US struggles to keep vows to veterans

WASHINGTON — Nearly 9 million US military veterans were promised free medical care through the Veterans Administration when they signed on for duty. Now the challenge for lawmakers is finding the money to fix a health care system that many say is broken.

Republicans and Democrats are disagreeing over how to pay for the hugely expensive changes. Members of a congressional panel sat down this week to work out differences in legislation overwhelmingly passed in both the Republican-controlled House of Representatives and the Democrat-led Senate.

Investigations have found mounting evidence that VA workers fabricated data on patients' waiting time for medical appointments in an effort to mask frequent, long delays. A VA audit showed that more than 57,000 new applicants for care have had to wait at least three months for initial appointments. Another 64,000 veterans who asked for appointments over the past decade never got them.

The problem has been caused largely by veterans returning from wars in Afghanistan and Iraq and aging Vietnam veterans who need increased care.

As more women join the military, investigators have found the VA is poorly equipped to treat them. Compounding the scandal, which prompted the resignation of VA Secretary Eric Shinseki last month, are findings that administrators were hiding the overall problem to ensure they did not lose performance bonuses.

Estimates of what it will cost to fix the system vary wildly. The Senate bill authorizes emergency funds amounting to about $35 billion over three years to pay for private care for those who qualify, the hiring of hundreds of doctors and nurses and the leases of 26 new health facilities in 17 states and Puerto Rico. The House bill authorizes a much smaller $620 million over the same period and does not include expanding facilities or hiring extra staff.

Small-government conservative Republicans are worried by an estimate from the non-partisan Congressional Budget Office last week that increased veteran health care access and facilities could cost the government an additional $50 billion a year, regardless of what plan ends up on President Barack Obama's desk for signing into law.

"Both the Senate and House have acted in near-unanimous fashion to address VA's accountability and delays in care crises, so I'm optimistic both chambers of Congress will soon agree on a final package to send to the president," Rep. Jeff Miller, chairman of the House Veterans Affairs Committee, said on the House floor this month. "There is widespread consensus that the situation at the VA is an emergency. So the question is not if something will be done, but rather when and how."

Republicans want to handle problems incrementally and have them paid for, in part, by cutting sections of the VA that they see as bloated and inefficient.

The bi-partisan Committee for a Responsible Federal Budget is lobbying hard against the Senate bill's far more expensive emergency funding provision. That kind of funding is similar to what paid the bills for the wars in Iraq and Afghanistan. There was no appropriation for spending; the bills were paid as they were incurred.

"The Senate-passed legislation provides an unprecedented 'blank check' to the VA ... and could add substantially to the national debt," the committee said.

Nevertheless, the near-unanimous passage of VA reform measures in both houses of Congress should make a deal inevitable. Both Senate and House leaders have vowed to get a bill to Obama's desk in early July.

Under the new law, if an acceptable version can be worked out by House and Senate negotiators , veterans would be able to visit civilian doctors for the next two years if they live more than 40 miles (64 kilometers) from a VA treatment center. That would apply also to those who have waited more than 30 days for an appointment.

Sen. Bernie Sanders, a left-leaning Independent who is chairman of the Senate Veterans Affairs Committee, led the push but worries that allowing visits to physicians outside the system will lead to the privatization of veterans care. That would gratify many Republicans who want to shrink the government across the board. They are still fighting Obama's overhaul of the U.S. health care system.

Sanders said the real problem is a 16 percent increase in patients cared for by the VA from 2008 to 2013.

"And here's the point to be made: A lot of these cases are difficult cases, not a middle-aged guy walking in for a physical checkup," he said. "Among the new folks you're dealing with post-traumatic stress syndrome, loss of legs, loss of arms."