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Congress Reaches Deal to Avert Shutdown of Veterans’ Health Choice Program

The Department of Veterans Affairs building in Washington. Congress agreed to a deal that would save the department’s program that pays for private doctor visits for veterans.Credit...Charles Dharapak/Associated Press

WASHINGTON — Lawmakers reached a deal late Thursday to stave off a painful shutdown of the multibillion-dollar Choice Program of the Department of Veterans Affairs. But the dayslong standoff over how to do so exposed fissures that could hinder efforts to craft a permanent solution.

The program, which pays for veterans to see a private doctor if they are facing long waits or travel times, was set to run out of money by mid-August, earlier than lawmakers initially expected. Now, after several days of tense negotiations, the House and Senate are both expected to pass bipartisan legislation that would infuse $2.1 billion in new funding for Choice over six months, as well as more than $1.4 billion hiring, work force improvements and the authorization of 28 leases that increase the department’s internal capacity to deliver care.

The measure passed the House 414 to 0 on Friday, just as lawmakers were about to begin their summer recess. The Senate, which is in session for two more weeks, is expected to pass the measure in short order and send it to the president’s desk.

The agreement was seen as a victory for a group of influential veterans organizations that teamed up with Democrats to defeat an earlier plan, advanced by House Republicans, that they said advanced private care at the expense of the department’s in-house offerings. The groups — and Democrats — have generally advocated simultaneous investment in both the private care program and the department itself.

Still, the process of reaching a deal appears to have renewed alarm among the groups and Democratic lawmakers about creeping privatization. At the same time, it has left Republicans, particularly in the House, feeling as though the groups and their Democratic counterparts waited until the last minute to raise concerns. Neither bodes well for a more ambitious effort, already underway, to rewrite the Choice program and half a dozen others that provide for care outside Veterans Affairs facilities.

Congress created the Choice program in response to a 2014 scandal over the manipulation of patient wait times at Veterans Affairs Department facilities. It was intended to temporarily relieve pressure on those facilities as the department retooled. Now, most lawmakers agree that though the program needs significant repair work, it should become permanent in some form.

The program has ballooned in size, driving up costs and leading to the unexpected shortage of funds. The department has already authorized more than 18 million appointments with private doctors this year, an increase of 26 percent over the same time last year. If the program were to languish for lack of funds, those patients would lose access to government-funded private care, putting a pinch of departmental resources that would, in turn, increase patient wait times, the department has said.

The deal to avert that came together in recent days, even as the Senate remained deeply divided in debate over a repeal of the Affordable Care Act and House lawmakers contended with a failed vote over a narrower Choice bill. Senator Johnny Isakson, Republican of Georgia and the Veterans Affairs Committee chairman, and the committee’s top-ranking Democrat, Jon Tester of Montana, led the negotiations with their House counterparts, Phil Roe, Republican of Tennessee, and Tim Walz, Democrat of Minnesota.

At times, it looked as if agreement may prove elusive, as lawmakers haggled over how much to spend, where to spend and how to pay for it. Making matters more difficult, the department’s secretary, David Shulkin, prematurely put out a statement on Wednesday afternoon praising the effort as if it was complete, even as negotiations were ongoing

Mr. Isakson met with representatives of several of the veterans groups opposing the earlier House plan on Tuesday to ensure that they would get behind the new measure.

The veterans groups — including Disabled American Veterans, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Vietnam Veterans of America — had sent a letter to lawmakers on Saturday objecting to the House bill’s terms and spent the weekend lobbying congressional staff members to change it.

“If new funding is directed only or primarily to private sector ‘choice’ care without any adequate investment to modernize V.A.,” the groups wrote, “the viability of the entire system will soon be in danger.”

The groups have traditionally had considerable influence on Capitol Hill.

Not all veterans groups share that concern, but fears of the balance of care being tipped in favor of the private sector — either inadvertently or intentionally — are likely to also help animate the debate over the program’s future, analysts who have followed the efforts said.

“At their core, I think veterans organizations are happy to go on with V.A. Choice as long as it is additive,” said Phillip Carter, who studies veterans issues at the Center for a New American Security. “But the minute they sense it will take away from legacy V.A. programs they will oppose it to the death.”

Republicans on Capitol Hill and leaders at the Veterans Affairs Department insist they are not interested in doing so and have tried to lay the issue to rest. Mr. Shulkin, argued against the idea in an op-ed on Monday in USA Today, in which he detailed increases to in-house, as well as private care in recent years. But congressional Republicans have also expressed skepticism about rising costs and, in particular, the need for allocating new money for department administered care.

President Trump, for his part, did not help alleviate those concerns on Tuesday when he told a gathering of veterans in Ohio that his administration planned to push to triple the number of veterans authorized to seek care from private doctors at government expense in short order.

“We have nearly doubled the number of veterans given approvals to see the doctor of their choice,” Mr. Trump said, without offering a timeline for the change he was talking about. “So, not only is it choice, but we’ve doubled up. And now we’re going to be tripling up very shortly.”

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A version of this article appears in print on  , Section A, Page 13 of the New York edition with the headline: Vote Preserves Veterans’ Program, for Now. Order Reprints | Today’s Paper | Subscribe

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