Veterans’ Medical Care:
FY2016 Appropriations
Sidath Viranga Panangala
Specialist in Veterans Policy
December 7, 2015
Congressional Research Service
7-5700
www.crs.gov
R44301
Veterans’ Medical Care: FY2016 Appropriations
Summary
The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain
eligibility criteria. Benefits to veterans range from disability compensation and pensions to
hospital and medical care. The VA provides these benefits through three major operating units:
the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the
National Cemetery Administration (NCA). This report focuses on funding for the VHA.
The President submitted his FY2016 budget request to Congress on February 2, 2015. The
President’s request for the VHA is approximately $60.6 billion (without collections), an
additional $1.3 billion (for the three medical care accounts) above the enacted 2016 advance
appropriations for VHA, which was $58.7 billion. When the $622 million request for the medical
and prosthetic research account is taken into consideration, the total amount requested for VHA is
a $1.9 billion increase over the FY2015 amount.
The House Appropriations Committee approved the FY2016 Military Construction and Veterans
Affairs appropriations bill (MILCON-VA appropriations bill) on April 22, 2015. The House
Veterans' Medical Care: FY2016 Appropriations
March 11, 2016
(R44301)
Jump to Main Text of Report
Contents
Tables
- Table 1. Veteran Population, VA Enrollees, and VA Patients, FY2000-FY2016
- Table 2. VHA Unique Enrollees, FY2012-FY2016
- Table 3. VHA Unique Patients, FY2012-FY2016
- Table 4. Department of Veterans Affairs, Budget Formulation Time Line
- Table 5. VA and VHA Appropriations, FY2015-FY2016, and Advance VHA Appropriations, FY2017
- Table 6. VHA Appropriations by Account, FY2015-FY2016, and Advance Appropriations, FY2017
- Table A-1. Priority Groups and Their Eligibility Criteria
- Table B-1. Department of Veterans Affairs, Enacted Appropriations FY1995-FY1999
- Table B-2. Department of Veterans Affairs Enacted Appropriations, FY2000-FY2004
- Table B-3. Department of Veterans Affairs Enacted Appropriations, FY2005-FY2010
- Table B-4. Department of Veterans Affairs Enacted Appropriations, FY2011-FY2015
Summary
The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA). This report focuses on funding for the VHA.
The President submitted his FY2016 budget request to Congress on February 2, 2015. The President's request for the VHA is approximately $60.6 billion (without collections), an additional $1.3 billion (for the three medical care accounts) above the enacted 2016 advance appropriations for VHA, which was $58.7 billion. When the $622 million request for the medical and prosthetic research account is taken into consideration, the total amount requested for VHA is a $1.9 billion increase over the FY2015 amount.
The House Appropriations Committee approved the FY2016 Military Construction and Veterans Affairs appropriations bill (MILCON-VA appropriations bill) on April 22, 2015. The House passed the measure (H.R. 2029
, , H.Rept. 114-92) on April 30. The House-passed bill provides
approximately $60.3 billion for the VHA (without collections).
On June 23, 2015, the VA transmitted a proposal to Congress seeking the transfer of funds from
the Veterans Choice Fund (established by Section 802 of P.L. 113-146, as amended) to the
discretionary medical care accounts for FY2015. On July 31, the Surface Transportation and
Veterans Health Care Choice Improvement Act of 2015 (P.L. 114-41) was enacted into law.
Among other things, P.L. 114-41 made modifications to the Veterans Access, Choice, and
Accountability Act of 2014 (P.L. 113-46 as amended) and authorized not more than $3.3 billion
from the Veterans Choice Fund to be transferred to other discretionary medical care accounts for
Care in the Community and to replenish those accounts for expenses incurred on or after May 1,
2015. This authority expired on October 1, 2015.
approximately $60.3 billion for the VHA (without collections).
Because none of the FY2016 regular appropriations bills were enacted by October 1, 2015, on
September 30 Congress passed and the President signed into law a continuing resolution (CR) for
the period October 1, 2015, through December 11, 2015. The Continuing Appropriations Act,
2016 (P.L. 114-53), funds most VA programs through a formula using the FY2015 level of
appropriations minus an across-the-board rescission of 0.2108%.
Although the Senate Appropriations Committee approved its version of the MILCON-VA
appropriations bill (H.R. 2029
; ; S.Rept. 114-57) on May 21, 2015, the Senate did not consider the
measure until November. On November 10, 2015, the Senate passed the MILCON-VA
appropriation bill, 2016, as amended by S.Amdt. 2763, as amended, in the nature of a substitute,
to H.R. 2029. For the VHA, the Senate-passed version of the MILCON-VA appropriations bill
provides $62.4 billion (without collections), which is $1.8 billion more than the Administration
’s
request for FY2016.
The appendixes of this report provide funding levels for all VA accounts from FY1995 to FY2015
(including rescissions, and supplements).
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Veterans’ Medical Care: FY2016 Appropriations
Contents
Introduction ..................................................................................................................................... 1
The Veterans Access, Choice and Accountability Act of 2014 (Choice Act) ............................ 2
The Veteran Patient Population ....................................................................................................... 3
Advance Appropriations .................................................................................................................. 6
Department of Veterans Affairs Budget ........................................................................................... 7
Overview of Veterans Health Administration’s Budget Formulation .............................................. 9
Funding for the VHA ............................................................................................................... 11
Medical Services ...................................................................................................................... 11
Medical Support and Compliance (Previously Medical Administration) ............................... 12
Medical Facilities .................................................................................................................... 12
Medical and Prosthetic Research ............................................................................................ 12
Medical Care Collections Fund (MCCF) ................................................................................ 12
FY2015 Budget Summary ............................................................................................................. 13
FY2016 VHA Budget .................................................................................................................... 14
President’s Request ................................................................................................................. 14
House Action ........................................................................................................................... 14
FY2015 VHA Budget Shortfall ............................................................................................... 14
Continuing Appropriations Act, 2016 (P.L. 114-53) ............................................................... 15
Senate Action .......................................................................................................................... 16
Figures
Figure 1. FY2015 VA Budget Enacted ............................................................................................ 8
Figure 2. FY2016 VA Budget Request ............................................................................................ 9
Tables
Table 1. Veteran Population, VA Enrollees, and VA Patients, FY2000–FY2016 ............................ 3
Table 2. VHA Unique Enrollees, FY2012-FY2016......................................................................... 4
Table 3. VHA Unique Patients, FY2012-FY2016 ........................................................................... 5
Table 4. Department of Veterans Affairs, Budget Formulation Time Line .................................... 10
Table 5. VA and VHA Appropriations, FY2015-FY2016, and Advance VHA
Appropriations, FY2017............................................................................................................. 17
Table 6. VHA Appropriations by Account, FY2015-FY2016, and Advance
Appropriations, FY2017............................................................................................................. 19
Table A-1. Priority Groups and Their Eligibility Criteria .............................................................. 21
Table B-1. Department of Veterans Affairs, Enacted Appropriations FY1995-FY1999 ............... 23
Table B-2. Department of Veterans Affairs Enacted Appropriations, FY2000- FY2004 .............. 26
Table B-3. Department of Veterans Affairs Enacted Appropriations, FY2005-FY2010 ............... 29
Table B-4. Department of Veterans Affairs Enacted Appropriations, FY2011-FY2015 ............... 32
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Veterans’ Medical Care: FY2016 Appropriations
Appendixes
Appendix A. Priority Groups ......................................................................................................... 21
Appendix B. Department of Veterans Affairs, Enacted Appropriations FY1995-FY2015............ 23
Contacts
Author Contact Information .......................................................................................................... 35
Acknowledgments ......................................................................................................................... 35
Congressional Research Service
Veterans’ Medical Care: FY2016 Appropriations
Introduction
The Department of Veterans Affairs (VA) provides a range of benefits and services to veterans1
who meet certain eligibility rules; these benefits include medical care, disability compensation
and pensions, education, vocational rehabilitation and employment services, assistance to
homeless veterans, home loan guarantees, administration of life insurance as well as traumatic
injury protection insurance for servicemembers, and death benefits that cover burial expenses.
The VA carries out its programs nationwide through three administrations and the Board of
Veterans Appeals (BVA).2 The Veterans Benefits Administration (VBA) is responsible for, among
other things, providing compensation, pensions, and education assistance. The National Cemetery
Administration (NCA)3 is responsible for maintaining national veterans’ cemeteries; providing
grants to states for establishing, expanding, or improving state veterans’ cemeteries; and
providing headstones and markers for the graves of eligible persons, among other things.
The Veterans Health Administration (VHA) is responsible for health care services and medical
and prosthetic research programs.4 The VHA is primarily a direct service provider of primary
care, specialized care, and related medical and social support services to veterans through the
nation’s largest integrated health care system. Inpatient and outpatient care are also provided in
the private sector to eligible dependents of veterans under the Civilian Health and Medical
Program of the Department of Veterans Affairs (CHAMPVA).5 In addition, the VHA provides
health care education and training for physician residents and other health care trainees.6 The
other statutory missions of VHA are to serve as a contingency backup to the Department of
Defense (DOD) medical system during a national security emergency,7 and to provide support to
the National Disaster Medical System and the Department of Health and Human Services as
necessary.8
In general, eligibility for VA health care is based on previous military service,9 presence of
service-connected disabilities,10 and/or other factors.11 Veterans generally must enroll in the VA
1
In general, payments of benefits made to, or on account of, a beneficiary under any law administered by the VA are
exempt from federal taxation. Furthermore, benefits are exempt, in most cases, from “attachment, levy, or seizure by or
under any legal or equitable process whatever, either before or after receipt by the beneficiary” (38 U.S.C.
§5301(a)(1)).
2
The BVA is part of the Department of Veterans Affairs, located in Washington, DC, and makes the final
determination on an appeal within the VA. The BVA reviews all appeals for entitlement to veterans’ benefits, including
claims for service connection, increased disability ratings, pension, insurance benefits, educational benefits, home loan
guaranties, vocational rehabilitation, dependency and indemnity compensation, health care services, and fiduciary
matters.
3
Established by the National Cemeteries Act of 1973 (P.L. 93-43).
4
38 U.S.C. §7301 and 38 U.S.C. §7303.
5
For more information on CHAMPVA, see CRS Report RS22483, Health Care for Dependents and Survivors of
Veterans, by Sidath Viranga Panangala.
6
38 U.S.C. §7302.
7
38 U.S.C. §8111A.
8
38 U.S.C. §1785.
9
Veteran status is established by active-duty status in the U.S. Armed Forces and a discharge or release there from
under conditions other than dishonorable (38 U.S.C.§101(2); 38 C.F.R. §3.1(d)). Generally, persons enlisting in one of
the Armed Forces after September 7, 1980, and officers commissioned after October 16, 1981, must have completed
two years of active duty or the full period of their initial service obligation to be eligible for VA health care benefits.
An exception may be granted if the servicemember was discharged or released because of an early out or hardship (10
U.S.C. §§1171 or 1173); was discharged or released for a service-connected disability directly due to service; or has a
(continued...)
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Veterans’ Medical Care: FY2016 Appropriations
health care system to receive medical care. Once enrolled, veterans are assigned to one of eight
's request for FY2016.
On December 18, 2015, the President signed the Consolidated Appropriations Act, 2016 (H.R. 2029; P.L. 114-113). Division J of the act contained the FY2016 Military Construction and Veterans Affairs Appropriations Act. The enacted measure provides $162.7 billion for the VA for FY2016 as whole. Of this amount, the MILCON-VA Appropriations Act provides $61.8 billion for VHA (without collections). This includes $2.5 billion in addition to the enacted FY2016 advance appropriations for VHA, which was $58.7 billion, and approximately $631 million for the medical and prosthetic research account. In total, the FY2016-enacted amount for VHA is $1.2 billion above the President's request for FY2016, and $5.3 billion above the FY2015-enacted amount of $56.4 billion (without collections).
The appendixes of this report provide funding levels for all VA accounts from FY1995 to FY2015 (including rescissions and supplements).
Veterans' Medical Care: FY2016 Appropriations
Introduction
The Department of Veterans Affairs (VA) provides a range of benefits and services to veterans1 who meet certain eligibility rules; these benefits include medical care, disability compensation and pensions, education, vocational rehabilitation and employment services, assistance to homeless veterans, home loan guarantees, administration of life insurance as well as traumatic injury protection insurance for servicemembers, and death benefits that cover burial expenses.
The VA carries out its programs nationwide through three administrations and the Board of Veterans Appeals (BVA).2 The Veterans Benefits Administration (VBA) is responsible for, among other things, providing compensation, pensions, and education assistance. The National Cemetery Administration (NCA)3 is responsible for maintaining national veterans' cemeteries; providing grants to states for establishing, expanding, or improving state veterans' cemeteries; and providing headstones and markers for the graves of eligible persons, among other things.
The Veterans Health Administration (VHA) is responsible for health care services and medical and prosthetic research programs.4 The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through the nation's largest integrated health care system. Inpatient and outpatient care are also provided in the private sector to eligible dependents of veterans under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).5 In addition, the VHA provides health care education and training for physician residents and other health care trainees.6 The other statutory missions of VHA are to serve as a contingency backup to the Department of Defense (DOD) medical system during a national security emergency,7 and to provide support to the National Disaster Medical System and the Department of Health and Human Services as necessary.8
In general, eligibility for VA health care is based on previous military service,9 presence of service-connected disabilities,10 and/or other factors.11 Veterans generally must enroll in the VA health care system to receive medical care. Once enrolled, veterans are assigned to one of eight categories (see Appendix A
).12).12 It should be noted that in any given year, not all enrolled veterans
obtain their health care services from the VA. While some veterans may rely solely on the VA for
their care, others may receive the majority of their health care services from other sources, such
as Medicare, Medicaid, private health insurance, and the military health system (TRICARE).
13
13 VA-enrolled veterans do not pay premiums or enrollment fees to receive care from the VA;
however, they may incur some out-of-pocket costs, such as copayments for VA care related to
conditions that are not service-connected.
14
14
The Veterans Access, Choice
, and Accountability Act of 2014
(Choice Act)
In response to the crisis of access to medical care at many VA hospitals and clinics across the
country reported in 2014,
1515 Congress passed the Veterans Access, Choice
, and Accountability Act
of 2014 (P.L. 113-146 as amended by P.L. 113-175
, , P.L. 113-235
, , P.L. 114-19, and P.L. 114-41
). ).
On August 7, 2014, President Obama signed the bill into law. The act, as amended, makes a
number of changes to programs and policies of the VHA that aim to increase access and lower
wait times for veterans who seek care at VA facilities. Among other things, the act establishes a
new program (the Veterans Choice Program) that would allow the VA to authorize care for
veterans outside the VA health care system if they meet certain criteria.
1616 Congress also provided
mandatory funding for the Choice Program, with a total of $10 billion over three years (through
2017). In addition, Section 801(a) of the Choice Act provided an additional mandatory funding of
$5 billion to increase veterans
’' access to health care by hiring more physicians and staff and to
improve VA
’'s physical infrastructure.
Although these mandatory funds are not part of the regular annual appropriations provided in the
MILCON-VA appropriations bill and not shown in the tables of this report, these funds are in
addition to the funds provided in the Consolidated and Further Continuing Appropriations Act,
2015 (H.R. 83
; ; P.L. 113-235
), and the House-passed FY2016 MILCON-VA appropriations bill and the Senate-passed amounts in its version of the FY2016 MILCON-VA appropriations bill. For more details on the VHA's request to Congress to authorize the use of approximately $3.3 billion ), and the House-passed FY2016 MILCON-VA appropriations bill
(...continued)
compensable service-connected disability (38 U.S.C. §5303A; 38 C.F.R. §3.12a).
10
A service-connected disability is a disability that was incurred or aggravated in the line of duty in the U.S. Armed
Forces (38 U.S.C. §101 (16)). The VA determines whether veterans have service-connected disabilities and, for those
with such disabilities, assigns ratings from 0% to 100% based on the severity of the disability. Percentages are assigned
in increments of 10 (38 C.F.R. §§4.1-4.31).
11
For information on eligibility for VA health care, see CRS Report R42747, Health Care for Veterans: Answers to
Frequently Asked Questions, by Sidath Viranga Panangala.
12
Ibid.
13
TRICARE provides medical care to active duty servicemembers and other eligible beneficiaries (such as military
retirees) through a combination of direct care in military clinics and hospitals and civilian-purchased care. For more
information on TRICARE, see CRS Report RL33537, Military Medical Care: Questions and Answers, by Don J.
Jansen.
14
For more information on VA cost-sharing requirements, see CRS Report R42747, Health Care for Veterans:
Answers to Frequently Asked Questions, by Sidath Viranga Panangala.
15
For details, see CRS Insight IN10063, Wait Times for Veterans Health Not New, by Sidath Viranga Panangala.
16
For a section-by-section description of all the provisions in the act, see CRS Report R43704, Veterans Access,
Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146), by Sidath Viranga Panangala et al. For issues
pertaining to implementation of the Veterans Choice Program, see CRS In Focus IF10224, Implementation of the
Veterans Choice Program (VCP), by Sidath Viranga Panangala.
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Veterans’ Medical Care: FY2016 Appropriations
and the Senate-passed amounts in its version of the FY2016 MILCON-VA appropriations bill. For
more details on the VHA’s request to Congress to authorize the use of approximately $3.3 billion
provided for the Veterans Choice Fund (Section 802 of P.L. 113-146, as amended) for Veterans
’
' Care in the Community programs, including up to $500 million for Hepatitis C pharmaceutical
expenses, and Congress
’'s passage of the Surface Transportation and Veterans Health Care Choice
Improvement Act of 2015 (H.R. 3236
; ; P.L. 114-41
), see the
“"FY2015 VHA Budget Shortfall
”
" section below.
The Veteran Patient Population
In FY2016, the VA estimates that there will be approximately 21.4 million living veterans who
served during World War II, Korea, Vietnam, and the Gulf War (which includes Operation Desert
Shield/Operation Desert Storm and Operation Enduring Freedom/Operation Iraqi
Freedom/Operation New Dawn [OEF/OIF/OND]), along with those who served in various other
military operations and in peacetime.
1717 Of this number, approximately 9.4 million are estimated
to be enrolled in the VA health care system (see Table 1 and Table 2) in FY2016. Table 1
provides the total living veteran population, the number of veterans enrolled in the VA health care
system, and the number of veteran and non-veteran patients (such as certain dependents of
veterans) for each year from FY2000 through FY2016 (note that FY2015 and FY2016 are
estimates). As shown in Table 1
, , between FY2000 and FY2016, the total veteran population
decreased by 14% and the number of veterans enrolled in the VA health care system increased by
90.1%, from about 4.9 million enrollees to approximately 9.4 million enrollees. Furthermore,
compared with the total living veteran population, the proportion of veterans enrolled in the VA
health care system increased from 18.5% in FY2000 to 44% in FY2016. Table 2
provides the
unique veteran enrollees, arranged by priority group from FY2012 through FY2016.
