Updated at 5:20 p.m.
In the wake of the VA hospital scandal, several reform proposals are taking shape in the Senate this week with a focus on allowing veterans to seek medical care outside the Veterans Affairs medical system.
Three Republican senators, John McCain of Arizona, Tom Coburn of Oklahoma, Jeff Flake of Arizona and Richard Burr of North Carolina, the ranking member on the Senate Veterans' Affairs Committee, announced a proposal on Tuesday, which they say will give veterans greater flexibility and choice in health care providers and increase accountability and transparency at the VA.
The legislation, "would empower veterans who can't schedule an appointment within a reasonable time or live too far away from the VA medical facility to exercise the choice - I emphasize the choice - of getting medical care from any doctor in a Medicare or Tricare program. I've always believed that veterans could choose and should choose," McCain said at a press conference announcing the bill. It would also prohibit the use of metrics like wait times from being used to award bonuses, penalize employees for falsifying data, and give the VA secretary the power to remove any top executive if they determine that his or her performance warrants removal.
On CBS' "Face the Nation" Sunday, McCain argued that the VA should aim to provide care in the military-specific areas where it excels, such as traumatic brain injuries, post-traumatic stress disorder, prosthesis and other war wounds.
"Why should a veteran have to get into a van and ride three hours to get to Phoenix in order to have routine medical care taken care of? Why doesn't that veteran have a card and go to the caregiver that he or she needs and wants?" McCain said. "That's the solution to this problem, this flexibility to the veteran to choose their healthcare, just like other people under other healthcare plans are able to do."
Burr noted that the bill does not encompass every reform Congress would like to put in place, but rather addresses the most urgent things needed at the moment.
The chairman of the Veterans' Affairs Committee, Sen. Bernie Sanders, I-Vt., introduced his own bill that allows any veteran who can't get a timely appointment the option to seek treatment at a community health center, military hospital or private doctors.
The bill will also would give the VA authority to immediately remove senior executives based on poor job performance while preventing wholesale political firings, authorize the agency to lease 27 new health facilities in 18 states, and use emergency funding to hire new doctors, nurses and other providers. That, Sanders believes, is the root of the problem.
"What is very clear to everybody right now is that in many parts of the country, the VA simply did not have the doctors and the staff to make sure the veterans got timely care," Sanders said on "Face the Nation."
Senate Majority Leader Harry Reid, D-Nev., praised Sanders' "really good" bill, which will "improve the manner in which the United States of America cares for its veterans."
"I'm hopeful that all members will support this," Reid said on the Senate floor Monday.
But the Republicans believe their bill fixes issues that Sanders' does not.
"Unlike Sen. Sanders' bill this legislation addresses the root causes of current VA scandal and empower veterans with greater flexibility to get the quality medical care that he or she deserves," McCain said. Coburn also disagreed with the premise that the agency needs more doctors, citing an Annals of Family Medicine study that said the average practitioner in the VA hospital sees just half the number of patients that the average practitioner outside the VA hospital system does.
That study, however, also concludes that "the average primary care physician's panel size is too large for delivering consistently high quality care under the traditional practice model."
Senate Republicans have also pushed for a VA reform bill passed overwhelmingly by the House last month, which would give the VA secretary increased power to fire or demote senior VA officials in an attempt to reduce red tape that can stretch out the process of removing an ineffective staffer from their position.
Criticism of the House-passed bill has come chiefly from the Senior Executives Association, a professional association that represents career federal executives in the Senior Executive Service (SES). They have warned members of Congress that the bill demonizes VA executives without actually fixing problems facing veterans' access to care.
White House Press Secretary Jay Carney said last month that the White House "share[s] the goals" of the House bill, but had other unnamed concerns about the legislation. He has not indicated whether the president will sign it if it passes the Senate.
Meanwhile, Sens. Mary Landrieu, D-La., and Jerry Moran, R-Kansas, have inserted the language of the House bill into the VA's 2015 spending bill in the Senate Appropriations Committee.
The pressure for a quick solution came to a head last week when an interim report from the VA's inspector general found "systemic" problems at a VA hospital in Phoenix, Ariz., confirming the mounting reports of misconduct and lengthy wait times that had been circulating for several weeks. Two days after the report was issued, VA Secretary Eric Shinseki stepped down amid growing calls for his resignation.