WASHINGTON — Calling the Trump administration’s fiscal years 2019 proposed budget for VA “very strong,” VA Secretary David Shulkin, MD, told lawmakers that it “provides the resources to continue VA modernization and to respond to the changing needs.”
The proposed budget is $198.6 billion for the agency, of which $88.9 billion is in discretionary funding. Shulkin explained that, in total, the discretionary request is an increase of $6.8 billion, or 8.3%, over the FY 2018 budget request.
As he has said previously, suicide is his “top clinical priority.”
“The budget includes $8.6 billion for VA’s mental health services, an increase of $468 million, a 5.8% increase above the 2018 current estimate,” he said last month.
As part of the budget request, VA is continuing to seek reforms to its community care program that would allow the agency to simplify eligibility requirements for the Choice program and to consolidate its various community care programs under one umbrella. The reforms to the Choice program have been an ongoing topic of debate in Congress.
Shulkin told lawmakers that the use of community care has grown, with about 36% of VA healthcare provided outside, adding, “When I arrived at VA in July of 2015, it was about 22%. Now it is at 36%.”
House Committee on Veterans’ Affairs Chairman Rep. Phil Roe (R-TN) asked how long it would take to revamp VA’s community care programs, if Congress is able to pass legislation.
Shulkin said that it would be about a yearlong process to transition to a new system in which all of the programs are integrated together and to change the eligibility requirements.
Ranking Member Rep. Tim Walz (D-MN), meanwhile, voiced concern about increases in community care spending and wanted to know about a proposed increase in funds for community care in the 2020 advanced appropriations.
“Is that the norm going forward? Are we going to start increasing 50% in the community?” he asked.
Shulkin attributed the proposed increased funding to greater use of community care as a result of the agency’s efforts to address the access crisis.
“I don’t think we are going to see the same continued rate of growth. I think what you saw was a Choice program implemented that was complex, that people weren’t able to use. Finally, now three years later, they are understanding how to use it, and that is why we saw such a big growth,” the VA secretary responded.
Walz said that, instead of spending money to fill vacancies so that veterans have access in VA, veterans will have to go outside of the healthcare system. He told Shulkin that, in his view, it was “becoming more and more difficult for you to say that you are not supporting privatization of the VA.”
Overshadowing the release of the budget request was a VA inspectors general report finding that Shulkin’s chief of staff, Vivieca Wright Simpson, altered an e-mail of another VA official in order to get approval of travel expenses for Shulkin’s wife of more than $4,000 for a European trip last summer.
The report also stated that Shulkin improperly accepted Wimbledon tennis championship tickets on that trip. The report recommended that the secretary repay more than $4,000 spent on his wife’s ticket.
Shulkin told lawmakers at the onset of the budget hearing that he did “regret the decisions that have been made that have taken the focus off of that important work.” He said he planned to reimburse the U.S. Treasury.
“I am committed to doing what we have to do to focus on veterans and make this better,” he said.
At the hearing, Roe told Shulkin that he encouraged him “to take every step to address the findings of this report and to make any changes necessary.”
During the hearing, Shulkin said that he recognized that the “optics of this are not good.”
“It is not the optics that are not good. It is the facts that are not good,” replied Rep. Mike Coffman (R-CO).
A day after the hearing, the VA announced that the Office of Accountability and Whistleblower Protection Executive Director Peter A. O’Rourke would replace Simpson, who stepped down.
Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..
The good news from a recent consultant study is that, overall, the VA healthcare system is generally equal or better than others when inpatient and outpatient quality is measured.