Congress Has One Hurdle Left to Pass a VA Bill, But It’s a High One

PHOENIX, AZ - MAY 08: Exterior view of the Veterans Affairs Medical Center on May 8, 2014 in Phoenix, Arizona. The Department of Veteran Affairs has come under fire after reports of the deaths of 40 patients forced to wait for medical care at the Phoenix VA hopsital.
National Journal
Stacy Kaper
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Stacy Kaper
June 24, 2014, 4:11 a.m.

The House and Sen­ate have agreed it’s time for re­form of the Vet­er­ans Af­fairs De­part­ment. Now they have to agree how to pay for it — and they have to do it quickly.

More than two dozen House and Sen­ate law­makers meet Tues­day to form­ally be­gin ne­go­ti­ations aimed at mer­ging the two chambe”s VA re­form bills in­to one. The meas­ures have some minor dis­crep­an­cies, but the big chal­lenge is how much the re­forms will cost and where the fed­er­al gov­ern­ment will find the fund­ing.

It was a ques­tion the cham­bers largely sidestepped as they rushed to pass re­forms in the wake of the VA scan­dal, which re­vealed that vet­er­ans were be­ing placed on “secret” wait­ing lists for treat­ment, and that some had died dur­ing the wait.

The Sen­ate deemed the re­forms im­per­at­ive and au­thor­ized emer­gency fund­ing to provide whatever re­sources ne­ces­sary to carry them out. Ce­ment­ing that sen­ti­ment, 75 sen­at­ors voted to waive budget off­set­ting pay-as-you-go rules to pro­tect that pro­vi­sion. The House bill would in­stead re­quire that the re­forms be fun­ded by Con­gress’s ap­pro­pri­ations pro­cess.

The ten­sion over pay­ment has been heightened as the Con­gres­sion­al Budget Of­fice has pro­jec­ted the meas­ures to cost more than ex­pec­ted.

CBO has said the Sen­ate bill could add as much as $35 bil­lion in dir­ect spend­ing over 10 years, and ul­ti­mately cost the fed­er­al gov­ern­ment an ad­di­tion­al $50 bil­lion a year as vets pur­sue ad­di­tion­al health care op­tions. The House bill — which seeks to slash health care wait times more ex­ped­i­tiously — is ex­pec­ted to en­tice more vet­er­ans in­to VA and private health care than the Sen­ate bill would, cost­ing the fed­er­al gov­ern­ment a pro­jec­ted $54 bil­lion per year.

“Their ini­tial urge was to for­get about fund­ing al­to­geth­er and get it past them, and now, of course, the whole pro­cess has slowed down, so now they are stuck with hav­ing to deal with budget real­ity. It’s go­ing to be dif­fi­cult,” said Joseph Ant­os, the Wilson H. Taylor Schol­ar in health care and re­tire­ment policy at the con­ser­vat­ive Amer­ic­an En­ter­prise In­sti­tute. “This is a prob­lem for Re­pub­lic­ans and Demo­crats alike.”

But as Con­gress ex­plores fund­ing solu­tions, vet­er­ans groups will be watch­ing care­fully, push­ing the law­makers to provide spe­cif­ic, long-term fund­ing for the re­forms. Tem­por­ary fund­ing or budget tricks, the groups say, could lead to a re­turn to the status quo, where vet­er­ans con­tin­ue to suf­fer from in­ad­equate care.

“Con­gress and VA must not rely on budget­ary gim­micks, such as un­real­ist­ic es­tim­ates of op­er­a­tion­al im­prove­ments, ef­fi­cien­cies, col­lec­tions, carry­overs, and con­tin­gen­cies. These un­doc­u­mented ‘sav­ings’ have rarely ma­ter­i­al­ized and have con­trib­uted sig­ni­fic­antly to fund­ing short­falls that have plagued VA for more than a dec­ade,” the heads of more than a dozen vet­er­ans or­gan­iz­a­tion wrote to con­gres­sion­al lead­ers last week.

The groups fear that, giv­en the polit­ic­al sens­it­iv­ity of the is­sue and the com­ing Fourth of Ju­ly re­cess, the groups will rush the bill through with an in­com­plete fund­ing ar­range­ment.

“They are not go­ing back home for the Ju­ly Fourth re­cess without hav­ing a bill on the pres­id­ent’s desk. They all want something to go home and cham­pi­on,” said Louis Celli, the le­gis­lat­ive dir­ect­or for the Amer­ic­an Le­gion. “I think they have to with all the ex­pos­ure on this.”¦ The vet­er­ans need help, they need to be seen.”

Ana­lysts and con­gres­sion­al aides fol­low­ing the pro­cess ex­pect law­makers to pull out their fisc­al tricks, in­clud­ing the use of ar­gu­ably bogus fund­ing sources or ad­op­tion of rose-colored as­sump­tions about cost sav­ings from cer­tain pro­grams. Al­tern­at­ively, law­makers could at­tempt cost-cut­ting by tight­en­ing re­stric­tions on who would be eli­gible for care or lim­it­ing ac­cess by oth­er means.

Most of the real wheel­ing and deal­ing is ex­pec­ted to take place be­hind closed doors, and ne­go­ti­ations among staffers have already be­gun.

Bey­ond fund­ing woes, the law­makers have a host of in-the-weeds de­tails to ham­mer out be­fore send­ing the bill to Pres­id­ent Obama.

Both bills make it easi­er to fire in­com­pet­ent seni­or VA lead­ers and aim to im­prove vet­er­ans’ ac­cess to health care with­in and out­side the VA.

But while the Sen­ate bill would cre­ate an ap­peals pro­cess for fired VA lead­ers to con­test their dis­missal, the House bill lacks that pro­vi­sion. The Sen­ate bill would also ex­pand the GI bill’s in-state tu­ition be­ne­fits fur­ther than sep­ar­ate House le­gis­la­tion would, in­clud­ing fund­ing to the spouses of de­ceased vet­er­ans who would have qual­i­fied for the tu­ition break.

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