WASHINGTON — In its FY 2022 budget proposal, VA is asking Congress to provide the department with a 10% increase over 2021 funding levels.
The amount, announced last month, raised eyebrows on both sides of the aisle and had some legislators questioning how high the VA budget needs to go before the agency is adequately funded.
The FY 2022 request totals $269.9 billion—an increase of nearly $30 billion from the previous year. This includes $101.5 billion for VA medical care—9% above the 2021 level. This is in addition to the $19.6 billion the department received as part of the CARES Act in March 2020, which has not entirely been spent, and $17 billion through the American Rescue Plan.
According to VA Secretary Denis McDonough, who defended the record-setting budget during a House VA Committee hearing last month, the growth is due in part to increased use of VA’s community care program. VA’s FY 2020 budget included $15.2 billion for community care. That rose to $18.5 billion in FY 2021. Now VA is asking for $23.4 billion—a 25% increase over the previous year. It’s also far higher than the amounts expected when Congress originally was debating the MISSION Act—the legislation that consolidated and expanded veterans’ opportunities to seek VA-funded care from private providers.
“Upward of 30% of our [medical care] costs have indeed gone to care in the community,” McDonough told legislators. “That got as high as 39% at the height of the pandemic. VA funding underwrote a lot of the community when private facilities were trying desperately to stay open.”
Even as VA facilities begin to offer their full slate of services again, however, veterans are still seeking community care in greater numbers.
“Just over the last several months, the monthly outlay for care in the community has been at record highs,” McDonough said. “Even as direct care reaches pre-pandemic levels as well, demand for [community] care is significant.”
“We’re in the midst of a bow-wave of care,” he declared. “We’re seeing demand for that care in both channels.”
With VA unable to predict how high the ceiling might go on community care utilization, most of the legislators on the committee displayed concern about a 10% increase becoming the norm rather than an aberration.
Ranking Republican Mike Bost (R-IL) was the most vocal in his concerns.
“The time has come to ask when VA will be adequately funded. Congress must prioritize veterans, but there is a natural limit to how big a budget can be,” Bost declared.
He noted that the 10% increase far outstripped the increase in veterans coming to the department. The number of veterans receiving disability compensation or pension benefits rose 4.3% in the previous year, he said, while the number of veterans receiving healthcare was up only 1.3%.
“I’m not suggesting cutting VA,” he explained. “But the budget growth has to be more in line with demand.”
Bost said he was also concerned that VA was using the one-time funding in the CARES Act and the American Rescue Plan to create permanent expenses that would then have to be supported in future budgets.
Bost suggested that it was future costs that had him most concerned, citing VA’s plans to expand care and benefits to veterans affected by toxic exposure. Several bills are being considered that would broaden eligibility for care and make it easier for veterans to claim a direct service connection between their illnesses and toxic exposures. As many as 3.5 million veterans from Iraq and Afghanistan alone could quality.
“This is the elephant in the room,” Bost said. “Preliminary cost estimates of those bills range up to $1.5 trillion. Potential bill costs of this magnitude are unheard of in VA and raise serious questions about our ability to pay for this legislation. I also question VA’s ability to implement it, and to do so without compromising services for veterans in other areas. We need a fiscally responsible approach … We need to figure out how to provide care and benefits for toxic exposed veterans without breaking the bank or crippling the department.”
Asked if VA can handle a bill with a $1.5 trillion price tag, McDonough declined to give a definitive answer.
“I avoid getting into fights between CMO versus OMB in cost estimates,” he said. “We are looking at the implications of the various legislative proposals on the hill [and] what they require in terms of personnel resources. If we’re looking at that high a number, we’ve got to try to figure out how to pay for this and make sure we’re not losing other services.”
One other notable increase in VA’s budget proposal is a request for $598 million to fund suicide prevention efforts—a 92% increase over 2021. Funding for mental healthcare in total would grow to $13.5 billion in this budget, up from $12 billion in 2021.
Asked about the near-doubling of VA’s suicide prevention budget, McDonough explained that the request is being spurred by a massive demand for the Veterans Crisis Line (VCL) in the past year.
“Some of this is related to the pandemic,” McDonough said. “But some is related to overall demand. Just in the last year we’ve seen 1.56 million veterans receiving mental health services … [Facilities] are reporting massive demand—in some cases as much as an 80%-100% increase in and around the pandemic.”
“The number of vets who come to us through the VCL is expanding substantially,” he added. “We’re getting quite good at connecting from the VCL to the emergency departments. That allows us to make very important handoffs during these moments of crisis for our veterans.”