As the Senate voted overwhelmingly to pass legislation designed to fix problems at the Department of Veterans Affairs, the amount of new spending in the measure began to clarify.  

And the price tag could be a gut-check when it comes to understanding what it really costs to fulfill sacred obligations to America’s veterans. The cost of the measure could be astronomical.  

That’s according to preliminary numbers circulated by the Congressional Budget Office Wednesday afternoon. The bill would give veterans new opportunities to seek care outside of the health care system provided by the Department of Veterans Affairs.  

CBO said in a Wednesday letter to Senate Veterans’ Affairs Chairman Bernard Sanders, I-Vt., that since the bipartisan legislation provides broad new powers to the VA that makes for a lot of uncertainty in estimating costs, but looking only at the provisions providing access to other providers, CBO said veterans would eventually seek $50 billion in additional care each year:

CBO estimates that, under Title III, enrolled veterans would ultimately seek to increase the amount of care they receive from VA by about 60 percent. In addition, CBO expects that some of the people who are eligible to enroll but not yet enrolled would choose to enroll because of the improvement in access to health care through VA. Most of the costs incurred to provide that care would be for care financed by other payers, including Medicare; a portion of those costs would thus be offset by savings to the Medicare program. All told, CBO expects that veterans would ultimately seek additional care that would cost the federal government about $50 billion a year, on net.

Maya MacGuineas, president of the outside group the Committee for a Responsible Federal Budget, blasted the open-ended spending in a statement released as the vote was coming to a close.

“The ’emergency’ designation is for sudden, unforeseen, and temporary needs — none of which define this situation — not a tool for politicians who are unwilling to pay the bills. Budgeting is about prioritizing, but by resorting to abusing the emergency escape clause, Washington is once again looking for the easy way out,” MacGuineas said. “The legislation also includes an unprecedented open-ended mandatory appropriation that basically gives the VA a blank check to spend as it wishes. Given recent reports, one would think Congress would want more accountability at the VA, not less.”

The CBO also said that the budgetary implications are difficult to assess, however:

The magnitude of those budgetary effects is highly uncertain. A significant number of veterans could receive new and expanded health care benefits under S. 2450. How many would ultimately receive those benefits and the resulting costs will depend on a number of factors that are very difficult to predict. Further, the specific parameters of the new program would depend on regulations that would need to be developed. Because the behavioral changes that would result from enacting those provisions are so uncertain, this estimate should be viewed as falling in the middle of a wide range of possible outcomes.

Sanders has said that the bill meets an obligation made to veterans.  

“Our job is to make certain that every veteran in the country gets quality health care in a timely manner,” he said in a statement just after the vote. “At a time when 2 million more veterans have come into the VA in the last four years, we must ensure that there are enough doctors, nurses and other health care professionals to meet the needs of veterans in every facility in the country.”