When Bernie Sanders and John McCain Wrote a Veterans Bill Together

On August 7, 2014, at Fort Belvoir in northern Virginia, President Barack Obama signed a bill with a long name and an unusual pair of parents. The Veterans Access, Choice, and Accountability Act had been negotiated in the weeks before by two senators who had almost nothing in common. One was Bernie Sanders of Vermont, an independent who called himself a democratic socialist and chaired the Senate Veterans' Affairs Committee. The other was John McCain of Arizona, a Republican, a former Navy pilot who had spent more than five years as a prisoner of war in North Vietnam, and the man who had lost the 2008 presidential election to Obama. They had spent years on opposite sides of nearly every fight about the role of government. That summer, they sat down with House negotiators and wrote a law together, because hospitals that were supposed to care for veterans had been hiding how long veterans were waiting.

In short: In 2014, revelations that VA facilities in Phoenix and elsewhere had concealed long waits for care shocked Congress. Sanders and McCain, ideological opposites, negotiated a reform that funded more VA doctors and let some veterans see private providers. The law passed with huge majorities, and the argument it started about public versus private care for veterans has never ended.

The list that wasn't on the books

The scandal began with a whistleblower. Dr. Sam Foote, a physician who had retired from the Phoenix VA Health Care System, went to the department's inspector general and then to the press with an allegation: the Phoenix facility had kept secret wait lists to hide how long veterans were waiting for appointments, while official records showed short waits that met the department's targets. Some veterans, he said, had died while waiting for care.

CNN reported his allegations in April 2014. The story moved quickly. The VA inspector general opened an investigation, and as investigators looked at other facilities, they found manipulated scheduling data in many places. Employees had been under pressure to meet waiting-time goals, and some had gamed the numbers rather than meet them. Performance bonuses were tied to those numbers.

The inspector general's reports confirmed that the Phoenix facility had kept unofficial lists and that many veterans had experienced long delays. Whether specific deaths were caused by the delays was harder to establish, and the inspector general was careful on that point. But the central fact, that the system had hidden its own failures from veterans and from Congress, was not in dispute.

Secretary of Veterans Affairs Eric Shinseki, a retired four-star Army general who had been wounded in Vietnam, resigned on May 30, 2014. He apologized publicly and said he had been misled by the system he ran.

Two men from opposite ends

It would be hard to design two more different senators.

Sanders had arrived in Congress in 1991 as the only House member who was neither a Democrat nor a Republican. He had spent his career arguing for a larger public sector, single-payer health care and taxes on the wealthy. When he took over the Veterans' Affairs Committee in 2013, he saw the VA as a model of what public health care could be: a single integrated system, run by the government, that studies often found delivered care of quality comparable to or better than the private sector, once a veteran got in the door.

McCain had a different relationship to the department. He was a veteran himself, and his time as a prisoner, including injuries that left him unable to raise his arms above his shoulders, was part of his public identity. He believed in a strong military and a hard foreign policy, and he was skeptical of large government bureaucracies. Arizona was the state where the scandal had begun, and his constituents were the ones on the secret list. He wanted veterans who could not get timely care at the VA to be able to go elsewhere.

Earlier in 2014, before the scandal broke, Sanders had pushed a broad veterans' bill expanding health care, education and other benefits. It failed in the Senate in February when Republicans blocked it on a budget point of order over its cost. The two men had been on opposite sides of that vote. Now, a few months later, they needed each other.

How the deal came together

Sanders and McCain each drafted their own response to the scandal. By early June, they had merged them into a single bill. The Senate passed it with only a handful of votes against. The House passed its own version, led by the chairman of its Veterans' Affairs Committee, Jeff Miller, a Republican from Florida. The two chambers had to reconcile them in a conference committee.

The negotiations were not easy. The main fight was over cost. Sanders wanted the bill to fund more VA doctors, nurses and facilities and to treat the spending as an emergency, so it would not have to be offset by cuts elsewhere. Republicans in the House wanted to keep the price down. At one point in July, talks appeared to collapse, with Sanders and Miller trading public accusations. Then they resumed.

The final agreement had three main parts.

First, a temporary program allowing veterans who had waited longer than a set time for an appointment, or who lived more than 40 miles from a VA facility, to get care from private providers paid for by the VA. That was the "Choice" in the bill's name, and it was McCain's priority.

Second, billions of dollars to hire more doctors and nurses and to lease new medical facilities within the VA itself. That was Sanders's priority, and he insisted on it as the long-term answer: if the VA was short of staff, the fix was more staff.

Third, accountability measures, including making it easier for the secretary to fire senior executives for poor performance, and new rules on bonuses and scheduling.

The final bill passed the House and the Senate in late July with overwhelming majorities, and the president signed it the following week. Most of it was paid for with emergency spending, as Sanders had wanted.

Why the odd couple could work together

There is a temptation to read this as a heartwarming story about two men putting aside their differences. That is part of it, but it is not the most useful part.

