Moving fast on a key recommendation from a presidential task force, the House Veterans Affairs Committee chairman has introduced a bill to require "full funding" of VA health budgets to ensure timely care to almost all enrolled veterans, including many with no service-connected ailments. The Veterans' Health Care Full Funding Act "would take the politics out" of VA health budgets and eliminate an "intolerable" waiting list of patients seeking care, said Rep. Chris Smith (R-N.J.), committee chairman. A fellow Republican on the committee, however, said politics, in fact, is driving this bill. The "full funding" mandate, said Rep. Steven Buyer (R-Ind.), is evidence that the task force exceeded its charter and allowed commissioners with ties to veterans organizations to "hijack" the process.
Smith's bill, HR 2475, would create an independent panel of economists to set health care funding levels for the Department of Veterans Affairs, based on the needs of patients enrolled in Priority Groups 1 through 7. Group 7 is vets with no service-related ailments and incomes above a national VA means test. But their earnings still fall below a government index of pay adequacy in their geographic area.
The President's Task Force to Improve Health Care Delivery for Our Nation's Veterans released its report in late May, saying that veterans deserve predictable access to care. One way to do that is to mirror full-funding protections that Congress set for DoD budgeting to ensure care to elderly military retirees under TRICARE-for-Life.
A second part of HR 2475 would force VA to meet its own access-to-care standards. If a patient seeking non-emergency care, for example, can't be seen within 30 days, VA would have to contract for a non-VA provider.
Rep. Rob Simmons (R-Conn.), health subcommittee chairman, joined Smith in launching the bill. Despite a 49-percent rise in VA health care budgets since 1996, hundreds of thousands patients still wait six months or more to see a primary care physician, Smith said. That's because the system has seen a 70 percent rise in patients over the same period.
Not all of the growth is from open enrollment. VA made a dramatic shift in care delivery, expanding from 170 VA hospitals into hundreds of local, more accessible clinics.
Buyer blames the clogged VA health care system, not on a funding shortfall but on the "mistake" he and other committee members made in '96 in voting for open enrollment to keep the new clinics full. The Congressional Budget Office had warned then that it would create a mismatch between demand and resources.
Rosy predictions by committee leaders and veterans groups that the move would be "budget neutral" -- thanks to system efficiencies, co-payments charged Group 7 and 8 enrollees, and collections from employer health insurance plans for VA-provided care -- were wrong, Buyer said.
Priority 7 and 8 veterans added $2 billion, or about 10 percent, to VA health care costs last year. Buyer said many of these veterans only enrolled sought care to get VA drug discounts. Committee report language from '96 on expanding VA eligibility said the bill "would not permit the VA simply to serve as a veterans' drugstore." Yet that has happened, he said.
Open enrollment is to blame for the bottleneck in care, Buyer said. "But instead of addressing the issue on Group 7s and 8s, veterans' groups are saying, 'just give us the money.' They are using language far beyond what they ever talked about. Some even say every veteran is to be treated the same."
Buyer could have been referring to Robert W. Spanogle, national adjutant of the American Legion. He was one of three task force commissioners to dissent on the "full funding" recommendation. Budgets aren't fully funded, he said, until all enrolled veterans, including Priority Group 8, are provided timely care.
In testimony June 17 before the House committee, Spanogle criticized arguments made by Buyer and others that VA health care was intended only for "core veterans", those disabled through service or in financial need.
"Contrary to comments made during commission meetings, there are no 'core veterans'," he said. "A veteran is a veteran. The 'traditional' veteran treated in VA medical facilities are any veteran needing medical care."
The influence of veterans' groups, Buyer said, pushed the task force beyond its charter of greater cooperation between VA and DoD health care to address the full-funding issue. If HR 2475 is enacted, it could add many billions of dollars a year to VA budgets. Chairman Smith, however, called the task force report "magnificent" and said he was grateful commissioners "felt that it was within their purview to make this bold but important recommendation."
In one of the final task force meetings, Spanogle said, he and two other commissioners "were warned by a colleague not to wear veterans' advocacy on our sleeves." He ignored the advice. "I consider fighting for the rights of every American veteran," he said, "a badge of honor." Treating all veterans the same, warned Buyer, means some of the most deserving can't get timely care -- unless VA budgets climb sharply. "Right now there are so many 7s and 8s trying to gain access, and they have more political clout because there are more of them. Politicians will play to the numbers," Buyer said. He won't join them this time.
"I'll stand to defend those who were injured in peace, wounded in war, and the indigent. Those are the ones we ought to take care of. Not guys like me."
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