18
Table 1. Veteran Population, VA Enrollees, and VA Patients, FY2000–FY2016
Patients Using VA Health Care During the Year
Year
Total Veteran
Population
VA-Enrolled
Veterans
Veterans
Non-Veterans
Total Patients
FY2000
26,745,368
4,936,259
3,462,082
355,191
3,817,273
FY2001
26,092,046
6,073,264
3,890,871
356,333
4,247,204
FY2002
25,627,596
6,882,488
4,246,084
380,320
4,671,037
FY2003
25,217,342
7,186,643
4,504,508
417,023
4,961,453
FY2004
24,862,857
7,419,851
4,713,583
453,250
5,166,833
FY2005
24,521,247
7,746,201
4,862,992
445,322
5,308,314
FY2006
24,179,183
7,872,438
5,030,582
435,488
5,466,070
FY2007
23,816,018
7,833,445
5,015,689
463,240
5,478,929
FY2008
23,442,489
7,834,763
5,078,269
498,420
5,576,689
17
Department of Veterans Affairs, Department of Veterans Affairs FY2014-2020 Strategic Plan, Washington, DC,
2014, p. 12. Also see Department of Veterans Affairs, FY2016 Budget Submission, Supplemental Information and
Appendices, Volume 1 of 4, February 2015, p. Supplemental Information-7.
18
The VA classifies veterans into eight enrollment Priority Groups based on an array of factors, including (but not
limited to) service-connected disabilities or exposures, 24 prisoner of war (POW) status, receipt of a Purple Heart or
Medal of Honor, and income.
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Veterans’ Medical Care: FY2016 Appropriations
Patients Using VA Health Care During the Year
Year
Total Veteran
Population
VA-Enrolled
Veterans
Veterans
Non-Veterans
Total Patients
FY2009
23,066,965
8,048,560
5,221,583
523,110
5,744,693
FY2010
23,031,892
8,343,117
5,441,059
559,051
6,000,110
FY2011
22,676,149
8,574,198
5,582,171
584,020
6,166,191
FY2012
22,328,279
8,762,548
5,680,374
652,717
6,333,091
FY2013
21,972,964
8,926,546
5,803,890
680,774
6,484,664
FY2014
21,999,108
9,078,615
5,955,725
677,010
6,632,735
FY2015
21,680,534
9,236,287
6,080,182
691,996
6,772,178
FY2016
21,368,156
9,382,605
6,192,154
703,235
6,895,389
Sources: Total Veteran Population numbers are from VetPop2011 (FY2010–FY2014), available at
http://www.va.gov/vetdata/18
Table 1. Veteran Population, VA Enrollees, and VA Patients, FY2000-FY2016
|
Year
|
Total Veteran Population
|
VA-Enrolled Veterans
|
Patients Using VA Health Care During the Year
|
Veterans
|
Non-Veterans
|
Total Patients
|
|
FY2000
|
26,745,368
|
4,936,259
|
3,462,082
|
355,191
|
3,817,273
|
|
FY2001
|
26,092,046
|
6,073,264
|
3,890,871
|
356,333
|
4,247,204
|
|
FY2002
|
25,627,596
|
6,882,488
|
4,246,084
|
380,320
|
4,671,037
|
|
FY2003
|
25,217,342
|
7,186,643
|
4,504,508
|
417,023
|
4,961,453
|
|
FY2004
|
24,862,857
|
7,419,851
|
4,713,583
|
453,250
|
5,166,833
|
|
FY2005
|
24,521,247
|
7,746,201
|
4,862,992
|
445,322
|
5,308,314
|
|
FY2006
|
24,179,183
|
7,872,438
|
5,030,582
|
435,488
|
5,466,070
|
|
FY2007
|
23,816,018
|
7,833,445
|
5,015,689
|
463,240
|
5,478,929
|
|
FY2008
|
23,442,489
|
7,834,763
|
5,078,269
|
498,420
|
5,576,689
|
|
FY2009
|
23,066,965
|
8,048,560
|
5,221,583
|
523,110
|
5,744,693
|
|
FY2010
|
23,031,892
|
8,343,117
|
5,441,059
|
559,051
|
6,000,110
|
|
FY2011
|
22,676,149
|
8,574,198
|
5,582,171
|
584,020
|
6,166,191
|
|
FY2012
|
22,328,279
|
8,762,548
|
5,680,374
|
652,717
|
6,333,091
|
|
FY2013
|
21,972,964
|
8,926,546
|
5,803,890
|
680,774
|
6,484,664
|
|
FY2014
|
21,999,108
|
9,078,615
|
5,955,725
|
677,010
|
6,632,735
|
|
FY2015
|
21,680,534
|
9,236,287
|
6,080,182
|
691,996
|
6,772,178
|
|
FY2016
|
21,368,156
|
9,382,605
|
6,192,154
|
703,235
|
6,895,389
|
Sources: Total Veteran Population numbers are from VetPop2011 (FY2010-FY2014), available at http://www.va.gov/vetdata/Veteran_Population.asp, and an archived copy of an earlier version no longer available
on the website (FY2000
–-FY2009). VA-Enrolled Veterans numbers and Patients Using VA Health Care During the
Year numbers were obtained from the Department of Veterans Affairs (VA) and/or the VA budget submissions
to Congress for FY2002
–-FY2016; the number for each fiscal year is taken from the budget submission two years
later (e.g., the FY2000 number is from the FY2002 budget submission).
Notes:
Note: FY2015 and FY2016 numbers are estimates.
Table 2. VHA Unique Enrollees, FY2012-FY2016
Priority Groups
FY2012
Actual
FY2013
Actual
FY2014
Actual
FY2015
Estimate
FY2016
Estimate
1
1,539,632
1,712,369
1,884,562
2,017,123
2,145,650
2
680,339
704,737
726,914
744,983
761,402
3
1,173,673
1,200,952
1,229,504
1,243,997
1,256,582
4
241,626
242,257
239,206
237,305
235,366
5
2,215,449
2,147,686
2,082,350
2,067,632
2,054,542
6
593,478
610,414
596,843
601,410
602,726
6,444,197
6,618,415
6,759,379
6,912,450
7,056,268
7
171,031
196,593
421,496
422,332
422,787
8
2,147,320
2,111,538
1,897,740
1,901,505
1,903,550
Subtotal Priority
Groups 1-6
Subtotal Priority
Groups 7-8
2,318,351
2,308,131
2,319,236
2,323,837
2,326,337
Total Enrollees
8,762,548
8,926,546
9,078,615
9,236,287
9,382,605
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans
Table 2. VHA Unique Enrollees, FY2012-FY2016
Priority Groups
|
FY2012Actual
FY2013 Actual
FY2014 Actual
|
FY2015 Estimate
|
FY2016 Estimate
|
|
1
|
1,539,632
|
1,712,369
|
1,884,562
|
2,017,123
|
2,145,650
|
|
2
|
680,339
|
704,737
|
726,914
|
744,983
|
761,402
|
|
3
|
1,173,673
|
1,200,952
|
1,229,504
|
1,243,997
|
1,256,582
|
|
4
|
241,626
|
242,257
|
239,206
|
237,305
|
235,366
|
|
5
|
2,215,449
|
2,147,686
|
2,082,350
|
2,067,632
|
2,054,542
|
|
6
|
593,478
|
610,414
|
596,843
|
601,410
|
602,726
|
|
Subtotal Priority Groups 1-6
|
6,444,197
|
6,618,415
|
6,759,379
|
6,912,450
|
7,056,268
|
|
7
|
171,031
|
196,593
|
421,496
|
422,332
|
422,787
|
|
8
|
2,147,320
|
2,111,538
|
1,897,740
|
1,901,505
|
1,903,550
|
|
Subtotal Priority Groups 7-8
|
2,318,351
|
2,308,131
|
2,319,236
|
2,323,837
|
2,326,337
|
|
Total Enrollees
|
8,762,548
|
8,926,546
|
9,078,615
|
9,236,287
|
9,382,605
|
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs and data from Department of Veterans Affairs, FY2016 Budget Submission, Medical Programs and Information
Technology Programs, Volume 2 of 4, February 2015,
ppp. VHA-24.
Note: For a description of Priority Groups, see Appendix A
.
.
For FY2016, VHA estimates that it will treat about 6.2 million unique veteran patients; of these,
VA anticipates treating more than 844,000 Operation Enduring Freedom (OEF), Operation Iraqi
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Veterans’ Medical Care: FY2016 Appropriations
Freedom (OIF), and Operation New Dawn (OND) veterans (see Table 3
).19).19 In FY2016, OEF,
OIF, and OND patients would represent approximately 12.3% of the overall patients served by
the VA (see Table 3
).20).20 Between FY2012 and FY2016, the number of unique veteran patients
treated by the VA will have grown by 9%.
The VHA also provides medical care to certain non-veterans; in FY2016, this population is
expected to increase by more than 11,000 patients over the FY2015 level.
2121 In total, including
non-veterans, it is estimated the VHA will treat nearly 6.9 million patients in FY2016, a slight
increase of 1.8% over the number of patients treated in FY2015 (see Table 3). Between FY2012
and FY2016, the number of patients (both veteran and non-veteran) treated by the VA will have
grown by 8.9%.
Table 3. VHA Unique Patients, FY2012-FY2016
FY2012
Actual
FY2013
Actual
FY2014
Actual
1
1,307,750
1,451,707
1,600,012
1,732,282
1,851,347
2
456,050
473,841
489,579
505,001
518,940
3
697,548
721,576
742,624
758,333
772,583
4
191,521
192,241
193,978
194,429
194,848
5
1,464,198
1,409,341
1,356,343
1,322,099
1,291,105
6
272,043
275,799
276,420
283,512
290,069
4,389,110
4,524,505
4,658,956
4,795,656
4,918,892
7
155,093
167,538
193,738
201,030
207,369
8
1,136,171
1,111,487
1,103,031
1,083,496
1,065,893
Subtotal Priority Groups 7-8
1,291,264
1,279,385
1,296,769
1,284,526
1,273,262
Subtotal Unique
Veteran Patients
5,680,374
5,803,890
5,955,725
6,080,182
6,192,154
OEF/OIF/OND veterans
included in the above total
539,970
616,487
697,479
773,513
844,695
Non-veteransa
652,717
680,774
677,010
691,996
703,235
6,333,091
6,484,664
6,632,735
6,772,178
6,895,389
Priority Groups
Subtotal Priority Groups 1-6
Total Unique Veteran
and non-Veteran
Patients
FY2015
Estimate
FY2016
Estimate
19
On September 1, 2010, the combat mission in Iraq (Operation Iraqi Freedom, OIF) formally ended and transitioned
to Operation New Dawn (OND), which ended on December 15, 2011. VA considers OND to be part of the same
contingency operation that was formerly called OIF. Therefore, VA considers participants in OND to be eligible for
health care under the legal authorities pertaining to OIF. OEF/OIF/OND data from Department of Veterans Affairs,
FY2016 Budget Submission, Medical Programs and Information Technology Programs, Volume 2 of 4, February 2015,
p.VHA-11.
20
In a given year not all enrolled veterans receive care from the VA, either because they are not sick or because they
have other sources of care such as the private sector.
21
Non-veterans include Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
patients (certain dependents of veterans), reimbursable patients in VA affiliated hospitals and clinics, care provided on
a humanitarian basis, veterans of World War II allied nations, and employees receiving preventative occupational
immunizations such as Hepatitis A&B and flu vaccinations.
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Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans
Table 3. VHA Unique Patients, FY2012-FY2016
Priority Groups
|
FY2012Actual
FY2013 Actual
FY2014 Actual
FY2015 Estimate
FY2016 Estimate
|
|
1
|
1,307,750
|
1,451,707
|
1,600,012
|
1,732,282
|
1,851,347
|
|
2
|
456,050
|
473,841
|
489,579
|
505,001
|
518,940
|
|
3
|
697,548
|
721,576
|
742,624
|
758,333
|
772,583
|
|
4
|
191,521
|
192,241
|
193,978
|
194,429
|
194,848
|
|
5
|
1,464,198
|
1,409,341
|
1,356,343
|
1,322,099
|
1,291,105
|
|
6
|
272,043
|
275,799
|
276,420
|
283,512
|
290,069
|
|
Subtotal Priority Groups 1-6
|
4,389,110
|
4,524,505
|
4,658,956
|
4,795,656
|
4,918,892
|
|
7
|
155,093
|
167,538
|
193,738
|
201,030
|
207,369
|
|
8
|
1,136,171
|
1,111,487
|
1,103,031
|
1,083,496
|
1,065,893
|
|
Subtotal Priority Groups 7-8
|
1,291,264
|
1,279,385
|
1,296,769
|
1,284,526
|
1,273,262
|
|
Subtotal Unique Veteran Patients
|
5,680,374
|
5,803,890
|
5,955,725
|
6,080,182
|
6,192,154
|
|
OEF/OIF/OND veterans included in the above total
|
539,970
|
616,487
|
697,479
|
773,513
|
844,695
|
Non-veteransa
652,717
|
680,774
|
677,010
|
691,996
|
703,235
|
|
Total Unique Veteran and non-Veteran Patients
|
6,333,091
|
6,484,664
|
6,632,735
|
6,772,178
|
6,895,389
|
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs and data from Department of Veterans Affairs, FY2015 Budget Submission, Medical Programs and Information
Technology Programs, Volume 2 of 4, February 2015,
ppp.VHA-24. OEF/OIF/OND data from Department of
Veterans Affairs, FY2016 Budget Submission, Medical Programs and Information Technology Programs, Volume 2 of 4,
February 2015, p. VHA-11.
Notes: For a description of Priority Groups, see Appendix A. Unique patients are those who receive at least
one episode of care from the VA or whose treatment is paid for by the VA and is counted only once in a given
fiscal year.
a.
a.
Non-veterans include Civilian Health and Medical Program of the Department of Veterans Affairs
(CHAMPVA) patients (certain dependents of veterans), reimbursable patients with VA-affiliated hospitals
and clinics, care provided on a humanitarian basis, veterans of World War II allied nations, and employees
receiving
preventativepreventive occupational immunizations such as Hepatitis A&B and flu vaccinations.
The rest of this report focuses on appropriations for VHA.
2222 It begins with a brief overview of
VHA’ VHA's budget formulation, a description of the accounts that fund the VHA, and a summary of
the FY2015 VHA budget. The report ends with a section discussing recent legislative
developments pertaining to the FY2016 VHA budget.
Advance Appropriations23
Advance Appropriations23
To understand annual appropriations for the Veterans Health Administration (VHA), it is essential
to understand the role of advance appropriations. In 2009, Congress enacted the Veterans Health
Care Budget Reform and Transparency Act of 2009 (P.L. 111-81), authorizing advance
appropriations for three of the four accounts that compose the VHA: medical services, medical
support and compliance, and medical facilities.
2424 The fourth account, the medical and prosthetic
research account, is not funded with an advance appropriation. P.L. 111-81 also required the
Department of Veterans Affairs to submit a request for advance appropriations for VHA with its
budget request each year. Congress first provided advance appropriations for the three VHA
accounts in the FY2010 appropriations cycle; the Consolidated Appropriations Act, 2010 (P.L.
111-117), provided advance appropriations for FY2011.
Subsequently, each successive appropriation measure has provided advance appropriations for the
VHA accounts:
the Department of Defense and Full-Year Continuing Appropriations Act, 2011
( (P.L. 112-10), provided advance appropriations for FY2012;
the Consolidated Appropriations Act, 2012 (P.L. 112-74), provided advance
appropriations for FY2013;
the Consolidated and Further Continuing Appropriations Act, 2013 (P.L. 113-6
), provided advance appropriations for FY2014;
),
provided advance appropriations for FY2014;
22
For an overview of the VA budget including funding for the Veterans Benefits Administration and the components of
the Department, see CRS Report R44241, Department of Veterans Affairs FY2016 Appropriations: In Brief, by Sidath
Viranga Panangala.
23
In general, an appropriations act makes budget authority available beginning on October 1 of the fiscal year for
which the appropriations act is passed (“budget year”). However, some types of appropriations do not follow this
pattern; among them are advance appropriations. An advance appropriation means an appropriation of new budget
authority that becomes available one or more fiscal years beyond the fiscal year for which the appropriations act was
passed (i.e., beyond the budget year). For more information on advance appropriations, see CRS Report R43482,
Advance Appropriations, Forward Funding, and Advance Funding: Concepts, Practice, and Budget Process
Considerations, by Jessica Tollestrup.
24
Codified at 38 U.S.C. §117.
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the Consolidated Appropriations Act, 2014 (P.L. 113-76), provided advance
appropriations for FY2015; and
the Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83
; ; P.L.
113-235), provided advance appropriations for FY2016.
In addition, the Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83
; ; P.L.
113-235), amended 38 U.S.C §117 and included three more accounts to the Advance
Appropriations list of accounts. Currently, three mandatory VA accounts exist under the Veterans
Benefits Administration (VBA): compensation and pensions, readjustment benefits, and veterans
insurance and indemnities are authorized to receive advance appropriations. Beginning with the
FY2016 MILCON-VA Appropriations bill, those accounts would receive advance appropriations
for FY2017 in addition to the three VHA accounts already authorized to receive advance
appropriations.
Under current budget scoring guidelines, advance appropriations of budget authority are scored as
new budget authority in the fiscal year in which the funds become newly available for obligation,
not in the fiscal year the appropriations are enacted.
25 25 Therefore, throughout the funding tables of
this report, advance appropriations numbers are shown under the label
“memorandum”"memorandum" and in the
corresponding fiscal year column. For example, funding shown for FY2015 does not include
advance appropriations provided in FY2015 by P.L. 113-235 for use in FY2016. Instead, the
advance appropriation provided in FY2015 for use in FY2016 is shown in the FY2016 column
under the label
“"memorandum.
”" Similarly, advance appropriations provided for FY2017 in the
FY2016 MILCON-VA appropriations bill appear in the FY2017 column and under the label
“memorandum.”
"memorandum."
Department of Veterans Affairs Budget
The VA budget includes both
mandatory26mandatory26 and discretionary funding.
2727 Mandatory accounts fund
disability compensation, pensions, vocational rehabilitation and employment, education, life
insurance, housing, and burial benefits (such as grave liners, outer burial receptacles, and
headstones), among other benefits and services. Discretionary accounts fund medical care,
medical research, construction programs, information technology, and general operating
expenses, among other things. Appendix B provides enacted VA appropriations from FY1995 to
FY2015, including all three administrations that compose the VA: VBA, VHA, and NCA.
Figure 1 provides a breakdown of FY2015 budget allocations for both mandatory and
discretionary programs. In FY2015, the total VA budget authority was approximately $159.1
billion; discretionary budget authority accounted for about 40.7% ($65 billion) of the total, with
25
Executive Office of the President, Office of Management and Budget (OMB), Appendix A-Scorekeeping Guidelines,
OMB Circular No. A–11, PART 7, July 2013, p. 2.
26
Mandatory programs funded through the annual appropriations process are commonly referred to as appropriated
entitlements. In general, appropriators have little control over the amounts provided for appropriated entitlements;
rather, the authorizing statute establishes the program parameters (e.g., eligibility rules, benefit levels) that entitle
certain recipients to payments. If Congress does not appropriate the money necessary to meet these commitments,
entitled recipients (e.g., individuals, states, or other entities) may have legal recourse. For an overview of mandatory
spending, see CRS Report RL33074, Mandatory Spending Since 1962, by Mindy R. Levit, D. Andrew Austin, and
Jeffrey M. Stupak.
27
Funding for discretionary programs are provided and controlled through the annual appropriations process. For more
information, see CRS Report R41726, Discretionary Budget Authority by Subfunction: An Overview, by D. Andrew
Austin.
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Veterans’ Medical Care: FY2016 Appropriations
billion; discretionary budget authority accounted for about 40.7% ($65 billion) of the total, with about 87.0% ($56.4 billion) of this discretionary funding going toward supporting VA health care
programs, including medical and prosthetic research. The VA
’'s mandatory budget authority
accounted for about 59.3% ($94.3 billion) of the total VA budget authority, with about 83.9%
($79.1 billion) of this mandatory funding going toward disability compensation and pension
programs.
