Emergency Spending Authorized for VA – Is it Enough?

Post Date: August 14, 2017

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Washington 8/14/17 – The day before the U.S. would lose two more American lives during combat operations in Iraq, President Donald Trump signed an emergency spending bill, the VA Choice and Quality Employment Act, that authorizes more than $2 billion for the Veterans Choice Program. At present, almost one-third of VA appointments are referred to the private sector, up from fewer than 20 % in 2014. The VA’s annual budget of about $180 billion will provide $2.1 billion in funding for veterans’ health care in the community at government expense.

While the new law will draw attention largely because of the urgency in which it replenished the VA’s healthcare budget — a budget that has been depleting faster than expected since 2014 — the new law also addresses other critical priorities aimed to improve the VA:

A bilateral exchange program for employees in VA and the private sector to cross-train providers in both health care domains

The development of training and annual performance standards for employees and preparing them for future leadership roles within the Department

The establishment of promotion tracks designed to retain employees with special expertise

Provisions to attract transitioning service members and recently graduated college students into employment opportunities with the VA

Training on recruitment and retention best practices for human resources professionals 

These and several other initiatives will be funded for six months through offsets such as reduced pensions for some Medicaid-eligible veterans and the collection of fees for housing loans. The law also provides an additional $1.8 billion for core VA health programs, which includes leases for 28 new VA medical facilities.

Critics of the Veterans Choice Program, which had included this author in the past, insist that expanding care in the community is merely a slow walk to privatization. Others argue that offsetting the cost of expanded community care by reducing other veterans’ benefits is unconscionable and will lead the VA to a slippery slope where even more benefits will be cut. But these arguments ignore the more immediate problem created by understaffing in VA and the accountability vacuum, particularly among VA’s senior middle management tiers, that has eclipsed all the great work VA has been doing.

Critics also disregard VA Secretary David Shulkin’s focus on investing in “foundational services” that are part of VA’s national commitment to provide: spinal cord injury treatment and rehabilitation, blinded rehabilitation, inpatient mental health, prosthetics, and care coordination, some of which will be funded through budget apportionments at each facility at the direction of the Secretary.

As those debates continue, however, the bigger problem is what will happen when the Administration and Congress can no longer move the goal posts where funding VA health care is concerned. The six-month funding plan that was underwritten by the new law bought Congress more time to debate broader issues over VA funding and its future. But bad news doesn’t improve with age, and the challenges may actually worsen if an incremental approach to investing in veterans’ healthcare doesn’t pay off soon.

On a positive note, at least in my view, the status quo is dying a slow but certain death in VA. The newly signed law could be what keeps VA from dying with it. While it will do nothing for the two brave souls our country lost in Iraq on Sunday, it will give the health and wellness of the nine million veterans enrolled in the VA health care system a fighting chance.