WASHINGTON, D.C. — The House of Representatives passed a comprehensive bipartisan bill on Monday aimed at expanding health care and support services for America’s veterans. The bill allows for greater access to private-sector medical care outside the Department of Veterans Affairs (VA).
The legislation, named the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, was approved with overwhelming support in a 389-9 vote.
The bill seeks to empower veterans by increasing their choices for medical and end-of-life care, bolstering caregiver programs, enhancing support for homeless veterans, and improving rural healthcare access. While widely celebrated for its potential to modernize the VA, it has also drawn criticism from a small faction of Republican lawmakers concerned about specific provisions.
Central to the legislation is a provision increasing VA coverage for in-home nursing care costs from 65% to 100%. This change allows disabled and aging veterans to live out their final days at home instead of in nursing facilities. Advocates, including caregivers and veterans’ groups, have long argued that veterans deserve this option for greater comfort and dignity.
In addition, the bill expands mental health support for caregivers, extends high-tech job training programs for veterans through 2027, and provides transportation and transitional housing assistance for homeless veterans. The measure increases the per diem rate for organizations offering short-term housing for homeless veterans and reinstates expired provisions that helped reduce homelessness during the COVID-19 pandemic.
Another significant provision bans the VA from overriding doctors’ referrals for patients to receive private care outside the VA system. While the restriction lasts only two years, the VA must report to Congress on its impact. This compromise addressed concerns among Democrats and some Republicans, enabling the bipartisan agreement.
To address rural healthcare disparities, the bill requires the VA to inform veterans of private care options when VA services are unavailable in a timely manner. It also mandates improved mobile mammography and breast cancer screening for veterans in remote areas.
Despite its widespread support, the legislation faced opposition from nine Republican lawmakers, including Reps. Jeff Duncan (SC), Paul Gosar (AZ), Matt Rosendale (MT), and Chip Roy (TX). Critics argued the bill could pave the way for privatizing the VA and expressed concerns about specific provisions, such as benefits for same-sex spouses of veterans.
“When a uniparty agreement comes together overnight, like it did with the Dole Act, it means a small group of individuals negotiated it and the American people—and in this case, our nation’s heroes—get the short straw,” said Rep. Rosendale, explaining his dissent.
Some Republicans also expressed disappointment over the removal of language addressing the VA’s troubled electronic health records program. The original draft of the bill would have ended the VA’s contract with Oracle Cerner if its system issues were not resolved, but this provision was cut from the final version.
The legislation now moves to the Senate, which must pass it before the congressional session ends in January. If it fails to clear the Senate, the legislative process will have to start over. Former Sen. Elizabeth Dole, the bill’s namesake, expressed optimism about its future, saying, “I am eager to see this package now quickly pass in the Senate and be sent to the president’s desk for his signature.”
Rep. Mike Bost (R-IL), Chairman of the House Veterans Affairs Committee, hailed the bill as transformative. “This bill will change the landscape for elderly veterans and finally give them a choice in where they choose to live out their sunset years,” Bost said.
Ranking member Rep. Mark Takano (D-CA) also praised the bipartisan effort: “This is not a perfect package—they rarely are—but it achieves many of the goals we set out to accomplish at the beginning of the Congress. Better late than never.”
As the nation waits for Senate action, veterans and their families stand to benefit significantly from the bill’s measures, which represent a major step forward in expanding choice and accessibility for those who served.