[Congressional Record Volume 155, Number 29 (Thursday, February 12, 2009)]
[Senate]
[Pages S2232-S2233]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA (for himself, Ms. Snowe, Mr. Johnson, Mr. 
        Rockefeller, Mr. Sanders, Mr. Tester, Mr. Begich, Mr. Bingaman, 
        Mrs. Boxer, Mr. Feingold, Ms. Landrieu, Mr. Lautenberg, Mr. 
        Menendez, Ms. Murkowski, Ms. Stabenow, Mr. Thune, Mr. Vitter, 
        Mr. Schumer, and Mr. Burr):
  S. 423. 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, and for other purposes; to the Committee on Veterans' 
Affairs.
  Mr. AKAKA. Mr. President, this is an important day for Congress, for 
veterans, and their families. Today we take another step towards 
securing timely, predictable funding for the Veterans Health Care 
system. Our plan will create a transparent funding process that will 
yield sufficient, on-time funding that will enable VA to care for 
veterans more effectively.
  Historically, VA's health care system has been plagued by 
underfunding. Only a few years ago, VA reported a shortfall of over $1 
billion dollars. VA has had to come back to Congress repeatedly to get 
supplementary funding for health care costs. Fortunately, in the past 
two years, we have begun to change course, by providing record-funding 
to meet the increased needs of veterans and their families.
  Even with sufficient funding, however, the money for VA has been 
provided late in 19 of the past 22 fiscal years. Sometimes, the 
appropriations have come as late as February, when VA needed the funds 
to spend in the preceding October.
  Funding levels and the timing of funding depend on the federal 
appropriations process--a process vulnerable to partisan posturing and 
last minute changes.
  This means that the largest health care system in the country--to 
which millions of wounded and indigent veterans turn to for care--does 
not know what funds it will receive, when it will be funded, or, in 
reality, whether vital programs will receive funding at all. This is no 
way to finance a national health care system with such a sacred 
obligation.
  Today we suggest a better option. I am proud to introduce the Senate-
version of the Veterans Health Care Budget Reform Act. This bill would 
require that veterans' health care be funded one-year in advance of the 
regular appropriations process.
  Unlike Medicare and Medicaid, veterans' health care would not be 
funded as an entitlement: Congress would still review and manage 
funding, as necessary, so as to maintain oversight.
  By knowing what funding they will receive one year in advance, VA 
would be able to plan more efficiently, and better use taxpayer dollars 
to care for veterans.
  In addition to improving timeliness, this bill will deliver a more 
transparent funding process. A GAO audit and public report to Congress 
on VA funding would be provided annually.
  I am proud to join a number of our nation's leading veterans' 
organizations, and a bipartisan team of supporters from the House and 
Senate in calling for this bill's passage. Joining me as cosponsors on 
this bill are Senators Snowe, Johnson, Rockefeller, Sanders, Tester, 
Begich, Bingaman, Boxer, Feingold, Landrieu, Lautenberg, Menendez, 
Murkowski, Stabenow, Thune, Vitter, and Mr. Schumer.
  Now is the time to secure timely, predictable veterans' health care 
funding. Mr. President, and 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 
placed in the Record, as follows:

                                 S. 423

       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 and Transparency Act of 2009''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Title 38, United States Code, authorizes the Secretary 
     of Veterans Affairs to furnish hospital and domiciliary care, 
     medical services, nursing home care, and related services to 
     eligible and enrolled veterans, but only to the extent that 
     appropriated resources and facilities are available for such 
     purposes.
       (2) For 19 of the past 22 fiscal years, funds have not been 
     appropriated for the Department of Veterans Affairs for the 
     provision of health care as of the commencement of the new 
     fiscal year, causing the Department great challenges in 
     planning and managing care for enrolled veterans, to the 
     detriment of veterans.
       (3) The cumulative effect of insufficient, late, and 
     unpredictable funding for the Department for health care 
     endangers the viability of the health care system of the 
     Department and impairs the specialized health care resources 
     the Department requires to maintain and improve the health of 
     sick and disabled veterans.
       (4) Appropriations for the health care programs of the 
     Department have too often proven insufficient over the past 
     decade, requiring the Secretary to ration health care and 
     Congress to approve supplemental appropriations for those 
     programs.
       (5) Providing sufficient, timely, and predictable funding 
     would ensure the Government meets its obligation to provide 
     health

[[Page S2233]]

     care to sick and disabled veterans and ensure that all 
     veterans enrolled for health care through the Department have 
     ready access to timely and high quality care.
       (6) Providing sufficient, timely, and predictable funding 
     would allow the Department to properly plan for and meet the 
     needs of veterans.

     SEC. 3. 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 2011, 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 for such appropriations accounts that first 
     become available for the first fiscal year after such 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 Support and Compliance.
       ``(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. 4. 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, its equivalent, or other methodologies, 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 
     2011, 2012, and 2013, 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.
                                 ______