[Congressional Record Volume 155, Number 95 (Tuesday, June 23, 2009)]
[House]
[Pages H7094-H7097]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    VETERANS HEALTH CARE BUDGET REFORM AND TRANSPARENCY ACT OF 2009

  Mr. FILNER. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 1016) to amend title 38, United States Code, to provide 
advance appropriations authority for certain medical care accounts of 
the Department of Veterans Affairs, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 1016

       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. SENSE OF CONGRESS.

       It is the sense of Congress that the provision of health 
     care services to veterans could be more effectively and 
     efficiently planned and managed if funding was provided for 
     the management and provision of such services in the form of 
     advance appropriations.

     SEC. 3. PRESIDENTS' BUDGET SUBMISSIONS.

       Section 1105(a) of title 31, United States Code, is amended 
     by adding at the end the following new paragraph:
       ``(36) information on estimates of appropriations for the 
     fiscal year following the fiscal year for which the budget is 
     submitted for the following accounts of the Department of 
     Veterans Affairs:
       ``(A) Medical Services.
       ``(B) Medical Support and Compliance.
       ``(C) Medical Facilities.
       ``(D) Information Technology Systems.
       ``(E) Medical and Prosthetic Research.''.

[[Page H7095]]

     SEC. 4. ADVANCE APPROPRIATIONS FOR CERTAIN ACCOUNTS OF THE 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) Advance Appropriations for Certain Accounts.--
       (1) In general.--Chapter 1 of title 38, United States Code, 
     is amended by inserting after section 116 the following new 
     section:

     ``Sec. 117. Advance appropriations for certain accounts

       ``(a) In General.--For each fiscal year, beginning with 
     fiscal year 2011, discretionary new budget authority provided 
     in an appropriations Act for the appropriations accounts of 
     the Department specified in subsection (c) shall--
       ``(1) be made available for that fiscal year; and
       ``(2) include, for each such appropriations account, 
     advance discretionary new budget authority that first becomes 
     available for the first fiscal year after the budget year.
       ``(b) Estimates Required.--The Secretary shall include in 
     documents submitted to Congress in support of the President's 
     budget submitted pursuant to section 1105 of title 31, United 
     States Code, detailed estimates of the funds necessary for 
     the accounts of the Department specified in subsection (c) 
     for the fiscal year following the fiscal year for which the 
     budget is submitted.
       ``(c) Accounts Specified.--The accounts specified in this 
     subsection are the following accounts of the Department of 
     Veterans Affairs:
       ``(1) Medical Services.
       ``(2) Medical Support and Compliance.
       ``(3) Medical Facilities.
       ``(4) Information Technology Systems.
       ``(5) Medical and Prosthetic Research.
       ``(d) Annual Report.--Not later than July 31 of each year, 
     the Secretary shall submit to Congress an annual report on 
     the sufficiency of the Department's resources for the next 
     fiscal year beginning after the date of the submittal of the 
     report for the provision of medical care. Such report shall 
     also include estimates of the workload and demand data for 
     that fiscal year.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 116 the following new item:

``117. Advance appropriations for certain accounts.''.

     SEC. 5. COMPTROLLER GENERAL 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 Base Line Model 
     Projections.--The Comptroller General shall conduct a study 
     of the adequacy and accuracy of the budget projections made 
     by the Enrollee Health Care Projection Model (in this section 
     referred to as the ``Model''), its equivalent, or other 
     methodologies utilized for the purpose of estimating and 
     projecting health care expenditures of the Department of 
     Veterans Affairs 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 of Veterans Affairs a report.
       (2) Elements.--Each report under this paragraph shall 
     include, for the fiscal year concerning the year for which 
     the budget 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 be made available to the public 
     by the Comptroller General.
       (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.

     SEC. 6. REPORT TO CONGRESS.

