Congress Grills Head of V.A. Over New Health Care Law

WASHINGTON – Foreshadowing a likely partisan battle next year, Robert L. Wilkie, the secretary of Veterans Affairs, faced sharp questioning from Democrats on Wednesday over how the department will carry out a new expansion of private-sector medical care for veterans.

Lawmakers attending a joint House-Senate hearing scrutinized evolving standards at the V.A. that dictate how and when veterans can get care outside of the system’s 1,300 government hospitals and clinics. The Trump administration is expected to better define the standards next year, but some at the hearing were not satisfied.

Senator Jon Tester of Montana, the ranking Democrat on the Senate veterans committee, complained that Congress had been “left trying to figure out why the V.A. is taking things in a different direction than what Congress intended.”

The criticism was notable since Mr. Wilkie has largely faced a friendly audience from both Republicans and Democrats since taking the helm of the department in July.

Currently, veterans facing a wait of at least 30 days or who required travel of 40 miles to receive treatment may seek private care funded by the government. The new law, known as the Mission Act, will change those standards.

But exactly how – which is at the heart of putting the new law into effect – remains unclear.

Many Democrats and some veterans’ service organizations have worried that the new criteria – known as access standards – could allow more costly private care to slowly replace many V.A. services, draining the rest of the department’s budget.

“We passed it with the best of intention,” Mr. Tester said of the Mission Act. “But it could be a train wreck, too.”

If that came to pass,” Mr. Tester warned Mr. Wilkie, “It’s in your lap.”

The Department of Veterans Affairs – which for years has been the subject of intense legislative scrutiny – came under new criticism this month after conceding it had failed to make housing and tuition payments under the G.I. Bill.

A Government Accountability Office report released this week revealed that suicide prevention efforts by the department fell sharply over the last two years in spite of President Trump’s promise early in his administration to stem the high rate of suicide among veterans.

The department failed to spend most of $6.2 million earmarked for suicide prevention outreach in 2018, something V.A. officials have blamed on leadership vacancies. At least one group, Vietnam Veterans of America, has asked for a congressional hearing on the matter. Committee members grilled Mr. Wilkie about these issues as well.

“I remain concerned with the department’s lack of transparency,” said Representative Mark Takano, Democrat of California and the incoming chairman of the House Veterans Affairs Committee. He called the “lack of leadership” noted in the G.A.O. report “shameful.”

Mr. Wilkie repeatedly demurred on the specifics of the standards for the new law, saying he needed to brief Mr. Trump on his proposals first. “If the veteran is not at the center of the standards, it won’t work,” he said.

Republicans also offered some scrutiny of the program’s budgets and priorities. Senator John Boozman, Republican of Arkansas, pressed Mr. Wilkie for better fiscal data and suggested that his staff sometimes had come to Capitol Hill “without their act together.”

But most Republicans praised Mr. Wilkie’s leadership. “I want to tell you how much I appreciate the good job you’ve done,” said Senator Johnny Isakson, Republican of Georgia and chairman of the Senate committee.

Some defended the Mission Act’s early start. “It’s not perfect,” said Representative Phil Roe, Republican of Tennessee and the outgoing chairman of the House panel. But, he added, “It did allow for the undeniable expansion of care.”

Mr. Wilkie officially took leadership of the V.A. after a tumultuous time for the department’s leadership. The president fired his first secretary, David J. Shulkin, the only holdover from the Obama administration to serve in Mr. Trump’s cabinet, after Mr. Shulkin battled with the department’s other political appointees. Mr. Shulkin’s status was further damaged by a report criticizing his travel spending.

On Wednesday, Mr. Wilkie carefully defended the department and its goals, repeatedly praising the V.A.’s work force as the “finest” in government and repeating his commitment to V.A. programs. He added that he did not believe the V.A. would be privatized, as many Democrats fear is the ultimate plan.

“My experience is veterans are happy with the service they get at the Department of Veterans Affairs,” he said. Veterans are not “chomping at the bit” to get services elsewhere, he added. “They want to go places where people speak the language and understand the culture.”