VA Health Care: “Postponed Proceedings”

The bills to improve the performance of Veterans Administration operations have passed the House and the Senate, in fact they’ve been waiting for a conference committee to iron out the differences between the two bills since mid June. That’s why it’s disappointing to find the following update on the progress of the final bill posted as follows:

“7/17/2014 POSTPONED PROCEEDINGS – At the conclusion of debate on the Barber motion to instruct conferees on H.R. 3230, the Chair put the question on adoption of the motion to instruct conferees and by voice vote, announced the noes had prevailed. Mr. Barber demanded the yeas and nays and the Chair postponed further proceedings until a time to be announced.”

No instructions from the House, no conference, no conference no conclusion.  What are the differences between the House and Senate versions?

# The House bill specifically bans the use of bonuses for VA employees, while the Senate version does not. The VA has already suspended performance awards of this nature.

# The Senate bill would allow the VA to lease 26 new facilities for veterans’ health care and would allocate $500 million for hiring new staff.  The House version doesn’t contain these provisions.

# The Senate bill provides for guaranteed in-state tuition for veterans at public colleges and universities; the House version of the bill does not.

# The Senate version of the legislation provides for expanding access to care for military sexual assault victims. The House version does not include this provision.  [WaPo]

# The House version assumes a maximum wait time of 14 days, the Senate version could allow up to 30 days. [CBO]

# The CBO analyzed the costs of implementation for securing private health care services when VA service could not be provided

“The Senate bill would require that all privately provided care be implemented through contracts. CBO expects the costs of contracted care to be closer to commercial rates, which are generally higher than Medicare rates. Although such contracts would probably be used under the House bill to cover some care, CBO estimates that the average payment rate under the House bill, including both contractual and non-contractual payments, would be lower than that under the Senate bill.” [CBO]

# The House version would allow direct reimbursement to private facilities, while under the terms of the Senate version as analyzed by the CBO the VA would negotiate contracts with providing facilities.  Thus, the access might be faster under the House version, but with less expense predictability than if the terms of the Senate version were applied.

Unfortunately, the situation is reduced to a battle over money.  The CBO released its appraisal of the costs on June 17, 2014:

House Version: “Based on that preliminary assessment, CBO estimates that implementing sections 2 and 3 of the House bill for that two-year period would have a net cost of about $44 billion over the 2014-2019 period, assuming appropriation of the necessary amounts. That net amount comprises increased costs of about $51 billion for VA, less a reduction of $7 billion in federal spending for Medicare and Medicaid.” […] All told, CBO expects that if the bill was fully implemented, some veterans would ultimately seek additional care that would cost the federal government about $54 billion a year, after accounting for savings to other federal programs.”

New “scoring” from the CBO reduced the figure from the original $54 billion to approximately $30 billion, but the negotiations were still stalled. [Hill]

Conferees from the House have been looking to cover the costs by using discretionary funding, those from the Senate are supporting a mandatory funding formula.  The House sponsor, Rep. Jeff Miller (R-FL), argued: “The Senate wants to throw money at a situation that is not defined, in an amount of money that is not defined. We’re re trying to define the issue and figure out how to pay for it,” Miller said.” [MilTimes]

Miller’s assessment may be overlooking the differences in the cost predictability between the provisions for paying private entities for health care services for veterans.

Senate Majority Leader Harry Reid (D-NV) expressed his impatience with the protracted timeline of the conferencing, “We’re having a little trouble getting the House to help us complete the conference,” Reid said.. “You know … just because we want something done when we’re in conference doesn’t mean it gets done.” [The Hill]

In the mean time — proceedings are postponed.

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