Three Republicans and at least one think-tank have opposed the bipartisan veterans affairs bill that passed the Senate with overwhelming support last week, saying the legislation was rushed to a vote before the costs were known.
So what do we know about the measure’s price tag?
First, let’s look at the language of the bill. The provisions largely address the scheduling scandal within the Department of Veterans Affairs’ health system, but they also expand certain benefits for former troops and their families.
The bill would give the VA greater authority to fire senior executives and provide funding for the agency to contract with private medical centers to help meet demand. It would also allow the VA to shift $500 million within its budget toward hiring more medical staff and give the agency permission to lease 26 additional medical facilities.
As for benefits, the measure would expand access to health care for military sexual-assault survivors, require public colleges and universities to offer in-state tuition rates for all veterans regardless of where they live and allow tuition assistance for surviving spouses of troops who died in the line of duty.
Now for the costs.
The contracting provision has caused perhaps the most concern. The Committee for a Responsible Federal Budget said that section would lead to one of the largest entitlement expansions since Medicare Part D, which subsidizes prescription drugs for Medicare beneficiaries.
Similarly, Sen. Jeff Sessions (R-Ala.), one of three lawmakers who voted against the legislation, said during remarks on the Senate floor last week: “We need to resist the temptation to create more entitlements and more entitlements, which is one of the reasons we are heading recklessly toward fiscal crisis.”
The nonpartisan Congressional Budget Office released a report on the costs of the contracting provision — and only that provision — less than an hour before the Senate voted on the bill. It estimated that the change would increase federal spending by about $35 billion over the next 10 years.
The report noted that improving access to care through expanded use of private providers could cause more veterans to seek health care through the VA. It said the additional costs for the federal government under the change could reach an estimated $50 billion per year.
The VA currently spends about $44 billion annually on health-care services for former troops, so the contracting provision could more than double that cost, if the projections prove to be correct.
However, the CBO issued a caveat about its estimates, saying: “The effects of providing such broad new authority to VA are highly uncertain, and CBO has been able to make only a preliminary and partial assessment of the legislation.”
The report also said that the ultimate costs of the bill “depend on a number of factors that are very difficult to predict,” including how many veterans would receive new or expanded benefits.
The CBO estimated that 8 million veterans who qualify for VA care have not enrolled in the department’s health-care system, and that about one-quarter of those individuals might choose to join the network as access expands. Current enrollees could create additional strain by seeking to increase the amount of care they receive, according to the report.
Sessions suggested that Congress should reject the Senate bill and focus instead on “reforms and solutions that improve the quality of service and the effectiveness that is delivered.”
But Senate Veterans Affairs Committee Chairman Bernard Sanders (I-Vt.), who sponsored the measure along with Sen. John McCain (R-Ariz.), has said that Congress has an obligation to support the troops that fought the nation’s wars.
“One of the costs of war is taking care of the men and women who fought in those wars,” Sanders said in an interview last week. “We have the moral obligation to do every thing we can to make them whole, to provide the benefits and medical care to which they are entitled. If anybody disagrees with taking care of veterans, they shouldn’t send them off to war in the first place.”
The VA legislation has moved to a conference committee that will try to work out a final agreement between the Senate and the House, which has passed many of the same provisions as stand-alone measures. The bill could arrive on President Obama’s desk as early as this week if the process moves smoothly.
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