On June 22, 2004, Senator Tom Daschle (D-S.Dak.) introduced Senate Amendment No. 3409 to S. 2400, the National Defense Authorization Act for Fiscal Year 2005. This amendment would guarantee full funding for the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) through a combination of discretionary and mandatory funds and ensure the viability of the health care system.
Certain Senators voiced opposition to the amendment for full funding, including Senators Warner (R-Va.) and Bond (R-Mo.) who believe that the current discretionary appropriations process has served veterans' needs. They noted that VA medical care funding has increased 34.7 percent since 2001. However, they failed to note that the number of veteran enrollees between fiscal years 2001 and 2003 increased by over 49 percent. Theoretically, enrolled veterans have full access to the VA health care system. In reality, long waiting times for appointments with health care providers continue to be a problem for a significant number of veterans. For far too long, VA has had to cope with constrained resources even as it faced significantly increased demand for services and rising costs for medical care and pharmaceuticals. Clearly, the increase in discretionary appropriations has not kept pace with the increased demand for VA health care. According to former Under Secretary for Health, Dr. Robert H. Roswell, in testimony before the House Veterans' Affairs Committee, at a minimum, VA requires approximately a 13- to 14-percent increase annually just to maintain current services.
In May 2001, President Bush created the President's Task Force to Improve Health Care Delivery for Our Nation's Veterans (PTF/Task Force). In its Final Report, dated May 2003, the PTF identified a significant mismatch between the demand for VA services and available funding, which, if left unresolved, would delay veterans' access to health care and threaten the quality of care provided. To resolve this intolerable situation, the Task Force recommended that the Federal Government should provide full funding for veterans health care through modifications to the current budget and appropriations process, by using a mandatory funding mechanism or by some other changes to achieve the desired goal. The Task Force pointed out that while mandatory funding does not guarantee access, it would likely eliminate a major impediment to providing access in a timely manner, specifically unpredictable or subjectively developed budget requests. The real problem as the PTF aptly states in its report, is that, "[t]he federal government has been more ambitious in authorizing veterans access to health care than it has been in providing the funding necessary to match declared intentions."
Senators Warner and Bond stressed their concerns that funding the VA health care system via a mandatory rather than a discretionary process will hurt the ability of Congress to ensure accountability within the system. Certainly, the amendment would provide VA a combination of discretionary and mandatory funds. Further, at the end of two years, the Comptroller General would determine whether adequate funding for veterans health care was achieved, and whether changes are needed to ensure adequate funds for these programs in future years. Congress would then be required to update the law to reflect the lessons learned. Therefore, Congress would continue to retain oversight of VA programs and health care services through the appropriations process, and various congressional committees. VA would still be held accountable for how it spends its money and how well it runs its health care programs.
Senator Bond also declared that VA cannot spend all of the additional funds contemplated in the amendment due to lack of space to accommodate the needs of patients and health care workers, as well as to recruit and retain qualified health care providers. Due to the uncertainties in the appropriation process, VHA is unable to adequately manage its health care programs and services or effectively recruit and retain health care providers. The ability to offer compensation, employment benefits and working conditions comparable to those available in the private community is critical to VHA's ability to recruit and retain nurses, particularly in highly competitive and limited labor markets and for hard-to-fill specialty assignments. With guaranteed full funding, VA can strategically plan for the long term to optimize its assets, achieve greater efficiency, and realize significant savings. Discretionary funding for VA medical care benefits neither VA nor taxpayers, and it is currently having a negative impact on veterans and their families.
Furthermore, Senator Bond believes the funding formula within the amendment does not reflect veterans' unique medical care needs and that Congress is better able to meet those needs. However, the level of funding to cover the costs of treating veterans is currently not guaranteed and VA has been forced to ration medical care based on inadequate resources. Testimony provided by the Task Force Co-chair, Dr. Gail Wilensky, before the House Veterans' Affairs Committee states, "[i]t was clear to us that, although there has been a historical gap between demand for VA care and the funding available in any given year to meet that demand, the current mismatch is far greater, for a variety of reasons, and its impact potentially far more detrimental, both to VA's ability to furnish high quality care and to the support that the system needs from those it serves and their elected representatives.
Since fiscal year 2000, VA appropriations have not been enacted at the beginning of the fiscal year. In the past two years alone, the VA health care system has had to struggle along at previous year's inadequate funding levels for nearly one-third of each year. Concurrently, the demand for VA medical care overwhelmed available resources as portrayed by the waitlist for veterans waiting six months or more for care rose to over 300,000. In order for VA to be able to bring demand for medical care in line with resources, veterans were locked out of the very system designed to treat them. Further, the number of veterans unable to enroll is expected to grow to over 520,000 by FY 2005.
While Senator Nickles (R-Okla.) asserted that this amendment would create a new entitlement program, Senator Warner stated it would not. In reality, Senate Amendment No. 3409 would not create an individual entitlement to health care nor change the VA's current mission. The Daschle amendment would simply provide full funding for VA health care through a combination of discretionary and mandatory funding. It 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. Under current law, all veterans are eligible to enroll for VA health care—title 38, United States Code, Section 1710, mandates the Secretary to provide certain veterans with hospital care and medical services that the Secretary determines to be needed, but only to the extent that resources are made available by Congress.
The Disabled American Veterans (DAV) shares the Task Force's vision of a veterans health care system that is no longer impaired by the mismatch between resources and the demand for care. Therefore, it is essential that some type of practical guaranteed full funding measure be enacted this year to ensure that all eligible veterans have access to timely, quality health care now and into the future. We believe that guaranteed full funding will eliminate the year-to-year uncertainty about funding levels and close the gap between funding and demand for veterans health care that has prevented the VA from being able to adequately plan for and meet the constantly growing needs of veterans seeking treatment. We firmly believe that Senator Daschle's amendment offered a reasonable long-term solution to the funding crisis in veterans health care. We look to Congress to meet its moral obligation and make veterans a top priority to resolve this untenable funding situation as recommended by the President's own Task Force.
We adamantly believe that America's citizens, as beneficiaries of veterans' military service and sacrifice, want the government to fully honor its moral obligation to provide quality and timely health care services to wartime service-connected disabled veterans. In fact, a recent nationwide survey, conducted by Princeton Survey Research Associates International for DAV and Paralyzed Veterans of America, showed strong support for veterans health care and benefits. Three out of four Americans (75 percent) believe veterans health care should be a "top to high priority" in the federal budget. Most Americans (87 percent) also support making veterans health care funding mandatory. Nearly all survey respondents (95 percent) said veterans should not have to wait to receive their benefits.
Veterans deserve an honest debate on the issues of foremost importance to them. Unfortunately, some who spoke in opposition to the Daschle amendment misrepresented its effects.
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