The Obama administration said it agrees with the majority of the recommendations from the congressionally- appointed VA Commission on Care, which in July released 18 suggestions to improve veterans health care.

President Barack Obama officially responded to the VA Commission on Care’s report ahead of the first congressional hearing on the recommendations next week.

Obama agreed with 15 of the 18 recommendations from the Commission, many of which the VA had already started to implement under Secretary Bob McDonald’s  MyVA initiative, he said in a Sept. 1 letter to Congress.

The administration concurred with the Commission’s recommendations to improve clinical operations, more consistently deliver health care to veterans, set up a more efficient appeals process, modernize IT and set up new professional development and performance management procedures.

McDonald agreed with the President’s evaluation, calling the 15 out 18 recommendations “feasible and advisable.”

But Obama and McDonald both took issue with the Commission’s suggestion that an 11-member board of directors oversee the Veterans Health Administration’s transformation and long term strategies.

“The proposal would undermine the authority of the secretary and the undersecretary for health, weaken the integration of the VA health care system with the other services and programs provided by the VA, and make it harder — not easier — for VA to implement transformative change,” Obama said. “Moreover, the Department of Justice has advised that the proposed recommendation would violate the Appointments Clause of the Constitution.”

The proposed board would have the authority to review and approve major operational and business plans, including the VHA’s budget request.

McDonald said he agreed with the idea that the department should seek external advice to help guide its decisions and policies. And the VA already has such a board, McDonald said. The secretary formed the MyVA Advisory Committee last year, he said in response to the President’s letter.

“This proposal would seem to establish VHA as an independent agency, which would frustrate ongoing efforts to improve the veteran’s experience by integrating veterans health care and services across VA, making it more difficult for veterans to receive the quality care where, when and how they need it.”

The President said he did agree with the Commission’s suggestion that the VA undersecretary for health position become a term appointment to remove it “from the turmoil and turnover of the political cycle.” The Commission suggested the board recommend a candidate to serve a five-year term as VHA secretary.

Obama also praised the Commission’s overall “principle” to create a better, more integrated VA health care network. But he remained cautious with his praise and urged Congress to pass the department’s plan to consolidate community care to get the job done.

McDonald took the administration’s concerns a step further. Veterans service organizations have told the VA they fear alternative proposals would compromise the VA’s ability to provide specialized treatment for post-traumatic stress disorder, spinal cord injuries and other conditions that affect veterans more directly, he said.

“We share their concern and therefore do not support any policies or legislation that will lead to privatization, which I am pleased the Commission did not recommend outright,” McDonald said.

A previous draft of the Commission’s report described a more drastic shift to slowly close VA medical centers and privatize VA care over time.

The House Veterans Affairs Committee is expected to review the commission’s recommendations at a hearing Sept. 7, where Commission Chairman Nancy Schlichting and Vice Chairman Delos Cosgrove are scheduled to testify.

The President said he’s directed the VA to develop plans to implement the Commission’s recommendations that he agrees with, adding that he will work with the VA Secretary on legislative proposals if necessary.

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