Military Update: VA care for ‘Priority 8’ veterans tied to reform
August 23, 2008
Congress is moving to reopen the VA health care system to many more thousands of Priority Group 8 veterans – those who aren’t poor, at least by government standards, and have no service-related ailments.
Disabled American Veterans and some partner organizations support such a move but with two caveats, explained DAV representatives.
First, accepting new “Priority 8” enrollees should be gradual to protect access to care for service-disabled veterans and all other current enrollees.
Second, resumption of Group 8 enrollments, which were suspended in 2003, should not occur without reform of VA health care budgeting to ensure that VA health budgets, year after year, finally become “sufficient, timely and predictable,” said Joseph A. Violante, DAV’s legislative director.
Congress has refused to pass a law that would mandate full funding of VA health care based on number of enrollees. But Violante said DAV has joined with eight other veterans’ service organizations to back an alternative to mandatory funding that lawmakers are more likely to embrace.
With the House having voted this month for a 10 percent rise in Priority 8 enrollments starting Oct. 1, and with Democratic senators also supporting for such a move, DAV and its partners believe VA budgeting reform has a new urgency to protect enrolled veterans’ access to care.
The Veterans’ Health Care Budget Reform Act, to be introduced after lawmakers return from recess in September, has two parts. One would put VA health care under an “advance appropriation” schedule. If it were in effect already, Congress this year would be passing a VA health budget that would take effect in fiscal 2010, a year ahead of the current schedule.
The goal, said Violante, is to end a crippling pattern by lawmakers of failing to pass VA health budgets before the fiscal year begins Oct. 1. These budget delays, which last two to three months, force VA medical facilities to operate under “continuing resolutions” which freeze spending at previous year levels until a new appropriations bill finally is passed and signed.
A man who understands the effect of such delays on facilities and patients is Bob Perrault who served as director of VA medical centers in Philadelphia, Atlanta and Charleston before retiring from the Veterans Health Administration in 2004 as VHA’s chief business officer.
Every year he can remember, Perrault said, the budget year would begin without a budget which meant no money to keep pace with medical inflation or rising VA enrollments. Hospitals and clinics would see their inventories of drugs and other medical supplies fall.
“We’d stopped buying equipment. We’d stopped doing maintenance just to try to maintain [staff] as long as we could. But even then we’d reach a crucial point where we would have to freeze hiring though we needed the staff to treat increasing demands from patient populations,” Perrault said.
“We had clinics stacked up, backlogs in getting patients seen and big waiting lists. We were criticized for being poor administrators when the real issue was the budget,” Perrault said.
“VA right now,” Violante added later, “should have already hired the doctors, nurses and clinicians they need [for fiscal 2009] because medical and nursing schools graduate their students in May and June. They are out looking for jobs. But VA can’t do that because they don’t know when their budget is going to be in place. So it has that impact.”
Adopting an “advanced appropriations” process would restore timeliness and predictability to VA health care budgets, Violante said.
Part two of the reform package would seek to keep funding levels for VA health care sufficient. Until very recently, VA health budgets were sharply under funded, Violante said. Yet Congress declines to support a mandatory full funding law, arguing that it limits congressional prerogatives. It also is an expansion of VA entitlements which triggers a “pay-go” budget rule. That rule requires that any new entitlement spending either be offset by an entitlement reduction or paid for with tax increases.
What DAV and fellow organizations in the Partnership for Veterans Health Care Budget Reform now propose is that VA be directed to use a new actuarial model it has developed which very accurately can project the per capita cost of providing health care to its enrolled patient population.
The Partnership's proposal would require the Government Accountability Office to verify annually the accuracy of these VA health cost projections so everyone knows the cost of continuing to provide current services to enrolled beneficiaries. If the administration then were to seek a budget that fell short of covering those projected costs, the White House would have to explain why both to Congress and to veterans, and the political heat could be severe.
VA now won’t share what its actuarial model shows about proper funding of VA health care, said Peter Dickinson, a consultant to DAV and former professional staff member on the House Veterans Affairs Committee.
“It’s sort of behind the curtain, inside the black box. Instead they put forward a number that may or may not be based on that but also reflects other [spending] priorities” of the administration, Dickinson said.
Requiring an annual audit to force VA to reveal what health care spending must be to support full services to all VA patients would make it politically difficult to short these budgets in the future, Dickinson said.
“If we can get a budget process that’s a year in advance and based on numbers we can look at,” Dickinson said, the cost of re-opening enrollment to Group 8s veterans would be known and presumably fully funded.
If health budgeting isn’t reformed, and enrollment doors swing open, “we could be in danger of returning to the days of ‘03 and ’04 when more than 300,000 veterans waited six months or longer to get an appointment.”
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