DAV: VA Reforms Must Go Beyond Short-Term, Short-Sighted Fixes

Veterans deserve an end to the ongoing threat posed by budget gimmicks and political gamesmanship

As Congress holds a confirmation hearing this week for President Obama’s nomination for Veterans’ Affairs Secretary, Robert McDonald, the House-Senate Conference Committee will continue negotiations over legislation that so far fails to address the root of why the Department of Veterans Affairs (VA) has struggled to provide access to all veterans in need of medical care. Currently, the legislation under consideration is almost exclusively focused on alleviating the immediate crisis by sending veterans out to the private sector to get care that VA would then pay for.

“In the rush to address the VA’s immediate crisis over waiting times, what policy makers have completely ignored is how this problem was caused by years of woefully inadequate funding and budget gimmicks engaged in by multiple Congresses and administrations,” said DAV’s Washington Headquarters Executive Director Garry Augustine. “To meet our veterans’ needs, the VA must have sufficient budgets, enacted on-time, free of fake efficiencies and other budget gimmicks.”

Last week, VA’s acting chief Sloan Gibson requested Congress provide an additional $17.6 billion over the next three years to meet increased patient demand and drive down waiting times. The additional resources, he argues, are needed to hire 10,000 new clinical staff members, including 1,500 new doctors, nurses and other health care providers. They are also needed to renovate eight VA medical centers, undertake repairs to 700 other VA facilities around the country, and lease an additional 77 clinics, altogether providing capacity for 4 million new appointments.

“We’re concerned the House-Senate Conference Committee will ignore Acting Secretary Gibson’s request, once again kicking the can when it comes to providing the VA with the resources and expanded capacity that we all know is needed,” added Augustine.

DAV plans to share these concerns when testifying on Thursday before the House Committee on Veterans’ Affairs.

End the VA Budget Gimmicks

“The worst scandal in decades at the VA doesn’t simply involve unethical staffers cooking the books on waiting times, inexcusable as this was. Rather, it is the woefully inadequate funding and cooking of the budget books by Congresses and administrations over many years that created these waiting lists in the first place,” said Augustine.

Here are some examples of the budget gimmicks that have plagued the VA:

  • VA’s Internal Projections Are Consistently Ignored – What distinguishes Acting Secretary Gibson’s request is that the VA rarely asks Congress for what it actually needs. While the VA’s own budget models make clear the agency needs more money — and a predictable funding stream — to do its job, year after year, the White House proposes and Congress appropriates billions less than what VA’s internal estimates show it needs.
  • Gross Underinvestment in VA’s Infrastructure – In February 2011, the VA’s Strategic Capital Investment Plan identified the need to invest between $53 and $65 billion for facility improvements over the next 10 years. However, the administration requested and Congress provided less than $2 billion annually for construction since then. This failure to build, maintain or replace VA’s hospitals and clinics directly harms the timeliness and quality of care. For example, the Phoenix VA medical center, where the whistle was first blown on the falsification of wait times, is long overdue for a new clinic to handle the rapid growth in patients.
  • Fake and Rarely Realized Efficiencies – Efficiencies, collections, carryovers and contingency funds are examples of accounting trickery used to paper over budget inadequacies. For example, when outlining the VA’s budget needs, administrations factor in projected savings, but as the General Accounting Office has pointed out, these have rarely, if ever, been achieved, leaving VA facilities further short of funding.
  • Constantly Late Budget Appropriations – Veterans appropriations bills have been delayed 22 out of the past 25 years, forcing the agency to wait months before it knows what it has to spend — surely a contributor to its management problems. This puts the VA in the untenable position of either rationing care to patients it already serves, or denying or delaying entry to new veterans. To free veterans from partisan gridlock, Congress should pass pending legislation, the bipartisan Putting Veterans Funding First Act, which would provide an advance appropriation for all VA functions. By authorizing the agency’s budget 12 months in advance, it will ensure that VA funding is sufficient, timely and predictable, and it will prevent cutoffs in benefits processing and payments to veterans that could occur in any future government shutdown.

“If our government can pay for the wars it asks our troops to fight, it must find a way to pay — fully and honestly — for the treatment veterans need after they return home,” added Augustine. “The long-term solution is simple enough: The Administration should present an honest budget based on the VA’s best internal projections. Congress should pass an honest budget resolution and honest VA appropriations so that the funds match the mission — without gimmicks and fake efficiencies. And all legislation should be enacted on time or through an advance appropriation.”