House lawmakers easily passed a sweeping overhaul of the troubled Department of Veterans Affairs that will make it easier for the nation's military veterans to seek medical care outside the government-run system.

On a vote of 420 to 5, the House sent the legislation to the Senate, where it is expected to be easily approved by the end of Thursday. Five conservative Republicans voted against the legislation: Reps. Rick Crawford (Ark.), Walter Jones (N.C.), Jack Kingston (Ga.), Mark Sanford (S.C.) and Steve Stockman (Tex.). It was not immediately clear why they did so.

The legislation comes with an estimated price tag of nearly $17 billion, which has caused concern among some fiscally conservative lawmakers. But with the public and military veterans groups demanding quick corrective action at the VA, congressional leaders knew that approving the reforms before the summer recess would be critical.

The vote in the House came one day after the Senate unanimously confirmed former Procter & Gamble chief Robert McDonald to head the VA. The vote represented a rare example of swift, bipartisan action by the Senate: Obama nominated McDonald on June 30 and the Senate Veterans Affairs Committee gave him a warm reception during his confirmation hearing last week.

McDonald, 61, will replace acting VA Secretary Sloan Gibson, who will continue serving as deputy secretary. Gibson had led the department in an acting capacity since Obama accepted the resignation of former VA chief Eric K. Shinseki in May amid reports of falsified scheduling records and extensive treatment delays at VA medical centers.

Once the VA reform bill becomes law, eligible military veterans will be able to obtain a “Veterans Choice Card” that allows them to seek health care outside the VA medical system from eligible private providers and at facilities operated by the Defense Department or Indian Health Service. Veterans could use VA benefits, but seek outside care if they're unable to receive an appointment within 30 days or if they live more than 40 miles from the nearest VA facility.

The measure also provides $5 billion in emergency spending to pay for hiring new employees and authorizes VA to enter into 27 leases for new major medical facilities.

In a key concession to lawmakers furious about accusations that workers improperly compiled secret lists of waiting patients in order to avoid poor performance reviews, the new legislation bars VA from using wait-time metrics as a factor in determining a worker’s overall performance. Instead, most performance reviews would focus on the quality of care received by veterans. Top VA managers will be able to quickly demote or fire poor-performing workers, with less than a month given for the worker to formally appeal the decision.

House Minority Whip Steny Hoyer (D-Md.), whose suburban Maryland district is home to tens of thousands of active and retired federal workers, criticized negotiators for including the new due process rules for demoting or firing workers, but still voted for the bill.

Josh Hicks contributed to this report.