       Not later than 90 days after the date of the enactment of 
     this Act, the Secretary of Veterans Affairs, shall submit to 
     the Committees on Veterans' Affairs, Appropriations, and the 
     Budget of the Senate and House of Representatives a report on 
     the requirements of this Act and the amendments made by this 
     Act. Such report shall include--
       (1) the Secretary's plans for improving the capability of 
     the Department of Veterans Affairs to better and more 
     accurately estimate future health care costs and demands; and
       (2) a description of impediments, statutory or otherwise, 
     to providing future year estimates and advance appropriations 
     for the Medical Services, Medical Support and Compliance, 
     Medical Facilities, Information Technology Systems, and 
     Medical and Prosthetic Research accounts of the Department.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Filner) and the gentleman from Arkansas (Mr. Boozman) 
each will control 20 minutes.
  The Chair recognizes the gentleman from California.
  Mr. FILNER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this is undoubtedly one of the most significant bills 
that this Congress will pass in this or any other session. The Veterans 
Health Care Budget Reform and Transparency Act was introduced in 
February, and this bipartisan measure is a response to years of chronic 
underfunding of the VA medical care system.
  During the last two decades, the VA budget has been in place at the 
start of the fiscal year barely four times. We all know that this delay 
in providing vital funding puts the provision of health care to 
veterans at a risk and hampers the VA's ability to plan its health care 
expenditures, hire needed health care professionals, and plan needed 
construction.
  In an unprecedented step, nine veterans groups formed the Partnership 
for Veterans Health Care Budget Reform. These groups, including The 
American Legion, AMVETS, Blinded Veterans Association, Disabled 
American Veterans, Jewish War Veterans, Military Order of the Purple 
Heart, Paralyzed Veterans of America, Veterans of Foreign Wars, and the 
Vietnam Veterans of America, formed to advocate for a VA health care 
budget that is sufficient, timely, and predictable.
  These groups put forward the idea that resources for VA health care 
should be provided through advanced appropriations so that when the 
fiscal year starts on October 1, the VA will know what its budget is a 
year in advance. That is what will happen when H.R. 1016 passes. It 
will ensure the VA can best plan and utilize taxpayer dollars to 
provide veterans with the health care they have earned and deserved. It 
provides the framework with which we can realize advanced 
appropriations for VA medical care accounts.
  As part of the annual budget submission, the President will be 
required to submit a request for certain VA accounts for the fiscal 
year following the fiscal year for which the budget is submitted. As 
part of the administration's FY 2011 budget, the President will include 
budget estimates for VA medical care, information technology, and 
medical and prosthetic research accounts for FY 2012. The VA will be 
required to provide detailed estimates in the budget documents it 
submits annually to Congress.
  Each July, the VA will be required to report to Congress if it has 
the resources it needs for the upcoming fiscal year in order for the 
Congress to address any funding imbalances. This will help to safeguard 
against the VA facing budget shortfalls such as it did just a few years 
ago.
  H.R. 1016 provides the framework for advanced appropriations, and we 
look to our colleagues on the Appropriations Committee to provide the 
dollars. I want to express our thanks to our colleague, Chet Edwards, 
who chairs the Military Construction/VA Subcommittee, for providing 
advanced funding for the VA medical care accounts for 2011, providing 
for an 8 percent increase for fiscal year 2011 above the historic 
fiscal year 2010 levels.

                              {time}  1230

  I want to thank also Chairman Obey for supporting advanced 
appropriations and Chairman Spratt of the Budget Committee for 
including advanced appropriations language in his budget resolution.
  All of us, working together, have succeeded in providing veterans 
with their top legislative priority. They spoke and we listened. I ask 
the rest of the House to join us in support of this bill, H.R. 1016, 
which passed unanimously from the Veterans' Affairs Committee last 
week.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BOOZMAN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in strong support of H.R. 1016, as amended, a 
bill that would authorize appropriations for several veterans health 
care accounts a year in advance beginning with fiscal year 2011. I also 
thank Chairman Filner for bringing this bill forward and trying to 
solve a problem that we've had in the past.
  The goal of the bill is to provide an increased level of fiscal 
certainty regarding operations of the VA hospital

