Roughly a fifth of President Donald Trump's proposed $87 billion fiscal 2020 budget for Department of Veterans Affairs medical care would go to its community-care programs, an allocation VA officials say is consistent with previous years and not an expansion of private care.
Eager to point out that the VA is committed to providing the majority of its health care services to veterans within its own medical facilities, officials said Monday the department has budgeted for an increase in care both at VA facilities and in the private sector for fiscal 2020 and 2021.
The budget for in-house VA care in fiscal 2020 would increase by more than $2 billion, to $70 billion, while the funding for community care would increase by roughly $1 billion to $17 billion.
The emphasis from VA officials comes as the department faces criticism from veteran service organizations and lawmakers over proposed rules to expand veterans' access community care.
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Critics say the new rules, which would allow veterans to see a private doctor if they travel more than 30 minutes for a primary-care appointment and more than 60 minutes for specialty care, are designed to encourage veterans to get care at non-VA facilities.
The proposal, coupled with a $55 billion award to Optum Public Sector Solutions to manage three of six VA private-sector care contracts, as well as concerns over the influence of organizations pressing the government to outsource VA medical care, have raised questions that the Trump administration is quietly privatizing VA care.
But during a briefing on the VA fiscal 2020 budget proposal Monday, VA officials said the department expects that 81 percent of its total medical care budget will go to in-house VA care, with roughly 19 percent of budgetary resources going to private care in the next two years.
The officials said the VA is forecasting a 1- to 2-percent growth in overall health care utilization in the next two years across the department and has allocated funds to the medical care budget line to handle the increases.
The VA does not, however, break down the projections into how many veterans are expected to use private health care versus VA care.
"What we see in our baseline population, [VA actuaries] projected an additional reliance on VA care based on the expanded access. ... If we get this wrong and we see a lot more veterans going to the community versus coming into the VA or vice versa, we can request from Congress a transfer among our programs to balance out the resources based on veterans' preferences," a VA official said.
In 2018, 34 percent of all VA appointments were in the community-care system, down from 36 percent in 2017.
In addition to the $87 billion health care budget, the proposal includes a nearly 45 percent increase for a new electronics health records system ($1.6 billion) and much needed information technology upgrades ($4.3 billion), among other items.
The budget would reduce VA funding for medical research by $17 million, with the bulk of the research ($107 million) going to central nervous system injuries and associated disorders. An additional $120 million is earmarked for mental health research and $33 million for substance abuse disorders.
The proposal also would cut construction allocations by 45 percent, although VA officials pointed out that the planned reductions in construction reflect a return to a normal budget line following a massive influx of cash needed to address immediate construction concerns in 2019.
But the budget also includes a proposal to "round down" the annual cost-of-living increases veterans receive with their disability compensation -- a move that reduces the COLA increase to the nearest whole dollar. Veterans groups successfully fought the proposal last year.
If approved, it would save the department $36 million in fiscal 2020. The plan also calls for capping the education benefit for flight training schools, a move that would save the VA $30 million each year.
The budget request also includes $217 billion in advanced appropriations for fiscal 2021. The VA is required to project and furnish its year-ahead numbers to ensure that VA medical care, disability benefits and other vital services are protected from budget delays.