A wide-ranging veterans policy bill that would bolster home caregiver programs and support for homeless veterans, among other areas, was approved by the House on Monday evening after election-season politics stalled the bill for months.

Tweaks were made to the legislation between when it was first introduced over the summer and Monday’s vote that got Democrats on board with the bill, allowing it to easily pass the House in a bipartisan 389-9 vote.

But the backbone of the bill — language aimed at making it easier for aging and disabled veterans to get home- and community-based nursing care — remained intact in the version of the bill approved Monday.

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“For nearly the entire 118th Congress, the House and Senate committees on Veterans Affairs have worked together to develop a bipartisan package of common-sense proposals,” House Veterans Affairs Committee Chairman Mike Bost, R-Ill., said on the House floor Monday afternoon. “The Dole Act is a result of that work and would enhance, reform and modernize nearly every part of the VA. Specifically, the Dole Act would change the landscape for elderly veterans and finally give them a choice in where they choose to live out their sunset years.”

Dubbed the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, the marquee provisions in the bill would increase the Department of Veterans Affairs’ share of covering home nursing care from 65% to 100% of costs and make several other changes to increase the accessibility of home nursing care for veterans.

The changes have long been sought by caregivers and their advocates who say that veterans should be able to live out their final days at home if they choose.

On veterans homelessness, the bill would increase the per diem rate the VA can pay to organizations providing short-term transitional housing from 115% of costs to 133%. It would also give the VA flexibility to provide unhoused veterans with bedding, shelter, food, hygiene items, blankets and rideshare services to medical appointments. Both changes would sunset in September 2027.

The VA had those authorities during the COVID-19 pandemic, and they were credited with reducing the veterans homelessness rate. But the authorities expired when the public health emergency did.

Those two aspects of the bill always had broad bipartisan support, but other aspects of the bill became political lightning rods.

Democrats argued that some language in the bill amounted to backdoor efforts to privatize the VA, while some Republicans argued that the bill did not go far enough in expanding veterans’ ability to seek private health care using VA funding. Veterans groups maintained both sides were playing politics with a much-needed bill ahead of a hotly contested election.

One of the sections caught in that fight — which would have established new access standards for veterans to get treatment at residential mental health and substance abuse programs and allow veterans to go to non-VA programs if the wait for a VA program is too long — was taken out of the bill approved Monday.

But another of the contentious sections made it into the approved bill. That section would ban the department from overriding a VA doctor’s referral for their patient to get outside care. The ban would last two years, after which the VA would need to report to Congress on its effects.

The tweak was enough to get Democrats to support the bill.

“Our caucus held firm on our values and have fought to preserve VA health care for current and future generations of veterans,” Rep. Mark Takano, D-Calif., the ranking member of the House Veterans Affairs Committee, said in a statement ahead of the bill’s passage. “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, and better late than never.”

In the end, all nine “no” votes came from Republicans: Reps. Josh Brecheen of Oklahoma; Eli Crane of Arizona; Jeff Duncan of South Carolina; Bob Good of Virginia; Paul Gosar of Arizona; Ralph Norman of South Carolina; Matt Rosendale of Montana; Chip Roy of Texas; and Keith Self of Texas.

“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,” Rosendale said in a statement on his vote against the bill.

Rosendale’s statement specifically objected to a provision in the bill that would define a surviving spouse as someone who “lived continuously with the veteran until their death and who has not remarried,” because, he said, it codifies language allowing the VA to pay benefits to same-sex partners.

He also cited that the bill approved Monday excluded any language related to the beleaguered electronic health records program.

The bill that was introduced in May would have required the VA to end its contract with Oracle Cerner unless its troubled system is fixed, among other provisions aimed at improving the health records program, but all of that language was taken out of the final bill.

A raft of other provisions were approved Monday, including ones authorizing grants for mental health care for veteran caregivers; mandating the VA provide caregivers booted from the Program of Comprehensive Assistance for Family Caregivers with the option to enroll in other caregiver programs; extending a high-tech job training program for veterans through 2027; allowing GI Bill beneficiaries to continue getting a housing allowance even if they are only part-time students in their final semester; and requiring the VA to reimburse ambulance costs for some rural veterans.

The bill must still be approved by the Senate before heading to President Joe Biden’s desk for his signature. The Senate has not yet said when it will take up the bill, but must do so before the end of this congressional session in January or else the legislative process would need to start from scratch.

“I know the determination that reaching consensus often requires, so I applaud the members of Congress and congressional staff who never gave up on this bill, and the coalition of veterans’ organizations that never wavered in their commitment to ensure that these life-changing and life-saving promises be delivered,” the bill’s namesake, former Sen. Elizabeth Dole, said in a statement released by the House Veterans Affairs Committee. “I am eager to see this package now quickly pass in the Senate and be sent to the president’s desk for his signature.”

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