Are Budget Battles Slowing Health Care Reforms for Veterans?

Congress is struggling to push legislation over the finish line in response to reports that veterans seeking health care have been left languishing on secret wait lists.

National Journal
Stacy Kaper
July 8, 2014, 7:03 p.m.

As law­makers scramble to push through le­gis­la­tion that aims to stop vet­er­ans from dy­ing wait­ing for health care, vet­er­ans’ groups hope fund­ing squabbles over the cost of the re­forms don’t im­pede vet­er­ans’ ac­cess to med­ic­al treat­ment.

The House and Sen­ate are still strug­gling to push le­gis­la­tion over the fin­ish line in re­sponse to re­ports raised back in April that vet­er­ans seek­ing health care have been left lan­guish­ing for months on secret wait lists—or nev­er even mak­ing it in­to the queue. Law­makers were ex­pec­ted to send re­form le­gis­la­tion to the pres­id­ent be­fore the Fourth of Ju­ly re­cess, but they failed to reach an agree­ment in time. They’re now un­der pres­sure to show res­ults be­fore Con­gress breaks again at the end of the month.

Not want­ing to let the mo­mentum from the crisis wane, vet­er­ans ser­vice or­gan­iz­a­tions are try­ing to: coax law­makers to pri­or­it­ize re­forms, help them con­vince the Con­gres­sion­al Budget Of­fice to lower its cost as­sump­tions, and guar­an­tee a fund­ing stream is put in place.

The le­gis­la­tion the House and Sen­ate con­fer­ence com­mit­tee is work­ing to iron out would make it easi­er to re­move in­com­pet­ent of­fi­cials at the Vet­er­ans Af­fairs De­part­ment and en­sure vet­er­ans re­ceive more timely care, even if it means go­ing out­side the VA.

The re­form en­joys broad bi­par­tis­an sup­port, but it’s suf­fer­ing from stick­er shock over es­tim­ates by the non-par­tis­an CBO that it could cost as much as $50 bil­lion a year to im­ple­ment.

Some vet­er­ans’ groups fear that law­makers could suc­cumb to pres­sure to show fisc­al re­straint and rely on budget gim­micks that bring the le­gis­la­tion’s cost es­tim­ates down, but that don’t provide suf­fi­cient re­sources to en­sure vet­er­ans’ ac­cess to care will be met.

“Our biggest con­cern is the fund­ing,” said Joseph Vi­olante, the na­tion­al le­gis­lat­ive dir­ect­or, with the Dis­abled Amer­ic­an Vet­er­ans. “There is no clear path here that I can see that VA is go­ing to get the fund­ing they need. … It’s frus­trat­ing, be­cause vet­er­ans are go­ing to have high ex­pect­a­tions of be­ing able to get timely care, wheth­er that’s in the private sec­tor or at the VA, and I don’t know that VA is go­ing to be able to ful­fill that.”

Oth­er vet­er­ans’ ad­voc­ates are fo­cus­ing on work­ing with con­fer­ence com­mit­tee mem­bers and the CBO to en­sure the key goals of the le­gis­la­tion are achieved while still keep­ing the costs down.

For ex­ample, a big part of the reas­on for the CBO’s high­er-than-ex­pec­ted cost es­tim­ate was its as­sump­tion that some 8 mil­lion ad­di­tion­al vet­er­ans might flock to the VA, giv­en the ex­pec­ted im­proved ac­cess to health care.

The bills un­der con­sid­er­a­tion would re­strict the vet­er­ans who could seek care out­side the VA to those who live more than 40 miles from a VA health cen­ter. But oth­er re­stric­tions that would keep costs down are un­der con­sid­er­a­tion, such as re­quir­ing that only vet­er­ans who were left wait­ing by the VA can go out­side it for treat­ment.

“We’ve en­cour­aged CBO to give Con­gress an es­tim­ate of just what it would cost to ad­dress the cur­rent vet­er­ans who are cur­rently en­rolled, who are ex­ist­ing on the back­log today, be­cause that was what this le­gis­la­tion was ori­gin­ally de­signed to ad­dress,” said Louis Celli, the le­gis­lat­ive dir­ect­or with the Amer­ic­an Le­gion. “If we had that es­tim­ate, I think every­body would be much more com­fort­able with the fact that this is an emer­gency piece of le­gis­la­tion spe­cific­ally de­signed to ad­dress this back­log, and if we use it for that, the costs will be much more in line and in keep­ing with something reas­on­able to ad­dress this emer­gency.”

Oth­er vet­er­ans’ or­gan­iz­a­tions are so fed up with wait­ing for re­forms to im­prove vet­er­ans’ care that they are com­fort­able with law­makers us­ing a vari­ety of budget tools to get the le­gis­la­tion signed in­to law. That’s even if it means the VA will have to prove it’s mak­ing pro­gress in or­der to se­cure ad­di­tion­al funds from Con­gress down the road to com­plete the re­forms.

“There is a range of op­tions to deal this from a budget­ary per­spect­ive, and I think they are go­ing to end up com­ing to an agree­ment on a way to move for­ward on the budget that re­cog­nizes the crisis as­pect of this and that is also fisc­ally re­spons­ible,” said Alex Nich­olson, the le­gis­lat­ive dir­ect­or of the Ir­aq and Afgh­anistan Vet­er­ans of Amer­ica.

He pre­dicted law­makers would have to rely on a mix of us­ing avail­able re­sources at the VA, debt fin­an­cing, and ad­di­tion­al ap­pro­pri­ations down the road, which he said was an ac­cept­able solu­tion.

“Our No. 1 pri­or­ity is for them to get it done. It’s con­cern­ing that it’s stretched it out this far already,” he said. “We don’t want to see this delayed by pos­tur­ing or fisc­al tac­tics. The pro­vi­sions that really ex­pand and en­hance the VA’s ca­pa­city and flex­ib­il­ity to help people who are ac­tu­ally wait­ing right now and are not get­ting care and treat­ment — that should be the No. 1 pri­or­ity.”

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