WASHINGTON — President Donald Trump signed the sweeping $52 billion VA Mission Act into law on Wednesday. Now the fight starts over what that means.

The measure, which drew bipartisan support in Congress and effusive praise from Trump at a White House signing ceremony, lays the groundwork for an overhaul of the Veterans Affairs community care programs, with the promise of easier access to free appointments with private-care doctors for veterans.

But major questions remain over how the new provisions will be funded and exactly who will benefit from the overhaul of Veterans Affairs health care offerings.

In his remarks before the signing, Trump insisted the measure gives veterans “real choice” in their health care decisions, adding that “we’ve been looking for choice for a long time.”

Specifics of who will be eligible for the new community care offerings won’t be settled for another year. Veterans groups are gearing up for months of negotiations behind the scenes on rules regarding when patients can seek outside care and what role department medical officials will have in continued oversight of their medical treatments.

“We have faith this administration will properly execute on the regulatory process,” said Dan Caldwell, executive director at Concerned Veterans for America.

“We’re going to be monitoring the rule-making process, and we’re hopeful we’ll get a good set of regulations that come out and ultimately increase choice for veterans in ways that are difficult to undermine by the bureaucracy.”

The bill also includes an expansion of caregiver benefits to veterans of all eras and plans for a review of all VA facilities in coming years, with an eye towards dramatic changes in the department’s national footprint.

But the health care aspects were the most controversial and most challenging for lawmakers. Although the legislation received bipartisan support in Congress and among veterans groups, critics of Trump have warned that the reforms could open the door to widespread outsourcing of veterans medical care to private-sector doctors.

That makes the upcoming rule making for the VA Mission Act a potential battlefield for both advocates and lawmakers. Numerous Democrats have accused Trump of working to privatize VA responsibilities, and major veterans groups have expressed concerns with funding being sent from within the department to outside doctors.

Officials from Vietnam Veterans of America noted that deadlines mandating certain decisions on the new regulations be completed within 120 days have the potential to produce rushed, problematic new guidelines.

“Will Congress still retain authority over this proposed shadow healthcare delivery system?” asked John Rowan, executive director at VVA. “Oversight with accountability is not spelled out to our satisfaction in this legislation.”

“Expanding the scope of the programs and services of Choice without a firm foundation is a recipe for disaster which will ultimately cheat veterans out of the health care they have earned and deserve.”

Also complicating the issue further is a memo to Hill staffers from White House officials opposing a Senate plan to raise non-defense spending caps to cover the costs of the new VA reforms. Administration officials say that money should come from cuts elsewhere in the federal bureaucracy.

The looming fights come after more than a year of intense debate on the issue of VA health care. More than one-third of all VA-funded medical appointments are handled outside the VA medical system, but Trump has repeatedly lamented that too many veterans are trapped using the federal system as their only health care option.

“If the VA can’t meet the needs of a veteran in a timely manner, that veteran will have the right to go right outside to a private doctor,” the president said. “So simple and yet so complex.”

Trump praised Republican congressional leaders for passage of the measure, but did not invite Senate Veterans’ Affairs Committee ranking member Jon Tester, D-Mont. and a co-author of the measure, to the event.

Rule-making responsibilities for now fall to acting VA Secretary Peter O’Rourke to oversee, although he is expected to return to his role as chief of staff after the confirmation of Robert Wilkie as the new permanent VA secretary. No timeline has been set for that process.

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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