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.

Turkey Time: DB’s Nominations

It’s holiday time, and here are DB’s nominations for the Birds of the Season.  The Turkeys are (in no particular order):

Presidential candidate Mitt “47%” Romney, who managed to insult ethnic minority groups, women, moderates, independent thinkers, elders on Social Security, students getting Pell Grants, advocates of clean energy, conservationists, women’s health care proponents, Medicare enrollees, consumer advocates, social safety net supporters, and then wondered why he didn’t win the 2012 election.

Senator John McCain (R-AZ), who having defended the nomination of Condoleeza Rice to be Secretary of State (Anyone remember that Mushroom Cloud reference?) attacked U.S. Ambassador to the United Nations Susan Rice for being “stupid” and “deceitful.”   This state of affairs shouldn’t be surprising because a quick search of DB would soon demonstrate that Senator McCain was quite often the recipient of the unwanted and un-complimentary Deck Bass award of recent memory.

Senator Harry Reid’s (D-NV) nemesis Mitch McConnell, Senate Minority Leader, gets a Turkey for his statement that revenue increases are maybe kind of sort of could be OK, IF we fix the Real Problem.  The Real Problem for Senator McConnell appears to be that Social Security exists.   There’s no reason to raise the retirement age in the United States, because the Social Security system adds ZIP ZERO ZILCH to the national debt.  However, if we want to make the system more secure — how about lifting the cap on taxable earnings above the current $110,000?

Republican members of the Ohio state legislature who decided not to consider a sex education bill in favor of advancing bills to strip funding from Planned Parenthood, and to enact a “heartbeat” anti-abortion bill. [TP] Because, hey, there’s nothing like preventing kids from getting medically accurate, scientifically valid, information on human sexuality to keep unwanted pregnancies from occurring?

Senator Rand Paul (R-KY) whose definition of “compromise” means that the GOP would consider cuts to military spending and all other spending cuts to reduce the national debt — but would not consider any proposals to pay for the Bush Tax Cuts and the two wars launched during the Bush Administration.  [TP] It seems obvious that Senator Paul would like to balance the national budget on the backs of the elderly, the sick, and the poor.   There’s a real Turkey.

Energy company backed climate change deniers whose opposition to any measures to conserve our planet by reducing our dependence on fossil fuels may be precipitating a situation which the UN Environment Program, the World Bank, PriceWaterhouseCooper, World Meteorological Organization, and the International Energy Agency say is dire now and could become life threatening sooner rather than later.  [HuffPo]

Hostess/Wonder Bread, which having been sold and bought three times since the 1980s and selling off valuable company assets all along the way, piled up so much debt that it first declared bankruptcy in 2004 — after management gave themselves handsome bonuses for creating the dismal financial situation.   During the 2004 bankruptcy process the union gave back $110 million in concessions, which they were told would be spent on new technology and machinery.  The promises were never kept by the two hedge funds and a private equity firm who own the company.  Instead the management saddled the corporation with about $800 million in debts, and then asked labor for 27% to 32% in additional give-backs.  [Counter] [Forbes]  This, while senior management asked the current bankruptcy court to give them a 75% bonus for sticking around to liquidate the company. [Reuters] Somehow, “gobble gobble” sounds entirely too polite.

Faux News commentator Bill O’Reilly who is quick to tell us that single women, ethnic minorities, and African Americans aren’t “traditional” Americans, i.e. “real Americans.”   O’Reilly joins Andrea Tantaros who opined that Food Stamps could be a wonderful “diet plan.” [MMA]

The Security and Exchange Commission, which is supposed to be the nation’s watchdog agency on Wall Street, seems to have been spending an inordinate amount of time on “extra-curricular” activities. [C&L] There’s more from Rolling Stone magazine.  The article is an antidote to the tryptophan in the turkey.

Don’t take House Speaker John Boehner (R-OH) too seriously when he says the Affordable Care Act is now the Law of the Land, he walked that statement back in land speed record time.  He and his conservative allies are supporting law suits to attack the bill’s provisions, delaying the implementation of the insurance exchanges, and rejecting Medicaid expansion.   [TPM]

The GOP operatives, legislators, and strategists who are promoting Vote Suppression.  [Nation]  Phony voter identification law proposals are still on the horizon, there’s a conservative backed case headed to the Supreme Court to gut the Voting Rights Act, and last year House Republicans tried to eliminate the US Election Assistance Commission.  Voting is a RIGHT, not a privilege.  Turkey.