do not show up to their appointment. And it would create a pilot program for veterans to get private outpatient care for mental health and substance abuse issues whenever they want.

The measure builds on a legislative achievement President Donald Trump frequently touts about his first term: the Mission Act, which overhauled how the department offers private-sector care to veterans.

While the Mission Act was bipartisan when it passed in 2018, it has since become a partisan lightning rod. Republicans accused the Biden administration of undermining the law and blocking eligible veterans from being able to access community care, while Democrats maintained that private care costs are growing unsustainably.

The community care budget has grown exponentially since the passage of the Mission Act and a predecessor law from 2014 called the Choice Act. In 2014, the Veterans Health Administration spent about $7.9 billion, or about 12% of its overall budget, on private care, compared to about $17.6 billion, or about 20% of the budget, in 2021, according to a Congressional Budget Office report from 2021. For 2026, congressional Republicans are on track to approve $34 billion for community care.

Under regulations issued after the Mission Act, veterans can go to private doctors if they face a wait time for VA doctors of more than 20 days for a primary or mental health care appointment or face a drive of 30 minutes or longer. For specialty care, the standards are a 60-minute drive or 28-day wait.

Those exact standards aren't a legal requirement. So Bost and Moran's bill, dubbed the Veterans' Assuring Critical Care Expansions to Support Servicemembers Act, or the ACCESS Act, would enshrine that criteria into law.

When it was first introduced in January, the ACCESS Act also included a requirement for the VA to take into account a veteran's preference for where they get treatment when making a referral to private health care. And it would have expanded eligibility for veterans to seek care at private residential mental health and substance abuse treatment facilities.

Both of those elements were taken out of the bill advanced by the House Veterans Affairs Committee on Wednesday. Republicans still support the ideas, but haven't found a way to pay for them yet, Bost said.

While Democrats on Wednesday recognized the removal of what they described as "harmful" sections of the bill, they took issue with other provisions they argued advance a GOP goal of privatizing the VA.

Specifically, Democrats targeted the language to disregard the availability of telehealth from eligibility for community care and the pilot program to expand access to private mental health care.

The three-year pilot program would allow veterans to get private outpatient mental health and substance abuse treatment without a referral or pre-authorization. The pilot would be available in at least five locations.

"Leaving veterans untethered in the community with no way for VA providers to know how a veteran is doing and whether they are continuing care or treatment is harmful to the veteran. Requiring referrals keeps that connection, that relationship, in place, and it can be live-saving," said Rep. Mark Takano, D-Calif., the ranking member of the committee. "This provision will also lead to a dramatic increase in spending on private-sector care, diminishing the availability of resources for investments in VA's direct care system."

At Wednesday's committee meeting, Republicans voted down several Democratic amendments, including ones to strike the pilot program and the language on telehealth.

The bill as a whole was approved by the committee in a 12-11 party line vote. The vote advanced the bill for consideration by the full House, which is leaving for a five-week summer break after Wednesday.

Related: GOP Chairmen Launch Effort to Expand Veterans' Access to Private Doctors