Remember the Veterans Health Care Crisis?

Here’s what Congress needs to do to push reform legislation over the final hump before campaign season hits.

 Corporal Arnold Franco, who served in the United States Army from 1943 to 1945 rides in a vehicle during the Veteran's Day Parade on November 11, 2013 in New York City.
National Journal
Stacy Kaper
July 6, 2014, 4:42 p.m.

Hav­ing so far failed to com­plete re­form le­gis­la­tion in­ten­ded to en­sure vet­er­ans don’t die wait­ing for health care, law­makers re­turn fa­cing sig­ni­fic­ant un­fin­ished busi­ness to show voters ac­tion be­fore they go home to cam­paign in Au­gust.

The House and Sen­ate are un­der the gun to show a re­sponse to re­ports that vet­er­ans have been left lan­guish­ing for months on secret wait­ing lists for med­ic­al treat­ment, or nev­er even get­ting onto such lists. Vet­er­ans are a pop­u­lar con­stitu­ency that neither party can af­ford to ig­nore, so the pres­sure is on to de­liv­er something law­makers can cam­paign on, be­fore elec­tion sea­son heats up.

But mem­bers serving on a joint House and Sen­ate con­fer­ence com­mit­tee, tasked with hash­ing out vet­er­ans re­form le­gis­la­tion, made little head­way be­fore re­cess.

The 28 com­mit­tee mem­bers agreed they are com­mit­ted to a bi­par­tis­an solu­tion that will make it easi­er for vet­er­ans to re­ceive the care they de­serve. But sev­er­al — par­tic­u­larly Re­pub­lic­ans — re­main hung up over con­cerns about es­tim­ates from the non­par­tis­an Con­gres­sion­al Budget Of­fice that the re­forms could cost as much as $50 bil­lion a year.

The le­gis­la­tion would make it easi­er to re­move in­com­pet­ent Vet­er­ans Af­fairs De­part­ment lead­ers. It also aims to en­sure vet­er­ans re­ceive more timely care, in­clud­ing by let­ting vet­er­ans who live more than 40 miles from a VA health cen­ter seek care from private pro­viders.

But law­makers largely do not want to be seen doub­ling the gov­ern­ment’s cost of VA health care to achieve this goal.

Be­fore re­cess, at the only pub­lic meet­ing of the con­fer­ence com­mit­tee, Sen. Richard Burr, R-N.C., who serves as the rank­ing mem­ber on the Sen­ate Vet­er­ans Af­fairs Com­mit­tee, blas­ted the CBO num­bers, call­ing the agency’s as­sump­tions “ludicrous” and chal­len­ging it to back them up.

Since then mem­bers and staff have met be­hind closed doors with CBO of­fi­cials, ask­ing for a jus­ti­fic­a­tion of its as­sump­tions. CBO has ar­gued that be­cause the le­gis­la­tion aims to im­prove ac­cess to VA health care and min­im­ize wait times, vet­er­ans are likely to in­crease the amount of care they re­ceive from the VA. And vet­er­ans who do not cur­rently rely on the VA are also more likely to en­roll in it and seek out this be­ne­fit.

Cur­rently about 8 mil­lion of roughly 21 mil­lion vet­er­ans are en­rolled in VA health care; of those, about 6. 5 mil­lion take ad­vant­age of it. CBO es­tim­ated that an­oth­er 8 mil­lion eli­gible vet­er­ans might seek ac­cess to VA health care be­cause of the im­prove­ments to its ac­cess that would be made through the le­gis­la­tion.

But some con­fer­ence com­mit­tee mem­bers are balk­ing, chal­len­ging these pre­dic­tions. They are ask­ing CBO and the VA to come up with new es­tim­ates of what the le­gis­la­tion would cost if ad­di­tion­al re­stric­tions or lim­it­a­tions were placed on the ex­pan­ded ac­cess to health care in a fi­nal bill.

“The first or­der of busi­ness is for VA and CBO to pro­duce in­form­a­tion re­gard­ing cer­tain costs and con­sid­er­a­tions as­so­ci­ated with pos­sible re­form per­muta­tions,” said a con­gres­sion­al aide fa­mil­i­ar with the ne­go­ti­ations.

No ad­di­tion­al form­al meet­ings of the full roster of con­fer­ees have been set, but in­di­vidu­al mem­bers and staff con­tin­ue to dis­cuss ways to whittle down the pro­jec­ted costs of the re­form.

Law­makers say they are com­mit­ted to hash­ing out a com­prom­ise bill and get­ting it through both cham­bers and to the pres­id­ent’s desk as quickly as pos­sible. But sources track­ing the ne­go­ti­ations ar­gue the cost wrinkles could take a while to iron out, mak­ing the Au­gust re­cess the next big dead­line for com­ple­tion.

“What needs to hap­pen is the con­fer­ees need to agree upon the size and scope and cost “¦ as well as some of the oth­er ini­ti­at­ives in the bill,” said Robert Norton, a deputy dir­ect­or of gov­ern­ment re­la­tions with the Mil­it­ary Of­ficers As­so­ci­ation of Amer­ica. “Our biggest con­cern is that they need to get it done. They need to make sure that vet­er­ans get ac­cess and are not stuck on these wait­ing lists for months on end.”

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