Department of Veterans Affairs Secretary Denis McDonough urged Congress on Thursday to back a massive funding increase to boost efforts in homelessness assistance and suicide prevention, and address the agency's crumbling and outdated medical infrastructure.
McDonough testified before a House Appropriations Committee subpanel that oversees the VA's funding, highlighting the need to dramatically increase the department's already mammoth budget by $8.5 billion, or 8.2%, to $113.1 billion total as part of President Joe Biden's 2022 budget request.
"President Biden defined our country's most sacred obligation as preparing and equipping the troops we send into harm's way and then caring for them and their families when they return," McDonough told lawmakers. "This budget ensures all veterans, including women veterans, veterans of color and LGBTQ+ veterans, receive the care and benefits they have earned."
The agency is the second largest part of the federal government in terms of size and budget, which has ballooned over the decades with no signs of slowing down. Lawmakers seldom push back publicly on VA spending, due to the political minefield they would have to navigate to avoid being perceived as curtailing veteran health care. Yet bills to expand or create services are often squashed behind closed doors due to cost.
Between 1970 and 2017, the VA's spending "grew significantly" faster than inflation, according to the Congressional Budget Office. Medical care spending grew from $27 billion in 2000 to $69 billion in 2017, an average annual increase of 5.7%. Part of this was due to the VA expanding various programs and investing in community care, on top of veterans from 20th century wars growing older and requiring more expensive care. The post-9/11 wars also significantly increased the veteran population.
In Biden's 2022 budget request, suicide prevention program spending would jump by more than 74%, rising from $310 million currently to $540 million.
Between 2005 and 2018, 89,160 veterans died by suicide, according to the most recent data from the VA -- more than the number of Americans killed in each major U.S. conflict except World War II and the Civil War.
Despite Congress' efforts and an ever-rising VA budget, there's no evidence the federal government has put a dent in the veteran suicide crisis, with the VA's data showing little change in the suicide numbers each year.
"Suicide is a complex issue with no single cause," McDonough told lawmakers. "Maintaining the integrity of VA's mental health care system is vitally important, but it is not enough. We know some veterans may not receive any health care services from VA, which highlights VA alone cannot end veteran suicide; it requires a nationwide effort."
The administration's budget request also includes a boost to homelessness programs, up 4.4% from current spending to $2.1 billion.
Under the plan, the VA also aims to become a more welcoming place for women and offer more gender-specific health care. McDonough told lawmakers that more women than ever are choosing the VA for their health care, accounting for more than 30% of new enrollees the past five years, more than triple the number of women enrolled in 2001.
No lawmakers seriously interrogated McDonough on the VA's huge money request. Biden's budget proposal comes alongside his $2 trillion-plus infrastructure plan still being drafted by Democrats on Capitol Hill, calling for even further boosts to the VA.
Biden's plan asks for $18 billion to modernize VA hospitals across the country. McDonough didn't overtly advocate for the ambitious infrastructure bill, but stressed to lawmakers that the VA's 1,700 facilities are quickly falling behind the private sector and are in serious need of upgrades.
McDonough told lawmakers that the median age of U.S. private-sector hospitals is roughly 11 years, while VA hospitals are 58 years old on average.
"With aging infrastructure comes operational disruption, risk and cost," he said. "The architects who designed and constructed many VA facilities in the decades following World War II could not have anticipated the requirements of today's medical technology and the key role infrastructure -- and technological infrastructure -- now plays in delivering safe and high-quality health care. As a result, many of VA's facilities were not designed with these technology and infrastructure requirements, which limits our agility and ability to meet the evolving health care needs of veterans."
-- Steve Beynon can be reached at Steve.Beynon@military.com. Follow him on Twitter @StevenBeynon.