Advance appropriations for VA care

“When funds ran short, we were forced to place veterans on waiting lists.” Former Spokane, Wash., VA Medical Center Director Joseph M. Manley, in July 2007 testimony before the Senate Committee on Veterans Affairs Since 2001, the number of veterans using VA health-care services has increased by 2 million. More than 225,000 of those patients have come home from the global war on terrorism, commonly suffering from lifelong disabilities such as traumatic brain injury, post-traumatic stress disorder, amputations, burns, and lost vision. Forty years ago, many of them would have died where they fell. Today, thanks to amazing advances in battlefield medicine, they survive like at no other time in history.

Discharged and home, this new generation of disabled veterans turns to VA for its extraordinary care and compassion. There, they join veterans of past wars, a great many of whom struggle with the latent effects of military service – from those whose hearing has steadily worsened since they first sustained artillery fire to those who suffer from the debilitating effects of Agent Orange or Gulf War illness. For VA care providers, the mission today could not be more daunting and complex.

Unfortunately, those VA providers are hamstrung by a budget process with no fewer than 12 stages of negotiation, from the time needs are estimated to the time the president signs off. Historically, the process fails to deliver funding on time, usually leaving VA budgets at facilities across the country unpredictable and, until recent years, insufficient.

Delayed budgets mean staff and services cannot be purchased to meet shifting demands. Delayed budgets mean waiting lists, nursing shortages, reduced hours of service and other cutbacks. Delayed budgets do not serve veterans in need. And that is the essential mission of VA.

The American Legion and eight other veterans service organizations are working together in the Partnership for Veterans Health Care Budget Reform to make significant changes in the process. Currently, Congress provides “advance appropriations” to some federal agencies to assure their timeliness, predictability and sufficiency. The American Legion believes VA health care deserves advance appropriations, too.

The process would establish, well ahead of the fiscal year, VA’s cut of the discretionary funding pie. Patient-demand estimates would be made public, and the Government Accountability Office would audit the estimates for accuracy and integrity, providing reports and recommendations during the fiscal year.

Early this year, the partnership urged the Obama administration to include advance appropriations for VA health care in its 2010 budget request. President Obama and new VA Secretary Eric Shinseki, along with the chairmen of both congressional Veterans Affairs committees, have all publicly voiced support of the model.

Last year’s timely VA appropriation was an aberration, due largely to the congressional leadership and the White House. In 19 of the last 21 years, however, VA funding has been late. In 2007, the fiscal year was four and a half months old before facilities knew what they had to work with. Veterans deserve nothing less than a VA health-care system funded on time, at predictable levels, sufficient to meet the needs of all who earned it.