Like a waiter bringing the check after a high-spirited meal in a fine restaurant, the Congressional Budget Office has dampened some good vibes among lawmakers who rushed to solve the access-to-care crisis for veterans.
CBO estimates the cost of requiring the Department of Veterans Affairs to provide non-VA medical care to any enrolled veteran who cannot get a VA medical appointment within 30 days, or who lives more than 40 miles from a VA medical facility, at a stunning $54 billion annually.
That estimate takes into account language in both the House and Senate versions of the bill that would end new guarantees on access to non-VA care after two years. But by then, CBO predicts, two million more vets who don’t use VA care today will be drawn to it by new ease of access.
Veterans service organizations, though grateful overall, are worried about unintended consequences of HR 4810, as passed by the House, and of HR 3230, as modified and passed by the Senate. If politicians aren’t truly committed to treating more vets, then VA budgets to run existing facilities could be put at risk and many vets won’t see gains in access long term.
Executives of 17 major veterans groups and military associations shared these and more concerns in a June 17 letter to chairmen and ranking members of the House and Senate veterans affairs committees. They will lead House-Senate conferees in ironing out differences between their separate bills. Plans are to have a final bill to President Barack Obama by July 4.
“While we appreciate the speed with which you have moved, the opportunity for veterans organizations and other key stakeholders to provide substantive input to the process has been limited,” warned the executives.
One big worry is that, in mandating expansion of VA’s purchased care authority, Congress must commit to forcing VA to accurately estimate and budget for the added health costs. Congress, in turn, must fully fund the new authorities and not rely on budget “gimmicks” or shift funds from accounts needed to run VA hospitals, clinics and other health care programs.
“Unless additional funding is provided specifically for the expansion of purchased care, needed care will remain delayed and VA facilities will be forced to continue making tradeoffs,” vet groups warned.
They fear the VA having to choose between “providing additional access through purchased care (or) expanding internal capacity for the future through additional hiring of clinicians, purchase of equipment or expansion of infrastructure.”
The House passed its bill from its VA committee chairman Rep. Jeff Miller, R-Florida, unanimously. The Senate bill drew only three “no” votes, all from Republicans worried over billions of dollars in unfunded costs. Sens. Bob Corker from Tennessee, Ron Johnson of Wisconsin and Jeff Sessions out of Alabama even wrote to House colleague Miller, usually a reliable deficit hawk, not to allow a final bill out of conference committee that would balloon VA health budgets.
Miller responded that he “is committed to paying for the reforms in a responsible manner that is fair to the taxpayers and to our veterans.”
The Senate-passed Veterans Access to Care Act from Sens. Bernie Sanders, I-Vermont, VA committee chair, and John McCain, R-Ariz., would expand VA reliance on medical services contracts with non-VA health care providers so any eligible veteran who requests VA care gets it promptly.
CBO calls it “broad new authority” that would entice about two million more veterans to enroll in VA care, many shifting in from Medicare or Medicaid. The 8.3 million veterans already enrolled in VA care would seek to increase their use of VA care by about 75 percent, the CBO estimates, given the new VA mandate on swift access or the convenience of local providers.
“All told,” CBO said, “if the bill was fully implemented, some veterans would ultimately seek additional care that would cost the federal government about $54 billion a year, after accounting for savings to other federal programs.”
VA care, the CBO noted, “requires no premiums, imposes no deductibles and assesses low or for many veterans no co-payments” and therefore would be attractive. But because new access mandates are to end after two years, about six million eligible veterans not currently enrolled “would not change their health care arrangements for that short period.”
New authorities in the House bill would expire two years after enactment but cover ongoing treatments up to 60 more days. Authorities, requirements and funding under the Senate bill would expire Sept. 30, 2016.
The Senate tagged its VA wait-time fix as an emergency appropriation, which lifts a requirement to find budget offsets to cover the cost. The House bill isn’t paid for, except partially with funds once earmarked for VA employee bonuses. Miller and staff were looking for other offsets.
In a floor statement Wednesday, Miller criticized the Senate for giving VA a “blank check” to improve access to care. He recalled “hearing after hearing” on VA “wasteful spending” and “bloated bureaucracies.”
“It is imperative that Congress follow a more methodical approach to funding new requirements, which preserves Congress’ oversight responsibility to protect taxpayer resources provided on behalf of America’s veterans. This is the House position and we ought to fight for it,” Miller said.
That same day, he chaired a hearing to review VA programs Congress previously approved to expand non-VA care for veterans, including contracts for specialty care with networks of physicians earlier established to support the military’s Tricare program. In opening remarks, Miller warned that Congress no longer would tolerate long delays by VA in authorizing private sector care to vets who can’t get timely care in VA hospitals or clinics.
“We cannot – and beginning now we will not – allow VA to continue to prioritize what may be right for the VA health care system – providing care to veterans at VA facilities first and foremost – over what is right for our veterans,” Miller said.
However, he assured veterans that the push to expand access to private sector care is to address the wait-time scandal only.
“To be clear,” Miller said, “I am in no way advocating for the dismantling of the VA health care system as some know it today.”
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