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Military Update: Private care for veterans boosted by congressional compromise

By: tom philpott Military Update
July 30, 2017 Updated: July 31, 2017 at 8:24 am
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On Capitol Hill, seasoned lawmakers worked with veteran service organizations to forge an intricate compromise that will funnel $2.1 billion in emergency dollars into the Department of Veterans Affairs 'Choice' plan to ensure that vital community-based health care option keeps operating.

The same deal would extend some temporary special VA fees, which were set to expire in 2024, out to 2027. This is to free up budget dollars to strengthen the VA direct care system with faster hiring authorities and new building leases to bring VA health care nearer to patient populations.

As leaders of the House and Senate veterans' affairs committees finalize bipartisan negotiations, President Trump, a commander in chief criticized as having impulse control issues, tweeted a surprise ban on transgender personnel serving in the military "in any capacity."

The policy shift came in three tweets, a total of 60 words. Trump said he had consulted with "generals and military experts" and decided the armed forces "cannot be burdened with the tremendous medical costs and disruption that transgenders in the military would entail."

The announcement left the Department of Defense effectively speechless, referring media queries to the White House for details where Trump's spokesman had none. Defense Secretary James Mattis, vacationing in Washington state, seemingly was unarmed to explain through his staff what had just occurred or how it would impact thousands of transgender personnel already serving openly, including in theaters of war.

By day's end the clearest guidance came from a defense official, speaking on background, who said department policies on currently serving transgender personnel would remain in effect, for now.

"A tweet is not policy," this official explained. "I know that's the culture we've moved into. But we still have to go by a formal (procedure) to make any changes." Here are more details on both developments:

Meanwhile, lawmakers forged ahead on a program to provide more privatized care to veterans.

In June VA Secretary David Shulkin warned Congress that Choice, an increasingly popular option for veterans to access community-based medical care, would run out of money by September.

In mid-July Rep. Phil Roe, R-Tenn., chairman of the House Veterans Affairs Committee, thought he had a plan ready to fund Choice for six months, time enough to review a new VA initiative to reform Choice that VA promises to have ready by October. Shulkin said that plan will make Choice the centerpiece of all VA community-based care and put VA providers back in charge of private sector referrals, based on individual patient needs.

Congress established Choice in 2014 as a temporary response to a department-wide patient wait list scandal. It created a $10 billion fund of emergency dollars to pay for it, rather shifting around money inside VA.

Roe's proposal last week to extend Choice didn't get the support he anticipated because it didn't rely again on emergency budgeting authority. Roe proposed instead creating funding offsets inside future VA budgets, by delaying for three years, from 2024 to 2027, scheduled expirations of special fees that Congress had imposed on VA-guaranteed home loans and pension cuts it had made to Medicaid-eligible veterans in nursing care facilities.

Veteran groups succeeded in blocking Roe's plan on the House floor. Roe and Sen. Johnny Isakson, R-Ga., chairman of the Senate Veterans Affairs Committee, began to work immediately with their committees' ranking Democrats, Sen. Jon Tester of Montana and Rep. Tim Walz of Minnesota, on a new deal. This one would keep Choice running into next year with $2.1 billion in emergency funding, and use benefit offsets Roe had eyed for Choice to expand patient capacity in the VA direct care system. It would do so through new building leases and a host of other initiatives.

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Send comments to Military Update, P.O. Box 231111, Centreville, VA, 20120, email milupdate@aol.com or twitter: Tom Philpott @Military_Update

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