Target: Sufficient, Timely, & Predictable $$

Reprinted from PN March 2009

Veterans groups push for real VA healthcare funding reform.

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As the 111th Congress opened, Paralyzed Veterans of America (PVA) initiated a major campaign to enact real funding reform for the Department of Veterans Affairs (VA) healthcare system.

Specifically, PVA, along with the nine major veterans' service organizations that comprise the Partnership for VA Health Care Budget Reform (Partnership), began advocating for making funding for veterans' healthcare an advance appropriation. This effort includes pushing for approval of a key piece of legislation, the Veterans Health Care Budget Reform Act, a bill originally introduced in the 110th Congress and that received President Obama's support. The bill would authorize Congress to fund VA medical services one year in advance so the money is guaranteed to be available when it is needed.

VA is the largest integrated healthcare system in the United States, employing more than 200,000 personnel who provide medical care to over 5.5 million veterans at more than 1,200 access points across the country. As a direct provider of services, VA is especially vulnerable to the inherently unpredictable nature of the annual discretionary appropriations process. Effectively managing such a large enterprise requires sufficient, timely, and predictable funding. Without reform of the budget process, the veterans' healthcare system will continue to face great challenges and pressures that could threaten the long-term quality of care provided to veterans.

During the previous two years, Congress has provided record funding levels for VA, particularly the healthcare system. Despite these achievements, there have been significant delays in VA's receiving funding. In fact, in 19 of the past 22 fiscal years, the VA appropriations bill was approved after the start of the new fiscal year on October 1. Moreover, during the six years prior to the current fiscal year, VA received its annual funding on average more than three months after the start of the new fiscal year. Political wrangling has often deadlocked the federal budget process and, in turn, the funding for veterans' healthcare.

This political inaction has led to continuing resolutions instead of regular approved appropriations bills, late-arriving final appropriations, offsets and across-the-board cuts, and supplemental and even "emergency" supplemental appropriations requiring a presidential declaration. These and other budget "gimmicks" have now become the norm rather than the exception. Not knowing when or what level of funding VA will receive from year to year—or whether Congress will approve or oppose the administration's proposals—hinders the ability of VA officials to plan their spending for the coming year.

A New Plan

For more than a decade, the Partnership has worked to achieve sensible and lasting reform of the funding process for veterans' healthcare. While it has long advocated converting VA's medical-care funding from discretionary to mandatory funding, Congress has shown little interest in moving mandatory funding legislation forward. With today's economic crisis further exacerbating the federal government's budget outlook, such a change may be even more difficult to achieve.

Over the past two years, the Partnership has explored several other budget-reform options that would achieve the same goals for which mandatory funding was proposed—sufficient, timely, and predictable funding—while taking into account the political and economic changes that have occurred since the Partnership was first formed.

As a result, the Partnership developed an alternative proposal that would change VA's medical-care appropriation to an advance appropriation, providing funding for the healthcare system up to one year before the operating year. Under this proposal, Congress would currently be considering the FY 2011 funding levels for VA, and the FY 2010 appropriations for VA healthcare would have already been completed. This would ensure that VA received its funding in a timely and predictable manner. Moreover, to ensure sufficiency, the proposal would require VA's internal budget model to be shared publicly with Congress to provide accurate estimates for VA healthcare funding, as determined by a Government Accountability Office (GAO) audit, before political considerations take over the process. This would add transparency and integrity to the VA healthcare budget process.

Find out more about the new plan which is expected to provide a more accurate and timely projection of funding needs for VA programs.


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Target: Sufficient, Timely, & Predictable $$


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