Public Law 114–187

Public Law 114–187 was enacted in October 2016 to amend prior Veterans' Access, Choice, and Accountability Act of 2014 provisions and to adjust Department of Veterans Affairs policy regarding access, accountability, and community care. The law was passed by the 114th United States Congress and signed into law by Barack Obama, reflecting responses to controversies involving VA medical centers, scrutiny from committees such as the House Committee on Veterans' Affairs and the Senate Committee on Veterans' Affairs, and recommendations from stakeholders including Veterans of Foreign Wars, American Legion, and the Disabled American Veterans.

Background and Legislative History

The legislative history traces to investigations of wait-time scandals at facilities such as the Phoenix VA Health Care System and to oversight by figures including Jason Chaffetz, Jeff Miller, and Richard Burr. Congressional hearings in the 113th United States Congress and 114th United States Congress involved testimonies from VA Secretaries including Eric Shinseki, Bob McDonald, and Robert A. McDonald, as well as inspectors general from the Department of Veterans Affairs Office of Inspector General and reports by the Government Accountability Office. Legislative action built on earlier statutes like the Veterans' Access, Choice, and Accountability Act of 2014 and on proposals by presidential candidates in the 2016 United States presidential election; the bill advanced through the United States House Committee on Appropriations and the United States Senate Committee on Appropriations before floor votes in both chambers.

Provisions of the Act

The Act amended authorities related to the Veterans Health Administration and expanded criteria for community care coordination, reimbursement, and eligibility tied to metrics used by administrators such as Shulkin (VA)-era officials and predecessors. It revised hiring and termination provisions affecting senior executives comparable to frameworks used by the Civil Service Reform Act of 1978 and incorporated reporting requirements similar to those in statutes overseen by the Office of Personnel Management, the Congressional Budget Office, and the Government Accountability Office. Budgetary and appropriation adjustments referenced mechanisms used by the Department of Defense for health services and drew comparisons with community care models in systems such as the TRICARE program administered by the Defense Health Agency.

Implementation and Administration

Implementation responsibilities fell primarily to the Secretary of Veterans Affairs and administrators within the Veterans Health Administration and required coordination with entities including the Centers for Medicare & Medicaid Services, state veterans' agencies such as the California Department of Veterans Affairs, and nonfederal providers including hospital systems like Mayo Clinic, Cleveland Clinic, and academic centers like Johns Hopkins Hospital. Administrative guidance drew on rulemaking practices from agencies including the Department of Health and Human Services and used data infrastructures analogous to those of the Veterans Benefits Administration and the National Academies of Sciences, Engineering, and Medicine for health outcomes research. Oversight and audit functions were exercised by the Department of Veterans Affairs Office of Inspector General, the Government Accountability Office, and congressional committees such as the House Committee on Veterans' Affairs and the Senate Committee on Veterans' Affairs.

Impact and Analysis

Analyses by think tanks and institutions including the RAND Corporation, the Brookings Institution, and the Heritage Foundation examined effects on access to care, cost trajectories, and provider networks, while academic studies in journals affiliated with institutions like Harvard Medical School, Yale School of Medicine, and Stanford University School of Medicine evaluated clinical outcomes and continuity of care. Stakeholder responses came from veterans service organizations such as the Veterans of Foreign Wars, the American Legion, and the Paralyzed Veterans of America, and from provider groups including the American Medical Association and the American Hospital Association. Economic assessments referenced models used by the Congressional Budget Office and compared veterans' care delivery to systems in other jurisdictions like the United Kingdom National Health Service and provincial programs in Canada.

Legal Challenges and Litigation

Litigation around implementation involved cases brought in federal courts, with plaintiffs represented by organizations such as the American Civil Liberties Union and firms appearing before circuits including the United States Court of Appeals for the Federal Circuit and the United States Court of Appeals for the District of Columbia Circuit. Issues litigated paralleled disputes in administrative law that invoked precedents from the United States Supreme Court and decisions interpreting statutes such as the Administrative Procedure Act and principles articulated in cases like Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc. and National Federation of Independent Business v. Sebelius. Remedies and injunctions were sought in district courts including the United States District Court for the District of Columbia and the United States District Court for the Northern District of California.

Category:United States federal veterans legislation