Take politics out of VA health care

By Tom Philpott

Moving fast on a key recommendation from a presidential task force, the House Veterans Affairs Committee chairman has introduced a bill to require “full funding’’ of VA health budgets to ensure timely care to almost all enrolled veterans, including many with no service-connected ailments.
The Veterans’ Health Care Full Funding Act “would take the politics out’’ of VA health budgets and eliminate an “intolerable’’ waiting list of patients seeking care, said Rep. Chris Smith (R-N.J.), committee chairman.
A fellow Republican on the committee, however, said politics, in fact, is driving this bill. The “full funding’’ mandate, said Rep. Steven Buyer (R-Ind.), is evidence that the task force exceeded its charter and allowed commissioners with ties to veterans organizations to “hi-jack’’ the process.
Smith’s bill, HR 2475, would create an independent panel of economists to set health care funding levels for the Department of Veterans Affairs, based on the needs of patients.
The President’s task force to improve health care delivery released its report in late May, saying veterans deserve predictable access to care. One way to do that is to mirror full-funding protections that Congress set for DoD budgeting to ensure care to elderly military retirees under TRICARE for Life.
A second part of HR 2475 would force VA to meet its own access-to-care standards. If a patient seeking non-emergency care, for example, can’t be seen within 30 days, VA would have to contract for a non-VA provider.
Despite a 49-percent rise in VA health care budgets since 1996, hundreds of thousands patients still wait six months or more to see a primary care physician, Rep. Rob Simmons (R-Conn.), health subcommittee chairman, said. That’s because the system has seen a 70 percent rise in patients over the same period.
Not all of the growth is from open enrollment. VA made a dramatic shift in care delivery, expanding from 170 VA hospitals into hundreds of local, more accessible clinics.
Buyer blames the clogged VA health care system, not on a funding shortfall but on the “mistake’’ he and other committee members made in ‘96 in voting for open enrollment to keep the new clinics full. The Congressional Budget Office had warned then that it create a mismatch between demand and resources.
Rosy predictions by committee leaders and veterans groups that the move would be “budget neutral’’ — thanks to system efficiencies, co-payments charged Group 7 and 8 enrollees and collections from employer health insurance plans for VA-provided care — were wrong, Buyer said.
Priority 7 and 8 veterans added $2 billion, or about 10 percent, to VA health care costs last year. Buyer said many of these veterans only enrolled sought care to get VA drug discounts.
Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: