First Step to Fix VA Can’t Be the Last | Commentary

Posted August 13, 2014 at 9:21am

The Department of Veterans Affairs health care access crisis was a long time in the making. Many years of inadequate funding, creative accounting, budget gimmickry, and lengthy delays in passing appropriations bills stretched the VA’s capacity to the breaking point and made competent management of the agency next to impossible.

That’s why the bipartisan, bicameral compromise just signed into law to address the crisis — while a welcome first step toward rebuilding the VA’s capacity to provide all enrolled veterans with timely, high-quality health care — must be the beginning of a long-term effort to restore America’s sacred compact with those who have fought for our freedom.

First, the good news about the legislation: It appropriates $5 billion desperately needed by the VA to hire more doctors, nurses and other clinical staff; repair and expand treatment space in VA’s aging facilities; and lease new outpatient clinics in underserved areas. That’s a decent down payment on the VA’s funding shortfall over the past decade, which totals more than $17 billion over the past decade for infrastructure and medical care. This appropriation came at the request last month by Deputy Secretary Sloan Gibson who argued $17.6 billion over the next three years is needed to address the VA’s access crisis by hiring 10,000 new clinical staff members, undertake major repairs and renovations at over 700 VA facilities, and lease an additional 77 clinics — all essential to ensuring that the VA can serve the influx of veterans needing its health care services.

Looking ahead, what’s needed is a commitment and action by Congress to appropriate the rest of Gibson’s request over the next two years, helping the VA play catch up in boosting their internal capacity to serve all who need care.

Matched with the internal investment is $10 billion set aside in the bill to allow veterans, especially those unable to get prompt VA appointments, to get care from private providers over for the next couple of years.

While no veteran should be forced to wait too long or travel too far to get care, we hope this turn to the private sector is viewed and accepted as a temporary stop-gap while the VA rebuilds its capacity. Moreover, the VA must remain fully responsible for ensuring the best health outcomes for veterans by coordinating the delivery of non-VA care, including all needed follow-up.

Health care professionals within the VA system possess unmatched expertise in treating traumatic brain injury, PTSD, amputations and other afflictions much more common among veterans than the public at large. And because this care often requires multiple providers — including neurologists, psychiatrists and physical therapists — coordination is essential. And that is something the VA excels in, especially in comparison to the private sector.

As this new law is being implemented, Congress must now take steps to prevent future funding shortfalls by ending the budget gimmicks that were at the root of the long wait times. This should start with an entirely new approach to funding the VA.

In future fiscal years, we need honest budgeting so that the money matches the mission. In recent decades, multiple administrations and Congresses have failed to ask for or appropriate the amount internal VA projections indicated is necessary, and the budgeting process has been plagued with gimmicks and fake efficiencies. Making matters worse, the VA is almost routinely forced to wait days, weeks and often months before knowing what all of its funding levels would be.

To end this toxic cycle of gridlock, Congress should pass legislation the moment they return from their August recess providing advance appropriations for all VA functions. The bipartisan Putting Veterans Funding First Act has already been approved by the House and Senate Veterans’ Affairs Committees and awaits floor action. By applying the same process that already works well in funding VA medical operations, this legislation will ensure that the entire VA knows its budget before the start of each fiscal year, improving management and preventing benefit cutoffs that could occur in any future government shutdown.

Under the leadership of new Secretary of Veterans Affairs Robert A. McDonald and with renewed attention to the need for a stronger VA, we now have a unique opportunity to fix some of the problems that have plagued the agency for years. Our nation made a decision to fight two wars over the past 12 years and now its obligation to all who served and sacrificed for our country must be sacrosanct. It’s time to stop playing accounting games and stop politics as usual, and instead put our veterans first with honest budgeting and advance appropriations.

Because we have upheld this solemn obligation in the past, our nation built the VA into one of the best health care systems anywhere in the world. Now, let’s restore this great achievement and do right by all who served their country with such honor.

Garry Augustine is executive director of the Washington Headquarters of Disabled American Veterans.