President Donald Trump signed a bill into law Wednesday that will give veterans more freedom to see doctors outside the troubled Veterans Affairs system, a major shift aimed at reducing wait times and improving care by steering more patients to the private sector.
At a Rose Garden event at the White House, Trump praised the legislation as fulfilling his pledge to fix the Department of Veterans Affairs by bringing accountability and providing private care to veterans whenever they feel unhappy with government-run healthcare.
"All during the campaign I'd go out and say, 'Why can't they just go see a doctor instead of standing in line for weeks and weeks and weeks?'" Trump said. "Now they can go see a doctor."
The sweeping $51 billion plan, which would also expand a VA caregivers program to cover families of veterans of all eras, cleared the Senate on a 92-5 vote last month.
The House approved it on a 347-70 vote.
The legislation will give veterans access to private care when they have endured lengthy wait times or the treatment was not what they had expected.
But it could escalate costs, and some lawmakers warn this could put the VA at risk of budget shortfalls next year.
A bipartisan group of senators is seeking to pay for the law by adding new funds to cover the VA private care program, but the White House has been quietly working to block that plan, saying it is "anathema to responsible spending."
Warning of "virtually unlimited increases" in veterans care spending, the Trump administration argued in a memo circulated to lawmakers that added costs to the newly expanded private care program should be paid for by cutting spending elsewhere at VA.
"Without subjecting the program to any budgetary constraint, there is no incentive to continue to serve veterans with innovative, streamlined, and efficient quality of care," according to the memo obtained by The Associated Press.
Major veterans groups have cautioned against "cannibalizing" VA programs to pay for Choice, saying more funding is needed.
"We do our veterans no favors by promising care without backing it up with resources," said Vermont Sen. Patrick Leahy, the top Democrat on the Senate Appropriations Committee.
He warned that failing to provide new funding "would jeopardize the health care and well-being of our veterans."
The VA secretary will have wide leeway in implementing the legislation based in part on available money. Trump is nominating acting VA secretary Robert Wilkie to permanently lead the government's second-largest department, which serves nine million veterans.
Democrats say they intend to question Wilkie at his confirmation hearing on whether he plans to "privatize" or degrade the VA health system, an issue former VA Secretary David Shulkin says led to his firing in March.
The legislation would create a presidentially appointed commission to review the closure of underperforming VA facilities.
House Democrats had sought restrictions on the commission but were rebuffed by House Republicans and the White House.
Democratic House Minority Leader Nancy Pelosi of California cautioned that the lack of new money for the legislation sets up "another VA crisis and billions in budget cuts to critical veteran initiatives down the road."
The measure builds on legislation passed in 2014 in response to a wait-time scandal at the Phoenix VA medical center, where some veterans died while waiting months for appointments.
The legislation would loosen Choice's restrictions that limit outside care to only when a veteran must wait 30 days for an appointment or drive more than 40 miles to a VA facility.
Currently, more than 30 percent of VA appointments are in the private sector.
Trump's action brought widespread praise from congressional Republicans and veterans groups.
"Those who have selflessly defended our nation will now have greater access to hospital care, life-saving medical services and extended care services, right in their own community," said Iowa Sen. Joni Ernst, who served in Kuwait during the Iraq War as part of the Army National Guard.
"As a veteran, and a proud American, I applaud this successful effort to ensure our veterans are receiving the care they have earned."
Arkansas Sen. Tom Cotton, who serves with Ernst on the Senate Armed Services Committee, said: "Veterans still face far too many obstacles when trying to get the care they need, and this bill will help remove a good number of them.
"Instead of forcing veterans to wait to see a doctor, we’ll expand their options so they can find one close to them.
"This is squarely in keeping with the mission of the VA, and I’m glad to see the president sign this important legislation," Cotton said.
Tennessee Rep. Phil Roe, chairman of the House Committee on Veterans' Affairs, said the bill was moving the agency "toward a veteran-centric healthcare system that marries the best of VA with the best of the private sector so veterans can finally have timely access to the quality care they have earned."
Keith Harman, national commander of Veterans of Foreign Wars, said "this historic legislation will help our veterans get the care they earned."
In addition, Arizona Sen. John McCain, a Navy veteran who is battling brain cancer, took to Twitter to support the new law:
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