巨大的退伍軍人預算缺口

巨大的退伍軍人預算缺口在撥款過程中造成了漏洞

https://rollcall.com/2024/07/26/massive-veterans-budget-gap-rips-hole-in-appropriations-process/

退伍軍人事務部遲遲告訴國會，他們需要另外 150 億美元用於福利和醫療保健

作者：Aidan Quigley 2024 年 7 月 26 日
退伍軍人事務部本財年和下一財年麵臨近 150 億美元的總預算缺口，國會共和黨人對最後一刻通知的資金危機表示不滿，立法者幾乎沒有時間嚐試解決。

退伍軍人事務部官員於 7 月 15 日告訴立法者，該機構需要 29 億美元的強製性支出用於退伍軍人養老金和其他福利，以彌補截至 9 月 30 日的財政年度剩餘幾個月的缺口。此外，除了 3 月份的撥款方案或 2025 財年眾議院和參議院軍事建設-退伍軍人事務部法案中提供的資金外，他們還需要為明年提供另外 120 億美元的可自由支配的醫療保健資金。

眾議院於 6 月 5 日通過了 2025 財年軍事建設-退伍軍人事務部法案，參議院撥款委員會於 7 月 11 日對其版本進行了標記，之後發布了該通知。

據參議院退伍軍人事務委員會排名成員傑裏·莫蘭 (Jerry Moran) 稱，如果國會在 9 月 20 日之前不采取行動，退伍軍人事務部估計，700 萬退伍軍人及其遺屬可能無法在 10 月 1 日收到福利金。兩院的共和黨人都認為，退伍軍人事務部和白宮管理和預算辦公室要麽應該預見到這一缺口，要麽故意向立法者隱瞞這一缺口。

“我認為這是退伍軍人事務部嚴重的財務管理不善和/或無能，”堪薩斯州共和黨議員莫蘭周四表示。“我非常擔心，退伍軍人事務部和行政管理和預算辦公室的管理部門在幾個月內誤導了國會，讓他們誤以為退伍軍人事務部的狀況以及照顧退伍軍人及其遺屬所需的資源水平。”

眾議院退伍軍人事務部主席、伊利諾伊州共和黨議員邁克·博斯特在 7 月 17 日的一封信中敦促該機構就資金短缺問題作出解釋，他將資金短缺歸咎於“令人不安的未列入預算的預期成本組合，以及其他缺乏充分解釋或推測的成本。”

博斯特寫道，資金短缺的一部分包括近 39 億美元的藥品和假肢成本，其中包括 10 億美元用於管理“慢性病”，可能與肥胖和昂貴的減肥藥 Ozempic 有關。他還表示，這是因為 VA 正在快速招聘，預計將招聘 22,304 名新全職員工。

創紀錄的需求
據該機構官員稱，問題的關鍵在於，在實施 2022 年法律的過程中，對醫療保健服務的需求增加，該法律擴大了在戰區服役期間接觸燃燒坑和其他毒素的退伍軍人的醫療服務。以前，生病的退伍軍人需要證明他們的疾病與他們的軍事服務直接相關；現在，人們推測這些疾病與服役有關。

VA 新聞秘書 Terrence Hayes 周四表示，在過去 365 天裏，有 412,867 名退伍軍人參加了 VA 的護理，比上一年增加了 27%。

[退伍軍人有毒物質暴露法案在曲折道路後獲得參議院批準]

不過，莫蘭表示，沒有理由不早點通知立法者。在 2025 財年加價開始之前，參議院撥款委員會主席、華盛頓州民主黨議員帕蒂·默裏和緬因州共和黨議員蘇珊·柯林斯達成協議，在常規預算上限的基礎上撥款 345 億美元用於緊急支出，如果他們知道 VA 的資金短缺，他們就可以將其納入談判中。

“隻有在我們完成工作後，我們才會被告知這個問題，”莫蘭說。“在我看來，VA 或 OMB 不可能直到那時才知道這些事實。”

