After a weekend of talks, House and Senate negotiators say they have reached a deal to help the troubled Department of Veterans Affairs address extensive wait times at VA medical centers, one of the root causes of the agency’s recent scheduling scandal.

Lawmakers now have about five working days to recommend changes and vote on the agreement before Congress begins its August recess. Sen. Bernie Sanders (I-Vt.) and Rep. Jeff Miller (R-Fla.), who lead the Senate and House veterans affairs committees, respectively, will try to round up support for sending the measure to President Obama before then.

In June, Sanders and Miller issued competing legislation aimed at improving VA wait times, but they eventually scaled back those plans to make them less expensive. Let’s look at what the recent proposals entail — including what we know about the upcoming deal — and examine how the costs have shrunk. (Or simply scroll down to read details of the new deal.)



Senate Veterans’ Affairs Committee Chairman Bernie Sanders (I-Vt.), right, meets with Robert McDonald, President Obama’s nominee for Secretary of Veterans Affairs, on Capitol Hill on July 8. (Alex Wong/Getty Images)

Cost concerns



Republicans have expressed the most concern about potentially drastic increases in VA spending and adding more patients to a system that already appears to be overwhelmed.

The Senate in February rejected a broad VA bill that would have expanded veterans’ benefits and repealed a military pension cut for new troops. The measure did not win enough GOP votes to waive a limit on VA spending established under the budget Congress and President Obama approved in December.

Despite the push-back from Republicans, Sanders has suggested that giving veterans the care they earned takes precedence over costs to the government. He said repeatedly in recent months that lawmakers should not send troops to war unless they are prepared to pay for their treatment and benefits when they return.

The old plans

The nonpartisan Congressional Budget Office compared the proposals from Sanders and Miller in a report last month, estimating that the Sanders plan would cost $35 billion through 2024, while Miller’s version would cost more, $44 billion through 2019.

Both of the proposals would provide the VA with greater authority to treat veterans with help from non-VA health-care providers and require the VA to ensure that all eligible veterans receive care in a timely fashion.



House Veterans’ Affairs Committee Chairman Jeff Miller (R-Fla.) speaks to members of the media after a conference committee meeting of the VA reform bill. (Alex Wong/Getty Images)

The Senate plan would have required treatment within 30 days, while the House proposal set a limit of 14 days. The CBO said the shorter wait time in the House measure would make care more accessible to veterans, increasing the number of new enrollees and, therefore, entailing greater costs.

Among other differences, the Senate bill would have required the VA to arrange contracts with non-VA providers, while the House bill would have reimbursed providers at the greater of the Medicare rate, the Tricare rate, or a rate established by the VA. The CBO said the Senate plan would cost more, since contract rates would likely be higher than Medicare and Tricare.

The Senate plan also would have lasted for an extra two months, until the end of September 2016, increasing the cost of the measure by 10 percent compared to the House version.

The new deal

Sanders last week proposed “compromise legislation” that he said would entail a price tag of $25 billion. On Friday, Miller offered $10 billion in emergency funding, saying Congress should go through the normal appropriations process to provide any additional money.

The lawmakers reportedly found middle ground after negotiating through the weekend. The costs of the deal are not yet known, but a House aide said the agreement more closely aligns with the original Senate proposal, according to a Washington Post report.

A draft summary of the legislation shows that the measure would provide a “Veterans Choice Card” that allows veterans to seek care from non-VA clinics, including Medicare-eligible providers and facilities operated by the Defense Department or the federal Indian Health Service centers, according to the article.

Veterans would need to be enrolled for VA care by Aug. 1 or within five years of ending military service in Afghanistan and Iraq, according to the draft agreement. The government would pay for veterans to go outside the VA network if they’re unable to receive appointments within 14 days or if they live more than 40 miles from a VA medical center.

The legislation would prevent the VA from using scheduling and wait-time metrics as factors in determining performance. Instead, most performance reviews would focus on the quality of care received by veterans, the draft summary said. That provision comes in response to reports that workers falsified scheduling records to avoid exceeding wait-time targets.