[Congressional Record Volume 154, Number 149 (Thursday, September 18, 2008)]
[Senate]
[Pages S9037-S9038]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA (for himself, Ms. Snowe, Mr. Feingold, Ms. Landrieu, 
        Mr. Johnson, Ms. Murkowski, Mr. Thune, Mr. Stevens and Mr. 
        Rockefeller):
  S. 3527. A bill to amend title 38, United States Code, to authorize 
advance appropriations for certain medical care accounts of the 
Department of Veterans Affairs by providing two-fiscal year budget 
authority; to the Committee on Veterans' Affairs.
  Mr. AKAKA. Mr. President, today I am introducing legislation that 
would secure more timely health care funding for the millions of 
veterans who rely on the Veterans Health Administration for their 
health care.
  I am pleased to be joined by Senators Snowe, Feingold, Landrieu, 
Johnson, Murkowski, Stevens, and Thune in introducing this important 
bill.
  Not all Americans realize that VA's health care system is the largest 
in the Nation.
  They do know, to be sure, that many veterans are injured while 
serving our country and, unfortunately, some of these injuries require 
a lifetime of care. Millions of veterans rely on VA for health care 
every year, and every year that number grows.
  Few Americans realize that the VA health care system must rely on an 
annual appropriation. While Congress has provided much-needed funding 
increases to veterans' health care in recent years, VA health care 
funding can be untimely and unpredictable, making it difficult for VA 
to manage its overall health care program effectively.
  A survey recently commissioned by the Disabled American Veterans 
found that 83 percent of respondents favor requiring Congress to 
determine the budget for veterans' health care a year in advance. This 
bill would do just that.
  During my time on the Veterans' Affairs Committee, I have heard 
former Secretaries of Veterans Affairs state plainly that the current 
process is no way to fund the Nation's largest health care system. We 
need to provide a more secure and predictable funding system for 
veterans health care. Our legislation will do exactly that.
  This legislation would require that veterans' health care be funded 
through the advance appropriations process. Under that process, 
programs are funded 2 years in advance, rather than a year at a time.
  Unlike the funding provided to Medicare and Medicaid, veterans' 
health care would not be funded as an entitlement--Congress would still 
be able to review and manage the funding, as necessary. But with 
advance appropriations, VA would be able to plan more efficiently, and 
better use taxpayer-dollars to care for veterans.

[[Page S9038]]

  Uncertain and untimely funding can limit VA health care's 
effectiveness, while they strive to meet the needs of veterans on a 
daily basis, as costs grow rapidly.
  What I am proposing today is not new. Congress already uses advance 
appropriations for programs that require funding in a timely manner, 
such as HUD Section 8 housing vouchers and the Low Income Heating 
Energy Assistance Program.
  To this extent, I submit that veterans' health care is just as 
deserving of secured and predictable funding.
  To increase transparency in this process, the bill I am introducing 
would require an annual GAO audit and public report to Congress on VA's 
funding forecasts.
  This process of continuous open review of VA appropriations would 
help VA funds go even further for veterans and taxpayers.
  Advance funding for veterans' health care has the strong support of 
the Partnership for Veterans Health Care Budget Reform, a coalition 
which includes the following veteran service organizations: AMVETS, 
Blinded Veterans Association, Disabled American Veterans, Jewish War 
Veterans, Military Order of the Purple Heart, Paralyzed Veterans of 
America, The American Legion, Veterans of Foreign Wars, and Vietnam 
Veterans of America.
  My friend and counterpart in the House of Representatives, House 
Veterans' Affairs Committee Chairman Robert Filner, is introducing a 
companion bill for advance funding as well.
  We are united in our determination to set down a marker for future 
action on veterans' health care through this bill, and place advance 
appropriations for veterans' health care on the National agenda.
  I urge all of our colleagues to join as supporters of more secure, 
timely funding for veterans' health care.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 3527

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Veterans Health Care Budget 
     Reform Act of 2008''.

     SEC. 2. TWO-FISCAL YEAR BUDGET AUTHORITY FOR CERTAIN MEDICAL 
                   CARE ACCOUNTS OF THE DEPARTMENT OF VETERANS 
                   AFFAIRS.

       (a) Two-Fiscal Year Budget Authority.--
       (1) In general.--Chapter 1 of title 38, United States Code, 
     is amended by inserting after section 113 the following new 
     section:

     ``Sec. 113A. Two-fiscal year budget authority for certain 
       medical care accounts

       ``(a) In General.--Beginning with fiscal year 2010, new 
     discretionary budget authority provided in an appropriations 
     Act for the appropriations accounts of the Department 
     specified in subsection (b) shall be made available for the 
     fiscal year involved and shall include new discretionary 
     budget authority first available after the end of such fiscal 
     year for the subsequent fiscal year.
       ``(b) Medical Care Accounts.--The medical care accounts of 
     the Department specified in this subsection are the medical 
     care accounts of the Veterans Health Administration as 
     follows:
       ``(1) Medical Services.
       ``(2) Medical Administration.
       ``(3) Medical Facilities.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of chapter 1 of such title is amended by inserting 
     after the item relating to section 113 the following new 
     item:

``113A. Two-fiscal year budget authority for certain medical care 
              accounts.''.

     SEC. 3. COMPTROLLER GENERAL OF THE UNITED STATES STUDY ON 
                   ADEQUACY AND ACCURACY OF BASELINE MODEL 
                   PROJECTIONS OF THE DEPARTMENT OF VETERANS 
                   AFFAIRS FOR HEALTH CARE EXPENDITURES.

       (a) Study of Adequacy and Accuracy of Baseline Model 
     Projections.--The Comptroller General of the United States 
     shall conduct a study of the adequacy and accuracy of the 
     budget projections made by the Enrollee Health Care 
     Projection Model, or its equivalent, as utilized for the 
     purpose of estimating and projecting health care expenditures 
     of the Department of Veterans Affairs (in this section 
     referred to as the ``Model'') with respect to the fiscal year 
     involved and the subsequent four fiscal years.
       (b) Reports.--
       (1) In general.--Not later than the date of each year in 
     2010, 2011, and 2012, on which the President submits the 
     budget request for the next fiscal year under section 1105 of 
     title 31, United States Code, the Comptroller General shall 
     submit to the appropriate committees of Congress and to the 
     Secretary a report.
       (2) Elements.--Each report under this paragraph shall 
     include, for the fiscal year beginning in the year in which 
     such report is submitted, the following:
       (A) A statement whether the amount requested in the budget 
     of the President for expenditures of the Department for 
     health care in such fiscal year is consistent with 
     anticipated expenditures of the Department for health care in 
     such fiscal year as determined utilizing the Model.
       (B) The basis for such statement.
       (C) Such additional information as the Comptroller General 
     determines appropriate.
       (3) Availability to the public.--Each report submitted 
     under this subsection shall also be made available to the 
     public.
       (4) Appropriate committees of congress defined.--In this 
     subsection, the term ``appropriate committees of Congress'' 
     means--
       (A) the Committees on Veterans' Affairs, Appropriations, 
     and the Budget of the Senate; and
       (B) the Committees on Veterans' Affairs, Appropriations, 
     and the Budget of the House of Representatives.

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