VA Asks for Billions to Treat 'Bow Wave' of Veterans Needing Care After Pandemic

Denis McDonough gives the keynote speech at Quantico National Cemetery
Denis McDonough, secretary of the Department of Veterans Affairs, gives the keynote speech at Quantico National Cemetery in Triangle, Virginia, May 28, 2021. (George Nudo/U.S. Marine Corps)

The Department of Veterans Affairs is seeing increased demand for health services from veterans who either deferred care or couldn't get appointments during the pandemic -- a surge that VA Secretary Denis McDonough says will add billions to its budget.

McDonough told the House Veterans Affairs Committee on Tuesday that funding is needed to add more than 19,000 new positions, including 17,000 health care jobs, and to cover the growing cost of care both at department facilities and in the community. The VA's latest budget request is $270 billion.

According to McDonough, the department saw "record high levels" of veterans receiving care at non-VA facilities in April and May through benefits provided under the 2018 Mission Act. At the same time, VA hospitals and clinics are returning to "pre-pandemic levels" of patient care, he said.

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The VA is asking for a 27% boost in its budget for community care for fiscal 2022, from $18.5 billion to $24.4 billion. It also wants another 24% increase from current funding levels for fiscal 2023 -- $24.2 billion for advanced appropriations, a budget item unique to the VA that ensures veteran services are never interrupted by legislative debate or delays.

At the same time, the department is asking for a 4% increase for health services at VA medical centers and clinics, from $56.5 billion to $58.8 billion.

"This is not hypothetical," McDonough told committee members. "We are in the midst of a 'bow wave' of care; we are seeing a demand for that care."

While VA medical centers never closed during the pandemic, schedulers moved most routine appointments to telehealth or telephone visits or canceled them. They also postponed elective procedures, prompting some veterans to delay care or seek treatment in their local communities.

The VA "underwrote a lot of care in the community when private facilities were trying desperately to stay open," McDonough said.

"The community care budget is growing. As a general matter, upward of 30%, 31% of our costs are care in the community, although it got as high as 39% at the height of the pandemic,” he said.

The VA Mission Act implemented sweeping changes to the department's community health care program, allowing veterans to see private health care providers at the VA's cost.

The legislation greatly expanded access to that care, and supporters have praised the benefit as a win for veterans who faced long wait times or who live far from a VA health facility. But critics said it would draw funds away from VA facilities and providers, amounting to the "privatization" of VA health care.

Rep. Mark Takano, D-Calif., chairman of the House Veterans Affairs Committee, and Rep. Mike Bost of Illinois, the committee's ranking Republican, have expressed concern over the explosive growth of the program and the VA's budget.

Takano questioned whether the expansion of the program was related to aging infrastructure at the VA that may prevent veterans from receiving specialized services.

"Funding requests for care in the community have grown substantially in recent years, due in large part to the expanded access standards and poor actuarial projections in early 2018," Takano said. "The Congressional Budget Office suggested estimated outlays for the program over a five-year period would be just under $23 billion ... but we're seeing this in one year."

Bost agreed.

"I think we are all concerned about the national debt outgrowing our economy. VA has requested a 10% increase next year. If that rate of growth continues, the VA budget will be $574 billion by 2030. The problem is the number of veterans using the VA services is not up by 10%," he said. "I'm not suggesting cutting VA, but the budget growth has to be more in line with demand."

The VA received influxes of funding in fiscal 2021 in addition to its base budget, including $36 billion in pandemic relief and recovery funds. Another $18 billion in the American Jobs Plan is marked for VA health care infrastructure.

The fiscal 2022 budget proposal includes a nearly 100% increase in the department's suicide prevention budget and an additional $1.5 billion for mental health services to meet increased demand.

McDonough said more than 1.6 million veterans sought mental health services through the VA last year and Veterans Crisis Line calls have nearly doubled.

Under the VA budget proposal, the Veterans Crisis Line would receive $142 million, while suicide prevention programs, including a grant program for community organizations that focus on suicide, would receive $598 million.

Lawmakers also pressed McDonough for a reaction to proposed legislation that would require the department to provide pay and benefits for service members with illnesses related to toxic exposures, including burn pits and other airborne hazards such as oil well fires.

Legislative packages now under debate could cost up to $1.5 trillion. By comparison, President Joe Biden's budget proposal for the federal government is $6 trillion.

"Bill costs of this magnitude are unheard of in the VA. They raise serious questions about our ability to pay for this legislation. They also raise questions about VA's ability to implement and to do so without compromising service for veterans in other areas," Bost said.

McDonough said the department is reviewing the current legislative proposals and what they would require in terms of VA personnel and support.

But Takano reaffirmed his commitment to legislation that would support affected veterans.

"Last month, I unveiled the 'Honoring Our Promise to Address Comprehensive Toxics Act' ... to recognize toxic exposure as a cost of war and ensure all veterans can utilize the care and benefits," he said. "I look forward to working with VA on this important issue."

Testifying after McDonough as part of a panel of veterans services organization representatives, AMVETS National Executive Director Joe Chenelly criticized the budget proposal, saying it lacks specifics to improve veterans' quality of life.

He said that part of the $1.5 billion for mental health services should fund a task force that would focus on providing a holistic approach to veterans' health, including physical and mental health and job and home security.

"We need to get out of the business of spending billions on ineffective mental health services and pharmaceuticals focused only on treating veterans' symptoms, and instead fund proactive programs that train veterans how to live happy, healthy lives of purpose," Chenelly said.

-- Patricia Kime can be reached at Follow her on Twitter @patriciakime

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