Senate Weighs Rising VA Health Costs, Infrastructure Needs Amid Budget Proposal

Department of Veterans Affairs (VA) Secretary Denis McDonough tested before the Senate Appropriations Subcommittee on Military Construction, VA, and Related Agencies (MilCon-VA) on May 4 regarding the administration’s fiscal year (FY) 2023 budget request. He previously appeared before the House MilCon-VA and VA Committee to respond to inquiries on the administration’s budget request [refer to Washington Highlights, April 8, April 29].

Like his counterparts in the House, subcommittee chair Martin Heinrich (DN.M.) noted the increasing costs of the VA budget request. “The cost of medical care across private and public sectors continues to rise. Although the pandemic is a factor, these requests continue a trend of large increases in VA medical care that reflect growing demand for both in-house and community care.” Ranking member John Boozman (R-Ark.) described the growth as “unsustainable” in his opening statement.

Acknowledging the administration’s request to create a new category outside of the traditional defense and non-defense categories for the $119 billion requested for VA medical care accounts, Heinrich added, “Each year, the Appropriations Committee must balance VA medical care with nondefense priorities across the government. … I agree that providing care for veterans should not come at the expense of other critical domestic programs.”

In making the case for a separate category for VA medical care accounts, McDonough outlined several other federal agencies that provide services to veterans including additional health coverage through the Centers for Medicare & Medicaid Services, student loans through the Department of Education, and housing support through the Department of Housing and Urban Development. “So, we can’t continue to grow at the expense of our partners who help us provide that critical care to veterans,” he said.

The VA’s recommendations to the Asset and Infrastructure Review (AIR) Commission, to ensure the VA’s clinical infrastructure reflects the needs of veterans, were again raised by several subcommittee members [refer to Washington Highlights, March 18]. McDonough described the purpose of the recommendations “to make some informed assessments as to how we can address what [veterans] will need and who can do it through a combination … of direct VA care and then care in the community, and then care with our academic affiliates.” He added that the VA has entered into a separate contract to analyze and update the existing data that informed the recommendations as the commission is formally established.

Sen. Patty Murray (D-Wash.) expressed frustration with recommendations to reduce services at VA medical centers in her state. “I want to be very clear; I will not stand for this. A reduction of inpatient services is just a complete nonstarter for me.”

McDonough noted that the Senate would need to approve the nominees to the AIR Commission before the recommendations would be considered.

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