“What, in effect, those people are saying is that the military service of our staff and our members and our ideas mean less than theirs simply because we don’t have a congressional charter and we don’t wear hats,” he said.
The relative newcomers to the world of veterans policy see in the debate an opportunity to advance their campaign against government-provided medical care. Together, they have pledged millions of dollars for advertising and outreach, and have unleashed a small army of lobbyists and donors to pressure the Trump administration and Republican lawmakers.
Their efforts come as lawmakers on Capitol Hill are crafting legislation that could drastically reshape the Department of Veterans Affairs’ Veterans Health Administration, a multibillion-dollar health system that provides care to nearly nine million veterans each year. They are hoping to complete their work before the end of the year, when a key agency program is set to run out of money.
With Republicans in control of the White House and both chambers of Congress, the Koch-funded efforts have already succeeded in disrupting the consensus-driven veterans community, where policy discussions have long been dominated by congressionally chartered veterans groups.
Those groups still have significant clout with lawmakers, and in many cases they have largely banded together to critique the Koch-driven proposal, which they fear would effectively dismantle the agency they have built up over decades. At least one left-leaning veterans advocacy group, VoteVets, has also joined them, pledging to spend hundreds of thousands of dollars to oppose privatization.
Representative Phil Roe, Republican of Tennessee and the chairman of the House Veterans Affairs Committee, said he was committed to moving bipartisan legislation and would engage with “all stakeholders with serious ideas.”
But Representative Tim Walz of Minnesota, the committee’s top Democrat, said Concerned Veterans for America should not be underestimated, particularly with its links to the White House and with other well-connected conservative groups waiting for a chance to take on a relatively popular government health care program.
“I don’t underestimate the Kochs one bit. It is brilliant what they are trying to do,” Mr. Walz said. “They are as close to this White House and to the secretary as anyone.”
Founded in 2012 with money from the Koch brothers and other conservative donors, Concerned Veterans for America first rose to prominence within the veterans community around a 2014 scandal over the manipulation of patient wait times at Department of Veterans Affairs facilities. In the aftermath, the group emerged as a vocal — and aggressive — critic of the agency. It advocated the creation of the so-called Veterans Choice program, which requires the agency to pay for veterans facing barriers to care within its own health system to get outside help.
“This has been a yearslong sustained campaign to reform and fix the V.A.,” Mr. Caldwell said. “We’ve really strongly advocated for three core reforms: accountability, making it easier to fire and discipline bad employees; choice, giving veterans more control over their health care; and transparency, making the V.A. share more information with the public in terms of how it’s performing.”
Now, Concerned Veterans wants legislators to go further, giving veterans the last say over where to use the health benefits they earn for years of service.
It is also better positioned. President Trump has spoken favorably of letting veterans choose. The group’s former executive director was considered to be Veterans Affairs secretary. Another senior adviser was given a top position there before moving over to the White House. And Marc Short, the White House’s legislative director, is a former top Koch lieutenant.
The latest push was a natural fit to activate other Koch groups, including Americans for Prosperity and Freedom Partners, according to a representative of the network, who asked for anonymity to discuss the group’s plans. The network plans to spend liberally from its $300 million to $400 million policy and politics budget for the year, financing outreach to activists, lobbying and direct advertising.
Other allied groups, including Grover Norquist’s Americans for Tax Reform and Tea Party Nation, have come along, signing a letter to lawmakers late last month amplifying many of Concerned Veterans’ long-running arguments.
That campaign has disturbed many of the old-line veterans groups, which argue that their privileged place in advising lawmakers is protected for a reason. Concerned Veterans and other advocacy groups working alongside it take directions from wealthy donors, they say, not veterans.
The old-line veterans groups and lawmakers from both parties supported the creation of the Choice program and largely agree that the agency’s health programs need reorganization. The House committee was set to vote on bipartisan legislation on Wednesday that would allow agency doctors to decide with the veteran when it was in a veteran’s best interest to seek private care — because a nearby government facility either was overburdened or could not provide specialty care.
The vote was ultimately postponed over cost concerns.
Republicans and conservative groups would prefer new spending be at least partly offset by cost savings and other cuts to the Department of Veterans Affairs. Democrats and the old-line veterans groups say they are unlikely to support a plan unless it makes simultaneous investments in the agency’s own capacity. Without it, they argue, the problems that have necessitated private care in the first place will only fester.
“This is starve the beast to the point that it can’t function situation,” Mr. Walz said of the latter plan, “because if you don’t do this, the complaints against the V.A. are going to increase exponentially. The wait lists are going to increase. And then they are going to say, ‘See, we need more outside care.’”
Mr. Caldwell said the House bill did not go far enough. The government, he argued, would still have too much control of veterans’ health choices. His group and its allies will keep fighting for a more ambitious reshaping of Veterans Affairs.