白宮預算辦公室將問題轉交給 VA。

該機構在其 2025 財年預算申請中假設退伍軍人醫療保健賬戶將大量動用未承付餘額來維持收支平衡，這讓他們有空間在 2025 財年申請比上一財年撥款更少的資金。

這為其他國內支出騰出了空間，同時仍保持在去年債務上限協議的預算上限之內——柯林斯和其他共和黨高層對此表示擔憂。

“我們曾對過度依賴未承諾的結轉資金提出質疑，然後我們發現存在巨大的缺口，可能會危及福利，”柯林斯說。“這是完全不可接受的。我很難相信這件事沒有對我們隱瞞。”

退伍軍人事務部部長丹尼斯·麥克多諾在周二的新聞發布會上表示，他已經向立法者明確表示，他會在需要時回到國會並要求額外的資源。

“我一直說我們相信我們已經擁有了我們需要的資源，但如果我們需要更多，我們會回來要求，因為我們想要退伍軍人

選擇 V??A，”他說。“而且，退伍軍人選擇 VA 的人數創下了曆史新高。”

據該部門稱，退伍軍人在 2023 年提交了 243 萬份索賠申請，比以往任何時候都多，比 2022 年高出 39%。

VA 發言人海耶斯表示，VA 為退伍軍人提供的護理和福利比以往任何時候都多，2022 年法律出台後的需求“甚至超出了最激進的預測和預期”。

“VA 正在與國會和管理與預算辦公室密切合作，以防止對退伍軍人產生任何不利影響的方式滿足這些需求——並允許我們繼續以創紀錄的速度向退伍軍人提供護理和福利，”海耶斯說。

創可貼修複？

目前尚不清楚立法者將如何采取行動解決短缺問題。參議院退伍軍人事務主席、蒙大拿州民主黨人喬恩·泰斯特 (Jon Tester) 表示，該部門可能能夠使用本財年的未承付餘額來維持運營。

“這個問題可能會通過結轉或撥款來解決。結轉可以解決這個問題，我還沒有看到具體數字，我不知道他們還剩下多少錢，”泰斯特說，他是一位陷入困境的現任議員，在一個深紅色州麵臨著艱難的連任競選。

雖然近 30 億美元的強製性福利資金可能被納入短期權宜之計，預計在 9 月底之後政府將保持運轉，但這不太可能在 VA 按時支付數百萬美元的 9 月 20 日截止日期之前完成。

關於 2025 財年 120 億美元的醫療保健資金，官員們表示，如果沒有額外資金，VA 將做出調整，以在可用預算範圍內生活，同時仍提供優質醫療服務。但該機構已明確表示，獲得額外資金會更好，他們沒有詳細說明如果沒有這筆資金，需要做出什麽樣的權衡。

就柯林斯而言，她“不知道”如何解決資金短缺問題。由於這一問題現在才剛剛浮出水麵，它可能會成為在決定白宮、參議院和眾議院控製權的關鍵11月選舉之前的競選話題。

Massive veterans budget gap rips hole in appropriations process

https://rollcall.com/2024/07/26/massive-veterans-budget-gap-rips-hole-in-appropriations-process/

VA belatedly tells Congress they need another $15 billion for benefits, health care

By Aidan Quigley  July 26, 2024

The Department of Veterans Affairs is facing a nearly $15 billion combined budget shortfall this fiscal year and next, and congressional Republicans are crying foul at the last-minute notification about a funding crisis lawmakers have little time to try to fix.

VA officials told lawmakers on July 15 that the agency needs $2.9 billion in mandatory spending for veterans pensions and other benefits to cover a gap for the remaining months of the fiscal year ending Sept. 30. And they need another $12 billion in discretionary medical care funds for next year on top of what was provided in a March appropriations package or in the fiscal 2025 House and Senate Military Construction-VA bills.

The notification came after the House passed its fiscal 2025 Military Construction-VA bill on June 5, and after the Senate Appropriations Committee marked up its version on July 11.

If Congress does not act by Sept. 20, the VA estimates that 7 million veterans and their survivors may not receive their benefits payments on Oct. 1, according to Senate Veterans’ Affairs Committee ranking member Jerry Moran. Republicans in both chambers believe that the VA and White House Office of Management and Budget either should have seen this shortfall coming, or deliberately hid it from lawmakers. 

“I think this is significant financial mismanagement, and/or incompetence at the Department of Veterans Affairs,” Moran, R-Kan., a senior Appropriations Committee member, said Thursday. “And I am gravely concerned that the administration, both the VA and OMB, specifically misled Congress for months about the state of affairs at the VA and the level of resources that are actually needed to care for veterans and their survivors.” 