Figure 2
Figure 2 provides the FY2016 budget request for both mandatory and discretionary programs.
For FY2016 the President
’'s budget requested approximately $164.6 billion in new budget
authority for the VA as a whole. A majority of the discretionary programs budget (36.8% of the
total VA budget) is for medical care for veterans, whereas almost the entire mandatory programs
budget is for benefits such as disability compensation, pensions, and readjustment benefits;
mandatory programs account for about 57.5% of the total VA budget.
Figure 1. FY2015 VA Budget Enacted
Figure 1. FY2015 VA Budget Enacted
Source: Chart prepared by the Congressional Research Service based on U.S. Congress, House Committee on
Appropriations, Subcommittee on Military Construction, Veterans Affairs, and Related Agencies,
Military
Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill,
2015,2015, report to accompany H.R. 2029
, 114th Congress, 1st, 114th
Congress, 1st session, April 24, 2015, H.Rept. 114-92, pp. 6-11.
Notes: Discretionary budget authority includes medical programs; information technology; construction; other
discretionary benefits, such as operation and maintenance of VA
’'s national cemeteries; and departmental
administration. Mandatory benefits include disability compensation, pensions, education,
and vocational rehabilitation
and employment services, among other benefits and services. Totals may not add due to rounding.
Congressional Research Service
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Veterans’ Medical Care: FY2016 Appropriations
Figure 2. FY2016 VA Budget Request
Figure 2. FY2016 VA Budget Request
Source: Chart prepared by the Congressional Research Service based on U.S. Congress, House Committee on
Appropriations, Subcommittee on Military Construction, Veterans Affairs, and Related Agencies,
Military
Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill, 2015, report to accompany H.R. 2029
, 114th Congress, 1st, 114th
Congress, 1st session, April 24, 2015, H.Rept. 114-92
,, pp. 6-11.
Notes: Discretionary budget authority includes medical programs; information technology; construction; other
discretionary benefits, such as operation and maintenance of VA
’'s national cemeteries; and departmental
administration. Mandatory benefits include disability compensation, pensions, education,
and vocational rehabilitation
and employment services, among other benefits and services. Totals may not add due to rounding.
Overview of Veterans Health Administration’s
Budget Formulation28
Overview of Veterans Health Administration's Budget Formulation28
Similar to most federal agencies, the VA begins formulating its budget request approximately 10
months before the President submits the budget to Congress, generally in early February. The
VHA’ VHA's budget request to Congress begins with the formulations of the budget based on the
Enrollee Health Care Projection Model (EHCPM)
29 and the Civilian Health and Medical Program
28
A major part of this discussion was drawn from U.S. Government Accountability Office, Veterans’ Health Care: VA
Uses a Projection Model to Develop Most of Its Health Care Budget Estimate to Inform the President’s Budget
Request, GAO-11-205, January 2011, pp. 4-8; and U.S. Government Accountability Office, Veterans’ Health Care
Budget: Better Labeling of Services and More Detailed Information Could Improve the Congressional Budget
Justification, GAO-12-908, September 2012, pp. 5-6.
29
The Veterans’ Health Care Eligibility Reform Act of 1996 (P.L. 104-262) required the VHA to manage the provision
(continued...)
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Veterans’ Medical Care: FY2016 Appropriations
29 and the Civilian Health and Medical Program Veterans Administration (CHAMPVA) Model. The two models collectively estimate the amount
of budgetary resources VHA will need to meet the expected demand for most of the health care
services it provides.
The EHCPM
’'s estimates are based on three basic components: the projected number of veterans
who will be enrolled in VA health care, the projected utilization of VA
’'s health care services—that
is, the quantity of health care services enrollees are expected to use—and the projected unit cost
of providing these services. Each component is subject to a number of adjustments to account for
the characteristics of VA health care and the veterans who access VA
’'s health care services. The
EHCPM makes projections three or four years into the future. Each year, VHA updates the
EHCPM estimates to
“"incorporate the most recent data on health care utilization rates, actual
program experience, and other factors, such as economic trends in unemployment and
inflation.
”30"30 For instance, in 2014, VHA used data from FY2013 to develop its health care budget
estimate for the FY2016 request, including the advance appropriations request for FY2017.
31
31
The CHAMPVA Model is a more recent model adopted by VHA in 2010. The CHAMPVA model
projects the cost of providing medical coverage to CHAMPVA-eligible beneficiaries.
3232 The
CHAMPVA Model is composed of two major components: the enrollment model and the claims
cost model. The enrollment model projects the number of beneficiaries enrolled in CHAMPVA,
and the claims cost model projects expenditures for providing care to beneficiaries. According to
the VHA, the
“"2013 CHAMPVA Model was developed using data from fiscal years 2005 to 2012,
publically available research, and input from a development team (including subject matter
experts from VHA and VHA
’'s CHAMPVA program).
”33
"33
Table 4 provides an approximate timeline for formulating the revised FY2016 VHA budget
request and the FY2017 advance appropriations request.
Table 4. Department of Veterans Affairs, Budget Formulation Time Line
(FY2016 budget request)
Month, Year
Activity
April, 2014
VA issues internal call letter for FY2016/FY2017 budget proposals.
May, 2014
(FY2016 budget request)
|
Month, Year
|
Activity
|
|
April, 2014
|
VA issues internal call letter for FY2016/FY2017 budget proposals.
|
May, 2014
|
VA Administrations (VBA, VHA, and NCA) develop FY2016 budget, program, and
legislative proposals; VA also develops the FY2017 Advance Appropriations request.
June, 2014
June, 2014
|
VA construction budget proposals for FY2016 prioritized through Strategic Capital
Investment Planning (SCIP) process.
July, 2014
VA leadership considers the FY2016/FY2017 budget proposals.
August, 2014
VA prepares the budget submission to Office of Management and Budget (OMB)
(...continued)
of hospital care and medical services through an enrollment system based on a system of priorities.
30
Department of Veterans Affairs, FY2014 Budget Submission, Medical Programs and Information Technology
Programs, Volume 2 of 4, February 2013, p. 1A-6.
31
VHA uses methodologies other than the EHCPM to develop estimates of the amount of resources needed for statebased long-term care programs, readjustment counseling, legislation recently enacted, expansions to homeless veterans
programs, and care provided to non-veterans patients.
32
For more information on CHAMPVA, see CRS Report RS22483, Health Care for Dependents and Survivors of
Veterans, by Sidath Viranga Panangala.
33
Department of Veterans Affairs, FY2015 Budget Submission, Medical Programs and Information Technology
Programs, Volume 2 of 4, March 2014, p. VHA-46.
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Veterans’ Medical Care: FY2016 Appropriations
Month, Year
Activity
September, 2014
VA submits 2016 budget to OMB and the FY2017 Advance Appropriations request.
November, 2014
VA receives OMB Passback of 2016/2017 budget decisions.
December, 2014
VA and OMB reach agreement on budget amounts.
January, 2014
VA prepares the FY2016 Congressional Budget Submissions.
February, 2015
President’s FY2016 Budget Request and the Advance Appropriations for FY2017
Submitted to Congress.
Source: Table prepared by CRS based on Investment Planning (SCIP) process.
|
July, 2014
|
VA leadership considers the FY2016/FY2017 budget proposals.
|
|
August, 2014
|
VA prepares the budget submission to Office of Management and Budget (OMB)
|
|
September, 2014
|
VA submits 2016 budget to OMB and the FY2017 Advance Appropriations request.
|
|
November, 2014
|
VA receives OMB Passback of 2016/2017 budget decisions.
|
|
December, 2014
|
VA and OMB reach agreement on budget amounts.
|
|
January, 2014
|
VA prepares the FY2016 Congressional Budget Submissions.
|
|
February, 2015
|
President's FY2016 Budget Request and the Advance Appropriations for FY2017 Submitted to Congress.
|
Source: Table prepared by CRS based on U.S. Congress, House Committee on Veterans' Affairs, U.S.
Department of Veterans Affairs Budget Request For Fiscal Year 2013
,112th Congress, 2nd,112th Congress, 2nd session, February 15, 2012,
p. 143.
Funding for the VHA
As noted previously, the VHA is funded through four appropriations accounts. These are
supplemented by other sources of revenue. Although the appropriations account structure has
been subject to change from year to year, the appropriation accounts used to support the VHA
traditionally included medical care, medical and prosthetic research, and medical administration.
In FY2004,
“"to provide better oversight and [to] receive a more accurate accounting of funds,
”
" Congress changed the VHA
’'s appropriations structure.
34 34 Specifically, the Department of Veterans
Affairs and Housing and Urban Development and Independent Agencies Appropriations Act,
2004 (P.L. 108-199
, , H.Rept. 108-401), funded VHA through four accounts: (1) medical services,
(2) medical administration (currently known as medical support and compliance), (3) medical
facilities, and (4) medical and prosthetic research. Brief descriptions of these accounts are
provided below.
Medical Services
Medical Services
The medical services account covers expenses for furnishing inpatient and outpatient care and
treatment of veterans and certain dependents, including care and treatment in non-VA facilities;
outpatient care on a fee basis; medical supplies and equipment; salaries and expenses of
employees hired under Title 38, United States Code (U.S.C.); cost of hospital food service
operations;
3535 aid to state veterans
’' homes; and assistance and support services for family
caregivers of veterans authorized by the Caregivers and Veterans Omnibus Health Services Act of
2010 (P.L. 111-163). For FY2013, the President
’'s budget request proposed the transfer of funding
for biomedical engineering services from the medical facilities account to this account.
3636 The
Consolidated and Further Continuing Appropriations Act, 2013 (P.L. 113-6), approved this
transfer. All subsequent appropriations acts have continued to fund biomedical engineering
services under this account.
34
U.S. Congress, Conference Committees, Consolidated Appropriations Act, 2004, conference report to accompany
H.R. 2673, 108th Cong., 1st sess., H.Rept. 108-401, p. 1036.
35
In its FY2008 budget request to Congress, the VA requested the transfer of food service operations costs from the
medical facilities appropriations to the medical services appropriations. The House and Senate Appropriations
Committees concurred with this request. The cost of food service operations support hospital food service workers,
provisions, and supplies related to the direct care of patients.
36
Biomedical engineering services include the maintenance and repair of all medical equipment used in the treatment,
monitoring, diagnosis, and therapy of patients.
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services under this account.
Medical Support and Compliance (Previously
Medical Administration)
Medical Administration)
This account provides for expenses related to the management, security, and administration of the
VA health care system through the operation of VA medical centers and other medical facilities,
such as community-based outpatient clinics (CBOCs) and Vet Centers.
3737 It also funds 21 Veterans
Integrated Service Network (VISN)
3838 offices and facility director offices; chief of staff
operations; public health and environmental hazard programs; quality and performance
management programs; medical inspection; human research oversight; training programs and
continuing education; security; volunteer operations; and human resources management.
Medical Facilities
Medical Facilities
The medical facilities account funds expenses pertaining to the operations and maintenance of the
VHA’ VHA's capital infrastructure. These expenses include utilities and administrative expenses related
to planning, designing, and executing construction or renovation projects at VHA facilities. It also
funds leases, laundry services, grounds maintenance, trash removal, housekeeping, fire
protection, pest management, and property disposition and acquisition.
Medical and Prosthetic Research
As required by law, the medical and prosthetic research program (medical research) focuses on
research into the special health care needs of veterans.
3939 This account provides funding for many
types of research, such as investigator-initiated research; mentored research; large-scale,
multisitemulti-site clinical trials; and centers of excellence. VA researchers receive funding not only through this
account but also from the Department of Defense (DOD), the National Institutes of Health (NIH),
and private sources.
In general, VA
’'s research program is intramural; that is, research is performed by VA investigators
at VA facilities and approved off-site locations. Unlike other federal agencies, such as NIH and
DOD, the VA does not have the statutory authority to make research grants to colleges and
universities, cities and states, or any other non-VA entities.
Medical Care Collections Fund (MCCF)
In addition to the appropriations accounts mentioned above, the committees on appropriations
include medical care cost recovery collections when considering funding for the VHA. Congress
has provided VHA the authority to bill some veterans and most health care insurers for
37
Vet Centers are community-based counseling centers that provide a wide range of social and psychological services,
such as professional readjustment counseling to veterans who have served in a combat zone, military sexual trauma
(MST) counseling, bereavement counseling for families who experience an active duty death, substance abuse
assessments and referral, medical referral, veterans’ benefits explanation and referral, and employment counseling,
among other services.
38
VISN offices provide management and oversight to the medical centers and clinics within their assigned geographic
areas. Each VISN office is responsible for allocating funds to facilities, clinics, and programs within its region and
coordinating the delivery of health care to veterans.
39
38 U.S.C. §7303(a)(3). The Office of Research and Development (ORD) within the Veterans Health Administration
(VHA) manages the medical research program. The medical research program encompasses, among other things,
biomedical laboratory research, clinical trials, health services research, and rehabilitation research.
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Veterans’ Medical Care: FY2016 Appropriations
has provided VHA the authority to bill some veterans and most health care insurers for nonservice-connected care provided to veterans enrolled in the VA health care system, to help
defray the cost of delivering medical services to veterans.
4040 Funds collected from first- and
thirdpartythird-party (copayments and insurance) bills are retained by the VA health care facility that provided
the care for the veteran. The VA estimates that MCCF total collections will be approximately $2.4
billion in 2016.
FY2015 Budget
Summary41
Summary41
The President
’'s FY2015 budget request was submitted to Congress on March 4, 2014. The
President’ President's budget requested $158.6 billion in budget authority for the VA as a whole. This
included $93.5 billion in mandatory funding and $65.1 billion in discretionary funding. For
FY2015, the Administration requested $56.6 billion for VHA. This included $45.4 billion for the
medical services account, $5.9 billion for the medical support and compliance account, $4.7
billion for the medical facilities account, and nearly $589 million for the medical and prosthetic
research account. Furthermore, as required by the Veterans Health Care Budget Reform and
Transparency Act of 2009 (P.L. 111-81), the President
’'s budget requested $58.6 billion in advance
appropriations for the three medical care accounts (medical services, medical support and
compliance, and medical facilities) for FY2016.
On April 3, 2014, the House Military Construction and Veterans Affairs Subcommittee approved
its version of a Military Construction and Veterans Affairs and Related Agencies Appropriations
bill for FY2015 (MILCON-VA Appropriations bill). The full House Appropriations Committee
approved a draft measure by voice vote on April 9, 2014, and the House passed the MILCON-VA
Appropriations bill for FY2015 (H.R. 4486
; ; H.Rept. 113-416) on April 30, 2014. The
HousepassedHouse-passed version of the MILCON-VA Appropriations bill for FY2015 proposed a total of $158.2
billion for the VA as whole. For FY2015, H.R. 4486 proposed $56.2 billion for VHA. On May 20,
2014, the Senate Military Construction, Veterans Affairs, and Related Agencies Subcommittee
marked up its version of the MILCON-VA Appropriations bill for FY2015. The full Senate
Appropriations Committee approved the measure (H.R. 4486
; ; S.Rept. 113-174) on May 22. The
committee-approved bill proposed $158.6 billion for the VA as a whole. For FY2015, H.R. 4486
( (S.Rept. 113-174) proposed $56.4 billion for VHA.
A MILCON-VA Appropriations bill funding most of the VA (excluding the three medical care
accounts: medical services, medical support and compliance, and medical facilities) was not
enacted prior to the beginning of FY2015, and Congress passed several continuing appropriations
resolutions (CRs) to fund the VA. The President signed the Consolidated and Further Continuing
Appropriations Act, 2015 (H.R. 83
; ; P.L. 113-235), on December 16, 2014. Division I of
P.L. 113-235 contained the FY2015 MILCON-VA Appropriations Act. The act provided appropriations totaling $159.1 billion for FY2015 for the functions of the VA as a whole and $56.4 billion for VHA. The MILCON-VA Appropriations Act, 2015, included $58.7 billion in advance FY2016 funding for the medical services, medical support and compliance, and medical facilities accounts.
FY2016 VHA Budget
This section of the report provides a chronological overview of the FY2016 VHA appropriations process. It begins with the President's request submitted to Congress in February 2015 and ends with the enactment of the Consolidated Appropriations Act, 2016 (P.L. 114-113), in December 2015. In between the President's request and the final passage of the Consolidated Appropriations Act, 2016, the House passed its version of the MILCON-VA appropriations bill for FY2016 (H.R. 2029; H.Rept. 114-92) in April 2015, which was followed by continuing resolutions (CRs) that funded parts of the Department at the beginning of FY2016 (VHA accounts were not affected since these accounts had already received advance appropriations for FY2016 in P.L. 113-235). This was followed by the Senate passage of its version of the MILCON-VA appropriations bill (H.R. 2029; S.Rept. 114-57) in November 2015. In the intervening period, and outside of the regular FY2016 appropriations process, Congress addressed a budget shortfall at the VA. This is described in the text box below under the heading "FY2015 Budget Shortfall."
President's Request
The President submitted his FY2016 budget request to Congress on February 2, 2015. The Administration'P.L. 11340
The Consolidated Omnibus Budget Reconciliation Act of 1985 (P.L. 99-272), enacted into law in 1986, established
means testing for veterans seeking care for nonservice-connected conditions. The Balanced Budget Act of 1997 (P.L.
105-33) established the Department of Veterans Affairs Medical Care Collections Fund (MCCF) and gave the VHA the
authority to retain these funds in the MCCF. Instead of returning the funds to the Treasury, the VA can use them,
without fiscal year limitations, for medical services for veterans. In FY2004, the Administration’s budget requested
consolidating several existing medical collections accounts into one MCCF. The conferees of the Consolidated
Appropriations Act of 2004 (H.Rept. 108-401) recommended that collections that would otherwise be deposited in the
Health Services Improvement Fund (former name), Veterans Extended Care Revolving Fund (former name), Special
Therapeutic and Rehabilitation Activities Fund (former name), Medical Facilities Revolving Fund (former name), and
the Parking Revolving Fund (former name) should be deposited in MCCF. The Consolidated Appropriations Act of
2005 (P.L. 108-447, H.Rept. 108-792) provided the VA with permanent authority to deposit funds from these five
accounts into the MCCF.
41
For a detailed discussion of the VHA appropriations for FY2015, see CRS Report R43547, Veterans’ Medical Care:
FY2015 Appropriations, by Sidath Viranga Panangala.
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Veterans’ Medical Care: FY2016 Appropriations
235 contained the FY2015 MILCON-VA Appropriations Act. The act provided appropriations
totaling $159.1 billion for FY2015 for the functions of the VA as a whole and $56.4 billion for
VHA. The MILCON-VA Appropriations Act, 2015 included $58.7 billion in advance FY2016
funding for the medical services, medical support and compliance, and medical facilities
accounts.
