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Compromise veterans bill passes House, heads back to Senate

The measure would expand health care eligibility for combat-related illnesses

The Tibor Rubin VA Medical Center in Long Beach on Wednesday, July 31, 2019.
The Tibor Rubin VA Medical Center in Long Beach on Wednesday, July 31, 2019. (Scott Varley/MediaNews Group/Torrance Daily Breeze via Getty Images)

The House passed a revised version of a sweeping expansion of veterans benefits Wednesday with a tweak designed to fix a constitutional glitch that had briefly derailed the measure.

On a 342-88 vote, the House sent back to the Senate — as an amendment to an unrelated bill  — legislation to provide easier access to health care and disability benefits to more than 3.5 million veterans who were exposed to toxic substances while serving overseas.

The benefits bill had already passed in different forms in both chambers. But an obscure tax provision added by the Senate triggered a constitutional concern in the House, where all tax measures must originate.

The revised bill drops the Senate-passed tax provision, though House members expressed frustration with the additional time and effort needed to get the bill to President Joe Biden’s desk.

“Our veterans do not have the time for technicalities. Their lives are literally on the line,” Rep. Raul Ruiz, D-Calif., said during floor debate.

The bill’s core would make servicemembers who contracted any of 23 conditions — from brain cancer to hypertension — after being deployed to Iraq, Afghanistan and other combat zones automatically eligible for VA health care and disability benefits. That’s a change from current law, which requires veterans to prove their illnesses were a direct result of their deployments rather than some other factor.

When the House first approved the bill in March on a 256-174 vote, it got just 34 GOP votes. Many more Republicans — 123 in all — backed the revised measure Wednesday, citing changes made by the Senate, which passed its version on an 84-14 vote last month.

“This is a better bill than the one that the House passed in March,” said Rep. Mike Bost of Illinois, the top Republican on the Veterans’ Affairs Committee, who was absent for the March vote but said at the time he would have voted against it. “It reflects bipartisan negotiations and input from VA, who is ultimately responsible for putting this into practice.”

Blue slip blues

After the Senate in June passed the expansion — which the Congressional Budget Office estimated as costing nearly $280 billion over a decade — House lawmakers discovered an issue that would hold up final passage for weeks.

Senators had added a provision that would give the Department of Veterans Affairs authority to buy out the contracts of doctors, nurses and other health care practitioners who agreed to work for the VA at rural or “highly rural” veterans clinics.

That buyout money would normally be taxed as income, so the Senate sponsors wanted to make that tax-free. But since the House never considered that tax provision, it ran afoul of the constitutional requirement that all revenue measures originate in that chamber, known as a blue slip.

Senate Veterans’ Affairs Chairman Jon Tester, D-Mont., tried to quickly fix the problem by unanimous consent on June 23 through an “engrossment correction” just before the chamber recessed for two weeks.

But Sen. Patrick J. Toomey, R-Pa., one of 14 Republicans to vote “no” in that chamber, objected. His chief concern was that the CBO estimated nearly $400 billion of existing VA health spending would no longer be bound by discretionary spending caps under a new Treasury fund the bill would create.

The alternative would have been to jump through the traditional procedural hoops in the Senate this month to get the blue slip problem fixed. Either way, the House would have had to re-vote on the amended version after the Senate worked through its process.

And the House couldn’t simply amend the Senate-passed bill to strike the blue slip provision and send it back, because lawmakers in that chamber view it as the Senate’s responsibility to fix such “constitutional defects.” Taking up a separate vehicle allows the House to address the matter without waiting for the Senate to act, and without technically fixing a problem of the Senate’s making.

And in this case, the vehicle had already passed the Senate — the underlying content was later included in the fiscal 2022 omnibus  — so the House’s amendment will enable the Senate to skip some procedural steps when it arrives back in that chamber.

But the need for a new bill irritated House Democrats. 

“I must express dismay also about the procedural steps we must now undertake because a single senator is preventing the Senate from quickly fixing the technical issue in this bill,” House Veterans’ Affairs Chairman Mark Takano, D-Calif., said during floor debate, without mentioning Toomey by name. “And he has held up this bill for no other reason than sour grapes.”

Toomey’s concern about shifting veterans health care funds to the mandatory side of the budget, thereby exempting the money from discretionary spending caps, was widely shared among House Republicans, including some who voted for the bill Tuesday.

Rep. Earl L. “Buddy” Carter, R-Ga., said it was “despicable” that Democrats were “using our veterans” to free up billions of dollars that could be spent on other programs. And Rep. Jake Ellzey, R-Texas, said he would push to move the VA health money back into discretionary accounts “when we take back the majority” in the November midterm elections.

Democrats defended the new entitlement money as a “cost of war” that rightfully belongs outside of the annual appropriations process.

“The entitlements we’re creating are 3.5 million veterans eligible for health care,” Takano said. “It’s going to mean those veterans are entitled to benefits.”

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