The Department of Veterans Affairs’ health care workforce is one step closer to receiving full collective bargaining rights on par with the rest of the federal workforce.

The House on Thursday passed the VA Employee Fairness Act in a 219-201 vote. The bill, if it passes the Senate, would provide full collective bargaining rights for 100,000 VA doctors, physician assistants, nurses, dentists and chiropractors.

With those expanded collective bargaining rights, Title 38 employees at VHA can negotiate with management on workplace practices that affect patient safety and care, working conditions, peer reviews and employee pay.

VA health care personnel would also have the authority to report inefficiencies and potentially dangerous policies or incidents to management without retaliation.

VA employees have had collective bargaining rights since 1991, but its health care workforce,  classified as Title 38 employees under law, cannot collectively bargain on matters of professional conduct or competence, peer review or changes to employee compensation.

House VA Committee Chairman Mark Takano (D-Calif.), the bill’s author, said that without full collective bargaining rights, VA health care employees have been prevented from raising grievances about staffing shortages or negotiating for higher pay.

“This has long been part of the fabric of the federal workforce, but there’s one glaring exception,” Takano said. “Title 38 health care professionals such as registered nurses, physicians, dentists, and physician’s assistants do not have the same rights as the psychologists, social workers, pharmacists, and licensed practical nurses who work side by side with them.”

Takano said the bill would ensure the VA provides “basic worker protections” to new health care hires as the agency ramps up hiring over the next five years as it prepares to bring an additional 3.5 million veterans into the VA healthcare system.

“A nurse needs to be able to ask that their pay errors are will be resolved. A doctor must feel empowered to raise medical safety concerns without fear of reprisal or retaliation. Without these protections, VA will continue to struggle to recruit and retain the best and brightest medical professionals that our country has to offer,” Takano said.

VHA is looking to hire 52,000 employees in fiscal 2023 to keep up with its rate of attrition.

VA Press Secretary Terrence Hayes said the agency “will continue to work together with our valued labor partners to provide the best possible work experience for them, so they can deliver the best possible health care to the veterans we serve.”

The bill has 218 co-sponsors in the House and has the backing of federal employee unions.

National Federation of Federal Employees National President Randy Erwin said the legislation would allow frontline VA health care workers to negotiate with management, “especially during a time when the VA is dealing with significant staffing and funding issues,” and would help the VA fill thousands of vacancies.

“The medical practitioners employed by the VA are the very best healthcare professionals across the United States,” Erwin said. “They have the expertise and experience to understand the complexities that come with serving our veterans. Because of this, it is critical that they are allowed to share their professional opinions on matters within their facilities and collectively bargain with management.”

American Federation of Government Employees National President Everett Kelley said thousands of Title 38 VA employees “have been unfairly deprived of the same collective bargaining rights of their colleagues simply because of their job title.”

“We call on the Senate to pass this critical legislation, and if not, President [Joe] Biden and VA Secretary Denis McDonough must use their authority to provide expanded collective bargaining rights through executive action, consistent with their statement of support for the bill,” Kelley said.

The Office of Management and Budget issued a statement Thursday supporting the bill, and advances the Biden administration’s goal of making the federal government a “model employer.”

“The administration is committed to continuing to work with Congress to support hard-working employees while protecting veterans’ access to the care and services that they have earned through service to the nation,” OMB wrote.

Takano said the bill would only allow VA health care employees and their unions to file grievances on items under their contract with the VA.

“It’s not in the contract, a grievance cannot occur,” Takano said.

Committee Ranking Member Mike Bost (R-Ill.) opposed the bill, saying the legislation would allow third-party arbitrators to “second-guess” the VA’s decision to fire poor-performing medical providers.

“Unfortunately, bad actors and subpar providers do exist. And when they harm veterans or pose risks, they must they need to be removed from patient care quickly,” Bost said. “It is also not hard to believe that expanding grievance and process envisioned by this bill could paralyze hospitals over the issue of patient care, clinic, clinical competency and pay. In that scenario, care would be delayed.”

Takano said the bill would also ensure federal health care employees have the same collective bargaining rights across government, and noted that health care workers at the Department of Defense hospitals already have full collective bargaining rights.

“A registered nurse has collective bargaining rights at DoD, but not a registered nurse at VA. This is the kind of legal contortion that should be fixed,” Takano said.

Bost said eliminating these collective bargaining exemptions would limit the VA’s ability to make personnel decisions to provide the best care to veteran patients.

“These very special specific exceptions were made for a reason. The secretary is responsible for ensuring veterans receive high-quality and timely health care. To do that, he or she must have the authority to make difficult decisions, keeping hospitals running safe and to put veterans first. The secretary’s first mission is he or she must continue to provide care even in the worst of times. However, HR 1948 will tie the secretary’s hands. And I worry enacting of this legislation would put patients at risk,” Bost said

The committee passed the bill last year, but Bost said the bill deserves a full hearing to further investigate the issue.

“We’re jamming through an 11th-hour bill with no clear idea that it does what my colleagues say it does. How can we support legislation like this in the last hour?” Bost said.

Rep. Brian Higgins (D-N.Y.) said the bill would allow VA medical workers to speak up about patient care concerns without fear of retaliation from management.

“Our laws do not provide adequate voice for those workers to ensure care is of the highest quality. The COVID-19 pandemic showed us why that voice is necessary. This bill changes that by granting all VA health care providers the same collective bargaining rights,” Higgins said.

Rep. Al Green (D-Texas) said full collective bargaining rights for VA health care employees will allow the workforce to bring issues to the attention of management, and raise “issues that are impacting patients that the administration won’t be aware of.”

“There are many people who won’t want to speak up simply because they fear retribution. The right to organize is the right to speak up and understand that you can do so without retribution,” Green said.

Unlike in the private sector, federal workers who have collective bargaining rights cannot strike and they cannot bargain over their level of pay.

While Title 38 employees would be able to collectively bargain over some pay issues, pay levels are set by the Civil Service pay grades each year, and are not subject to collective bargaining.

“They are not going to go on strike. They are not going to shut down a VA hospital. They are not going to have the ability to cause the management to have to take some extreme measures. This is just a give people the opportunity to talk about the things that are important to the patients,” Green said.

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