FY2016 VHA Budget
President’s Request
The President submitted his FY2016 budget request to Congress on February 2, 2015. The
Administration’s FY2016 budget requested $164.6 billion for the VA as a whole (Table 5). For
VHA, the Administration requested $60.6 billion (without collections). For the three medical care
accounts (medical services, medical support and compliance, and medical facilities), the President
requested $1.3 billion over the advance appropriated amount of $58.7 billion for FY2016 (
Table
6Table 6). These additional funds were requested for the costs associated with newer pharmaceutical
therapies for Hepatitis C treatment; higher usage of caregiver stipends related to the Program of
Comprehensive Assistance for Family Caregivers, established by the Caregivers and Veterans
Omnibus Health Services Act of 2010 (P.L. 111-163); and higher projected utilization of the VA
homeless veterans programs. Furthermore, as required by the Veterans Health Care Budget
Reform and Transparency Act of 2009 (P.L. 111-81), the President
’'s budget requested
approximately $63.3 billion in advance appropriations for the three medical care accounts
(medical services, medical support and compliance, and medical facilities) for FY2017 (Table 6
).
House Action
).
House Action
On April 22, 2015, the House Appropriations Committee approved its version of the
MILCONVAMILCON-VA Appropriations bill for FY2016 (H.R. 2029
; ; H.Rept. 114-92). The House passed the measure
on April 30. The House-passed measure provides approximately $60.3 billion for VHA (without
collections) for FY2016. This includes $972 million over the advance appropriated amount of
$58.7 billion for FY2016 for three of the four accounts that compose the VHA (Table 6). This
amount is 25% less than the President
’'s requested additional amount of $1.3 billion over the
FY2016 advance appropriated amount. According to the committee report (H.Rept. 114-92
) "the ) “the
current year budget request is unusually large and has worked to provide more than 85 percent of
the request. Within the funds provided, the Committee expects the resources to be used for
unbudgeted costs of Hepatitis C treatment, higher than anticipated usage of Caregivers program
stipends, and projected utilization of homelessness programs.
”42"42 The House-passed measure also
includes $63.3 billion in advance appropriations for the three medical care accounts (medical
services, medical support and compliance, and medical facilities) for FY2017 (Table 6
).
).
FY2015 VHA Budget Shortfall
On June 23, 2015, the VA transmitted a proposal to Congress seeking the transfer of funds from
the Veterans Choice Fund (established by Section 802 of P.L. 113-146, as amended) to the
discretionary medical care accounts for FY2015. The VA
’'s proposal requested a transfer of up to
$3 billion to meet demand for care outside of the VA health care system (Care in the Community),
42
H.Rept. 114-92, p.35.
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14
Veterans’ Medical Care: FY2016 Appropriations
of which no more than $500 million was for Hepatitis C treatment. A majority of these funds were
to replenish expenses incurred in the medical services account since May 2015 to provide Care in
the Community.
43 43 During a hearing on the FY2015 budget shortfall held on June 25 before the
House Veterans Affairs Committee, the Deputy Secretary of Veterans Affairs testified that the
VHA expected to spend $10.1 billion in FY2015 for Care in the Community, whereas the FY2015
budget had estimated only $7.3 billion for this function. Furthermore, the VA stated its Hepatitis
C treatment costs to be approximately $1.1 billion in FY2015. The VHA had reallocated
approximately $697 million out of other activities to fund Hepatitis C treatments, and it needed
approximately $400 million to bridge the shortfall for FY2015.
44
44
On July 31, the Surface Transportation and Veterans Health Care Choice Improvement Act of
2015 (P.L. 114-41) was enacted into law. Among other things, P.L. 114-41 made modifications to
the Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113-46 as amended)
45 and
45 and authorized not more than $3.3 billion from the Veterans Choice Fund to be transferred to other
discretionary medical care accounts for Care in the Community and to replenish those accounts
for expenses incurred on or after May 1, 2015. Of this amount, no more than $500 million was for
pharmaceutical expenses relating to the treatment of Hepatitis C. This transfer authority ended on
October 1, 2015. Furthermore, P.L. 114-41 required the VA Secretary to provide Congress with a
plan to consolidate all non-VA health care programs by establishing a new, single program to be
known as the
“"Veterans Choice Program
”" to furnish hospital care and medical services to veterans
enrolled in the VA health care system at non-VA facilities. The plan was submitted to Congress on
October 30, 2015.
46
46 These transfers are not shown in Table 5 and Table 6 of this report.
Continuing Appropriations Act, 2016 (P.L. 114-53
)47
)47
Because none of the regular FY2016 appropriations bills, including the MILCON-VA
appropriations bill, were enacted before the start of FY2016, on September 30, Congress passed
and the President signed into law a continuing resolution (CR) for the period October 1, 2015,
through December 11, 2015. The Continuing Appropriations Act, 2016 (P.L. 114-53), funds most
VA programs through a formula using the FY2015 level of appropriations minus an across-
thebroadthe-broad rescission of 0.2108%.
The Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83
; ; P.L. 113-235
), ),
provided advance appropriations of $58.7 billion for FY2016 for the medical services, medical
support and compliance, and medical facilities accounts, which became available on October 1,
2015. Section 115 of P.L. 114-53 would require that the across-the-broad rescission of 0.2108%
be applied to rescind funds from the FY2016 advanced appropriated accounts for VHA.
43
For more information and accompanying VA documents, see http://www.va.gov/opa/pressrel/pressrelease.cfm?id=
2718.
44
U.S. Congress, House Committee on Veterans’ Affairs, The State of VA’s [Veterans Affairs] Fiscal Year 2015
Budget, 114th Cong., 1st sess., June 25, 2015.
45
See CRS Report R43704, Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146), by
Sidath Viranga Panangala et al.
46
The full plan can be found at http://www.va.gov/opa/publications/VA_Community_Care_Report_11_03_2015.pdf,
and a fact sheet produced by the VA on the plan is available at http://bit.ly/1MpV1R8.
47
For more information, see CRS Report R44214, Overview of the FY2016 Continuing Resolution (H.R. 719), by
Jessica Tollestrup.
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Veterans’ Medical Care: FY2016 Appropriations
Senate Action
On
Senate Action
Following the passage of the Bipartisan Budget Act of 2015 (P.L. 114-74), which increased the discretionary spending caps for FY2016 and FY2017, on, November 5, 2015, the Senate agreed to consider its version of the MILCON-VA Appropriations bill for FY2016. It should be noted that on May 21, 2015, the Senate Appropriations Committee approved its version of the
MILCONVA Appropriations bill (H.R. 2029; S.Rept. 114-57). However, the bill was not taken up for
consideration by the Senate until November. Following the passage of the Bipartisan Budget Act
of 2015 (P.L. 114-74), which increased the discretionary spending caps for FY2016 and FY2017,
on, November 5, 2015, the Senate agreed to consider its version of the MILCON-VA
Appropriations bill for FY2016. MILCON-VA appropriations bill (H.R. 2029; S.Rept. 114-57). Senator Kirk then proposed S.Amdt. 2763 in the nature of a
substitute to H.R. 2029
( (S.Rept. 114-57
).48).48 The Senate passed S.Amdt. 2763 in the nature of a
substitute to H.R. 2029, as amended, on November 10. The Senate-passed version of the
MILCON-VA Appropriations bill (H.R. 2029
; ; S.Amdt. 2763, as amended) provides $165.8
billion for the VA as a whole, which is $1.1 billion more than the President
’'s request of $164.6
billion for FY2016 (Table 5). For the VHA, the Senate-passed version of the MILCON-VA
appropriations bill provides $62.4 billion (without collections), which is $1.8 billion more than
the Administration
’'s request for FY2016 (Table 5 and Table 6). Furthermore, the bill provides
approximately $3.1 billion over the previously advanced appropriated amount of $47.6 billion for
the medical services account for FY2016 (Table 6
).
).
The Senate-passed version of the MILCON-VA Appropriations bill (H.R. 2029
; ; S.Amdt. 2763, as
amended) directs that of the total amount provided for the medical services account for FY2016,
$900 million shall be for Hepatitis C Virus treatments. Furthermore, the Senate-passed
MILCONVAMILCON-VA appropriations bill provides $8.9 million more than the President
’'s request of $621.8 million
for the medical and prosthetic research account, requires the VA to spend not less than $10
million to hire additional caregiver support coordinators for the Comprehensive Assistance for
Family Caregivers program, and requires the VA to use not less than $5 million from the medical
services account for FY2016 to carry out a pilot program to assess the feasibility and advisability
of establishing a grants program to provide furniture, household items, and other assistance to
formerly homeless veterans who are moving into permanent housing. All other amounts reflect
the Senate Appropriations Committee-approved version of the MILCON-VA appropriations bill
( (H.R. 2029
; ; S.Rept. 114-57) (Table 6
).
Consolidated Appropriations Act, 2016 (H.R. 2029; P.L. 114-113)
On December 18, 2015, the President signed the Consolidated Appropriations Act, 2016, completing the FY2016 appropriations process. Division J of the Consolidated Appropriations Act, 2016, contained the MILCON-VA Appropriations Act. The enacted measure provides $162.7 billion for the VA for FY2016 of this amount for VHA, P.L. 114-113, provides a total of $61.8 billion (without collections). For the medical services account, the Consolidated Appropriations Act, 2016, provides $2.4 billion for FY2016 in addition to advance appropriations amount of $47.6 billion that was provided in P.L. 113-235 (see Table 6). Similarly, for the medical facilities account, P.L. 114-113 provides $105 million for FY2016 in addition to the $4.9 billion that was provided as advance appropriations in P.L. 113-235. For the medical and prosthetic research account, the Consolidated Appropriations Act, 2016 (H.R. 2029; P.L. 114-113), provides $631 million, which is $8.9 million above the President's request for FY2016. Furthermore, Section 243 of Division J P.L. 114-113 establishes a Recurring Expenses Transformational Fund for VA. This fund will receive expired (after five fiscal years) discretionary unobligated balances of budget authority and will be available in this fund until expended. The funds in this account would be used for VA medical facility infrastructure improvements, including nonrecurring maintenance, at existing VA hospitals and clinics, and information technology systems improvements.
Explanatory Statement Health Care Highlights
The explanatory statement accompanying Division J of the Consolidated Appropriations Act, 2016 (MILCON-VA Appropriations Act, 2016), included several areas of concern and interest that are of importance to the appropriations committees. These include among other areas the following (this is not an exhaustive list):49
Veterans Choice Program
Among other things, the explanatory statement expresses concern about uncertainty of funding among the myriad of non-VA community care programs, VA provided care, and the Veterans Choice Program established by the Veterans Access, Choice and Accountability Act of 2014 (P.L.113-146 as amended). In addition, the explanatory statement acknowledges that the Veterans Access, Choice and Accountability Act of 2014 may have created "significant unfunded liabilities"50 and provides bill language permitting the VA to transfer funds between multiple appropriations accounts and the medical services account.
Caring for Veterans with Hepatitis C
The MILCON-VA Appropriations Act, 2016, includes bill language requiring the VA to spend at least $1.5 billion for Hepatitis C treatments in FY2016. This includes the costs associated with new Hepatitis C treatment regimens.
Program of Comprehensive Assistance for Family Caregivers
The MILCON-VA Appropriations Act, 2016, provides additional funding for the Program of Comprehensive Assistance for Family Caregivers established by the Caregivers and Veterans Omnibus Health Services Act of 2010 (P.L. 111-163). This additional funding would fund increasing demand for the program, increasing costs associated with the tax free stipend paid directly to the designated primary family caregiver, and the recruitment of additional caregiver support coordinators.
Vet Centers
The MILCON-VA Appropriations Act, 2016, provides additional funding for Vet Center services. This includes "mobile Vet Centers, to address the unmet mental health needs of veterans in rural and highly rural areas."51
Health Care for Veterans in Rural Communities
Division J of the Consolidated Appropriations Act, 2016 (MILCON-VA Appropriations Act, 2016), continues funding for VHA's Office of Rural Health and "permits the transfer of up to $20 million from the Office of Rural Health budget to the Grants to States for Construction of Extended Care Facilities in order to ensure the needs of rural and highly rural areas are taken into account in the allocation of these construction funds."52
Veteran Homelessness—Furniture Pilot
Among other things, the explanatory statement accompanying the MILCON-VA Appropriations Act, 2016, directs the VA to carry out a pilot program to assess the feasibility and advisability of establishing a grants program to provide furniture, household items, and other assistance to formerly homeless veterans who are moving into permanent housing.
Mental Health
Among other things, the explanatory statement urges the VA to implement a program that would designate a VA liaison to coordinate with local law enforcement authorities to address the needs of veterans who are considered an immediate threat to themselves and others. Furthermore, it encourages the VA in consultation with the Department of Defense (DOD) to "enter into a contract with an independent third party to carry out a study on the impact combat service has had on suicide rates and serious mental health issues among veterans."53
Health Care for Women Veterans
The explanatory statement accompanying the MILCON-VA Appropriations Act, 2016, directs the VA to ensure that VA clinicians that treat women veterans are "trained to treat and address the unique health issues facing women veterans."54 Furthermore, it directs the Secretary to conduct an internal analysis to ensure that each Veterans Integrated Service Network (VISN) is integrating the unique needs of female veterans into each component of VA's healthcare system.55
Transportation Pilot Program
Among other things, explanatory statement urges the VA to conduct a pilot program that would use mobile applications (mobile apps) to transport veterans to VA medical facilities and non-VA community providers. The pilot program would use mobile apps of companies offering transportation services on demand to transport veterans for medical care in at least three metropolitan areas in three different VISNs.56
).
48
“Amendments Submitted and Proposed,” Congressional Record, daily edition, vol. 161, No. 165 (November 5,
2015), pp. S7823-S7832.
Congressional Research Service
16
Table 5. VA and VHA Appropriations, FY2015-FY2016, and Advance VHA Appropriations, FY2017
($ in thousands)
Consolidated and Further
Continuing Appropriations
Act, 2015 (P.L. 113-235)
President’s Request
House-Passed
(H.R. 2029;
H.Rept. 114-92 )
Senate-Passed
(H.R. 2029; S. Amdt. 2763,
as amended)
FY2015
FY2016
FY2016
FY2017
FY2016
FY2017
$159,144,807a
—
$164,649,778
—
$163,206,916
—
$165,792,416
—
Total
Mandatory
$94,131,393a
—
$94,546,757
—
$94,546,757
—
$94,546,757
—
Total
Discretionary
$65,013,414
—
$70,103,021
—
$68,660,159
—
$71,215,569
—
$56,432,338c
—
$60,583,305
—
$60,255,569
—
$62,388,212
—
$58,662,202
—
Total Department
of Veterans Affairs
(VA)
Total Veterans
Health
Administration
(VHA)b
Memorandum:d
Advance
appropriations
VHA
—
$63,271,000
—
$63,271,000
FY2016
—
FY2017
$63,271,000
Source: Table prepared by the Congressional Research Service based on U.S. Congress, House Committee on Appropriations, Subcommittee on Military Construction,
Veterans Affairs, and Related Agencies,
President's Request
|
House-Passed(H.R. 2029;H.Rept. 114-92)
Senate-Passed(H.R. 2029; S.Amdt. 2763, as amended)
Consolidated Appropriations Act, 2016 (H.R. 2029;P.L. 114-113)
FY2015
|
FY2016
|
FY2016
|
FY2017
|
FY2016
|
FY2017
|
FY2016
|
FY2017
|
FY2016
|
FY2017
|
Total Department of Veterans Affairs (VA)
|
$159,144,8070
—
|
$164,649,778
|
—
|
$163,206,916
|
—
|
$165,792,416
|
—
|
$162,671,005
|
—
|
Total Mandatory
|
$94,131,3930
—
|
$94,546,757
|
—
|
$94,546,757
|
—
|
$94,546,757
|
—
|
$91,256,062
|
—
|
|
Total Discretionary
|
$65,013,414
|
—
|
$70,103,021
|
—
|
$68,660,159
|
—
|
$71,215,569
|
—
|
$71,414,943
|
—
|
Total Veterans Health Administration (VHA)a
$56,432,338b
—
|
$60,583,305
|
—
|
$60,255,569
|
—
|
$62,388,212
|
—
|
$61,767,227
|
—
|
Memorandum:cAdvance appropriations VHA
—
|
$58,662,202
|
—
|
$63,271,000
|
—
|
$63,271,000
|
—
|
$63,271,000
|
—
|
$63,271,000
|
Source: Table prepared by the Congressional Research Service based on U.S. Congress, House Committee on Appropriations, Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill, 2016, report to accompany H.R. 2029
, 114th Congress, 1st, 114th Congress,
1st session, April 24,
2014, 2015, H.Rept. 114-92
, pp. 6-10; and; U.S. Congress, Senate Committee on Appropriations,
Subcommittee on Military Construction, Veterans Affairs,
and Related Agencies, Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill, 2016, report to accompany H.R. 2029
,114th Congress, 1st,114th Congress, 1st session, May
21, 2015, S.Rept. 114-57
, pp. 111-113.
a.; "Amendments Submitted and Proposed," Congressional Record, daily edition, vol. 161, No. 165 (November 5, 2015), pp. S7823-S7832; and "Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2016" Congressional Record, daily edition, vol. 161, No. 167 (November 10, 2015), pp. S7878-S7881; Explanatory Statement Submitted By Mr. Rogers of Kentucky, Chairman of The House Committee On Appropriations Regarding House Amendment No. 1 To The Senate Amendment on H.R. 2029—Continued, Congressional Record, daily edition, vol. 161, Book III (December 17, 2015), pp. H10403-H10411.
Notes: This amount reflects rescissions included in the Consolidated and Further Continuing Appropriations Act, 2015 (P.L. 113-235). This amount does not include
mandatory funding of $15 billion authorized and appropriated in the Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146) as amended
by P.L. 113-175
,, P.L. 113-235
, , P.L. 114-19, and
P.L. 114-41
.
b. .
a.
Includes funding for medical services, medical support and compliance, medical facilities, and medical and prosthetic research accounts, and excludes collections
deposited into the Medical Care Collections Fund (MCCF).
c.
b.
This amount does not reflect any rescissions included in the Consolidated and Further Continuing Appropriations Act, 2015 (P.L. 113-235
).
c.
).
CRS-17
d.
CRS-18
The Veterans Health Care Budget Reform and Transparency Act 2009 (P.L. 111-81; codified at 38 U.S.C. §117) provided for advance appropriations (appropriations
that become available one fiscal year after the fiscal year for which the appropriations act was enacted) for VA
’'s medical services, medical support and compliance,
and medical facilities appropriations accounts, and requires the VA to submit a request for advance appropriation with its annual congressional budget submission.
Under current budget scoring guidelines, new budget authority for an advance appropriation is scored in the fiscal year in which the funds become available for
obligation. Therefore, in this table the advance appropriations budget authority for FY2016 provided in the Further Continuing Appropriations Act, 2015 (P.L.
113235113-235), is recorded in the FY2016 column. Likewise, the Administration
’'s advance appropriations request for FY2017 and advance appropriations budget authority for
FY2017 provided in the Military Construction and Veterans Affairs, and Related Agencies Appropriations
bills (Act, 2016 (H.R. 2029
) for 2016; P.L. 114-113) are recorded in the FY2017
column.
