The Choice Program was due to expire this summer, but Congress passed, and President Trump signed, legislation to extend the program at least until its funding ran out. The VA now says it needs a new bill to keep the program running, but lawmakers in the Senate want to use the impending deadline to write a law that would revise Choice and give veterans much more flexibility to seek private care outside the VA health system. There’s even talk that Republicans would tie legislation expanding private health-care options for veterans to an increase in the debt ceiling, hoping that linking a popular measure to an unpopular one would solve two problems at once.

Veterans affairs has long been a bipartisan issue on Capitol Hill, and the $16 billion legislation lawmakers passed responding to the 2014 crisis and making it easier for the government to fire or punish senior executives was one of the few collaborative efforts to succeed in the final years of the Obama administration. Even now, despite concerns on the left about the direction Republicans are going, the debate over the future of veterans health is far more civil than the rancorous fight over civilian health-care and the GOP’s proposed replacement for the Affordable Care Act. The parties share some common ground: Liberal Democrats acknowledge the need for veterans to have access to private care in some circumstances, and Republican leaders insist they remain committed to a “robust” Veterans Health Administration.

Yet the specter of privatization has hovered over the debate in ways that echo long-running arguments over public education, where Democrats have opposed GOP efforts to enact voucher programs—and to a lesser extent, expand charter schools—on the grounds that they would divert funding and institutional support for traditional public schools. “If there’s some veteran in South Dakota, or Vermont who lives a zillion miles away from a VA hospital, should that person be able to get their health care across the street in their community? Who would argue against that?” Senator Bernie Sanders of Vermont said last week at a hearing to consider a range of veterans-affairs legislation, including a Republican proposal to expand the Choice Program.

“But here is the problem: While we want to give veterans choice, we do not want to do it in a way which dismantles the VA,” Sanders continued. “We want to strengthen the VA. What we don’t want to do is dismantle the VA piece by piece and put that money into the Choice Program.”

As Sanders has pointed out, the GOP proposals to direct more money to private care come at a time when the VA has some 45,000 vacancies. Under its new secretary, David Shulkin, the department has also begun publishing, under a new office dedicated to accountability and the protection of whistleblowers, a list of employees it has either removed or suspended for violations. The first report, posted last week and covering the first six months of the year, ran 27 single-spaced pages.