President Donald Trump's signature policy for veterans -- shifting much of their health care from the government-run system to private doctors and hospitals -- is under attack from newly empowered Democrats and their allies on Capitol Hill.
Veterans Affairs Secretary Robert Wilkie is moving quickly to roll out new rules by June that would expand access to private care, especially for veterans in rural and congested areas, if they have a 30-minute drive to receive primary care.
Within two years, as many as half the seven million veterans now seen at VA could receive their care elsewhere, advocates of the change say. Trump's proposed budget, released last week, includes up to $3.2 billion in new spending next year for private-sector visits, including to walk-in clinics.
VA, with 1,200 hospitals and clinics, is the country's largest health-care system. For conservatives who failed to repeal the Affordable Care Act, rerouting veterans' care to the private sector is the next front in the battle over U.S. health policy. For Trump, giving veterans more choices will probably be a reelection theme next year as he seeks shorter waits and potentially better care for veterans, a crucial constituency.
But Democrats now in charge in the House are resisting. They say proposed rules on when veterans could go outside VA are too lenient and would damage the government system -- a long-held fear of Democrats who worry union jobs will be siphoned and the government system dismantled.
While not directly opposing a veteran's right to see a private doctor, opponents are undermining the new policy in a series of hearings, statements and letters and preparing for aggressive oversight as VA rolls out rules to put in place legislation Congress passed last year.
Democrats and some veterans groups have accused Wilkie of leaving them out of planning. "They profess to be against privatization," said Rep. Mark Takano, D-Calif., who ascended to chairman of the House Veterans' Affairs Committee in January, "but by default, we will see privatization happen under our very noses."
The VA Mission Act's bipartisan passage was a victory for the president, who vowed to revamp veterans' access to a health-care system beset by poor access after a 2014 scandal.
The law boosted a group backed by billionaire industrialist Charles Koch that has shaped Trump's veterans policy. Concerned Veterans for America has quickly mobilized against the law's critics, launching a paid lobbying campaign this month to defend it.
Meanwhile, the American Federation of Government Employees -- the largest federal employee union -- is mobilizing its 230,000 VA members to pressure Wilkie to fill some 42,700 health-care vacancies, criticizing him for giving short-shrift to hiring.
VA officials note that the law passed Congress with overwhelming support -- and authorizes the secretary to set the rules. They dismiss Democrats' privatization claims and say they do not envision a massive exodus to the private sector beyond the 34 percent of appointments now there.
"VA has more employees than ever before, its budget is bigger than ever before and the department is completing more internal medical appointments than ever before," spokesman Curt Cashour said in an email.
But Wilkie has told VA employees and lawmakers the Mission Act will "fundamentally transform VA health care," calling it the biggest change since World War II. A senior VA official and an advocate with knowledge of the planning process estimate a dramatic increase in the use of private doctors.
This article was written by Lisa Rein, a reporter for The Washington Post.