Table 6. VHA Appropriations by Account, FY2015-FY2016, and Advance Appropriations, FY2017
($ in thousands)
Account
|
Consolidated and Further
Continuing Appropriations Act,
2015 (
P.L. 113-235)
President's Request
|
House-Passed (H.R. 2029; H.Rept. 114-92)
Senate-Passed (H.R. 2029; S.Amdt. 2763, as amended)
Consolidated Appropriations Act, 2016 (H.R. 2029;P.L. 114-113)
FY2015
|
FY2016
|
FY2016
|
FY2017
|
FY2016
|
FY2017
|
FY2016
|
FY2017
|
FY2016
|
FY2017
|
|
Medical Services
|
$45,015,527
|
—
|
$47,603,202
|
—
|
$47,603,202
|
—
|
$47,603,202
|
—
|
$47,603,202
|
—
|
|
Additional funding over FY2015 Advance Appropriation
|
209,189
|
—
|
—
|
—
|
—
|
—
|
—
|
—
|
—
|
—
|
|
Additional funding over FY2016 Advance Appropriation
|
—
|
—
|
1,124,197
|
—
|
971,554
|
—
|
3,095,275
|
—
|
2,369,158
|
—
|
|
Subtotal Medical Services
|
45,224,716
|
—
|
48,727,399
|
—
|
48,574,756
|
—
|
50,698,477
|
—
|
49,972,360
|
—
|
|
Medical Support and Compliance
|
5,879,700
|
—
|
6,144,000
|
—
|
6,144,000
|
—
|
6,144.000
|
—
|
6,144,000
|
—
|
|
Additional funding over FY2016 Advance Appropriation
|
—
|
—
|
69,961
|
—
|
—
|
—
|
—
|
—
|
—
|
—
|
|
Subtotal Medical Support and Compliance
|
5,879,700
|
—
|
6,213,961
|
—
|
6,144,000
|
—
|
6,144,000
|
—
|
6,144,000
|
—
|
|
Medical Facilities
|
4,739,000
|
—
|
4,915,000
|
—
|
4,915,000
|
—
|
4,915,000
|
—
|
—
|
—
|
|
Additional funding over FY2016 Advance Appropriation
|
—
|
—
|
105,132
|
—
|
—
|
—
|
—
|
—
|
105,132
|
—
|
|
Subtotal Medical Facilities
|
4,739,000
|
—
|
5,020,132
|
—
|
4,915,000
|
—
|
4,915,000
|
—
|
5,020,132
|
—
|
|
Medical and Prosthetic Research
|
588,922
|
—
|
621,813
|
—
|
621,813
|
—
|
630,735
|
—
|
630,735
|
—
|
|
Subtotal Medical and Prosthetic Research
|
588,922
|
—
|
621,813
|
—
|
621,813
|
—
|
630,735
|
—
|
630,735
|
—
|
Total VHA Appropriations(without collections)
56,432,338
|
—
|
60,583,305
|
—
|
60,255,569
|
—
|
62,388,212
|
—
|
61,767,227
|
—
|
|
Medical Care Collection Fund (MCCF)
|
2,456,000
|
—
|
2,445,000
|
—
|
2,445,000
|
—
|
2,445,000
|
—
|
2,445,000
|
—
|
Total VHA Appropriations(with collections)
$58,888,338
|
—
|
$63,028,305
|
—
|
$62,700,569
|
—
|
$64,833,212
|
—
|
$64,212,227
|
—
|
Memorandum:a
Advance Appropriations
FY2015
|
FY2016
|
FY2016
|
FY2017
|
FY2016
|
FY2017
|
FY2016
|
FY2017
|
FY2016
|
FY2017
|
|
Medical Services
|
—
|
$47,603,202
|
—
|
$51,673,000
|
—
|
$51,673,000
|
—
|
$51,673,000
|
—
|
$51,673,000
|
|
Medical Support and Compliance
|
—
|
6,144,000
|
—
|
6,525,000
|
—
|
6,525,000
|
—
|
6,525,000
|
—
|
6,524,000
|
|
Medical Facilities
|
—
|
4,915,000
|
—
|
5,074,000
|
—
|
5,074,000
|
—
|
5,074,000
|
—
|
5,074,000
|
|
Total VHA Advance Appropriations
|
—
|
$58,662,202
|
—
|
$63,271,000
|
—
|
$63,271,000
|
—
|
$63,271,000
|
—
|
$63,271,000
|
Source: Table prepared by the Congressional Research Service based on U.S. Congress, House Committee on Appropriations, P.L. 113-235)
Account
Medical Services
FY2015
FY2016
President’s Request
FY2016
$45,015,527
—
209,189
—
—
—
Additional funding over FY2015 Advance
Appropriation
$47,603,202
FY2017
—
House-Passed
(H.R. 2029; H.Rept. 114-92)
FY2016
$47,603,202
—
FY2017
—
—
Senate-Passed (H.R. 2029;
S. Amdt. 2763, as amended)
FY2016
$47,603,202
FY2017
—
—
—
Additional funding over FY2016 Advance
Appropriation
—
—
1,124,197
—
971,554
—
3,095,275
Subtotal Medical Services
45,224,716
—
48,727,399
—
48,574,756
—
50,698,477
—
5,879,700
—
6,144,000
—
6,144,000
—
6,144.000
—
Medical Support and Compliance
Additional funding over FY2016 Advance
Appropriation
—
—
69,961
—
Subtotal Medical Support and Compliance
5,879,700
—
6,213,961
—
Medical Facilities
4,739,000
—
4,915,000
—
Additional funding over FY2016 Advance
Appropriation
—
—
105,132
—
Subtotal Medical Facilities
4,739,000
—
5,020,132
—
Medical and Prosthetic Research
588,922
—
621,813
Subtotal Medical and Prosthetic Research
588,922
—
621,813
56,432,338
—
2,456,000
—
$58,888,338
—
Total VHA Appropriations
(without collections)
Medical Care Collection Fund (MCCF)
Total VHA Appropriations
(with collections)
CRS-19
—
—
—
—
—
6,144,000
—
6,144,000
—
4,915,000
—
4,915,000
—
—
—
—
4,915,000
—
4,915,000
—
—
621,813
—
630,735
—
—
621,813
—
630,735
—
—
60,255,569
—
62,388,212
2,445,000
—
2,445,000
—
2,445,000
$63,028,305
—
$62,700,569
—
$64,833,212
60,583,305
—
—
—
—
Account
Consolidated and Further
Continuing Appropriations Act,
2015 (P.L. 113-235)
President’s Request
House-Passed
(H.R. 2029; H.Rept. 114-92)
Senate-Passed (H.R. 2029;
S. Amdt. 2763, as amended)
Memorandum:a
Advance Appropriations
FY2015
FY2016
FY2016
FY2017
FY2016
FY2017
FY2016
FY2017
Medical Services
—
$47,603,202
—
$51,673,000
—
$51,673,000
—
$51,673,000
Medical Support and Compliance
—
6,144,000
—
6,525,000
—
6,525,000
—
6,525,000
Medical Facilities
—
4,915,000
—
5,074,000
—
5,074,000
—
5,074,000
Total VHA Advance Appropriations
—
$58,662,202
—
$63,271,000
—
$63,271,000
—
$63,271,000
Source: Table prepared by the Congressional Research Service based on U.S. Congress, House Committee on Appropriations, Subcommittee on Military Construction,
Veterans Affairs, and Related Agencies, Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill, 2016, report to accompany H.R. 2029
, 114th Congress, 1st, 114th Congress,
1st session, April 24,
2014, H. 2015, H.Rept. 114-92
, pp. 6-10; and; U.S. Congress, Senate Committee on Appropriations,
Subcommittee on Military Construction, Veterans Affairs,
and Related Agencies, Military Construction, Veterans Affairs, And Related Agencies Appropriations Bill, 2016, report to accompany H.R. 2029
,114th Congress, 1st,114th Congress, 1st session, May
21, 2015, S.Rept. 114-57
, pp. 111-113.
a.
CRS-20
; "Amendments Submitted and Proposed," Congressional Record, daily edition, vol. 161, No. 165 (November 5, 2015), pp. S7823-S7832; and "Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2016" Congressional Record, daily edition, vol. 161, No. 167 (November 10, 2015), pp. S7878-S7881; Explanatory Statement Submitted By Mr. Rogers of Kentucky, Chairman of The House Committee On Appropriations Regarding House Amendment No. 1 To The Senate Amendment on H.R. 2029-Continued, Congressional Record, daily edition, vol. 161, Book III (December 17, 2015), pp. H10403-H10411.
a.
The Veterans Health Care Budget Reform and Transparency Act 2009 (P.L. 111-81; codified at 38 U.S.C. §117) provided for advance appropriations (appropriations
that become available one fiscal year after the fiscal year for which the appropriations act was enacted) for VA
’'s medical services, medical support and compliance,
and medical facilities appropriations accounts, and requires the VA to submit a request for advance appropriation with its annual congressional budget submission.
Under current budget scoring guidelines, new budget authority for an advance appropriation is scored in the fiscal year in which the funds become available for
obligation. Therefore, in this table the advance appropriations budget authority for FY2016 provided in the Further Continuing Appropriations Act, 2015 (P.L.
113235113-235), is recorded in the FY2016 column. Likewise, the Administration
’'s advance appropriations request for FY2017 and advance appropriations budget authority for
FY2017 provided FY2017 in the Military Construction and Veterans Affairs, and Related Agencies Appropriations
bills (Act, 2016 (H.R. 2029
) for 2016; P.L. 114-113) are recorded in the FY2017
column.
Veterans’ Medical Care: FY2016 Appropriations
Appendix A. Priority Groups
Table A-1. Priority Groups and Their Eligibility Criteria
Priority Group 1
column.
Appendix A.
Priority Groups
Table A-1. Priority Groups and Their Eligibility Criteria
|
Priority Group 1
|
Veterans with service-connected disabilities rated 50% or more disabling
Veterans determined by VA to be unemployable due to service-connected conditions
Priority Group 2
Veterans with service-connected disabilities rated 30% or 40% disabling
Priority Group 3
Veterans who are former POWs a
Veterans awarded the Purple Heartb
Veterans in receipt of the Medal of Honorc
|
Priority Group 2
|
|
Veterans with service-connected disabilities rated 30% or 40% disabling
|
|
Priority Group 3
|
Veterans who are former POWsa
Veterans awarded the Purple Heartb
Veterans in receipt of the Medal of Honorc
Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty
Veterans with service-connected disabilities rated 10% or 20% disabling
Veterans awarded special eligibility classification under Title 38, U.S.C., Section 1151,
“"benefits for individuals disabled
by treatment or vocational rehabilitation
”
Priority Group 4
"
|
Priority Group 4
|
Veterans who are receiving aid and attendance or housebound benefits
Veterans who have been determined by VA to be catastrophically disabled
Priority Group 5
|
Priority Group 5
|
Nonservice-connected veterans and noncompensable service-connected veterans rated 0% disabled whose previous
year’ year's gross household income (earned and unearned income) is below the established VA means test thresholds
d
Veterans receiving VA pension benefits
Veterans eligible for Medicaid benefits
Priority Group 6
Compensable 0% service-connected veterans
Mexican Border War veterans
Veterans solely seeking care for disorders associated with:
d
|
Veterans receiving VA pension benefits
|
|
Veterans eligible for Medicaid benefits
|
|
Priority Group 6
|
|
Compensable 0% service-connected veterans
|
|
Mexican Border War veterans
|
|
Veterans solely seeking care for disorders associated with:
|
—exposure to herbicides while serving in Vietnam between January 9,1962, and May 7,1975; or
—ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki; or
―̶
—Project 112/SHAD (Shipboard Hazard and Defense) participants; or
—for disorders associated with service in the Gulf War and who served between August 2, 1990, and November
11, 1998; or
—for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after
November 11, 1998, as follows:
—Veterans discharged from active duty before January 27, 2003, and did not enroll on or before such date,
for a three-year period beginning on January 27, 2008
―̶
—Veterans discharged from the active duty after January 27, 2003, for a five-year period beginning on the
date of such discharge or release
—Veterans discharged from active duty after January 1, 2009, and before January 1, 2011, but did not enroll
during the five-year period of post discharge eligibility, there is a one-year period to enroll beginning on the
Congressional Research Service
21
Veterans’ Medical Care: FY2016 Appropriations
date of the enactment of the Clay Hunt Suicide Prevention for American Veterans Act (February 12, 2015)
e
e
Veterans who served on active duty at Camp Lejeune in North Carolina for not less than 30 days during the period
beginning on August 1,1953, and ending on December 31, 1987, for any of the 15 medical conditions specified in 38
U.S.C. 1710(e)(1)(F).
f
Priority Group 7
f
|
Priority Group 7
|
Veterans who agree to pay specified copayments with income and/or net worth above the VA means test threshold and
income below the VA national geographic income thresholds
Priority Group 8
|
Priority Group 8
|
Veterans who agree to pay specified copayments with income and/or net worth above the VA means test threshold and
the VA national geographic threshold
Subpriority a: Noncompensable 0% service-connected and enrolled as of January 16, 2003, and who have remained
enrolled since that date and/or placed in this subpriority due to changed eligibility status
Subpriority b: Noncompensable 0% service-connected and enrolled on or after June 15, 2009, whose income exceeds
the current VA means test threshold or VA national geographic income thresholds by 10% or less
Subpriority c: Nonservice-connected veterans enrolled as of January 16, 2003, and who have remained enrolled since
that date and/or placed in this subpriority due to changed eligibility status
Subpriority d: Nonservice-connected veterans enrolled on or after June 15, 2009, whose income exceeds the current
VA means test threshold or VA national geographic income thresholds by 10% or less
Subpriority e: Noncompensable 0% service-connected veterans not meeting the above criteria (
currentlycurrently not eligible for
enrollment)
enrollment)
Subpriority g: Nonservice-connected veterans not meeting the above criteria (
currentlycurrently not eligible for enrollment)
Source: Department of Veterans Affairs.
Notes: Service-connected disability means, with respect to disability, that such disability was incurred or
aggravated in the line of duty in the active military, naval, or air service.
a.
a.
Veterans who are former Prisoners of War (POWs) are placed in Priority Group 3. This change occurred
with the enactment of the Former Prisoner of War Benefits Act of 1981
( (P.L. 97-37) on August 14, 1981.
b.
b.
Veterans in receipt of a Purple Heart are in Priority Group 3. This change occurred with the enactment of
the Veterans Millennium Health Care and Benefits Act (P.L. 106-117) on November 30, 1999.
c.
c.
Veterans in receipt of the Medal of Honor are in Priority Group 3. This change occurred with the
enactment of the Caregiver and Veterans Omnibus Health Services Act of 2010 (P.L. 111-163) on May 5,
2010.
d.
d.
To align VA
’'s health care program with other federal health care programs
’' financial assessment
requirements, effective January 1, 2015, VA stopped collecting veterans
’' net worth information for purposes
of financial assessment for health benefits.
e.
e.
These changes were made by the Clay Hunt Suicide Prevention for American Veterans Act (P.L. 114-2
).
f.
).
f.
Veterans who served on active duty at Camp Lejeune in North Carolina between August 1, 1953, and
December 31, 1987, are placed in Priority Group 6. These veterans are eligible to receive free medical care
for the following 15 illnesses or conditions: esophageal cancer; lung cancer; breast cancer; bladder cancer;
kidney cancer; leukemia; multiple myeloma; myleodysplasic syndromes; renal toxicity; hepatic steatosis;
female infertility; miscarriage; scleroderma; neurobehavioral effects; and non-Hodgkin
’'s lymphoma. This
change originally occurred with the enactment of the Honoring America
’'s Veterans and Caring for Camp
Lejeune Families Act of 2012 (P.L. 112-154) on August 6, 2012. The previous time period of January 1, 1957,
through December 31, 1987, contained in P.L. 112-154 was then amended by the Consolidated and Further
Continuing Appropriations Act, 2015 (H.R. 83
; ; P.L. 113-235
).
Appendix B.
).
Congressional Research Service
22
Appendix B. Department of Veterans Affairs, Enacted Appropriations
FY1995-FY2015
Table B-1. Department of Veterans Affairs, Enacted Appropriations FY1995-FY1999
($ in Thousands)
FY1995
Enacted
FY1996
Enacted
FY1997
Enacted
FY1998
Enacted
FY1999
Enacted
$17,626,892
$18,331,561
$18,671,259
$19,932,997
$21,857,058
—
$100,000
$928,000
$550,000
—
$1,286,600
$1,345,300
$1,377,000
$1,366,000
$1,175,000
$24,760
$24,890
$38,970
$51,360
$46,450
Education Loan Program Account
$196
$196
$196
$201
$207
Loan Guaranty Program Account
$78,035
$75,088
$47,901
—
—
$428,120
$569,348
$263,869
—
—
$1,042
$487
$110
—
—
Veterans Housing Benefit Program Fund
—
—
—
$192,447
$263,587
Veterans Housing Benefit Program Fund Administrative Expenses
—
—
—
$160,437
$159,121
$54
$54
$49
$44
$55
Vocational Rehabilitation Loan Program Administrative Expenses
$767
$377
$377
$388
$400
Native American Veterans Housing Loan Program Administrative Expenses
$218
$205
$205
$515
$515
$19,446,684
$20,447,506
$21,327,936
$22,254,389
$23,502,393
$16,232,756
$16,564,000
$17,013,447
$17,057,396
$17,306,000
-$84,762
-$21,250
—
—
-$35,373
Veterans Benefits Administration (VBA)
Compensation and Pensions
Supplemental
Readjustment Benefits
Veterans Insurance and Indemnities
Guaranty & Indemnity Program Account
Direct Loan Program
Vocational Rehabilitation Loan Program
Subtotal VBA
Veterans Health Administration (VHA)
Medical Care
Rescission
CRS-23
FY1995
Enacted
Medical Administration and Miscellaneous Operating Expenses (MAMOE)
FY1996
Enacted
FY1997
Enacted
FY1998
Enacted
FY1999
Enacted
$69,808
$63,602
$61,207
$59,860
$63,000
-$44
-$86
—
—
-$67
Health Professional Scholarships
$10,386
—
—
—
—
Medical and Prosthetic Research
$252,000
$257,000
$262,000
$272,000
$316,000
-$574
-$322
—
—
-$348
—
—
—
$666,579
$587,000
$16,479,570
$16,862,944
$17,336,654
$18,055,835
$18,236,212
$72,663
$72,604
$76,864
$84,183
$92,006
-$128
-$97
—
—
-$122
$72,535
$72,507
$76,864
$84,183
$91,884
$890,600
$848,143
$827,584
$786,135
$855,661
-$879
-$1,127
—
—
-$1,558
$31,819
$30,900
$30,900
$31,013
$36,000
-$32
-$42
—
—
-$43
$355,612
$136,155
$250,858
$175,000
$142,300
-$32,337
-$186
-$32,100
—
-$13
$153,540
$190,000
$175,000
$177,900
$175,000
-$634
-$260
—
—
-$16
—
—
—
$32,100
—
$16,300
—
$12,300
—
—
—
—
—
—
-$23
$500
—
—
—
—
Rescission
Rescission
Medical Care Collections Fund (MCCF)
Subtotal VHA
National Cemetery Administration (NCA)
Rescission
Subtotal NCA
Departmental Administration
General Operating Expenses
Rescission
Office of Inspector General
Rescission
Construction, Major Projects
Rescission
Construction, Minor Projects
Rescission
Supplemental
Parking Fund
Rescission
Grants to Republic of the Philippines
CRS-24
FY1995
Enacted
Grants for State Extended Care Facilities
FY1996
Enacted
FY1997
Enacted
FY1998
Enacted
FY1999
Enacted
$47,397
$47,397
$47,397
$80,000
$90,000
$5,378
$1,000
$1,000
$10,000
$10,000
$1,467,264
$1,251,980
$1,312,939
$1,292,148
$1,307,308
Total Department of Veterans Affairs with MCCF
$37,466,053
$38,634,937
$40,054,393
$41,686,555
$43,137,797
Total Department of Veterans Affairs without MCCF
$37,466,053
$38,634,937
$40,054,393
$41,019,976
$42,550,797
Total Mandatory
$19,445,449
$20,446,674
$21,327,109
$22,092,804
$23,342,095
Total Discretionary with MCCF
$18,020,604
$18,188,263
$18,727,284
$19,593,751
$19,795,702
Total Discretionary without MCCF
$18,020,604
$18,188,263
$18,727,284
$18,927,172
$19,208,702
Grants for State Veterans Cemeteries
Subtotal Departmental Administration
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs, Office of Management, Office of Budget.
