It would have been nice if we had gotten direct (assured) funding. Considering how long we fought for this, and how adamant the previous administration was in their opposition to allowing any change, we have President Obama to thank for at least 'getting' us Advanced Funding and the positive effects it could have on the Veteran's VA availability of health care. And if you're asking yourself Direct... Advanced... say what... read on
Some Background - The Federal Budget
The entire federal budget can be divided into three categories: direct funded, advanced (discretionary) funded and discretionary funded programs.
Direct programs (often called entitlements because the programs have specific criteria with program-recipients 'entitled' to payments) receive guaranteed appropriations - mandatory federal funding. Direct programs include: Social Security, Medicaid, Medicare, and (surprise, surprise, surprise) congressional salaries and benefits (including health care).
Discretionary programs are funded annually by, that is their appropriations are at, the discretion of Congress.
The newest kid on the block is Advance Funded Programs - in reality program as there is only one so far. Advance funding provides that in a current budget cycle an item is funded is for the next budget cycle; the item is funded one year in advance.
Some Background - Federal Health Care Spending
Nearly 90 percent of all federal health care spending is direct funded; it has mandatory federal funding.
Only Native American and active duty military health care are discretionary funded.
Veteran health care, which had also been discretionary funded, is now advance funded.
Who Do We Have To Thank For This
Over a decade ago, nine veteran groups joined together to form The Partnership for Veterans Health Care Budget Reform, representing America's Veterans. They are:
- The American Legion,
- AMVETS, American Veterans,
- Blinded Veterans Association, BVA,
- Disabled American Veterans, DAV,
- Jewish War Veterans of the USA, JWV,
- Military Order of the Purple Heart, MOPH,
- Paralyzed Veterans of America, PVA,
- Veterans of Foreign Wars, VFW, and
- Vietnam Veterans of America, VVA.
A Recent Letter Of Theirs
January 9, 2009
The Honorable Barack Obama
President-elect of the United States
Presidential Transition Office
Dear President-elect Obama:
On behalf of the eight million veterans represented by the nine national veterans service organizations in The Partnership for Veterans Health Care Budget Reform, we are writing to urge you to recommend passage of advance appropriations legislation for the FY 2010 appropriations cycle in your first budget request and legislative program. We were pleased to read recent news accounts reporting Veterans Affairs Secretary-designee Eric Shinseki s support for the advance appropriations proposal. The inclusion of this proposal in your first budget submission would send a strong signal to the leadership of the 111th Congress and the veterans community of your firm commitment to change the funding process for veterans health care.
Notwithstanding the recent achievements of the 110th Congress for veterans, VA has received its annual funding for health care programs late in 19 of the last 22 years. Over the past seven years, VA received its final budget an average of three months after the start of the new fiscal year. Not knowing when or what level of funding will be approved from year to year hinders the ability of VA officials to efficiently plan and responsibly manage this exceptional health care system. Compounding the problem are new demands placed on the VA system: over the past decade the number of veterans treated at VA facilities has almost doubled and the newest generation of wartime veterans has increasingly complex mental and physical health care needs that may require a lifetime of care.
The Partnership for Veterans Health Care Budget Reform remains committed to fundamentally change the way veterans health care is funded. While mandatory funding has been the focus over the past several years, The Partnership developed an alternative approach to achieve the same critical goals as mandatory funding "sufficient, timely and predictable funding " which is embodied in the Veterans Health Care Budget Reform Act (S. 3527 / H.R. 6939) introduced last year by Senate Veterans Affairs Committee Chairman Daniel Akaka and House Veterans Affairs Committee Chairman Bob Filner, respectively. This legislation would authorize Congress to approve appropriations for veterans health care one year in advance of the start of the fiscal year, and add greater transparency and integrity to VA s internal budget process to ensure sufficient funding levels are ultimately approved.
The Veterans Health Care Budget Reform Act received strong bipartisan support from leaders in the 110th Congress, including you, Sen. John McCain and others. Along with The Partnership , the legislation has also been endorsed by The Military Coalition, comprised of 35 organizations representing more than 5.5 million members of the uniformed services " active duty, National Guard, Reserve, retired, former officers, and their families " and the American Federation of Government Employees (AFGE). In addition, a growing list of more than two dozen former high-ranking VA officials, including medical center directors, regional health care network directors, Under Secretaries, Assistant Secretaries, and Secretaries, have joined together to support this commonsense funding reform. A national survey commissioned by Disabled American Veterans (DAV) last year also showed that more than 80% of the American public supports reforming VA health care funding through an advance appropriations process.
Mr. President-elect, we agree with your statement that it is time to, | end the unpredictability and inadequacy of VA s discretionary funding process and instead, use an advance appropriations process that would allow Congress to provide VA health care dollars in advance and allow for improved planning and predictability. As you and your transition team continue developing your first budget request and legislative program, we urge you to include clear language requesting advance appropriations for VA medical care accounts. We stand ready to work with you, VA Secretary-designee Eric Shinseki, OMB Director-designee Peter Orzag, and others in your transition team and incoming Administration to ensure that this vital budgetary reform is enacted into law early in the 111th Congress.
Respectfully, The Partnership for Veterans Health Care Budget Reform
And What Just Happened
WASHINGTON (Associated Press & Larry Scott Founder and Editor VA Watchdog dot Org) - President Barack Obama on Thursday [October 22, 2009) signed into law a measure (The Veterans Health Care Budget Reform And Transparency Act -
- Public Law 111-081) designed to keep funding for veterans' medical care steady amid future budget negotiations.
Noting the Veterans Affairs Department is providing care for veterans without a Congress-approved budget right now, Obama said the new law would guarantee timely and predictable funding by laying out the VA budget ahead of schedule. The president said the measure would let the VA know as much as a year ahead of time just how many tax dollars officials could expect to buy equipment, provide health care and hire employees.
"Over the past two decades, the VA budget has been late almost every year, often by months," Obama said in the White House's East Room, surrounded by veterans and lawmakers. "At this very moment, the VA is operating without a budget, making it harder for VA medical centers and clinics to deliver the care our vets need."
The White House said changing the funding process was needed to protect veterans' programs, given that Congress has been late 20 of the last 23 years in passing a budget bill. Aides say the uncertainty of the budget process harms those who have served in uniform because of financial uncertainty for programs.
"This is inexcusable. This is unacceptable," Obama said.
The VA provides health care for more than 23 million American veterans; as many as a quarter of the nation's population qualifies for VA coverage, either as veterans or family members of veterans. But the budget uncertainties have led to delays in replacing medical equipment or insufficient staff to handle their work.
Obama said the funding stability will help veterans receive the care they deserve.
"It ensures that veterans' health care will no longer be held hostage to the annual budget battles in Washington," he said.
--- Regards, Walt Schmidt