WASHINGTON - United in response to a national uproar, Congress is suddenly moving quickly to address military veterans' long waits for care at VA hospitals.
The House unanimously approved legislation Tuesday to make it easier for patients enduring lengthy delays for initial visits to get VA-paid treatment from local doctors instead. The Senate was poised to vote on a similar bill within 48 hours, said Democratic leader Harry Reid.
The legislation comes close on the heels of a Veterans Affairs Department audit showing that more than 57,000 new applicants for care have had to wait at least three months for initial appointments and an additional 64,000 newly enrolled vets who requested appointments never got them.
"I cannot state it strongly enough -- this is a national disgrace," said Veterans Affairs Committee Chairman Jeff Miller, R-Fla., chief author of the House legislation.
Miller made his comments minutes before the House completed the first of two votes on its measure. Lawmakers approved the bill 421-0, then re-voted a little over an hour later, making sure no one was left out on the politically important vote, with five more in favor and no one against. Miller sheepishly admitted the reason for the second vote: He was in his office and missed the first tally.
Rep. Mike Michaud of Maine, top Democrat on the Veteran Affairs Committee, said the care that veterans receive at VA facilities is "second to none -- that is, if you can get in. As we have recently learned, tens of thousands of veterans are not getting in."
The House bill and a similar version in the Senate would spend hundreds of millions of dollars to hire more doctors and nurses, but that may be easier said than done given a nationwide shortage of primary care physicians.
"This is not a problem that is just isolated to the VA," said Rep. Dina Titus, D-Nev. "It's out there in the community."
Primary care physicians are expected to become increasingly in demand as millions of people newly insured under the federal health care law start looking for regular doctors. The Association of American Medical Colleges has projected that by 2020, there will be 45,000 too few primary care physicians, as well as a shortage of 46,000 surgeons and specialists.
Shortages tend to be worse in both rural and inner-city areas.
Nevada already has a chronic shortage of doctors, both in primary care and among specialists, Titus said. The state ranks 46th among states and the District of Columbia for availability of general and family practitioners, she said, and 51st for surgeons.
While she voted for the bill, Titus said Congress and the Obama administration need to do more to ensure that veterans receive care in the private sector.
The American Medical Association added its voice, in Chicago, as the House was voting. At its annual policy meeting, the AMA approved a resolution urging President Barack Obama to take immediate action to enable veterans to get timely access to care from outside the VA system. The nation's largest doctors group also recommended that state medical societies create and make available registries of outside physicians willing to treat vets.
"Clearly there is a problem," said Dr. Robert Wah, the AMA's incoming president. He didn't say how Obama should ensure vets get access to non-VA doctors but said the president needed to address the issue immediately.
Sen. John McCain, R-Ariz., a chief author of the Senate measure, said he believed the Senate would approve the bill in the next day or two, adding that it shouldn't be hard for the two chambers to craft a compromise version.
"I don't think there's a lot of major differences," McCain said.
Sen. Bernie Sanders, I-Vt., chairman of that chamber's Veterans Affairs Committee, said that by Senate standards, lawmakers are moving at "lightning speed."
The Senate bill would authorize the VA to lease 26 new health facilities in 17 states and Puerto Rico and spend $500 million to hire more doctors and nurses. The House bill does not include a specific dollar amount, but Miller said the VA would save $400 million annually by eliminating bonuses, money the agency could use for expanded care.
The House bill would let veterans facing long delays for appointments or living more than 40 miles from a VA facility choose to get care from non-agency providers for the next two years. Some veterans already get outside care, but the process is cumbersome and riddled with delays, veterans and their advocates say.
The bill would ban bonuses for all VA employees through 2016 and require an independent audit of agency health care. An earlier House-passed bill would make it easier to fire top VA officials.
The VA, which serves almost 9 million veterans, has been reeling from mounting evidence that workers fabricated statistics on patients' waits for medical appointments in an effort to mask frequent, long delays.
The controversy led Eric Shinseki to resign as head of the VA on May 30, but the situation remains a continuing embarrassment for Obama and a potential political liability for congressional Democrats seeking re-election in November.
The agency has started removing top officials at its medical facility in Phoenix, a focal point of the department's problems, and investigators have found indications of long waits and falsified records of patients' appointments at many other facilities.
Richard Griffin, acting VA inspector general, told lawmakers his investigators were probing for wrongdoing at 69 agency medical facilities, up from 42 two weeks ago. He said he has discussed evidence of manipulated data with the Justice Department, which he said was still considering whether crimes occurred.
"Once somebody loses his job or gets criminally charged, it will no longer be a game, and that will be the shot heard around the system," Griffin said.