Notes: Totals may not add up due to rounding.
CRS-25
Table B-2. Department of Veterans Affairs Enacted Appropriations, FY2000- FY2004
($ in Thousands)
FY2000
Enacted
FY2001
Enacted
FY2002
Enacted
FY2003
Enacted
FY2004
Enacted
Veterans Benefits Administration (VBA)
Compensation and Pensions
$21,568,364
$22,766,276
$24,944,288
$28,949,000
$29,845,127
—
$589,413
$1,100,000
—
—
$1,469,000
$1,634,000
$2,135,000
$2,264,808
$2,529,734
—
$347,000
—
—
—
$28,670
$19,850
$26,200
$27,530
$29,017
$215
$221
$65
$71
$71
$48,250
—
—
—
—
Veterans Housing Benefit Program Fund
$282,342
$165,740
$203,278
$437,522
$305,834
Veterans Housing Benefit Program Fund Administrative Expenses
$156,958
$162,000
$164,497
$168,207
$154,850
—
-$356
-$123
-$1,093
-$914
$57
$52
$72
$54
$52
$415
$432
$274
$289
$300
—
-$1
—
-$2
-$2
$520
$532
$544
$558
$571
Rescission
—
-$1
—
-$4
-$3
Subtotal VBA
$23,554,791
$25,685,156
$28,574,095
$31,846,939
$32,864,636
$19,006,000
$20,281,587
$21,331,164
$23,889,304
—
—
—
$142,000
—
—
-$79,519
-$46,234
-$16,084
—
—
Supplemental
Readjustment Benefits
Supplemental
Veterans Insurance and Indemnities
Education Loan Program Account
Guaranteed Transitional Housing for Homeless Veterans
Rescission
Vocational Rehabilitation Loan Program
Vocational Rehabilitation Loan Program Administrative Expenses
Rescission
Native American Veterans Housing Loan Program Administrative Expenses
Veterans Health Administration (VHA)
Medical Care
Supplemental
Rescission
CRS-26
FY2000
Enacted
Medical Administration and Miscellaneous Operating Expenses (MAMOE)
FY2001
Enacted
FY2002
Enacted
FY2003
Enacted
FY2004
Enacted
$59,703
$62,000
$66,731
$74,716
—
—
-$136
-$50
-$486
—
—
—
—
—
$17,867,220
—
—
—
—
-$103,823
—
—
—
—
$5,000,000
—
—
—
—
-$29,500
—
—
—
—
$4,000,000
—
—
—
—
-$23,600
$321,000
$351,000
$371,000
$400,000
$408,000
—
-$772
-$278
-$2,600
-$2,407
$563,755
$767,687
$1,133,214
$1,474,716
$1,708,026
$19,870,939
$21,415,132
$23,027,697
$25,835,650
$28,823,916
$97,256
$109,889
$121,169
$133,149
$144,203
Rescission
—
-$241
-$91
-$865
—
Supplemental
—
$217
—
—
-$851
$97,256
$109,865
$121,078
$132,284
$143,352
$912,594
$1,050,000
$1,195,728
$1,254,000
$1,283,272
Rescission
—
-$2,382
-$900
-$8,151
-$7,571
Supplemental
—
—
$2,000
$100,000
—
$43,200
$46,464
$52,308
$58,000
$62,000
—
-$102
-$39
-$377
-$366
$65,140
$66,040
$183,180
$99,777
$273,190
Rescission
Medical Services
Rescission
Medical Administration
Rescission
Medical Facilities
Rescission
Medical and Prosthetic Research
Rescission
Medical Care Collections Fund (MCCF)
Subtotal VHA
National Cemetery Administration (NCA)
Subtotal NCA
Departmental Administration:
General Operating Expenses
Office of Inspector General
Rescission
Construction, Major Projects
CRS-27
FY2000
Enacted
Rescission
FY2001
Enacted
FY2002
Enacted
FY2003
Enacted
FY2004
Enacted
—
-$145
—
-$649
-$1,612
$160,000
$162,000
$210,900
$226,000
$252,144
Rescission
—
-$366
—
-$1,469
-$1,488
Supplemental
—
$8,840
—
—
—
Parking Fund
—
—
$4,000
—
—
Rescission
—
-$14
—
—
—
$90,000
$100,000
$100,000
$100,000
$102,100
—
-$220
$25,000
-$650
-$602
$25,000
$25,000
—
$32,000
$32,000
—
-$55
—
-$208
-$189
$1,295,934
$1,455,060
$1,772,177
$1,858,273
$1,992,878
Total Department of Veterans Affairs with MCCF
$44,818,920
$48,665,214
$53,495,047
$59,673,147
$63,824,783
Total Department of Veterans Affairs without MCCF
$44,255,165
$47,897,527
52,361,833
$58,198,431
$62,116,757
Total Mandatory
$23,348,376
$25,522,279
$28,408,766
$31,678,860
$32,709,712
Total Discretionary with MCCF
$21,470,544
$23,142,935
$25,086,281
$27,994,287
$31,115,071
Total Discretionary without MCCF
$20,906,789
$22,375,248
$23,953,067
$26,519,571
$29,407,045
Construction, Minor Projects
Grants for State Extended Care Facilities
Rescission
Grants for State Veterans Cemeteries
Rescission
Subtotal Departmental Administration
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs, Office of Management, Office of Budget.
Notes: Totals may not add up due to rounding.
CRS-28
Table B-3. Department of Veterans Affairs Enacted Appropriations, FY2005-FY2010
($ in Thousands)
FY2005
Enacted
FY2006
Enacted
FY2007
Enacted
FY2008
Enacted
FY2009
Enacted
FY2010
Enacted
Veterans Benefits Administration (VBA)
Compensation and Pensions
$32,607,688
$33,897,787
$38,172,360
$41,236,322
$43,111,681
$47,396,106
—
—
—
—
$700,000
—
$2,556,232
$3,309,234
$3,262,006
$3,300,289
$3,832,944
$9,232,369
Veterans Insurance and Indemnities
$44,380
$45,907
$49,850
$41,250
$42,300
$49,288
Veterans Housing Benefit Program Fund
$43,784
$64,586
$66,234
$17,389
$2,000
$23,553
—
—
—
-$108,000
—
—
$154,075
$153,575
$154,284
$154,562
$157,210
-$1,233
—
—
—
—
—
Vocational Rehabilitation Loan Program
$47
$53
$53
$71
$61
$29
Vocational Rehabilitation Loan Program
Administrative Expenses
$311
$305
$306
$311
$320
-$2.865
—
—
—
—
$571
$580
$584
$628
$646
-$4.569
—
—
—
—
—
$35,405,848
$37,472,027
$41,705,677
$44,642,822
$47,847,162
$56,867,419
$19,472,777
$21,322,141
$25,518,254
$29,104,220
$30,969,903
$34,707,500
$1,500,000
$1,225,000
$466,800
—
—
—
$38,783
$198,265
—
—
—
—
Supplemental
Readjustment Benefits
Credit Subsidy
Veterans Housing Benefit Program Fund
Administrative Expenses
Rescission
Rescission
Native American Veterans Housing Loan Program
Administrative Expenses
Rescission
Subtotal VBA
$165,082
$328
—
$664
Veterans Health Administration (VHA)
Medical Services
Budget Supplemental
Hurricane Supplemental
CRS-29
FY2005
Enacted
Pandemic Influenza Supplemental
FY2006
Enacted
FY2007
Enacted
FY2008
Enacted
FY2009
Enacted
FY2010
Enacted
—
$27,000
—
—
—
—
-$155,782
—
—
—
—
—
$20,855,778
$22,772,406
$25,985,054
$29,104,220
$30,969,903
$34,707,500
$4,705,000
$2,858,442
$3,177,968
$3,517,000
$4,450,000
$4,930,000
Supplemental
$1,940
—
$250,000
—
—
—
Rescission
-$37,640
—
—
—
—
—
Medical Facilities
$3,745,000
$3,297,669
$3,569,533
$4,100,000
$5,029,000
$4,859,000
Supplemental
$46,909
—-
$595,000
—
$1,000,000
—
Rescission
-$29,960
—
—
—
—
—
$405,593
$412,000
$413,980
$480,000
$510,000
$581,000
Supplemental
—
—
$32,500
—
—
—
Rescission
-$3,245
—
—
—
—
—
$1,953,020
$2,170,000
$2,198,154
$2,414,000
$2,544,000
$2,847,565
$31,642,395
$31,510,517
$36,222,190
$39,615,220
$44,502,903
$47,925,065
$148,925
$156,447
$160,747
$195,000
$230,000
$250,000
Rescission
-$1,191
—
—
—
$50,000
—
Supplemental
$50
$200
—
—
Subtotal NCA
$147,784
$156,647
$160,747
$195,000
$280,000
$250,000
$1,324,753
$1,410,520
$1,481,472
$1,605,000
$1,801,867
$2,086,707
Rescission
-$10,598
—
—
—
—
-$6,100
Supplemental
$545
$24,871
$83,200
$100,000
$157,100
—
—
—
—
—
$198,000
—
$69,711
$70,174
$70,641
$80,500
$87,818
$109,000
Rescission
Total Medical Services
Medical Administration
Medical and Prosthetic Research
Medical Care Collections Fund (MCCF)
Subtotal VHA
National Cemetery Administration (NCA)
—
Departmental Administration:
General Operating Expenses
Filipino Veterans Equity Compensation Fund
Office of Inspector General
CRS-30
FY2005
Enacted
Rescission
FY2006
Enacted
FY2007
Enacted
FY2008
Enacted
FY2009
Enacted
FY2010
Enacted
-$558
—
—
—
$1,000
—
—
$1,213,820
$1,213,820
$1,966,465
$2,489,391
$3,307,000
—
—
$35,100
$20,000
$50,100
—
$458,800
$607,100
$399,000
$1,069,100
$923,382
$1,194,000
Rescission
-$3,670
—
—
—
—
—
Supplemental
—
$953,419
—
$396,377
—
—
$230,779
$198,937
$198,937
$630,535
$741,534
$703,000
Rescission
-$1,846
—
—
—
—
—
Supplemental
$36,343
$1,800
$326,000
—
—
—
$105,163
$85,000
$85,000
$165,000
$175,000
$100,000
-$841
—
—
—
$150,000
—
$32,000
$32,000
$32,000
$39,500
$42,000
$46,000
-$256
—
—
—
—
—
$2,240,324
$4,597,641
$3,925,171
$6,072,477
$6,817,192
$7,539,607
Total Department of Veterans Affairs with
MCCF
$69,436,351
$73,736,832
$82,013,784
$90,525,519
$99,447,257
Total Department of Veterans Affairs
without MCCF
$67,483,331
$71,566,832
$79,815,630
$88,111,519
$96,903,257
Total Mandatory
$35,252,084
$37,317,514
$41,550,450
$44,487,250
$47,688,925
$56,701,316
Total Discretionary with MCCF
$34,184,267
$36,419,318
$40,463,334
$46,038,269
$51,758,332
$55,880,775
Total Discretionary without MCCF
$32,231,247
$34,249,318
$38,265,180
$43,624,269
$49,214,332
$53,033,210
Information Technology
Supplemental
Construction, Major Projects
Construction, Minor Projects
Grants for State Extended Care Facilities
Rescission
Grants for State Veterans Cemeteries
Rescission
Subtotal Departmental Administration
$112,582,091
$109,734,526
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs, Office of Management, Office of Budget.
Notes: Totals may not add up due to rounding.
CRS-31
Table B-4. Department of Veterans Affairs Enacted Appropriations, FY2011-FY2015
($ in Thousands)
FY2011
Enacted
FY2012
Enacted
FY2013
Enacted
FY2014
Enacted
FY2015
Enacted
Compensation and Pensions
$53,978,000
$51,237,567
$60,599,855
$71,476,104
$79,071,000
Readjustment Benefits
$10,396,245
$12,108,488
$12,023,458
$13,135,898
$14,997,136
Veterans Insurance and Indemnities
$77,589
$100,252
$104,600
$77,567
$63,257
Veterans Housing Benefit Program Fund
$19,078
$318,612
$184,859
$2,036,607
$459,807
Veterans Housing Benefit Program Fund
Administrative Expenses
$165,082
$154,698
$157,605
$158,430
$160,881
-$330
—
—
—
—
$29
$19
$19
$5
$10
-$1
—
—
—
—
$337
$343
$346
$354
$361
-$10
—
—
—
—
$707
$1,116
$1,087
$1,109
$1,130
-$44
—
—
—
—
$64,636,683
$63,921,095
$73,071,830
$86,886,074
$94,753,582
$37,136,000
$39,649,985
$41,509,000
$43,557,000
$45,015,527
Budget Supplemental
—
—
—
$40,000
$209,189
Hurricane Supplemental
—
—
$21,000
—
—
-$74,272
—
-$14,937
-$179,000
-$28,830
Veterans Benefits Administration (VBA)
Rescission
Vocational Rehabilitation Loan Program
Rescission
Vocational Rehabilitation Loan Program
Administrative Expenses
Rescission
Native American Veterans Housing Program
Administrative Expenses
Rescission
Subtotal VBA
Veterans Health Administration (VHA)
Medical Services
Rescission
CRS-32
FY2011
Enacted
FY2012
Enacted
FY2013
Enacted
FY2014
Enacted
$37,061,728
$39,649,985
$41,515,063
$43,418,000
$45,195,886
$5,307,000
$5,535,000
$5,746,000
$6,033,000
$5,879,700
-$44,546
—
-$2,039
-$50,000
-$5,609
$5,740,000
$5,426,000
$5,441,000
$4,872,000
$4,739,000
Supplemental
—
—
$6,000
$85,000
—
Rescission
-$26,450
—
-$1,991
—
-$1,999
$590,000
$581,000
$581,905
$585,664
$588,922
-$10,162
—
—
—
-$409
$2,775,214
$2,830,302
$2,903,092
$3,087,990
$3,223,932
$51,392,784
$54,022,287
$56,189,031
$58,031,654
$59,619,422
$250,000
$250,934
$258,284
$250,000
$256,800
Rescission
-$500
—
-$341
-$1,000
-$170
Supplemental
—
—
$2,100
—
—
$249,500
$250,934
$260,043
$249,000
$256,630
$2,622,110
$2,018,764
$2,164,074
$2,465,490
$2,534,254
-$87,834
—
-$2,856
—
-2,355
—
$416,737
$424,737
$415,885
$321,591
—
—
-$561
-$2,000
-446
$109,367
$112,391
$114,848
121,411
$126,411
-$585
—
—
—
—
$3,307,000
$3,111,376
$3,323,053
$3,703,344
$3,903,344
—
-1,066
Total Medical Services
Medical Administration
Rescission
Medical Facilities
Medical and Prosthetic Research
Rescission
Medical Care Collections Fund (MCCF)
Subtotal VHA
National Cemetery Administration (NCA)
Subtotal NCA
FY2015
Enacted
Departmental Administration:
VBA - General Operating Expenses
Rescission
General Administration
Rescission
Office of Inspector General
Rescission
Information Technology
Rescission
CRS-33
-$166,396
FY2011
Enacted
Construction, Major Projects
FY2012
Enacted
FY2013
Enacted
FY2014
Enacted
FY2015
Enacted
$1,151,036
$589,604
$531,767
$342,130
$561,800
-$2,302
—
—
—
—
$467,700
$482,386
$606,728
$714,870
$495,200
-$935
—
—
—
—
—
—
—
511,200
—
$85,000
$85,000
$84,888
$85,000
$90,000
-$170
—
—
—
—
$46,000
$46,000
$45,939
$46,000
$46,000
-$92
—
—
—
—
$7,454,899
$6,862,258
$7,499,618
$8,403,330
$8,173,912
Total Department of Veterans Affairs with
MCCF
$123,733,866
$125,056,574
$ 137,020,522
$153,570,058
$162,803,546
Total Department of Veterans Affairs
without MCCF
$120,958,652
$122,226,272
$ 134,117,429
$150,482,068
$159,579,614
Total Mandatory
$64,470,912
$63,764,919
$72,912,772
$86,726,176
$94,591,200
Total Discretionary with MCCF
$59,263,338
$61,291,655
$64,107,750
$66,843,881
$68,212,346
Total Discretionary without MCCF
$56,488,124
$58,461,353
$61,204,657
$63,755,892
$64,988,414
Rescission
Construction, Minor Projects
Rescission
Supplemental
Grants for State Extended Care Facilities
Rescission
Grants for State Veterans Cemeteries
Rescission
Subtotal Departmental Administration
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs, Office of Management, Office of Budget.
Notes: For FY2014, the total mandatory amount does not include the mandatory amount of $15 billion provided by the Veterans Access, Choice and Accountability Act
of 2014 (P.L. 113-146 as amended by P.L. 113-175, P.L. 113-235, P.L. 114-19, and P.L. 114-41). Totals may not add up due to rounding.
CRS-34
Veterans’ Medical Care: FY2016 Appropriations
Author Contact Information
Sidath Viranga Panangala
Specialist in Veterans Policy
spanangala@crs.loc.gov, 7-0623
Acknowledgments
Adam N. Salazar, a Research Assistant in the Domestic Social Policy Division, provided invaluable
assistance with authoring this report.
