MYTH: Mandatory funding creates an individual entitlement to health care.
REALITY: The Assured Funding for Veterans Health Care Act of 2003 (H.R. 2318) would not create an individual entitlement to health care nor change the Department of Veterans Affairs' (VA's) current mission. It would simply shift the current funding for VA health care from a discretionary to a mandatory program. The Act does not expand current eligibility for VA medical care, the current benefits package, or VA's mission. While all entitlement programs are mandatory, not all mandatory programs are entitlements.
Therefore, Congress must make VA health care accounts non-discretionary. If veterans' health care were a mandatory program, sufficient funding to treat enrolled veterans who fell under its mandatory provisions would be guaranteed for so long as the authorizing law remained in effect. Veterans would not have to fight for sufficient funding in the budget and appropriation processes every year as they now do. Making veterans' health care funding mandatory would also eliminate the year-to-year uncertainty about funding levels, which have prevented the VA from being able to adequately plan for and meet the growing needs of veterans seeking treatment. Guaranteed funding is a common sense solution to the decades-long crisis that has led to the severe rationing of health care that plagues the VA medical care system.
MYTH: Guaranteed funding would open the VA health care system to all veterans.
REALITY: The Health Care Eligibility Reform Act of 1996 theoretically opened the VA health care system to all 27 million veterans; however, it was never anticipated that all veterans would seek or need VA health care. Many veterans have private health insurance and will likely never elect to use the system.
The Secretary is required by law to make an annual enrollment decision based on available resources. He must determine if there is sufficient funding to treat all categories of veterans without a negative impact on quality or timeliness of health care delivery. The Veterans Health Care Funding Guarantee Act would not affect the Secretary's authority to manage enrollment into the VA health care system. Because of insufficient funding, VA has not had the resources necessary to provide timely medical care to all enrolled veterans who need it, and now the Secretary has been forced to close VA's doors entirely to some veterans. Thus, guaranteed funding would only ensure the Secretary has sufficient funds to treat those veterans enrolled for VA health care.
MYTH: Guaranteed funding for VA health care would cost too much.
REALITY: Congress typically provides an annual discretionary appropriation for VA health care short of actual needs, and guaranteed funding would simply ensure that VA is provided the necessary resources to care for enrolled veterans. Guaranteed funding under the Act would utilize a formula based on the number of enrolled veterans multiplied by the cost per patient, with an annual adjustment for medical inflation.
The Health Care Eligibility Reform Act paved the way for the creation of a Uniform Benefits Package—a standard health benefits plan that emphasizes preventative and primary care and a full range of outpatient and inpatient services to all enrolled veterans.
The change in the VA health care system due to eligibility reform has created a more cost effective and efficient health care system. The creation of Community-Based Outpatient Clinics and outreach brought record numbers of veterans into the VA health care system. Improvements in the quality of care and patient safety have made VA a world leader in the health care industry. The goal of eligibility reform was elimination of unnecessary expensive inpatient health care services and the development of cost-effective preventative and primary health care services.
Guaranteed funding would ensure that VA receives sufficient resources to treat veterans using the system. The annual adjustment for inflation would allow VA to keep pace with increased costs for medical equipment, supplies, and pharmaceuticals.
MYTH: Veterans in Priority Group 7 and 8 are using up all of VA's health care resources; and it therefore costs too much to continue to treat these veterans.
REALITY: Among the 6.7 million enrollees in the VA health care system, 2.1 million veterans from Priority Groups 7 and 8 accounts for only 31 percent of the total enrolled population. As of September 30, 2002, the total expenditure for these veterans was $2 billion, which is only 10.5 percent of the total expenditure for all priority groups. Furthermore, Priority Group 7 and 8 veterans are typically lower users of VA health care than higher Priority Groups.
Moreover, VA provides medical care for Medicare-eligible veterans in these Priority Groups at a substantially lower cost than Medicare providers, which results in considerable savings for the United States Government.
Finally, a sufficient number of veterans are needed to ensure the viability of the system for its core users, preserve its specialized programs, and to remain cost effective. Therefore, guaranteed funding for VA health care should include all categories of veterans who are enrolled in the VA health care system.
MYTH: Congress would lose oversight over the VA health care system if VA shifted from discretionary to mandatory funding.
REALITY: While funding would be removed from the direct politics, uncertainties, and capriciousness of the annual appropriations process, Congress would retain oversight of VA programs and health care services, as it does with other federal mandatory programs. VA would still be held accountable for how it spends its money and how well it runs health care programs.
Guaranteed funding for VA health care would free members of Congress from the annual budgetary battles they face and allow them to concentrate on oversight of VA programs and services.
MYTH: The viability of the VA health care system can be maintained even if VA only treats service-connected veterans or the “core group," Priority Groups 1-6.
REALITY: The VA is a unique health care system, which offers an array of specialized services to meet the complex health care needs of veterans. Many of these specialized services such as prosthetics, spinal cord injury, blind rehabilitation, mental health, and traumatic brain injury are not available in the private sector. The private sector does not have the experience or the special expertise to provide many of these services.
Thus, the VA health care system should be maintained and devoted solely to treat these veterans. But, to maintain this system, a proper patient mix and larger number of veterans is needed to ensure the viability of the system for its core users, preserve its specialized programs, and to remain cost effective.
A veteran injured today in Afghanistan or Iraq will need the VA health care system beyond the middle of this century. However, if the VA health care system was allowed to be significantly reduced, these brave men and women would not be able to replicate the special care they receive from VA in the private sector, which is currently undergoing a crisis of its own.
