The headquarters of the U.S. Department of Veterans Affairs (VA) stands in Washington, D.C., U.S., on Friday, May 10, 2013. The VA postponed purchases of cardiac monitors, radiological equipment and pain-medication pumps for patients last year. It didn't replace old surgical tools, oxygen-delivery systems or deteriorating operating-room stretchers. Photographer: Andrew Harrer/Bloomberg

Veterans’ Health Program Price Tag Still Unknown, Say Lawmakers

September 26, 2018 Jack Fitzpatrick
  • Long-term costs for new law could hamper future budget talks
  • Administration hasn’t submitted estimate for VA MISSION Act

Lawmakers say the Trump administration has kept them in the dark about the cost of a new law on veterans’ health care, a looming long-term expenditure that could complicate future budget negotiations.

The VA MISSION Act (Public Law 115-182) aims to give veterans more flexibility to seek subsidized health care at private facilities outside the Department of Veterans Affairs. It also changed the program’s funding, leaving it to lawmakers to provide discretionary money each year rather than relying on an automatic, or mandatory, cash stream. That led to a debate over how much the new law will cost in fiscal 2019 and beyond, and how the legislation will be carried out. The administration hasn’t sent Congress a formal cost estimate, according to the joint explanatory statement appropriators released with a bill funding the program.Administration officials haven’t told lawmakers much about the cost and implementation, Senate Appropriations Military Construction-VA Subcommittee Chairman John Boozman (R-Ark.) said in a brief interview yesterday. Boozman said his subcommittee will hold an oversight hearing to get more information from VA officials.“These are the things that we simply have to know,” Boozman said. “You can’t really make a final decision until you know what the cost is. And they have not been very accurate in their forecasting in the past, so that’s been a real problem.”

Trump signed into law a fiscal 2019 Military Construction-VA spending bill last week in a three-bill appropriations package (H.R. 5895), which includes $1.75 billion in discretionary money to pay for the health law, in addition to the last of the program’s mandatory funding.

“For the first time in American history, I am about to sign a bill that will fully and permanently give our great and cherished veterans choice so you don’t have to wait in a line for 18 days to take care of a simple” ailment, Trump said at a bill signing ceremony in Nevada last week.

But Boozman and others said they still haven’t received details from the administration on the department’s plan to carry out the new law. That means lawmakers aren’t sure if the $1.75 billion, based on a Congressional Budget Office estimate, will be enough to pay for the program until the end of fiscal 2019, or how much the program will cost in later years.

The CBO estimated the new law will cost $46.5 billion from fiscal 2019 to 2023.

The House and Senate Appropriations committees’ joint explanatory statement for the Military Construction-VA say the program will switch to discretionary from mandatory funding as early as May 2019, but that the administration hasn’t given a cost estimate for the new law. The measure directs the department to report monthly to lawmakers on the cost of its health care coverage at non-VA facilities.

“We don’t know the actual cost because we don’t have the details from the administration on the transition to a discretionary program,” Debbie Wasserman Schultz (D-Fla.), ranking member of the House Appropriations Military Construction-VA Subcommittee, told reporters earlier this month, shortly before the House passed the funding bill.

Even if the spending measure has enough money for the program until the end of fiscal 2019, lawmakers will have to determine how much the new law will cost in future years. Senate Appropriations Chairman Richard Shelby (R-Ala.) said the cost over the next few years will be “a lot of money, up to 50, 60 billion bucks, maybe more.”

Lawmakers acted in February to raise spending caps under the Budget Control Act (Public Law 112-25) for fiscal 2018 and 2019. The negotiations over caps for fiscal 2020 and 2021 may center largely on allowing enough spending on VA health care without requiring cuts to other discretionary programs. The spending caps end after fiscal 2021. Fully funding the VA’s new Veterans Community Care Program without cutting money elsewhere would cost $55 billion over the next decade, according to an estimate by the Committee for a Responsible Federal Budget.

Appropriations Action

House lawmakers plan to vote Wednesday on the final version of a bill covering defense and Labor-HHS-Education appropriations (H.R. 6157), along with a continuing resolution funding other agencies at fiscal 2018 levels through Dec. 7.

The House Rules Committee is scheduled to meet later this afternoon to draw up a rule to consider the conference report.

Lawmakers have yet to reach a deal on a spending package (H.R. 6147) covering Interior-Environment, Financial Services, Transportation-HUD and Agriculture-FDA.

To contact the reporter on this story: Jack Fitzpatrick in Washington at jfitzpatrick@bgov.com

To contact the editors responsible for this story: Katherine Rizzo at krizzo@bgov.com; Bennett Roth at broth@bgov.com; Robin Meszoly at rmeszoly@bgov.com

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