Congressional Research Service
35
($ in Thousands)
|
FY1995 Enacted
FY1996Enacted
FY1997 Enacted
FY1998 Enacted
FY1999 Enacted
|
Veterans Benefits Administration (VBA)
|
|
|
|
|
|
|
Compensation and Pensions
|
$17,626,892
|
$18,331,561
|
$18,671,259
|
$19,932,997
|
$21,857,058
|
|
Supplemental
|
—
|
$100,000
|
$928,000
|
$550,000
|
—
|
|
Readjustment Benefits
|
$1,286,600
|
$1,345,300
|
$1,377,000
|
$1,366,000
|
$1,175,000
|
|
Veterans Insurance and Indemnities
|
$24,760
|
$24,890
|
$38,970
|
$51,360
|
$46,450
|
|
Education Loan Program Account
|
$196
|
$196
|
$196
|
$201
|
$207
|
|
Loan Guaranty Program Account
|
$78,035
|
$75,088
|
$47,901
|
—
|
—
|
|
Guaranty & Indemnity Program Account
|
$428,120
|
$569,348
|
$263,869
|
—
|
—
|
|
Direct Loan Program
|
$1,042
|
$487
|
$110
|
—
|
—
|
|
Veterans Housing Benefit Program Fund
|
—
|
—
|
—
|
$192,447
|
$263,587
|
|
Veterans Housing Benefit Program Fund Administrative Expenses
|
—
|
—
|
—
|
$160,437
|
$159,121
|
|
Vocational Rehabilitation Loan Program
|
$54
|
$54
|
$49
|
$44
|
$55
|
|
Vocational Rehabilitation Loan Program Administrative Expenses
|
$767
|
$377
|
$377
|
$388
|
$400
|
|
Native American Veterans Housing Loan Program Administrative Expenses
|
$218
|
$205
|
$205
|
$515
|
$515
|
|
Subtotal VBA
|
$19,446,684
|
$20,447,506
|
$21,327,936
|
$22,254,389
|
$23,502,393
|
|
Veterans Health Administration (VHA)
|
|
|
|
|
|
|
Medical Care
|
$16,232,756
|
$16,564,000
|
$17,013,447
|
$17,057,396
|
$17,306,000
|
|
Rescission
|
-$84,762
|
-$21,250
|
—
|
—
|
-$35,373
|
|
Medical Administration and Miscellaneous Operating Expenses (MAMOE)
|
$69,808
|
$63,602
|
$61,207
|
$59,860
|
$63,000
|
|
Rescission
|
-$44
|
-$86
|
—
|
—
|
-$67
|
|
Health Professional Scholarships
|
$10,386
|
—
|
—
|
—
|
—
|
|
Medical and Prosthetic Research
|
$252,000
|
$257,000
|
$262,000
|
$272,000
|
$316,000
|
|
Rescission
|
-$574
|
-$322
|
—
|
—
|
-$348
|
|
Medical Care Collections Fund (MCCF)
|
—
|
—
|
—
|
$666,579
|
$587,000
|
|
Subtotal VHA
|
$16,479,570
|
$16,862,944
|
$17,336,654
|
$18,055,835
|
$18,236,212
|
|
National Cemetery Administration (NCA)
|
$72,663
|
$72,604
|
$76,864
|
$84,183
|
$92,006
|
|
Rescission
|
-$128
|
-$97
|
—
|
—
|
-$122
|
|
Subtotal NCA
|
$72,535
|
$72,507
|
$76,864
|
$84,183
|
$91,884
|
|
Departmental Administration
|
|
|
|
|
|
|
General Operating Expenses
|
$890,600
|
$848,143
|
$827,584
|
$786,135
|
$855,661
|
|
Rescission
|
-$879
|
-$1,127
|
—
|
—
|
-$1,558
|
|
Office of Inspector General
|
$31,819
|
$30,900
|
$30,900
|
$31,013
|
$36,000
|
|
Rescission
|
-$32
|
-$42
|
—
|
—
|
-$43
|
|
Construction, Major Projects
|
$355,612
|
$136,155
|
$250,858
|
$175,000
|
$142,300
|
|
Rescission
|
-$32,337
|
-$186
|
-$32,100
|
—
|
-$13
|
|
Construction, Minor Projects
|
$153,540
|
$190,000
|
$175,000
|
$177,900
|
$175,000
|
|
Rescission
|
-$634
|
-$260
|
—
|
—
|
-$16
|
|
Supplemental
|
—
|
—
|
—
|
$32,100
|
—
|
|
Parking Fund
|
$16,300
|
—
|
$12,300
|
—
|
—
|
|
Rescission
|
—
|
—
|
—
|
—
|
-$23
|
|
Grants to Republic of the Philippines
|
$500
|
—
|
—
|
—
|
—
|
|
Grants for State Extended Care Facilities
|
$47,397
|
$47,397
|
$47,397
|
$80,000
|
$90,000
|
|
Grants for State Veterans Cemeteries
|
$5,378
|
$1,000
|
$1,000
|
$10,000
|
$10,000
|
|
Subtotal Departmental Administration
|
$1,467,264
|
$1,251,980
|
$1,312,939
|
$1,292,148
|
$1,307,308
|
|
Total Department of Veterans Affairs with MCCF
|
$37,466,053
|
$38,634,937
|
$40,054,393
|
$41,686,555
|
$43,137,797
|
|
Total Department of Veterans Affairs without MCCF
|
$37,466,053
|
$38,634,937
|
$40,054,393
|
$41,019,976
|
$42,550,797
|
|
Total Mandatory
|
$19,445,449
|
$20,446,674
|
$21,327,109
|
$22,092,804
|
$23,342,095
|
|
Total Discretionary with MCCF
|
$18,020,604
|
$18,188,263
|
$18,727,284
|
$19,593,751
|
$19,795,702
|
|
Total Discretionary without MCCF
|
$18,020,604
|
$18,188,263
|
$18,727,284
|
$18,927,172
|
$19,208,702
|
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs, Office of Management, Office of Budget.
Note: Totals may not add up due to rounding.
Table B-2. Department of Veterans Affairs Enacted Appropriations, FY2000-FY2004
($ in Thousands)
|
FY2000 Enacted
FY2001 Enacted
FY2002Enacted
FY2003Enacted
FY2004 Enacted
|
Veterans Benefits Administration (VBA)
|
|
|
|
|
|
|
Compensation and Pensions
|
$21,568,364
|
$22,766,276
|
$24,944,288
|
$28,949,000
|
$29,845,127
|
|
Supplemental
|
—
|
$589,413
|
$1,100,000
|
—
|
—
|
|
Readjustment Benefits
|
$1,469,000
|
$1,634,000
|
$2,135,000
|
$2,264,808
|
$2,529,734
|
|
Supplemental
|
—
|
$347,000
|
—
|
—
|
—
|
|
Veterans Insurance and Indemnities
|
$28,670
|
$19,850
|
$26,200
|
$27,530
|
$29,017
|
|
Education Loan Program Account
|
$215
|
$221
|
$65
|
$71
|
$71
|
|
Guaranteed Transitional Housing for Homeless Veterans
|
$48,250
|
—
|
—
|
—
|
—
|
|
Veterans Housing Benefit Program Fund
|
$282,342
|
$165,740
|
$203,278
|
$437,522
|
$305,834
|
|
Veterans Housing Benefit Program Fund Administrative Expenses
|
$156,958
|
$162,000
|
$164,497
|
$168,207
|
$154,850
|
|
Rescission
|
—
|
-$356
|
-$123
|
-$1,093
|
-$914
|
|
Vocational Rehabilitation Loan Program
|
$57
|
$52
|
$72
|
$54
|
$52
|
|
Vocational Rehabilitation Loan Program Administrative Expenses
|
$415
|
$432
|
$274
|
$289
|
$300
|
|
Rescission
|
—
|
-$1
|
—
|
-$2
|
-$2
|
|
Native American Veterans Housing Loan Program Administrative Expenses
|
$520
|
$532
|
$544
|
$558
|
$571
|
|
Rescission
|
—
|
-$1
|
—
|
-$4
|
-$3
|
|
Subtotal VBA
|
$23,554,791
|
$25,685,156
|
$28,574,095
|
$31,846,939
|
$32,864,636
|
|
Veterans Health Administration (VHA)
|
|
|
|
|
|
|
Medical Care
|
$19,006,000
|
$20,281,587
|
$21,331,164
|
$23,889,304
|
—
|
|
Supplemental
|
—
|
—
|
$142,000
|
—
|
—
|
|
Rescission
|
-$79,519
|
-$46,234
|
-$16,084
|
—
|
—
|
|
Medical Administration and Miscellaneous Operating Expenses (MAMOE)
|
$59,703
|
$62,000
|
$66,731
|
$74,716
|
—
|
|
Rescission
|
—
|
-$136
|
-$50
|
-$486
|
—
|
|
Medical Services
|
—
|
—
|
—
|
—
|
$17,867,220
|
|
Rescission
|
—
|
—
|
—
|
—
|
-$103,823
|
|
Medical Administration
|
—
|
—
|
—
|
—
|
$5,000,000
|
|
Rescission
|
—
|
—
|
—
|
—
|
-$29,500
|
|
Medical Facilities
|
—
|
—
|
—
|
—
|
$4,000,000
|
|
Rescission
|
—
|
—
|
—
|
—
|
-$23,600
|
|
Medical and Prosthetic Research
|
$321,000
|
$351,000
|
$371,000
|
$400,000
|
$408,000
|
|
Rescission
|
—
|
-$772
|
-$278
|
-$2,600
|
-$2,407
|
|
Medical Care Collections Fund (MCCF)
|
$563,755
|
$767,687
|
$1,133,214
|
$1,474,716
|
$1,708,026
|
|
Subtotal VHA
|
$19,870,939
|
$21,415,132
|
$23,027,697
|
$25,835,650
|
$28,823,916
|
|
National Cemetery Administration (NCA)
|
$97,256
|
$109,889
|
$121,169
|
$133,149
|
$144,203
|
|
Rescission
|
—
|
-$241
|
-$91
|
-$865
|
—
|
|
Supplemental
|
—
|
$217
|
—
|
—
|
-$851
|
|
Subtotal NCA
|
$97,256
|
$109,865
|
$121,078
|
$132,284
|
$143,352
|
|
Departmental Administration:
|
|
|
|
|
|
|
General Operating Expenses
|
$912,594
|
$1,050,000
|
$1,195,728
|
$1,254,000
|
$1,283,272
|
|
Rescission
|
—
|
-$2,382
|
-$900
|
-$8,151
|
-$7,571
|
|
Supplemental
|
—
|
—
|
$2,000
|
$100,000
|
—
|
|
Office of Inspector General
|
$43,200
|
$46,464
|
$52,308
|
$58,000
|
$62,000
|
|
Rescission
|
—
|
-$102
|
-$39
|
-$377
|
-$366
|
|
Construction, Major Projects
|
$65,140
|
$66,040
|
$183,180
|
$99,777
|
$273,190
|
|
Rescission
|
—
|
-$145
|
—
|
-$649
|
-$1,612
|
|
Construction, Minor Projects
|
$160,000
|
$162,000
|
$210,900
|
$226,000
|
$252,144
|
|
Rescission
|
—
|
-$366
|
—
|
-$1,469
|
-$1,488
|
|
Supplemental
|
—
|
$8,840
|
—
|
—
|
—
|
|
Parking Fund
|
—
|
—
|
$4,000
|
—
|
—
|
|
Rescission
|
—
|
-$14
|
—
|
—
|
—
|
|
Grants for State Extended Care Facilities
|
$90,000
|
$100,000
|
$100,000
|
$100,000
|
$102,100
|
|
Rescission
|
—
|
-$220
|
$25,000
|
-$650
|
-$602
|
|
Grants for State Veterans Cemeteries
|
$25,000
|
$25,000
|
—
|
$32,000
|
$32,000
|
|
Rescission
|
—
|
-$55
|
—
|
-$208
|
-$189
|
|
Subtotal Departmental Administration
|
$1,295,934
|
$1,455,060
|
$1,772,177
|
$1,858,273
|
$1,992,878
|
|
Total Department of Veterans Affairs with MCCF
|
$44,818,920
|
$48,665,214
|
$53,495,047
|
$59,673,147
|
$63,824,783
|
|
Total Department of Veterans Affairs without MCCF
|
$44,255,165
|
$47,897,527
|
52,361,833
|
$58,198,431
|
$62,116,757
|
|
Total Mandatory
|
$23,348,376
|
$25,522,279
|
$28,408,766
|
$31,678,860
|
$32,709,712
|
|
Total Discretionary with MCCF
|
$21,470,544
|
$23,142,935
|
$25,086,281
|
$27,994,287
|
$31,115,071
|
|
Total Discretionary without MCCF
|
$20,906,789
|
$22,375,248
|
$23,953,067
|
$26,519,571
|
$29,407,045
|
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs, Office of Management, Office of Budget.
Note: Totals may not add up due to rounding.
Table B-3. Department of Veterans Affairs Enacted Appropriations, FY2005-FY2010
($ in Thousands)
|
FY2005 Enacted
FY2006 Enacted
FY2007 Enacted
FY2008Enacted
FY2009 Enacted
FY2010 Enacted
|
Veterans Benefits Administration (VBA)
|
|
|
|
|
|
|
Compensation and Pensions
|
$32,607,688
|
$33,897,787
|
$38,172,360
|
$41,236,322
|
$43,111,681
|
$47,396,106
|
|
Supplemental
|
—
|
—
|
—
|
—
|
$700,000
|
—
|
|
Readjustment Benefits
|
$2,556,232
|
$3,309,234
|
$3,262,006
|
$3,300,289
|
$3,832,944
|
$9,232,369
|
|
Veterans Insurance and Indemnities
|
$44,380
|
$45,907
|
$49,850
|
$41,250
|
$42,300
|
$49,288
|
|
Veterans Housing Benefit Program Fund
|
$43,784
|
$64,586
|
$66,234
|
$17,389
|
$2,000
|
$23,553
|
|
- Credit Subsidy
|
—
|
—
|
—
|
-$108,000
|
—
|
—
|
|
Veterans Housing Benefit Program Fund Administrative Expenses
|
$154,075
|
$153,575
|
$154,284
|
$154,562
|
$157,210
|
$165,082
|
|
Rescission
|
-$1,233
|
—
|
—
|
—
|
—
|
—
|
|
Vocational Rehabilitation Loan Program
|
$47
|
$53
|
$53
|
$71
|
$61
|
$29
|
|
Vocational Rehabilitation Loan Program Administrative Expenses
|
$311
|
$305
|
$306
|
$311
|
$320
|
$328
|
|
Rescission
|
-$2.865
|
—
|
—
|
—
|
—
|
—
|
|
Native American Veterans Housing Loan Program Administrative Expenses
|
$571
|
$580
|
$584
|
$628
|
$646
|
$664
|
|
Rescission
|
-$4.569
|
—
|
—
|
—
|
—
|
—
|
|
Subtotal VBA
|
$35,405,848
|
$37,472,027
|
$41,705,677
|
$44,642,822
|
$47,847,162
|
$56,867,419
|
Veterans Health Administration (VHA)
|
|
|
|
|
Medical Services
|
$19,472,777
|
$21,322,141
|
$25,518,254
|
$29,104,220
|
$30,969,903
|
$34,707,500
|
|
- Budget Supplemental
|
$1,500,000
|
$1,225,000
|
$466,800
|
—
|
—
|
—
|
|
- Hurricane Supplemental
|
$38,783
|
$198,265
|
—
|
—
|
—
|
—
|
|
- Pandemic Influenza Supplemental
|
—
|
$27,000
|
—
|
—
|
—
|
—
|
|
Rescission
|
-$155,782
|
—
|
—
|
—
|
—
|
—
|
|
Total Medical Services
|
$20,855,778
|
$22,772,406
|
$25,985,054
|
$29,104,220
|
$30,969,903
|
$34,707,500
|
|
Medical Administration
|
$4,705,000
|
$2,858,442
|
$3,177,968
|
$3,517,000
|
$4,450,000
|
$4,930,000
|
|
Supplemental
|
$1,940
|
—
|
$250,000
|
—
|
—
|
—
|
|
Rescission
|
-$37,640
|
—
|
—
|
—
|
—
|
—
|
|
Medical Facilities
|
$3,745,000
|
$3,297,669
|
$3,569,533
|
$4,100,000
|
$5,029,000
|
$4,859,000
|
|
Supplemental
|
$46,909
|
—-
|
$595,000
|
—
|
$1,000,000
|
—
|
|
Rescission
|
-$29,960
|
—
|
—
|
—
|
—
|
—
|
|
Medical and Prosthetic Research
|
$405,593
|
$412,000
|
$413,980
|
$480,000
|
$510,000
|
$581,000
|
|
Supplemental
|
—
|
—
|
$32,500
|
—
|
—
|
—
|
|
Rescission
|
-$3,245
|
—
|
—
|
—
|
—
|
—
|
|
Medical Care Collections Fund (MCCF)
|
$1,953,020
|
$2,170,000
|
$2,198,154
|
$2,414,000
|
$2,544,000
|
$2,847,565
|
|
Subtotal VHA
|
$31,642,395
|
$31,510,517
|
$36,222,190
|
$39,615,220
|
$44,502,903
|
$47,925,065
|
|
National Cemetery Administration (NCA)
|
$148,925
|
$156,447
|
$160,747
|
$195,000
|
$230,000
|
$250,000
|
|
Rescission
|
-$1,191
|
—
|
—
|
—
|
$50,000
|
—
|
|
Supplemental
|
$50
|
$200
|
—
|
—
|
|
—
|
|
Subtotal NCA
|
$147,784
|
$156,647
|
$160,747
|
$195,000
|
$280,000
|
$250,000
|
Departmental Administration:
|
|
|
|
|
|
General Operating Expenses
|
$1,324,753
|
$1,410,520
|
$1,481,472
|
$1,605,000
|
$1,801,867
|
$2,086,707
|
|
Rescission
|
-$10,598
|
—
|
—
|
—
|
—
|
-$6,100
|
|
Supplemental
|
$545
|
$24,871
|
$83,200
|
$100,000
|
$157,100
|
—
|
|
Filipino Veterans Equity Compensation Fund
|
—
|
—
|
—
|
—
|
$198,000
|
—
|
|
Office of Inspector General
|
$69,711
|
$70,174
|
$70,641
|
$80,500
|
$87,818
|
$109,000
|
|
Rescission
|
-$558
|
—
|
—
|
—
|
$1,000
|
—
|
|
Information Technology
|
—
|
$1,213,820
|
$1,213,820
|
$1,966,465
|
$2,489,391
|
$3,307,000
|
|
Supplemental
|
—
|
—
|
$35,100
|
$20,000
|
$50,100
|
—
|
|
Construction, Major Projects
|
$458,800
|
$607,100
|
$399,000
|
$1,069,100
|
$923,382
|
$1,194,000
|
|
Rescission
|
-$3,670
|
—
|
—
|
—
|
—
|
—
|
|
Supplemental
|
—
|
$953,419
|
—
|
$396,377
|
—
|
—
|
|
Construction, Minor Projects
|
$230,779
|
$198,937
|
$198,937
|
$630,535
|
$741,534
|
$703,000
|
|
Rescission
|
-$1,846
|
—
|
—
|
—
|
—
|
—
|
|
Supplemental
|
$36,343
|
$1,800
|
$326,000
|
—
|
—
|
—
|
|
Grants for State Extended Care Facilities
|
$105,163
|
$85,000
|
$85,000
|
$165,000
|
$175,000
|
$100,000
|
|
Rescission
|
-$841
|
—
|
—
|
—
|
$150,000
|
—
|
|
Grants for State Veterans Cemeteries
|
$32,000
|
$32,000
|
$32,000
|
$39,500
|
$42,000
|
$46,000
|
|
Recission
|
-$256
|
—
|
—
|
—
|
—
|
—
|
|
Subtotal Departmental Administration
|
$2,240,324
|
$4,597,641
|
$3,925,171
|
$6,072,477
|
$6,817,192
|
$7,539,607
|
|
Total Department of Veterans Affairs with MCCF
|
$69,436,351
|
$73,736,832
|
$82,013,784
|
$90,525,519
|
$99,447,257
|
$112,582,091
|
|
Total Department of Veterans Affairs without MCCF
|
$67,483,331
|
$71,566,832
|
$79,815,630
|
$88,111,519
|
$96,903,257
|
$109,734,526
|
|
Total Mandatory
|
$35,252,084
|
$37,317,514
|
$41,550,450
|
$44,487,250
|
$47,688,925
|
$56,701,316
|
|
Total Discretionary with MCCF
|
$34,184,267
|
$36,419,318
|
$40,463,334
|
$46,038,269
|
$51,758,332
|
$55,880,775
|
|
Total Discretionary without MCCF
|
$32,231,247
|
$34,249,318
|
$38,265,180
|
$43,624,269
|
$49,214,332
|
$53,033,210
|
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs, Office of Management, Office of Budget.
Note: Totals may not add up due to rounding.
