Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014

Background

CNN reported on April 27, 2014 that at least 40 United States Armed Forces veterans died while waiting for care at the Phoenix, Arizona, Veterans Health Administration facilities. By June 5, 2014, Veterans Affairs internal investigations had identified a total of 35 veterans who had died while waiting for care in the Phoenix VHA system. An investigation of delays in treatment throughout the Veterans Health Administration system is being conducted by the Veterans Affairs Office of the Inspector General, and the House has passed legislation to fund a $1 million criminal investigation by the Justice Department. On May 16, 2014, the Veterans Health Administration's top health official, Dr. Robert Petzel, retired early at the request of Secretary of Veterans Affairs Eric Shinseki. On May 30, 2014, Secretary Shinseki, himself, resigned from office amid the fallout from the controversy. As of early June 2014, several other VA medical centers around the nation have been identified with the same problems as the Phoenix facility, and the investigations by the VA Inspector General, the Congress and others are widening.

Provisions of the bill

Congressional Budget Office report

This summary is based largely on the summary provided by the Congressional Budget Office, as introduced in the Senate on June 10, 2014. This is a public domain source. Title III of S. 2450 was incorporated completely into H.R. 3230. This relationship was identified by the Congressional Research Service.

The Congressional Budget Office (CBO) has prepared a preliminary analysis of Title III of S. 2450, the Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014, as introduced in the Senate on June 10, 2014. That title would authorize and fund enhancements to several programs of the United States Department of Veterans Affairs (VA). In particular, VA would receive expansive authority for the next few years to contract with health care providers who are not employed by the VA, and VA would be required to use that authority to ensure that all eligible veterans would receive requested health care in a timely fashion. The effects of providing such broad new authority to VA are highly uncertain, and CBO has been able to make only a preliminary and partial assessment of the legislation. Based on that preliminary assessment, CBO estimates that enacting Title III of S. 2450 would increase direct spending by roughly $35 billion over the 2014-2024 period. CBO has not yet estimated the budgetary effects of the other titles of S. 2450.

VA currently has about 8.4 million veterans enrolled in its health care program. Of the remaining roughly 13 million living veterans, CBO estimates that about 8 million qualify to enroll in VA's health care program but have not enrolled. VA currently spends about $44 billion providing health care services to veterans, or about $5,200 per enrollee. (That amount does not include spending on programs that CBO expects would not be increased under this legislation, such as long-term care, caregivers, and ending veterans' homelessness.) Based on information from VA on veterans' reliance on VA, CBO estimates that this cost represents about 30 percent of the total amount of health care received by those veterans.

CBO estimates that, under Title III, enrolled veterans would ultimately seek to increase the amount of care they receive from VA by about 60 percent. In addition, CBO expects that some of the people who are eligible to enroll but not yet enrolled would choose to enroll because of the improvement in access to health care through VA. Most of the costs incurred to provide that care would be for care financed by other payers, including Medicare; a portion of those costs would thus be offset by savings to the Medicare program. All told, CBO expects that veterans would ultimately seek additional care that would cost the federal government about $50 billion a year, on net.

However, CBO expects that VA would have difficulty in quickly setting up a program to contract for health care nationwide and in establishing administrative processes to approve care by private health care providers. Moreover, the amount of care that veterans sought through VA might increase gradually over time. Thus, CBO expects that, of the amount of additional care sought by veterans, VA would provide only about 20 percent in 2015 and about 50 percent in 2016. VA would also spend a comparatively small amount in 2014 on administration and new hiring. Thus, CBO estimates that implementing title III would cost roughly $500 million in 2014, $10 billion in 2015, and $25 billion in 2016.

The magnitude of those budgetary effects is highly uncertain. A significant number of veterans could receive new and expanded health care benefits under S. 2450. How many would ultimately receive those benefits and the resulting costs will depend on a number of factors that are very difficult to predict. Further, the specific parameters of the new program would depend on regulations that would need to be developed. Because the behavioral changes that would result from enacting those provisions are so uncertain, this estimate should be viewed as falling in the middle of a wide range of possible outcomes.

Procedural history

The bill H.R. 3230 was introduced into the United States House of Representatives on October 2, 2013 by Rep. Hal Rogers (R-KY) as the "Pay Our Guard and Reserve Act". The bill was referred to the United States House Committee on Appropriations. The bill was one of the October 2013 mini-continuing resolutions passed by the House during the United States federal government shutdown of 2013. On October 3, 2013 the House voted in Roll Call Vote 516 to pass the bill 265-160. On June 11, 2014, the United States Senate changed the name of the bill to the "Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014" and voted to pass the bill 93-3 in Roll Call Vote 187.

Chairman of the House Committee on Veterans Affairs Jeff Miller said that "many of the provisions included in today's Senate-passed bill are based on ideas that have already cleared the House, so I'm hopeful both chambers of Congress can soon agree on a final package to send to the president's desk." Miller was referring to the Veteran Access to Care Act of 2014 (H.R. 4810; 113th Congress) which contained similar provisions and passed the House on June 10, 2014.

The House and Senate established a conference committee to agree on amendments to the bill. The committee met on June 24, 2014. The House voted to agree to the conference report on July 30, 2014 with a vote of 420-5 in Roll Call Vote 467. The Senate voted to agree to the conference report on July 31, 2014 with a vote of 91-3 in Roll Call Vote 254. President Barack Obama signed the bill into law on August 7, 2014.

Debate and discussion

Senators John McCain (R-AZ) and Bernie Sanders (I-VT) were the two main senators who negotiated the bill. McCain said "is this a final solution to these problems? No, but it is a beginning." McCain also called the situation an "emergency" and said "if it's not an emergency that we've neglected these brave men and women who have protected our country, then I don't know what is."

Only three senators voted against the bill, Jeff Sessions (R-AL), Bob Corker (R-TN), and Ron Johnson (R-WI).