Last Wednesday, Donald Trump gathered lawmakers, veterans’ advocates, and journalists in the White House Rose Garden to bask in an elusive political victory with the signing of the VA Mission Act.
The law was forged with bipartisan input and was backed by 38 veterans service organizations. It also received overwhelming Democratic support. Only two of the 42 members of the House and Senate Veterans Affairs Committee opposed the bill when it came up for a vote. Those lawmakers—Rep. Tim Walz and Sen. Bernie Sanders—still applauded many of the law’s statutes, from its expansion of the VA caregiver program for post 9/11 veterans to the raising of limits on a debt reduction program aimed at attracting doctors to the agency.
These lawmakers expressed concerned that the law will make permanent the privatizing principles set forth in the 2014 VA Choice Act, an emergency measure passed to ensure timely care for veterans following a wait time scandal at a hospital in Phoenix. The Choice Act has caused even longer wait times for veterans and has diverted funds from the Veterans Health Administration (VHA) budget that could have been used to remediate the agency’s long-standing capacity problems—the agency is currently operating with over 36,000 vacancies.
“This bill provides $5 billion for the Choice program,” Sen. Sanders said in a statement announcing his opposition. “It provides nothing to fill the vacancies at the VA. That is wrong. My fear is that this bill will open the door to the draining, year after year, of much needed resources from the VA.”
The Trump administration was closely involved in shaping the bill and getting it passed, and the president signed the bill on the 74th anniversary of D-Day while casting it as a fulfillment of the nation’s moral obligation to those who have served.
Yet, behind Trump’s pledged commitment to those who have served is a White House working to undermine care for veterans. Lawmakers and veterans advocates accustomed to more constructive policymaking have been caught on their heels by a series of frenzied Trumpian maneuvers.
After Trump signed the VA Mission Act into law, it entered the guardianship of the executive branch. Immediately, the White House began backtracking on some of the law’s requirements, and now advocates are worried that key statues could be misinterpreted or implemented so to further the conservative fever dream in which the only choice left for veterans seeking health care is the private sector.
Meanwhile, the Trump administration has been working behind the scenes to scuttle bipartisan efforts to fund the Mission Act’s expansive new programs—which Trump claims to support. A White House memo circulated in Congress during the drafting process asserted that Trump would not support the expansion of one key program “without further engagement with Congress on fiscal constraints.” It went on to say that new spending on private care should be offset by other agency cuts.
Calls for fiscal conservatism have taken a harder edge in recent days. Hours before Trump signed the VA Mission Act, the Washington Post reported that the White House was opposing efforts to raise spending caps on the VA budget to pay for the law’s new programs, claiming that the money can be found in current agency allocations.
The VA Mission Act will expand caregiver benefits to thousands of new families and result in more than 600,000 additional veterans seeking care in the first few years after its passage—policymakers estimate that if new money isn’t allocated for these programs, more than $50 billion could be plundered from other VA programs over the next five years. (This is not the first time the Trump administration has worked to ransack the VA budget: last Winter, former VA Secretary David Shulkin attempted to shift a half-billion dollars in VA money earmarked to help homeless veterans into the agency’s Choice account, which funds private sector appointments.)
Republican and Democratic leaders on the Senate Appropriations Committee are still hopeful a bipartisan effort can move forward to allocate the required money for the VA Mission Act, though there’s talk that House Speaker Paul Ryan and his nest of fiscal hawk acolytes may still squawk over the new money.
“The law has to be properly funded,” said Rick Weidman, executive director of policy and government affairs of the group Vietnam Veterans for America. “If it is not, the only way to pay for the huge cost of privatization will be to make a lot of people who depend on VA care ineligible by retracting eligibility for care only to combat veterans who have service related conditions.”
Hours after the bill was signed, the White House announced it would ignore some of the law’s oversight statutes, including one that granted congressional input over future pilot programs with private partners. The White House also nixed a statute requiring input from Congress and veterans’ organizations for a newly-established commission tasked with recommending the future infrastructure requirements of the agency. The makeup of the commission is hugely important, since the commission’s recommendations, if approved by the president, would be directly implemented by the VA secretary without congressional approval. The recommendations could include a variety of directives, from the hiring of new personnel to the shuttering of VA hospitals and the implementation of new private contracts.
Three congressionally chartered veterans service organizations were promised seats on the commission, and some advocates said they had received assurances from the administration that the Mission Act would not be implemented to hasten privatization. There are various safeguards in the law aimed at blocking an unfettered increase in private care, including requirements that private providers record and supply access data to the VA so veterans can be well informed over whether private care would be worth it. As a recent report from the Government Accountability Office found, wait times for private care obtained through the Choice Act could take twice as long as promised.
Despite language in the law preserving the role of the VA as the protector of veterans’ care, the Trump administration still holds tremendous sway over when veterans should make the jump into the private sector, since it will interpret and implement the law’s eligibility provisions for private care.
The White House staffers who worked closely to shape the Mission Act’s language will now have a say in the rulemaking process, including two with close ties to the Koch brothers: Trump’s legislative director Marc Short and former VA adviser Darin Selnick, who recently left the administration to rejoin his old employer, the Koch-funded, pro-privatization Concerned Veterans for America.
“There’s a lot of autonomy held by the VA and the administration to implement these programs, and there are a lot of wrong turns that could take place,” said Matthew Shuman, legislative director of the group American Legion. “But the Legion is two blocks from the VA office, and our technical experts will be meeting with officials throughout the rule making process. We will be vigilant.”
The open question is how much sway veterans service organizations will now have on Trump, who has repeatedly refused to heed their advice. Trump has frozen veterans advocates out of meetings, ignored their pleas to keep former VA Secretary David Shulkin in his job, and has paid no mind to their VA budget recommendations. As the VA Mission Act is implemented, vigilance from top veterans advocates will be essential. But it may mean little to a president who often deviates from his marching orders.