Table B-4. Department of Veterans Affairs Enacted Appropriations, FY2011-FY2015
($ in Thousands)
FY2011 Enacted
FY2012 Enacted
FY2013 Enacted
FY2014 Enacted
FY2015 Enacted
Veterans Benefits Administration (VBA)
|
|
Compensation and Pensions
|
$53,978,000
|
$51,237,567
|
$60,599,855
|
$71,476,104
|
$79,071,000
|
|
Readjustment Benefits
|
$10,396,245
|
$12,108,488
|
$12,023,458
|
$13,135,898
|
$14,997,136
|
|
Veterans Insurance and Indemnities
|
$77,589
|
$100,252
|
$104,600
|
$77,567
|
$63,257
|
|
Veterans Housing Benefit Program Fund
|
$19,078
|
$318,612
|
$184,859
|
$2,036,607
|
$459,807
|
|
Veterans Housing Benefit Program Fund Administrative Expenses
|
$165,082
|
$154,698
|
$157,605
|
$158,430
|
$160,881
|
|
Rescission
|
-$330
|
—
|
—
|
—
|
—
|
|
Vocational Rehabilitation Loan Program
|
$29
|
$19
|
$19
|
$5
|
$10
|
|
Rescission
|
-$1
|
—
|
—
|
—
|
—
|
|
Vocational Rehabilitation Loan Program Administrative Expenses
|
$337
|
$343
|
$346
|
$354
|
$361
|
|
Rescission
|
-$10
|
—
|
—
|
—
|
—
|
|
Native American Veterans Housing Program Administrative Expenses
|
$707
|
$1,116
|
$1,087
|
$1,109
|
$1,130
|
|
Rescission
|
-$44
|
—
|
—
|
—
|
—
|
|
Subtotal VBA
|
$64,636,683
|
$63,921,095
|
$73,071,830
|
$86,886,074
|
$94,753,582
|
Veterans Health Administration (VHA)
|
|
Medical Services
|
$37,136,000
|
$39,649,985
|
$41,509,000
|
$43,557,000
|
$45,015,527
|
|
- Budget Supplemental
|
—
|
—
|
—
|
$40,000
|
$209,189
|
|
- Hurricane Supplemental
|
—
|
—
|
$21,000
|
—
|
—
|
|
Rescission
|
-$74,272
|
—
|
-$14,937
|
-$179,000
|
-$28,830
|
|
Total Medical Services
|
$37,061,728
|
$39,649,985
|
$41,515,063
|
$43,418,000
|
$45,195,886
|
|
Medical Administration
|
$5,307,000
|
$5,535,000
|
$5,746,000
|
$6,033,000
|
$5,879,700
|
|
Rescission
|
-$44,546
|
—
|
-$2,039
|
-$50,000
|
-$5,609
|
|
Medical Facilities
|
$5,740,000
|
$5,426,000
|
$5,441,000
|
$4,872,000
|
$4,739,000
|
|
Supplemental
|
—
|
—
|
$6,000
|
$85,000
|
—
|
|
Rescission
|
-$26,450
|
—
|
-$1,991
|
—
|
-$1,999
|
|
Medical and Prosthetic Research
|
$590,000
|
$581,000
|
$581,905
|
$585,664
|
$588,922
|
|
Rescission
|
-$10,162
|
—
|
—
|
—
|
-$409
|
|
Medical Care Collections Fund (MCCF)
|
$2,775,214
|
$2,830,302
|
$2,903,092
|
$3,087,990
|
$3,223,932
|
|
Subtotal VHA
|
$51,392,784
|
$54,022,287
|
$56,189,031
|
$58,031,654
|
$59,619,422
|
|
National Cemetery Administration (NCA)
|
$250,000
|
$250,934
|
$258,284
|
$250,000
|
$256,800
|
|
Rescission
|
-$500
|
—
|
-$341
|
-$1,000
|
-$170
|
|
Supplemental
|
—
|
—
|
$2,100
|
—
|
—
|
|
Subtotal NCA
|
$249,500
|
$250,934
|
$260,043
|
$249,000
|
$256,630
|
Departmental Administration:
|
|
VBA - General Operating Expenses
|
$2,622,110
|
$2,018,764
|
$2,164,074
|
$2,465,490
|
$2,534,254
|
|
Rescission
|
-$87,834
|
—
|
-$2,856
|
—
|
-2,355
|
|
General Administration
|
—
|
$416,737
|
$424,737
|
$415,885
|
$321,591
|
|
Rescission
|
—
|
—
|
-$561
|
-$2,000
|
-446
|
|
Office of Inspector General
|
$109,367
|
$112,391
|
$114,848
|
121,411
|
$126,411
|
|
Rescission
|
-$585
|
—
|
—
|
—
|
—
|
|
Information Technology
|
$3,307,000
|
$3,111,376
|
$3,323,053
|
$3,703,344
|
$3,903,344
|
Rescission
|
-$166,396
|
—
|
-1,066
|
|
Construction, Major Projects
|
$1,151,036
|
$589,604
|
$531,767
|
$342,130
|
$561,800
|
|
Rescission
|
-$2,302
|
—
|
—
|
—
|
—
|
|
Construction, Minor Projects
|
$467,700
|
$482,386
|
$606,728
|
$714,870
|
$495,200
|
|
Rescission
|
-$935
|
—
|
—
|
—
|
—
|
|
Supplemental
|
—
|
—
|
—
|
511,200
|
—
|
|
Grants for State Extended Care Facilities
|
$85,000
|
$85,000
|
$84,888
|
$85,000
|
$90,000
|
|
Rescission
|
-$170
|
—
|
—
|
—
|
—
|
|
Grants for State Veterans Cemeteries
|
$46,000
|
$46,000
|
$45,939
|
$46,000
|
$46,000
|
|
Rescission
|
-$92
|
—
|
—
|
—
|
—
|
|
Subtotal Departmental Administration
|
$7,454,899
|
$6,862,258
|
$7,499,618
|
$8,403,330
|
$8,173,912
|
|
Total Department of Veterans Affairs with MCCF
|
$123,733,866
|
$125,056,574
|
$ 137,020,522
|
$153,570,058
|
$162,803,546
|
|
Total Department of Veterans Affairs without MCCF
|
$120,958,652
|
$122,226,272
|
$ 134,117,429
|
$150,482,068
|
$159,579,614
|
|
Total Mandatory
|
$64,470,912
|
$63,764,919
|
$72,912,772
|
$86,726,176
|
$94,591,200
|
|
Total Discretionary with MCCF
|
$59,263,338
|
$61,291,655
|
$64,107,750
|
$66,843,881
|
$68,212,346
|
|
Total Discretionary without MCCF
|
$56,488,124
|
$58,461,353
|
$61,204,657
|
$63,755,892
|
$64,988,414
|
Source: Table prepared by the Congressional Research Service based on data from the Department of Veterans Affairs, Office of Management, Office of Budget.
Notes: For FY2014, the total mandatory amount does not include the mandatory amount of $15 billion provided by the Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113-146 as amended by P.L. 113-175, P.L. 113-235, P.L. 114-19, and P.L. 114-41). Totals may not add up due to rounding.
Author Contact Information
[author name scrubbed], Specialist in Veterans Policy
([email address scrubbed], [phone number scrubbed])
Acknowledgments
Adam N. Salazar, a former Research Assistant in the Domestic Social Policy Division, provided invaluable assistance with authoring this report.
Footnotes
| 1.
|
In general, payments of benefits made to, or on account of, a beneficiary under any law administered by the VA are exempt from federal taxation. Furthermore, benefits are exempt, in most cases, from "attachment, levy, or seizure by or under any legal or equitable process whatever, either before or after receipt by the beneficiary" (38 U.S.C. §5301(a)(1)).
|
| 2.
|
The BVA is part of the Department of Veterans Affairs, located in Washington, DC, and makes the final determination on an appeal within the VA. The BVA reviews all appeals for entitlement to veterans' benefits, including claims for service connection, increased disability ratings, pension, insurance benefits, educational benefits, home loan guaranties, vocational rehabilitation, dependency and indemnity compensation, health care services, and fiduciary matters.
|
| 3.
|
Established by the National Cemeteries Act of 1973 (P.L. 93-43).
|
| 4.
|
38 U.S.C. §7301 and 38 U.S.C. §7303.
|
| 5.
|
For more information on CHAMPVA, see CRS Report RS22483, Health Care for Dependents and Survivors of Veterans, by [author name scrubbed].
|
| 6.
|
38 U.S.C. §7302.
|
| 7.
|
38 U.S.C. §8111A.
|
| 8.
|
38 U.S.C. §1785.
|
| 9.
|
Veteran status is established by active-duty status in the U.S. Armed Forces and a discharge or release there from under conditions other than dishonorable (38 U.S.C.§101(2); 38 C.F.R. §3.1(d)). Generally, persons enlisting in one of the Armed Forces after September 7, 1980, and officers commissioned after October 16, 1981, must have completed two years of active duty or the full period of their initial service obligation to be eligible for VA health care benefits. An exception may be granted if the servicemember was discharged or released because of an early out or hardship (10 U.S.C. §§1171 or 1173); was discharged or released for a service-connected disability directly due to service; or has a compensable service-connected disability (38 U.S.C. §5303A; 38 C.F.R. §3.12a).
|
| 10.
|
A service-connected disability is a disability that was incurred or aggravated in the line of duty in the U.S. Armed Forces (38 U.S.C. §101 (16)). The VA determines whether veterans have service-connected disabilities and, for those with such disabilities, assigns ratings from 0% to 100% based on the severity of the disability. Percentages are assigned in increments of 10 (38 C.F.R. §§4.1-4.31).
|
| 11.
|
For information on eligibility for VA health care, see CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked Questions, by [author name scrubbed].
|
| 12.
|
Ibid.
|
| 13.
|
TRICARE provides medical care to active duty servicemembers and other eligible beneficiaries (such as military retirees) through a combination of direct care in military clinics and hospitals and civilian-purchased care. For more information on TRICARE, see CRS Report RL33537, Military Medical Care: Questions and Answers, by [author name scrubbed].
|
| 14.
|
For more information on VA cost-sharing requirements, see CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked Questions, by [author name scrubbed].
|
| 15.
|
For details, see CRS Insight IN10063, Wait Times for Veterans Health Not New, by [author name scrubbed].
|
| 16.
|
For a section-by-section description of all the provisions in the act, see CRS Report R43704, Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146), by [author name scrubbed] et al. For issues pertaining to implementation of the Veterans Choice Program, see CRS In Focus IF10224, Implementation of the Veterans Choice Program (VCP), by [author name scrubbed].
|
| 17.
|
Department of Veterans Affairs, Department of Veterans Affairs FY2014-2020 Strategic Plan, Washington, DC, 2014, p. 12. Also see Department of Veterans Affairs, FY2016 Budget Submission, Supplemental Information and Appendices, Volume 1 of 4, February 2015, p. Supplemental Information-7.
|
| 18.
|
The VA classifies veterans into eight enrollment Priority Groups based on an array of factors, including (but not limited to) service-connected disabilities or exposures, 24 prisoner of war (POW) status, receipt of a Purple Heart or Medal of Honor, and income.
|
| 19.
|
On September 1, 2010, the combat mission in Iraq (Operation Iraqi Freedom, OIF) formally ended and transitioned to Operation New Dawn (OND), which ended on December 15, 2011. VA considers OND to be part of the same contingency operation that was formerly called OIF. Therefore, VA considers participants in OND to be eligible for health care under the legal authorities pertaining to OIF. OEF/OIF/OND data from Department of Veterans Affairs, FY2016 Budget Submission, Medical Programs and Information Technology Programs, Volume 2 of 4, February 2015, p.VHA-11.
|
| 20.
|
In a given year not all enrolled veterans receive care from the VA, either because they are not sick or because they have other sources of care such as the private sector.
|
| 21.
|
Non-veterans include Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) patients (certain dependents of veterans), reimbursable patients in VA affiliated hospitals and clinics, care provided on a humanitarian basis, veterans of World War II allied nations, and employees receiving preventive occupational immunizations such as Hepatitis A&B and flu vaccinations.
|
| 22.
|
For an overview of the VA budget including funding for the Veterans Benefits Administration and the components of the Department, see CRS Report R44241, Department of Veterans Affairs FY2016 Appropriations: In Brief, by [author name scrubbed].
|
| 23.
|
In general, an appropriations act makes budget authority available beginning on October 1 of the fiscal year for which the appropriations act is passed ("budget year"). However, some types of appropriations do not follow this pattern; among them are advance appropriations. An advance appropriation means an appropriation of new budget authority that becomes available one or more fiscal years beyond the fiscal year for which the appropriations act was passed (i.e., beyond the budget year). For more information on advance appropriations, see CRS Report R43482, Advance Appropriations, Forward Funding, and Advance Funding: Concepts, Practice, and Budget Process Considerations, by [author name scrubbed].
|
| 24.
|
Codified at 38 U.S.C. §117.
|
| 25.
|
Executive Office of the President, Office of Management and Budget (OMB), Appendix A-Scorekeeping Guidelines, OMB Circular No. A-11, PART 7, July 2013, p. 2.
|
| 26.
|
Mandatory programs funded through the annual appropriations process are commonly referred to as appropriated entitlements. In general, appropriators have little control over the amounts provided for appropriated entitlements; rather, the authorizing statute establishes the program parameters (e.g., eligibility rules, benefit levels) that entitle certain recipients to payments. If Congress does not appropriate the money necessary to meet these commitments, entitled recipients (e.g., individuals, states, or other entities) may have legal recourse. For an overview of mandatory spending, see CRS Report RL33074, Mandatory Spending Since 1962, by [author name scrubbed], [author name scrubbed], and [author name scrubbed].
|
| 27.
|
Funding for discretionary programs are provided and controlled through the annual appropriations process. For more information, see CRS Report R41726, Discretionary Budget Authority by Subfunction: An Overview, by [author name scrubbed].
|
| 28.
|
A major part of this discussion was drawn from U.S. Government Accountability Office, Veterans' Health Care: VA Uses a Projection Model to Develop Most of Its Health Care Budget Estimate to Inform the President's Budget Request, GAO-11-205, January 2011, pp. 4-8; and U.S. Government Accountability Office, Veterans' Health Care Budget: Better Labeling of Services and More Detailed Information Could Improve the Congressional Budget Justification, GAO-12-908, September 2012, pp. 5-6.
|
| 29.
|
The Veterans' Health Care Eligibility Reform Act of 1996 (P.L. 104-262) required the VHA to manage the provision of hospital care and medical services through an enrollment system based on a system of priorities.
|
| 30.
|
Department of Veterans Affairs, FY2014 Budget Submission, Medical Programs and Information Technology Programs, Volume 2 of 4, February 2013, p. 1A-6.
|
| 31.
|
VHA uses methodologies other than the EHCPM to develop estimates of the amount of resources needed for state-based long-term care programs, readjustment counseling, legislation recently enacted, expansions to homeless veterans programs, and care provided to non-veterans patients.
|
| 32.
|
For more information on CHAMPVA, see CRS Report RS22483, Health Care for Dependents and Survivors of Veterans, by [author name scrubbed].
|
| 33.
|
Department of Veterans Affairs, FY2015 Budget Submission, Medical Programs and Information Technology Programs, Volume 2 of 4, March 2014, p. VHA-46.
|
| 34.
|
U.S. Congress, Conference Committees, Consolidated Appropriations Act, 2004, conference report to accompany H.R. 2673, 108th Cong., 1st sess., H.Rept. 108-401, p. 1036.
|
| 35.
|
In its FY2008 budget request to Congress, the VA requested the transfer of food service operations costs from the medical facilities appropriations to the medical services appropriations. The House and Senate Appropriations Committees concurred with this request. The cost of food service operations support hospital food service workers, provisions, and supplies related to the direct care of patients.
|
| 36.
|
Biomedical engineering services include the maintenance and repair of all medical equipment used in the treatment, monitoring, diagnosis, and therapy of patients.
|
| 37.
|
Vet Centers are community-based counseling centers that provide a wide range of social and psychological services, such as professional readjustment counseling to veterans who have served in a combat zone, military sexual trauma (MST) counseling, bereavement counseling for families who experience an active duty death, substance abuse assessments and referral, medical referral, veterans' benefits explanation and referral, and employment counseling, among other services.
|
| 38.
|
VISN offices provide management and oversight to the medical centers and clinics within their assigned geographic areas. Each VISN office is responsible for allocating funds to facilities, clinics, and programs within its region and coordinating the delivery of health care to veterans.
|
| 39.
|
38 U.S.C. §7303(a)(3). The Office of Research and Development (ORD) within the Veterans Health Administration (VHA) manages the medical research program. The medical research program encompasses, among other things, biomedical laboratory research, clinical trials, health services research, and rehabilitation research.
|
| 40.
|
The Consolidated Omnibus Budget Reconciliation Act of 1985 (P.L. 99-272), enacted into law in 1986, established means testing for veterans seeking care for nonservice-connected conditions. The Balanced Budget Act of 1997 (P.L. 105-33) established the Department of Veterans Affairs Medical Care Collections Fund (MCCF) and gave the VHA the authority to retain these funds in the MCCF. Instead of returning the funds to the Treasury, the VA can use them, without fiscal year limitations, for medical services for veterans. In FY2004, the Administration's budget requested consolidating several existing medical collections accounts into one MCCF. The conferees of the Consolidated Appropriations Act of 2004 (H.Rept. 108-401) recommended that collections that would otherwise be deposited in the Health Services Improvement Fund (former name), Veterans Extended Care Revolving Fund (former name), Special Therapeutic and Rehabilitation Activities Fund (former name), Medical Facilities Revolving Fund (former name), and the Parking Revolving Fund (former name) should be deposited in MCCF. The Consolidated Appropriations Act of 2005 (P.L. 108-447, H.Rept. 108-792) provided the VA with permanent authority to deposit funds from these five accounts into the MCCF.
|
| 41.
|
For a detailed discussion of the VHA appropriations for FY2015, see CRS Report R43547, Veterans' Medical Care: FY2015 Appropriations, by [author name scrubbed].
|
| 42.
|
H.Rept. 114-92, p. 35.
|
| 43.
|
For more information and accompanying VA documents, see http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2718.
|
| 44.
|
U.S. Congress, House Committee on Veterans' Affairs, The State of VA's [Veterans Affairs] Fiscal Year 2015 Budget, 114th Cong., 1st sess., June 25, 2015.
|
| 45.
|
See CRS Report R43704, Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146), by [author name scrubbed] et al.
|
| 46.
|
The full plan can be found at http://www.va.gov/opa/publications/VA_Community_Care_Report_11_03_2015.pdf, and a fact sheet produced by the VA on the plan is available at http://bit.ly/1MpV1R8.
|
| 47.
|
For more information, see CRS Report R44214, Overview of the FY2016 Continuing Resolution (H.R. 719), by [author name scrubbed].
|
| 48.
|
"Amendments Submitted and Proposed," Congressional Record, daily edition, vol. 161, No. 165 (November 5, 2015), pp. S7823-S7832.
|
| 49.
|
For a complete discussion, see Explanatory Statement Submitted By Mr. Rogers of Kentucky, Chairman of The House Committee On Appropriations Regarding House Amendment No. 1 To The Senate Amendment on H.R. 2029-Continued, Congressional Record, daily edition, vol. 161, Book III (December 17, 2015), pp. H10394-H10401.
|
| 50.
|
Ibid., p. H10394.
|
| 51.
|
Ibid., p. H10395.
|
| 52.
|
Ibid., p.H10395.
|
| 53.
|
Ibid., p.H10395.
|
| 54.
|
Ibid., p.H10395.
|
| 55.
|
Ibid., p.H10395.
|
| 56.
|
Ibid., H10396.
|