A fast-moving deal between Sens. Bernie Sanders and John McCain, the Vermont independent and the Arizona Republican, would implement a series of reforms at the Department of Veterans Affairs. Many of the deal's provisions have previously been approved in separate bills by the House. Here is a side-by-side comparison. (Read here for the fact sheet of Senate bill and here for the text of the Senate bill. House bills are linked individually.)


House bill (HR 4031): Would allow the secretary of Veterans Affairs to fire any Senior Executive Service employee whose performance warrants such removal or to demote that person to the ranks of "General Schedule" federal jobs. The employee would have no right to appeal.

Senate bill: Would allow the secretary to fire or demote to a General Schedule position any SES employee whose performance warrants such removal. The employee would seven days to appeal to the federal Merit Systems Protection Board, which would then have 21 days to render a final decision. The VA would have to prove that the discipline is warranted and legal. The employee would not be paid pending the MSPB appeal. Appeals beyond the MSPB would be prohibited.


House bills (HR 357 and HR 4810): Would impose a five-year ban on performance bonuses to VA senior executives and require an independent audit of agency health care.

Senate bill: Would prohibit the use of scheduling and wait-time metrics as factors in determining performance bonuses for top-level employees. Also would prohibit performance goals that might create disincentives for health care administrators to refer patients to private medical providers. Performance plans would ensure standards are based on quality of care at medical facilities.


House Bill (HR 4810): Would require the Office of Management and Budget to estimate additional resources, if any, that are needed by VA. VA carried over $543 million in unspent health care funds in 2014, and is expected to carry over $450 million in unspent funds next fiscal year.

Senate bill: Authorizes “such sums as may be necessary.” Sanders previously stated the bill would authorize $500 million in un-obligated funds in the current budget to hire new doctors and nurses.

Falsification of data

House bill: No bill would address this.

Senate bill: Would require VA to establish disciplinary procedures, including firing, for employees who knowingly falsify data pertaining to wait times and quality- of-care measures, or compel others to do so.

Medical facilities

House bill (HR 3521): Would authorize VA to lease space or land for major medical facilities in 18 states and Puerto Rico.

Senate bill: Same as House bill but would cover just 17 states and Puerto Rico.

Private providers

House bill (HR 4810): Would allow patients to receive care from private providers at VA's expense if they live more than 40 miles from the nearest VA facility or cannot get a medical appointment within the wait times set by agency guidelines.

Senate bill: Same as House bill.

Sexual trauma

House bill (HR 2527): Would extend counseling and care to veterans for sexual trauma that occurred during active duty, or during inactive duty training.

Senate bill: Would extend counseling and care to service members who suffered sexual trauma while serving on inactive training duty. Also expands eligibility for VA care of military sexual trauma to active duty service members, along with the care offered by the Defense Department.


House bill (HR 4810): Would require OMB to estimate additional resources, if any, that VA needs.

Senate bill: Would allow expedited hiring into positions identified by the inspector general as experiencing staffing shortages.