Veterans Access, Choice, and Accountability Act of 2014

Veterans Access, Choice, and Accountability Act of 2014
Name	Veterans Access, Choice, and Accountability Act of 2014
Enacted by	113th United States Congress
Signed into law	August 7, 2014
Public law	Pub.L. 113–146
Nickname	Choice Act

Veterans Access, Choice, and Accountability Act of 2014 was enacted in response to a national scandal involving delayed health care and administrative failures at the Department of Veterans Affairs facilities, prompted by investigative reporting and congressional inquiries. The law created a framework for eligible veterans to receive care from non-VA providers, expanded hiring and removal authorities for senior VA officials, and authorized supplemental funding to address backlogs in medical scheduling and construction. Congressional action followed hearings led by members of the United States Senate, the United States House of Representatives, and committees such as the Senate Committee on Veterans' Affairs and the House Committee on Veterans' Affairs.

Background and Legislative History

The statute emerged after reporting by The Phoenix New Times, investigations by CBS News, and oversight by lawmakers including Senator Richard Burr, Senator Bernie Sanders, Representative Jeff Miller, and Representative Denny Heck, which highlighted wait-time manipulations at facilities like the Phoenix VA Health Care System. Public scrutiny intensified following testimony before panels chaired by figures such as Senator Patty Murray and hearings featuring VA officials including Secretary Eric Shinseki and later Secretary Robert A. McDonald, leading to legislative proposals from both President Barack Obama administration advisors and members of the 113th United States Congress. The bill incorporated elements from earlier proposals like the Veterans' Access to Care through Choice, Accountability, and Transparency Act and drew on bipartisan negotiations with stakeholders such as the American Legion, Veterans of Foreign Wars, and the Disabled American Veterans.

Provisions of the Act

Key provisions created a temporary Veterans Choice Program enabling eligible veterans to obtain care from community providers when facing long wait times or geographic barriers, linked to distance criteria such as living more than 40 miles from a VA medical facility or experiencing scheduling delays. The law expanded personnel authorities authorizing expedited removal and disciplinary actions for senior executives, modifying statutes related to the Civil Service Reform Act of 1978 and integrating elements of accountability advocated by figures like Senator John McCain and Representative Jeff Miller. It authorized capital projects and leases for clinics and mandated scheduling reforms influenced by best practices from systems such as the Department of Defense health networks and models studied by the RAND Corporation. The statute also required enhanced reporting, data sharing, and performance metrics to be submitted to oversight bodies including the Government Accountability Office and the Congressional Budget Office.

Implementation and Administration

Administration fell to the Department of Veterans Affairs, under the oversight of secretaries including Robert A. McDonald and later David Shulkin, with operational input from the Veterans Health Administration and coordination with private-sector networks such as Tricare vendors and regional hospital systems like Mayo Clinic and Kaiser Permanente. Implementation required rulemaking guided by the Office of Management and Budget and interaction with state agencies including Veterans Affairs (state) departments and tribal organizations like the National Indian Health Board. The program relied on contractor networks, credentialing procedures mirroring standards from the Joint Commission, and electronic health record exchanges intended to interoperate with systems developed by companies like Cerner Corporation. Oversight included audits by the Department of Defense Office of Inspector General and reviews by congressional committees.

Funding and Budgetary Impact

Congress provided supplemental appropriations and advance appropriations, creating a choice fund administered through accounts tracked by the Congressional Budget Office and scrutinized in budget resolutions like those negotiated in the Office of Management and Budget process. Funding mechanisms included transfers from existing VA medical accounts, emergency supplemental allocations similar to prior authorizations for agencies such as the Federal Emergency Management Agency, and offsets debated in the Senate Budget Committee and the House Appropriations Committee. The Congressional Budget Office produced cost estimates and baseline adjustments, while the Government Accountability Office reported on obligations and long-term fiscal implications, especially concerning the sustainability of contracts and potential effects on Medicare and Medicaid coordination.

Criticism, Legal Challenges, and Revisions

Critics from organizations including the American Medical Association and advocacy groups like Iraq and Afghanistan Veterans of America argued the program risked fragmenting care and eroding the VA's integrated model, prompting legal challenges and litigation addressing contractor payments and provider credentialing with plaintiffs represented by firms that have appeared before the United States Court of Appeals for the Federal Circuit and the United States District Court for the District of Columbia. Congressional critics such as Senator Tom Coburn and commentators in outlets like The Washington Post and The New York Times raised questions about implementation, leading to subsequent legislative adjustments in later bills including provisions in the Veterans Access and Accountability Act debates and appropriations language in the Consolidated Appropriations Act. GAO reports and inspector general investigations motivated policy revisions under successive secretaries.

Impact on Veterans’ Care and Outcomes

The program produced mixed results: some veterans reported improved access to community-based providers including specialists affiliated with Johns Hopkins Medicine and Cleveland Clinic, while audits by the Government Accountability Office and studies by think tanks like the Brookings Institution and Veterans Health Council highlighted administrative complexity, cost growth, and challenges in continuity of care. Research published by institutions such as RAND Corporation and analyses from the Kaiser Family Foundation examined effects on wait times, health outcomes, and patient satisfaction, finding variability across regions including comparisons involving networks in Phoenix, Arizona and Atlanta, Georgia. Subsequent reforms and ongoing oversight continued to shape veteran health policy in the United States Senate and the United States House of Representatives.

Category:United States federal legislation Category:Veterans affairs in the United States