Accordingly, we must continue to focus on maintaining and improving the VA health care system so that VA can continue to deliver cost-effective high quality health care to its core constituency, veterans with service-connected disabilities, low incomes, and veterans with special needs, and all enrolled veterans, well into the future. Priority Groups 7 and 8 are therefore important to the maintenance of this unique system.
MYTH: Providing guaranteed funding for VA health care will not solve VA's problems.
REALITY: VA must have a sufficient budget to effectively manage its health care programs and services and to hire the appropriate number of clinicians, nurses and support staff to meet the demand for high quality medical care. VA must also have the ability to adequately prepare for the coming year well in advance. With guaranteed funding, VA can strategically plan for the long term to optimize its assets, achieve greater efficiency, and realize long-term savings. Discretionary funding for VA medical care benefits neither VA nor taxpayers, and it certainly is now having a negative impact on veterans.
VA continues to struggle to provide timely health care services to all veterans seeking care due to insufficient funding. The guaranteed funding formula in the Act provides a standardized approach in solving the access issue. It also allows VA to prepare for the new fiscal year 3-4 months prior to its beginning.
MYTH: Veterans health care should be privatized because the system is too big, inefficient, and unresponsive to veterans.
REALITY: Privatization of veterans health care is a serious threat to the viability of the VA health care system and the specialized disability programs VA has developed to treat our nation's most severely disabled service-connected veterans and veterans with special needs.
The private sector would not want to enroll VA patients, who are often elderly, have multiple disabilities, or are chronically ill. These veterans would pose too great an underwriting risk for private insurers and health maintenance organizations. The VA provides a wide range of specialized care to meet the unique needs of veterans. Spinal cord injury medicine, blind rehabilitation, prosthetics, advanced rehabilitation, posttraumatic stress disorder, mental health care services, and long-term care are at the very heart of the VA health care mission. Unquestionably, VA provides much more comprehensive services for these veterans' specific needs than would the private sector.
In addition, the VA supplies one-third of all care provided for this nation's chronically mentally ill. The VA is also the largest source of health care for AIDS-related disorders. One-third of the nation's homeless are veterans, and the VA has developed broad-reaching programs to meet their psycho-social needs.
Those in government who oversee and implement public programs that serve America's veterans must provide the resources and authority necessary to carry out those programs. And the best way to ensure that is for VA to continue as a distinct entity, directly accountable to the American people for providing high-quality, cost-effective health care services to meet the unique needs of the veteran population. Anything less than that would be to abandon this nation's sacred obligation to veterans.
The VA health care system was created for the unique needs of disabled veterans and, therefore, must be maintained. While private sector hospitals have administrative costs and profit motives, studies have shown that VA provides more cost-effective care than comparable private sector health care. Without VA, millions of veterans would be forced to rely on Medicare and Medicaid at substantially greater federal and state expense.
MYTH: The merits inherent in veterans' benefits will alone always ensure that Congress sufficiently funds veterans' programs.
REALITY: Over the years, Congress has authorized many beneficial VA health care programs and services for veterans. Unfortunately, sufficient funding to ensure these programs and services are readily accessible for veterans has not kept pace with demand for services. Keeping VA health care funding under a discretionary program forces veterans to unfairly compete with other programs for limited resources.
Funding for veterans benefits and health care services should be a top priority for Congress and this Administration. These costs are a continuing cost of national defense and war. Once the battlefields fall silent, veterans should not have to beg for benefits they have earned and rightfully deserve. A promise of benefits and services alone is not good enough. Approved programs must be sufficiently funded. As a nation, we must be willing to bear the costs of providing special benefits to such a unique group—those men and women who were willing, on behalf of all Americans, to serve in peace time and fight our wars to preserve our cherished freedoms and democratic values.
To assure the veterans medical care system is maintained as a top government priority, its funding should be mandatory to remove it from competition with politically popular but less meritorious projects and programs.
MYTH: We already have too many mandatory programs.
REALITY: The government is already providing mandatory funding for one class of veterans—longevity military retirees who are Medicare-eligible under TRICARE for Life, Public Law 106-398, enacted in October 2000. For fiscal year 2004, the Administration is proposing an entitlement program for military retirees under the age of 65, similar to the TRICARE for Life program.
While it is necessary for our government to provide a mandatory program to meet the health care needs of the men and women who dedicated a career to the defense of our nation, and for their families, it is no less important to guarantee funding for the VA health care system.
Congress must ensure that all veterans enrolled in VA health care receive timely, quality health care through a mandatory funding program. Veterans have earned the right and they deserve no less from their government.
MYTH: Under a mandatory funding program, VA would no longer have an incentive to find efficiencies and to supplement its appropriation with third-party collections.
REALITY: Mandatory funding will provide sufficient resources to ensure high quality health care services when veterans need it. Mandatory funding for veterans health care is based on a formula that includes the number of enrolled patients and a per capita amount for each patient. It is not intended to provide excess funding for veterans health care. Under this method, inefficiencies in spending would be easily revealed.
VA Central Office (VACO) would still be responsible for local managers using funds appropriately and efficiently. Hospital directors would still be required to meet performance standards and third-party collection goals. Current checks and balances will help ensure accountability. VACO provides monetary incentives to local managers who meet their goals and strive for the most efficient ways of delivering high quality health care to our nation's veterans.
Finally, VACO would continue to evaluate local mangers and distribute allocations to Veterans Integrated Service Networks based on need and performance.
|
Printer-Friendly Version