Timely budgets would ease VA stress

To protect hospitals and clinics from budget interruptions tied to political wrangling in Washington, Congress is moving this year to put the VA health-care system on an advanced funding cycle – a step The American Legion and other veterans service organizations have urged.

In recent years, Congress has routinely been two to four months late in passing VA funding bills, forcing medical facilities to operate under continuing budget resolutions that freeze spending at previous-year levels.

Without new budgets that reflect inflation and revised VA health-care enrollments, hospitals and clinics have had to delay hiring staff, making facility repairs and buying sufficient inventories of drugs, equipment and other supplies.

Last year, the Legion and eight other VSOs formed the Partnership for Veterans Health Care Budget Reform. The organization was formed to educate lawmakers, and the Bush administration, on the impact that chronic budget delays have on VA health care – and how advance funding would address the problem. Last fall, the House and Senate Veterans Affairs committee chairmen got behind it.

Initially, the Obama administration – like its predecessor – opposed advance funding for the nation’s largest system of hospitals and clinics. That changed in April when the president announced that VA would work with Congress on an advance appropriations bill, so VA clinics and hospitals no longer would suffer a budget hiccup each fall.
Steady progress has been made since then, both in the House and the Senate, on two separate types of legislation. One, crafted by the Veterans Affairs committees, would authorize advance funding and create oversight mechanisms to monitor its effectiveness and the accuracy of cost projections.

This bill, the Veterans Health Care Budget Reform and Transparency Act of 2009 (H.R. 1016, sponsored by Rep. Bob Filner, D-Calif., and S. 423, sponsored by Sen. Daniel Akaka, D-Hawaii), was passed by the House in July and by the Senate in August.

The bill directs the president to submit estimates of budget dollars needed for veterans health-care accounts a year in advance. Another provision directs the VA secretary to report annually to Congress on the sufficiency of medical resources appropriated for the coming year, to include estimates of patient workload and demand for services.

A third directive requires the U.S. comptroller general, who heads the Government Accountability Office, to study the adequacy and accuracy of VA projections for health-care expenditures (as far out as five years) and to report the findings to appropriate congressional committees.

This package of provisions is very close to what the partnership for reform endorsed.
On a second legislative track, taken by the appropriations committees, is a bill to ensure that actual budget dollars are advanced for VA health care a year early. The fiscal 2010 appropriations bills, drafted by these committees, would fund VA health accounts for the fiscal year that begins this month and for fiscal 2011, too.

If, ironically, the VA appropriations bill doesn’t get passed on time again this year, VA health-care facilities may have to endure another tight budget for a few months. But this would be their last year of uncertainty.

However, the House already has passed its VA appropriations bill (H.R. 3082). The Senate version (S. 1407) cleared the appropriations committee  July 7 and was awaiting consideration by the full Senate. The advance appropriations portion of the bill includes $48.2 billion for fiscal 2011. That amount is for planned medical services ($37.14 billion), medical support and compliance ($5.31 billion), and medical facilities ($5.74 billion).

Tom Philpott, a former Coast Guardsman, has written about veterans and military personnel issues for more than 30 years.