President Trump took one of his first steps Wednesday to address chronic problems in the Department of Veterans Affairs by signing a bill that extends stopgap services for veterans to go outside the VA medical system for care.
After campaigning on the issue of improving substandard care for veterans that dogged President Obama, Mr. Trump signed a reauthorization of the Veterans Access, Choice and Accountability Act and announced that he would devote a press conference to veterans issues next week.
"The veterans have poured out their sweat and blood and tears for this country for so long, and it's time that they are recognized and it's time that we now take care of them and take care of them properly," Mr. Trump said.
The Choice program was set to expire in August without the legislation and with nearly $1 billion unspent in the account. Congress developed the program after a scandal erupted in 2014 during the Obama administration over wait times at the VA medical center in Phoenix, where dozens of veterans died waiting for care.
Veterans groups say the legislation is needed but that Congress and the Trump administration need to do much more.
"They need more doctors, they need nurses," said Garry Augustine, president of the 1.3-million-member Disabled American Veterans. "There's a lot of things in motion now that are moving in a positive direction. But it's the second-largest bureaucracy in the government. You don't change it overnight."
Providing care for the nation's roughly 21 million veterans has challenged previous administrations and sometimes has caused major political headaches for presidents who don't adequately address problems within the VA.
President George W. Bush feuded with fellow Republicans who accused him of not increasing funding enough for the VA as veterans returned from the wars in Iraq and Afghanistan.
Mr. Obama pledged to eliminate the backlog of disability and pension claims. His administration reduced it from about 600,000 to 100,000 but failed to eliminate the mountain of pending claims by the time he left office in January. Cutting into the claims backlog also resulted in a dramatic rise in the number of appeals, to a current backlog of about 450,000.
Mr. Obama fired his first VA secretary, Eric K. Shinseki, in the wake of the scandal over delayed care. The Obama administration also was beset with unresolved problems of whistleblower retaliation, wasteful employee bonuses and the failure to hold accountable managers found to have engaged in wrongdoing.
During Mr. Obama's presidency, funding for the VA rose by about 85 percent, although some of that increase was the result in a rise in the total number of veterans who qualified for mandatory benefits. In fiscal 2017, the VA budget was $182.3 billion, including $78.7 billion in discretionary spending.
Mr. Trump campaigned hard on improving services for veterans, saying their treatment by the previous administration was a disgrace.
"Our veterans, in many cases, are being treated worse than illegal immigrants," Mr. Trump said in September.
The president has proposed a 6 percent boost in the VA budget for fiscal 2018. The VA is one of the few federal agencies slated for an increase in Mr. Trump's first budget.
Some veterans are encouraged by Mr. Trump's choice of physician David Shulkin to lead the VA. Mr. Shulkin served in a top post at the agency at the end of the Obama administration.
"He knew what was being done to improve it because there was improvement going on under [former Secretary Bob] McDonald and [Deputy Secretary] Sloan Gibson," Mr. Augustine said. "Now he's continuing the progress that was being made."
Only three months into the administration, there are ample signs of improvements that still need to be made at the VA. About one-third of veterans are going outside the system to private doctors but are encountering delays in paperwork and scheduling, as well as incorrect billing.
The Washington DC VA Medical Center, a VA facility, was cited by inspectors in a report this month for its mismanagement of medical equipment, supplies and staffing.
"The ongoing inventory practices at the medical center are placing patients at unnecessary risk," VA Inspector General Mike Missal wrote in the interim report, adding that the facility's leaders "have been slow to remediate these serious deficiencies."
The VA quickly fired the director of the D.C. medical center, calling it an "urgent patient safety issue."
"We are focused clearly on accountability. No leader or other employee stands above the paramount concern of ensuring the safety of our veterans," Mr. Shulkin told reporters.
Some VA workers say low morale and management problems at the agency have not changed.
"The mood in the field is very pessimistic," said one midlevel VA manager who spoke on the condition of anonymity. "Personally, I am not optimistic. There are not enough resources available to provide same-day access [for patients] and keep the crumbling VA infrastructures running. They cannot meet the staffing levels of the private sector due to the bizarre nature of VA's funding model. Yet Shulkin is threatening to fire leaders who aren't 'focused' on these areas. Very demoralizing."
Mr. Shulkin said at the White House on Wednesday that the measure extending the Choice program was an example of "how we are making things better" for veterans.
"By working together, we're going to continue this progress," he said.
The Choice law allows any veterans who either have had to wait 30 days for an appointment or live 40 miles or more from the nearest VA facility to visit a private doctor. But bureaucratic problems have prevented many veterans from using the program.
Mr. Shulkin has called on Congress to approve a more permanent solution to veterans' health care.
Mark Lucas, executive director of Concerned Veterans for America who attended the bill signing, said Congress needs to expand private health care options for veterans.
"The Choice program was passed as a quick fix to the wait list manipulation scandal that broke three years ago," Mr. Lucas said. "While it's helped, too many veterans still are forced to seek care at failing VA facilities."
Administration officials and veterans advocates portrayed the legislation as a temporary fix until lawmakers can devise long-range solutions.
"What we want to do is put the veteran in charge of these choices, not the bureaucracy," said House Veterans' Affairs Committee Chairman David P. Roe, Tennessee Republican. "And I think Dr. Shulkin is just the person to see that happen."
A report released Wednesday said more veterans younger than 65 have gained health insurance coverage under the Affordable Care Act, which Mr. Trump and his Republican allies in Congress are trying to repeal and replace.
The study by the nonpartisan Urban Institute found that about 429,000 veterans nationwide gained coverage in 20 states with the largest veteran populations, reducing the uninsured rate among veterans younger than 65 by nearly 40 percent from 2013 to 2015.
Mr. Trump held a private meeting at the White House with Mr. Shulkin on Wednesday morning and said the VA secretary "updated me on the massive and chronic challenge he inherited at the VA, but also the great progress that he is making."
"It's one of my most important things," Mr. Trump said of veterans issues. "I've been telling all of our friends at speeches and rallies for two years about the VA, how we're going to turn it around. And we're doing that."