The more useful point is that each got something he actually wanted, and neither had to pretend to believe what he did not. McCain did not become a defender of government-run health care. Sanders did not become an advocate of private-sector solutions. They agreed on the immediate problem, veterans waiting too long, and each could accept the other's piece of the answer as long as his own piece was in it. The resulting law was not a muddy middle. It was two clear ideas, side by side.

The other ingredient was public pressure. Few things unite Congress like the image of a veteran dying on a waiting list. Members of both parties wanted to be able to go home and say they had done something, and they were willing to spend a large sum of money, in an era of tight budgets, to do it.

There is also the matter of trust. McCain was known for working across the aisle, from campaign finance reform with Russ Feingold to immigration reform with Ted Kennedy. Sanders, for all his reputation as an outsider, had a long record, going back to his House years, of passing amendments with Republican votes. Both knew how to make a deal when one was possible, and both were known to keep their word.

The argument that never ended

The Choice program was meant to be temporary. It was also, by many accounts, poorly run at first: veterans and private providers complained of confusion, delayed payments and long waits for authorizations. Congress extended and modified it several times.

In 2018, Congress replaced it with a broader, permanent program for community care. The new law was named for McCain, who was by then gravely ill with brain cancer, along with two other veterans who had served in Congress: Daniel Akaka of Hawaii and Sam Johnson of Texas. President Trump signed the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act, known for short as the MISSION Act, in June 2018. McCain died that August.

Sanders had concerns about the MISSION Act. He and others warned that steering more money to private providers, without matching investment in the VA's own capacity, could gradually hollow out the public system. Supporters argued that veterans deserved the freedom to choose where they get care, and that the VA would improve under competition.

That argument has continued ever since, and it is now one of the central debates about the future of veterans' health care. Studies comparing VA care to community care have found that VA care often holds up well on quality, while community care can sometimes be faster in certain places. Spending on community care has grown sharply as a share of the VA health budget. In 2025, the department announced plans for deep staff reductions, then scaled them back, amid fierce criticism from veterans' groups.

Here is the case we would make, labeled as such. The 2014 law got the balance roughly right: fix the immediate crisis by letting veterans get care outside when the VA could not provide it in time, and fix the underlying problem by building up the VA's own capacity. Community care is a useful supplement; it is a poor substitute for a well-staffed public system that specializes in the injuries and illnesses of military service. Veterans themselves often say they prefer the VA once they get in. The goal should be a VA that can see them quickly, not a VA that shrinks into a billing office for private providers.

What the odd couple teaches

Neither Sanders nor McCain would have chosen the other as a partner. They worked together because their constituents needed them to, because the facts were too stark to ignore, and because each saw a way to get something he believed in.

That is a better model of bipartisanship than the one usually on offer. It does not require anyone to abandon principle or split the difference on everything. It requires identifying a concrete problem, letting each side bring its strongest idea to the table, and refusing to let the perfect version of either idea block a law that helps people now.

Veterans come from every part of the country and every political tradition. They are rural and urban, young and old, of every race. They have long been one of the few constituencies for whom Congress can still act together. Progressives who care about public health care have a natural ally in veterans who depend on the largest public health system in the country. That alliance runs through red states as much as blue ones.

What forty miles meant in a rural state

The distance rule in the Choice program sounds like a technicality. For many veterans it was the whole point.

Large parts of the country, especially in the Mountain West, the Plains and rural Appalachia, are a long drive from the nearest VA medical center. A veteran on a ranch in eastern Montana or in a mountain town in Arizona might face hours on the road for a routine appointment, and a winter storm could turn that drive into a day. The 2014 law tried to address this by letting veterans who lived more than 40 miles from a VA facility see a private provider closer to home.

The rule ran into trouble almost immediately. Early on, the distance was measured as a straight line on a map rather than as the miles a veteran would actually drive, so someone separated from a clinic by a mountain range or a lake might not qualify. Veterans and members of Congress from both parties complained, and the rule was later changed to use driving distance. Another early complaint was that a small clinic offering limited services could count as the nearest facility even when it could not provide the care a veteran needed.

These sound like administrative details. They are where policy meets a person's life. A good law can fail in the fine print, and the people who notice first are usually those who depend on it. That the problems were fixed is a credit to veterans who complained loudly and to lawmakers who listened.

What you can do

• Ask your members where they stand on VA staffing. Use our representatives lookup to find your House member's and senators' phone numbers and contact forms, and check their latest votes before you call. Hiring and keeping VA clinicians is the piece of the 2014 deal that needs the most attention now.
• Follow the debate over public and private care. The health care for all topic page collects coverage of public health systems, including the VA, and the arguments over privatization.
• Help a veteran get connected. Many veterans do not know what care they are eligible for. Our organizations directory lists nonprofits by cause in every state, including legal aid and health groups that help veterans with enrollment and claims. This is general information; individual eligibility depends on service history.
• Collect examples of cross-party wins. Our list of bills both parties passed together shows the Choice Act is not an isolated case.
• Talk to a veteran about their care. Ask what works and what does not. Their answers will be more specific, and more persuasive, than any think-tank report.