House Veterans’ Affairs Chairman Mike Bost, R-Ill., pushed the agency for answers about the shortfall in a July 17 letter, where he blamed the shortfall on a “troubling mix of anticipated costs that were not budgeted for and other costs that lack sufficient explanation or are speculative.” 

Bost wrote that part of the shortfall consists of nearly $3.9 billion for pharmaceutical and prosthetics costs, including $1 billion to manage “chronic disease,” possibly related to obesity and the pricey weight loss drug Ozempic. He also suggested it was because of the VA’s rapid hiring, projected at 22,304 new full-time employees.

Record demand

According to agency officials, the crux of the issue is increased demand for health care services amid implementation of a 2022 law that expanded access for veterans exposed to burn pits and other toxins while serving in combat zones. Previously, veterans who got sick needed to prove their illnesses were directly tied to their military service; now, the presumption is such diseases are service-connected. 

Over the last 365 days, 412,867 veterans have enrolled in VA care — a 27 percent increase compared to the previous year, VA press secretary Terrence Hayes said Thursday. 

[Veterans toxic exposure bill clears Senate after tortuous path]

Still, Moran said there’s no reason why lawmakers couldn’t have been informed sooner. Before their fiscal 2025 markups began, Senate Appropriations Chair Patty Murray, D-Wash., and ranking member Susan Collins, R-Maine, reached a deal to allocate $34.5 billion in emergency spending on top of regular budget caps, and had they known about the VA shortfall, they could have factored it into their negotiations.

“Only after we did our work are we informed of this problem,” Moran said. “And it could not, in my view, been only then that VA or OMB knew these facts.” 

The White House budget office referred questions to the VA.

The agency in its fiscal 2025 budget request assumed veterans health care accounts would dip heavily into unobligated balances to make ends meet, giving them room to request less overall in fiscal 2025 money than was appropriated for the previous fiscal year.

That freed up room for other domestic spending, while remaining within budget caps from last year’s debt ceiling agreement — something Collins and other top Republicans expressed concern about.

“We had raised questions about the over-reliance on unobligated carryover funds, and then we find that there is this enormous shortfall that could jeopardize benefits,” Collins said. “And that is just completely unacceptable. It’s hard for me to believe that this wasn’t concealed from us.” 

VA Secretary Denis McDonough said during a Tuesday press conference that he has been clear to lawmakers that he would come back to Congress and ask for additional resources when they were needed. 

“I kept saying we believe we have what we need, but if we need more, we’re going to come back and ask for it, because we want veterans to choose VA,” he said. “And at record levels, veterans are choosing VA.” 

Veterans submitted 2.43 million claims applications in 2023, more than ever before and 39 percent higher than in 2022, according to the department. 

Hayes, the VA spokesman, said the VA is delivering more care and benefits to veterans than ever, and the demand following the 2022 law has “exceeded even the most aggressive projections and expectations.” 

“VA is working closely with Congress and the Office of Management and Budget to address these needs in a way that prevents any adverse impacts on veterans — and allow us to continue to deliver care and benefits to veterans at record rates,” Hayes said. 

Band-Aid fix?

It’s not clear how lawmakers will move to address the shortfall. Senate Veterans’ Affairs Chairman Jon Tester, D-Mont., said the department may be able to get by using unobligated balances from this fiscal year. 

“It will probably get fixed with carryover or appropriations. It could be taken care of with carryover, I haven’t seen the figures yet, I don’t know what kind of money they have left over,” said Tester, an embattled incumbent facing a tough reelection bid in a deep-red state.

While the nearly $3 billion in mandatory benefits funding could be included in the short-term stopgap measure that is expected to be needed to keep the government open after the end of September, it is unlikely that will be done by the VA’s Sept. 20 deadline to make millions of payments on time.

Regarding the $12 billion in fiscal 2025 health care funds, officials say if no additional funds are provided, the VA will make adjustments to live within the available budget while still providing quality care. But the agency has made clear receiving additional money would be preferable, and they aren’t detailing what sort of trade-offs would be necessary without it.

For her part, Collins said she had “no idea” how the shortfall will be addressed. And with this issue only emerging now, it could wind up in campaign talking points ahead of critical November elections to determine control of the White House, Senate and House.