Can the VA fire its way out of its problems?

WASHINGTON —  “Zero-sum situation.” “Culture of bureaucracy.” “Doesn’t make sense in the 21st century.”

These were some of the harsh words that some members of Congress, including First District Rep. Tim Walz, have spoken recently over an agency many are well past fed up dealing with: the Department of Veterans’ Affairs.

If you believe the headlines, Congress’ goal of improving the VA will be a monumental task: Over the past two years, the agency has weathered a lot of bad press, from reports of interminable wait times at hospitals to unfair medical billing practices to allegations of bureaucrats gaming the system for personal gain.

Those stories have prompted Republicans to hold up the VA, which operates a massive health care network that provides care to nine million veterans and employs roughly 250,000 people, as Exhibit A of federal government incompetence and complacency. In the past year and a half, they have put forth a raft of reforms aimed at streamlining the agency — or, depending on how you view it — placing punitive measures on VA employees.

Others, including many Democrats, dispute the idea that primary blame for the VA’s woes lies on its employees. Instead, they have favored a number of smaller, targeted reforms to do the heavy lifting to make the VA better without wading into union politics.

Members of Congress love to talk about honoring America’s veterans — but if the last months are any indication, they have a long way to go in figuring out the best way to do it.

Scandal upon scandal

Exactly how bad are things at the VA? If the past two years are a guide, very bad. The agency had a blockbuster scandal on its hands in spring 2014 when it was revealed that 35 veterans had died while waiting for care at a Phoenix, Arizona, VA hospital, and that officials had manipulated wait times to obscure the problem.

That scandal opened wider investigations from the White House, the FBI, Congress and the VA itself, which found similar problems nationwide. Top agency officials, including Secretary Eric Shinseki, stepped down as a result.

In the aftermath of the debacle, Congress and President Obama undertook a raft of measures aimed at helping veterans get care. Many were designed to help veterans circumvent problematic facilities, and one bill passed by Congress gave veterans more flexibility in going to non-VA doctors.

But problems with the institution persisted: In June of this year, it came to light that faulty billing practices at Minnesota and Wisconsin VA health facilities were confusing and putting undue financial burden on veterans. The entire Minnesota congressional delegation, joined by some Wisconsin members, sent an outraged letter to current Secretary Robert McDonald over the issue.

If that all were not enough, recently it was revealed that certain VA officials had maneuvered to create new jobs for themselves in different cities.

A government report charges that Kimberly Graves, a VA administrator from Philadelphia, persuaded a superior to leave a post in St. Paul, which she then filled. She received $129,000 in relocation fees — a move Rep. John Kline called “unconscionable … a clear violation of the public trust and blatant abuse of power.”

Graves failed to appear before the Veterans’ Affairs Committee in October and was promptly subpoenaed. Last week, she appeared before the committee in Washington and pled the fifth.

To lawmakers, it was textbook behavior from an agency that has circled the wagons. “It seems like the veterans administration has had this blank check — so they’ve gotten complacent and recalcitrant and unresponsive. Some heads need to roll,” Rep. Rick Nolan said.

Making firings easier

Many close observers of the VA agree that a negative culture has festered in the agency for years, with bad habits building up to create a bureaucratic mess unique in the federal government simply because of the immense size and scope of the VA.

To fix the problems, Republicans have taken direct aim at the public sector unions that represent VA employees, arguing that limiting their influence is perhaps the single biggest thing Congress can do to remedy the situation. Generally, Republican arguments on the effect of federal workers unions mirror their arguments on teachers unions: They believe that unions help protect subpar employees from being fired.

Rep. Jeff Miller, the Republican Veterans’ Affairs Committee chair, said last week that it is too hard to fire underperforming employees and too hard to hire new, eager ones. He said the most important thing the VA could do is “make it easier to discipline individuals who can’t or won’t do their jobs.” Since Shinseki stepped down as secretary last year, the rate of firings at the VA has slowed.

To that end, Republicans this year introduced legislation, the VA Accountability Act of 2015, aimed at giving top VA executive officials more authority to fire lower level administrative workers. It was co-sponsored by Kline, and passed the House with some Democratic support. In a statement, Kline — a former Marine and one of three veterans in the Minnesota delegation — said the law “would give the VA secretary new authority to fire corrupt or incompetent employees — putting the treatment of our veterans before bureaucrats.”

The bill, Kline said, “comes in response to the VA’s long and well-documented history of not holding problem employees accountable,” adding it would be a “significant step toward increasing oversight and transparency.”

Walz, along with many other Democrats, opposed the VA Accountability Act, saying it was purely partisan. At a Wednesday talk hosted by the Brookings Institution, he said “it doesn’t make much sense to strip workers of collective bargaining,” and that it’s the “only strength they have.” He added that Wisconsin Gov. Scott Walker’s weakening of public sector unions in that state has had a chilling effect on whistleblowers — like the ones who stepped forward this year to shed light on poor management, high workload and unsafe environments at the St. Cloud VA hospital.

On Thursday, Nolan spoke of a myth that “somehow because of federal employee protections and because of unions, it’s impossible to fire a federal employee. That’s just not true,” he said. “I think we need to leave those protections in place.”

Walz has emphasized the importance of unions that represent VA employees, but has signalled a willingness to work with his Republican colleagues on so-called accountability measures that may weaken the unions. “When I hear someone hasn’t been fired who should be fired, I’m madder than anyone,” he said.

“Whatever it takes to deliver the highest quality health care is the one we should choose. I don’t have an ideological dog that I’m tied to in this fight.”

Incremental improvements

For now, the likeliest scenario is that the VA will be improved incrementally, with lawmakers and the White House agreeing on noncontroversial laws, like one passed last year that expanded veterans’ access to care and hired more doctors and nurses for VA facilities.

Walz has been able to produce VA reform legislation that can earn support from both parties. In July, he introduced two bills: one that would require the VA to submit to an independent health-care audit every two years, and one to streamline how members of the private sector health-care industry operate at VA facilities.

And in the wake of the VA billing problem, Kline and Sen. Amy Klobuchar introduced legislation aimed at reforming how the health-care system bills patients. (Kline’s bill will be considered in committee November 17.)

In October, Walz, along with Rep. Tom Emmer, introduced a bill to make VA internal reports more transparent and accessible to Congress and the public. That was introduced in response to their joint visit this fall to the St. Cloud VA.

Whether there will be a grand showdown between Congress and VA employee unions remains to be seen. While Obama is in office, it’s highly likely he will veto a bill like the VA Accountability Act of 2015 — if it even survives the Senate. “There will be those who don’t understand the issue who will see this as a proxy fight over public sector unions,” Walz said.

“If you’re looking for a silver bullet that’s gonna weaken public sector unions and fix the VA, you’re gonna be looking for a long time.”