Mandatory VA Healthcare Funding: Currently, VA healthcare is funded through a process that requires Congressional debate every year. This means that the VA healthcare budget is a political football tossed back and forth year after year. Over the last five years, a movement has grown to make VA healthcare funding what is called an “entitlement.” In Congressional jargon, an entitlement is something that is automatically funded unless Congress takes action, the exact opposite of what happens now. Instead of being an annual political football, VA healthcare would be funded by a formula.
Mandatory Funding for VA Healthcare
Coalition of Veterans Organizations
March 19, 2007
VA healthcare funding by Congress is “discretionary” funding. By this, we mean that each year, the VA healthcare is funded according to the judgment of Congress and the President. As a result, VA healthcare funding is a political football, debated each year according to the political needs of the Administration and Congress.
Veterans’ call for mandatory funding means that VA healthcare funding would become an “entitlement.” In Congress, an entitlement is funded each year according to a formula. It is not subject to political debate. The formula Veterans are calling for would include three parts: the number of Veterans using the VA, the cost of actually treating a Veteran, and an annual adjustment for increases in providing medical care.
The number of Veterans using the VA is a straightforward projection the VA makes every year anyway. The cost of actually treating a veteran is already known. Current funding is insufficient to cover the actual costs of covering Veterans and is leading to the cost cuts in services provided to veterans. The mandatory funding bill needs to have a one-time increase in funding to make sure the real costs of treating Veterans is funded. Increases in the cost of healthcare each year are also well known. That is how insurance companies determine how much to raise their rates. The significant increases in recent years in the VA healthcare budget have not been enough to cover these yearly increases in healthcare costs. The GAO has pointed out that recent VA projections of healthcare costs have seriously underestimated actual costs. The mandatory funding bill must ensure that this is corrected immediately.
This year, the Democrats have proposed a VA healthcare budget of $37.1 billion for fiscal year 2008. That is an increase of $4.8 billion (a 14.8 percent increase over fiscal year 2007). The President has proposed a budget of $34.2 billion (an increase of 5.5 percent over 2007). The contrast between these offers gives some idea of how the political process makes VA healthcare funding a political football.
Veterans and the major Veterans organizations have called for mandatory VA healthcare funding. “The DAV and other groups have long urged Congress to enact legislation that will provide a reliable, predictable funding stream for veterans’ health care. Assured funding will enable the VA to efficiently and effectively plan for and meet the growing needs of our nation’s sick and disabled veterans, both now and in the future,” said the DAV National Commander Bradley S. Barton recently.
The Mandatory VA Healthcare Funding bill before this Congress (the 100th) is HR 1382 Sponsored by Rep. Randy Kuhl (R-NY). There are no co-sponsors for this bill. It uses the formula outlined above. While it does not call explicitly for a one-time increase in funding, that is built in to the formula it uses. Mandatory funding bills have been put forward in each Congress since 2002.
Another bill before the House Veterans Affairs Committee was submitted by Rep. Christopher Smith (R-NJ). This could be called the “Not-quite Mandatory Funding Bill” HR 1041. It sets up a board to determine VA healthcare budget needs and requires the President to submit that as his VA healthcare budget. Additionally, it also calls for Vets to face no more than 30-day wait to get into a VA.
One politically connected person has suggested that in order to make VA funding truly “mandatory,” a Trust Fund would have to be set up with an independent funding source. This has, to our knowledge, never been proposed in legislation. The idea is similar to the Social Security, Medicare and Federal Highway Trust Funds. It would be funded by a tax and the funds could not be used for any other purpose than VA healthcare. A tax on military hardware procurement has been suggested as a possible source of funds. The idea behind this is that without a Trust Fund, any Congress can undo what another Congress has done, so VA healthcare would still be, in fact, a political football. Congress has been much less willing to tamper with Trust Funds, so this would better ensure consistent VA healthcare funding.
The key idea here is that the VA should not be the one to determine who they treat. Congress should tell the VA who to treat and then the VA should do it. Thus, Congress should set the eligibility requirements for VA healthcare.
Eligibility for VA healthcare should be extended to all veterans who have been honorably discharged from the military service, including the regular, reserve and National Guard components. There should be no income provisions or “means test” and there should be no exclusions or divisions among veterans as to who shall be treated.
This specifically means that the 2-year limitation on VA healthcare that has been imposed on veterans that served in Iraq and Afghanistan will be eliminated and they, like veterans of other wars, will have lifetime access to the VA.
It also means that the “freeze” or exclusion of so-called “Priority 8” veterans would be eliminated. There would be no longer a need to have any income-related criteria for receiving VA healthcare.
Modern warfare has meant a drastic change in the needs of Veterans. Many more Veterans are living after devastating wounds received in combat. In World War II there were two casualties for every fatality. In Vietnam, it was 3 to 1. Currently, it is running 16 to 1! This means that men and women are returning to civilian life with devastating and lifetime wounds—both physical and mental. Veterans with shattered bodies need the VA specifically to deal with the kinds of conditions that one rarely sees outside the military. The VA has always excelled at this.
But modern warfare is also devastating to the mental state of those serving and we are seeing more men and women returning from war with extreme and severe mental and emotional disorders than ever before. Many of these conditions take years to develop and to manifest themselves with sufficient severity for the veteran to seek help. Setting time limitations is a lesson unlearned from previous conflicts and absolutely demonstrates the VA’s inability to care for the wounded. In addition limitations cut off the veterans possibility for recovery and rehabilitation. Recent legislation has ensured that mental health and physical health are seen as equivalent. This law must be applied to VA healthcare.
There are many more women in combat than ever before. The VA must recognize the expanded needs of women and their particular forms of trauma. In addition to combat-induced suffering of combat wounds and mental and emotional illness, women are subjected to sexual abuse and even assault.
No legislation has yet been proposed that covers everything said above. Two bills, HR 612 (Rep. Filner, D-CA, Chair of the House Veterans Affairs Committee) and S 383 (Akaka, D-HI, Chair of the Senate Veterans Affairs Committee) calls for extending the 2-year limitation for veterans that served in Afghanistan and Iraq from 2 to 5 years. We consider this totally insufficient, inadequate and uncaring. Another bill, HR 463 (Rep. Rothman, D-NJ), calls for the elimination of the freeze on Priority 8 veterans.
Reform of funding and full accounting for all VA mental health services for veterans. Scores of veterans—many returning from Iraq and Afghanistan—do not receive the mental heath care they need, despite front-page stories detailing the horrors these veterans face.