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Washington – President Donald Trump’s expansion of a program aimed at steering more veterans to private health care is getting an $8.9 billion boost as part of the massive government spending bill approved by the House, setting up a potential battle over the direction of the Veterans Affairs Department.

The deal provides $81 billion for VA medical care to treat 9.3 million veterans, including the $8.9 billion for private care under a law passed last year expanding the Veterans Choice program. Another $11.3 billion is on tap for private care in 2021.

Major veterans groups have cautioned against “cannibalizing” VA programs to pay for Choice, which they worry could lead to privatization of VA.

The program gives veterans wider access to private care when they have endured lengthy wait times or the treatment was not what they had expected. The price tag could soar as the expanded program takes hold, putting the VA at risk of future budget shortfalls.

Democratic presidential contenders including Vermont Sen. Bernie Sanders and Massachusetts Sen. Elizabeth Warren have urged reinvestment in the VA over expanded private care options. Former Vice President Joe Biden and Pete Buttigieg, a mayor of South Bend, Indiana, have said they will roll back or change some of the Trump administration’s rules on Choice.

“As the increasing need for medical care by wounded, ill and injured veterans and their family caregivers is being forced to fit under tight budget caps, we are concerned necessary resources could be shifted away from the VA healthcare system, which independent research has shown provides higher quality care than the private sector,” said Joy Ilem, national legislative director for Disabled American Veterans.

“While community care programs are vital to fill and supplement VA in many locations, we believe the value to veterans and the taxpayer of every dollar spent in the VA health care system is greater than if it were spent in the community,” she said.

House Democrats had pushed for Choice money to be exempt from budget caps, to avoid the risk of cuts to core VA programs as costs grow in the coming years. Ultimately, however, the money was kept under budget caps.

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