By Ledyard King and Nicole Gaudiano
Things weren't looking good for passage of a compromise bill reforming veterans health care.
Prospects of a deal threatened to unravel last week despite broad bipartisan congressional support for action, fueled by national outrage over lengthy patient wait times that may have led to the deaths of veterans.
At one point, frustrated Republicans sat in a corner of the Capitol at a hastily called negotiating session attended by a single House Democrat. Angry Senate Democrats met elsewhere, accusing Republicans of trying to ram through a plan without their input. The possibility Congress would leave for its summer break empty-handed seemed increasingly likely.
An odd couple occupied the center of the storm: Republican Jeff Miller of Chumuckla, a button-down, pragmatic conservative and former TV weatherman who chairs the House Veterans' Affairs Committee, and independent Bernie Sanders of Vermont, a fiery, self-described Democratic Socialist and former small-city mayor who chairs the Senate Veterans' Affairs Committee.
Over a sometimes-tense weekend that involved plenty of discussion, some of it acrimonious, Miller, Sanders and their staffs reached agreement on two key sticking points: the cost of the bill and the authority of the Veterans Affairs secretary to discipline and fire senior staff.
The two shook hands, announced a compromise and saw their respective chambers overwhelmingly adopt the deal this week. The House vote was 420-5 and the Senate vote was 91-3.
"I never doubted that we would reach an agreement that would be acceptable for both houses," Miller said in an interview Thursday, shortly after the House vote. "As different as we are politically, we are both realists. And I know Sen. Sanders wanted to solve the problem as much as I did and he gave. And we gave. And that is what a (compromise) is all about."
Sanders wasn't so sure at times.
"This has by far been the hardest thing that I have ever had to do since I have been in the United States Congress," he said Thursday before the Senate vote. "But the stakes in terms of the needs of millions of veterans were so high that we just worked very, very hard on it."
Passage of the legislation -- the Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 -- means the "do-nothing Congress" can legitimately claim to have risen above the partisan rancor and done something.
Norm Ornstein, a congressional scholar at the American Enterprise Institute, called it "the first encouraging sign that the last stages of the 113th Congress will not be a total, embarrassing failure."
The nearly $17 billion measure will:
* Cover most veterans who receive health care treatment from private providers if they can't get an appointment at a VA facility within 30 days or live more than 40 miles from the nearest one.
* Require an independent assessment of VA medical care and establish a congressional commission to evaluate access to care throughout the VA health care system.
* Provide $5 billion to hire doctors and other medical staff.
* Authorize 27 major medical facility leases in 18 states, including $12 million over 20 years to lease space for a larger clinic in New Port Richey.
* Allow the VA secretary to fire or demote any of about 450 senior agency executives in an expedited fashion (if warranted) and provide no more than 21 days for appeal. Many received bonuses amid reports by whistle-blowers of poor care, lengthy wait times and falsification of records to make it seem veterans were getting treatment more quickly than they really were.
'A perfect storm'
Both sides initially were far apart on funding.
Republicans didn't want to add money, saying the VA already had the resources to make the changes. Democrats were ready to approve a bill projected to cost $35 billion a year, without finding other ways to offset the cost. Sanders insisted it be considered "the cost of war," referring to conflicts in Afghanistan and Iraq initiated by President George W. Bush.
Already-thorny negotiations became more difficult last month when Acting VA Secretary Sloan Gibson said the agency needed an addition $17.6 billion just to address existing deficiencies in staffing, equipment and space.
In the end, Miller and Sanders signed off on a plan that will cost $17 billion over 10 years, $5 billion of which will be absorbed through the existing VA budget.
While Sanders agreed with Miller that the VA secretary should have greater power to fire top-level managers, the senator wanted to make sure due process wasn't sacrificed.
Miller gave some ground on that issue as well, agreeing to an appeals process provided it didn't exceed three weeks.
Sanders said Miller had the difficult task of negotiating on behalf of "a very, very conservative" House generally at odds with the Senate.
"Many Republicans that I've dealt with go through the motions, but at the end of the day they don't want to accomplish anything," the senator said. "That was not the case with Miller. I think from the beginning he understood the seriousness of the issue and that he wanted to accomplish something significant."
Miller and Sanders benefited from an important ally: timing.
With a congressional recess approaching and veterans' organizations demanding action following reports of patients dying while they waited for care, lawmakers were eager to accomplish something.
"It was a perfect storm," said Ryan Gallucci, a lobbyist for the Veterans of Foreign Wars, which passed a resolution at its national convention July 21 prodding lawmakers to act. "It was a crisis that demanded decisive action."
Praise for Miller
Some veterans groups say -- and Miller concedes -- that it probably wouldn't have mattered who chaired the veterans' panels because circumstances dictated congressional response.
But the groups credit Miller for sounding the alarm for years about mismanagement at the VA and for holding frequent hearings where VA officials, including the secretary, were forced to answer difficult questions. In addition, Miller's staff began developing rapport with agency whistle-blowers whose public stories unveiled a nationwide pattern of troubling practices.
Paul Rieckhoff, chief executive officer and founder of the Iraq and Afghanistan Veterans of America, praised Miller not only for being persistent on accountability but for being bipartisan in running the committee, something he says is lacking in the Senate committee.
"There are a lot of people in this Congress who are not reasonable. Jeff Miller is a reasonable guy, and he's much more reasonable than people we've had in the past," Rieckhoff said. "The other piece of it, too, is that he's knowledgeable. Jeff Miller'll spend his break going to three VA hospitals."
Miller, whose Pensacola-area district boasts more veterans than any other, said he plans to visit medical centers in New Mexico, New York and Texas during the recess.
Criticism
Not everyone's enamored with the House chairman or the bill he was instrumental in passing.
Joseph Violante, national legislative director for the Disabled American Veterans, said the VA already had the ability to discipline employees who weren't doing their jobs. He worries the new rule will push talented managers to other government agencies that provide employees greater due process.
He also questioned the need for more private health care, saying the VA spent roughly $4.8 billion last year on "fee-based" care to outside providers.
And while he credits Miller for exposing problems at the VA, Violante said it was overkill.
"There comes a point in time where these hearing don't accomplish anything other than beating up on VA," he said. "I'd rather see Congress take a position that does more oversight than just plain criticism of VA, and I think unfortunately this legislation is a little bit over-reaching on the part of Congress. They're doing more managing of the VA health care system than oversight, and that concerns me."
But Carl Blake a lobbyist for the Paralyzed Veterans of America, lauded the bill and how it came to pass, given the general lack of cooperation between the Senate and the House.
"It's reassuring that those two committees with two chairmen who are not anywhere near each other on the ideological spectrum can some together to deal with this issue and come up with a compromise," Blake said. "Not everybody got everything they wanted but generally everybody's pretty satisfied."