- The Washington Times - Tuesday, June 17, 2014

Designees from the House and Senate will begin this week to hammer out differences between the House and Senate legislation to let veterans get health care outside the Department of Veterans Affairs, including looking for ways to cover the cost.

Sen. Bernard Sanders, Vermont independent, said Tuesday that conferees will be selected from both the House and Senate on Wednesday.

Both chambers passed legislation last week that would let veterans see doctors outside Veterans Affairs facilities if they faced long waits or lived more than 40 miles from a facility. The Senate bill, however, is more broad, including G.I. bill and sexual assault reforms, and conferees will need to work out differences between the two bills.

“I am very confident that working with Chairman [Jeff] Miller and Ranking Member [Michael] Michaud, we can bridge the differences and send the president a bill he can sign in the near future,” Mr. Sanders said Tuesday on the Senate floor. “We don’t want this to drag on and on and on. We want to get this bill done quickly.”

One of the largest points of contention will likely be the cost. Many argue that fixing the embattled VA is an emergency and should be paid for with emergency funds, but some lawmakers say Congress will need to find the money somewhere during negotiations on the final bill.

While the bills do very much the same thing in letting veterans see outside doctors under certain situations, that portion of the Senate bill will cost at least $35 billion while the House bill will cost just $620 million, according to Congressional Budget Office estimates.

That’s because the Senate bill appropriates funds for the program to give vets a choice of doctor, while the House bill creates the program but does not appropriate any money, according to a spokeswoman for Sen. Tom Coburn, Oklahoma Republican.

“Under the Senate bill, the VA can spend what it needs to run the program,” Elaine Joseph said. “In the House bill, Congress would have to later appropriate money for the program.”

A CBO estimate released Wednesday found that the House bill would increase spending by at least $44 billion a year, “assuming appropriation of the necessary amounts.”

Mr. Sanders argued on the floor that the crisis at the VA is an emergency, with more than 57,000 veterans waiting more than 90 days for an initial appointment, and doesn’t need to be offset.

“This is an emergency,” he said. “Veterans in this country must get the quality health care they need and they must get it in a timely manner. And we must provide the funding the VA needs and do it in an expeditious way.”

All members of his party, however, aren’t behind him. Minority Whip Steny Hoyer, Maryland Democrat, told reporters Tuesday morning that just because the actions at the VA were intolerable doesn’t give Congress permission to ignore the budget.

“Clearly systemic reform and efficiency and effectives of operation is absolutely essential. What happened in the VA and the impact its had on our veterans was unacceptable,” Mr. Hoyer said. “But that does not mean we need to not have any considers for fiscal responsibility and sustainability over time.”

There are several other differences between the bills. In the House bill, veterans would be able to see outside doctors if they had to wait longer than two weeks for an appointment. The Senate bill allowed the VA to set its own wait time limit, and for the purpose of the estimate, the CBO used a 30 day wait. The House cost estimate also allows the VA to pay private doctors directly at the Medicare rate, which would likely be cheaper than having to negotiate contracts, which is required in the Senate bill, according to the CBO.

As a result of a shorter wait time and an easier payment system, CBO predicts that the House bill would allow for the system to be implemented faster and would draw more veterans to enroll in care at the VA, thus raising the cost.

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