[[Page H7096]]

system. By funding the accounts for medical services, medical support 
and compliance, medical facilities, information technology systems, and 
medical and prosthetic research, the Department of Veterans Affairs 
should be able to manage its health care personnel needs in day-to-day 
operations. I would note that the last three accounts that I mentioned 
were included in the bill by an amendment offered by the ranking 
member, Mr. Buyer, and adopted by the full committee. Adding these 
accounts has improved the bill by providing more complete medical 
funding needs.
  Advanced funding alone will not solve the VA's ability to provide 
quality medical care. Without accurate predictive data, advanced 
appropriations will not necessarily provide the right amount of funding 
the VA needs to operate its health care system. Therefore, the bill 
also contains provisions that require a combination of reports and 
analysis to determine the quality of the data VA will be using in its 
financial model to determine funding needs.
  Mr. Speaker, this bill, while not a perfect solution, is a very 
reasonable way to allow the advanced funding concept to be tested in 
practice, and I urge all of my colleagues to support H.R. 1016, as 
amended.
  Mr. Speaker, I reserve the balance of my time.
  Mr. FILNER. Mr. Speaker, I would like to yield 5 minutes to the 
gentlewoman from Illinois (Mrs. Halvorson). She is a new member of our 
committee and of this Congress, but she has added a dynamic element to 
our deliberations, and we thank her for her commitment to veterans.
  Mrs. HALVORSON. Mr. Speaker, I rise in support of H.R. 1016, the 
Veterans Health Care Budget Reform and Transparency Act of 2009, which 
was introduced under the leadership of the chairman of the Committee on 
Veterans' Affairs, Mr. Filner. I want to thank Mr. Filner and the 
Subcommittee on Health Care chairman, Mr. Michaud, for their great 
leadership on this issue.
  The Veterans Affairs health care system includes 153 medical centers 
with a facility in each State, Puerto Rico, and the District of 
Columbia. Almost 5.5 million people received care in the VA health care 
facilities in 2008, and VA's outpatient clinics registered over 60 
million visits. This is one of the largest health care providers in the 
country.
  However, in fiscal year 2009, for only the third time in the past 20 
years, VA received its budget prior to the start of the new fiscal 
year. It isn't reasonable to expect that one of the largest, fastest-
growing health care providers in the country can operate in the most 
efficient and effective manner if they don't know what their budgets 
will be.
  The current budget process continues to hamper and threaten VA health 
care delivery. When VA does not receive its funding in a timely manner, 
it is forced to ration its care. So much-needed medical staff cannot be 
hired, equipment cannot be procured, waiting times increase, and the 
quality of care suffers.
  H.R. 1016 will solve many of these problems and fund the VA 1 year in 
advance. It will allow the VA to spend money more efficiently while at 
the same time providing better and more comprehensive care for our 
veterans. H.R. 1016 will make sure that the VA has the resources that 
it needs in a timely manner so that it can provide quality care without 
having to question what funds will be available next month.
  I am here today in an attempt to serve our veterans' best interest 
and to fight to make sure they receive the best care possible. To that 
end, I stand in favor of H.R. 1016 and strongly urge my colleagues to 
vote ``yes.''
  I thank the chairman for yielding.
  Mr. BOOZMAN. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. FILNER. Mr. Speaker, I would yield 3 minutes to another new 
Member from New Mexico (Mr. Teague). He's also on a committee that has 
half of our committee's new members. They have added a real element of 
dynamism. We thank Mr. Teague for his commitment to veterans also.
  Mr. TEAGUE. Mr. Speaker, I rise today in support of H.R. 1016, the 
Veterans Health Care Budget Reform and Transparency Act of 2009. I 
would like to thank the distinguished gentleman from California, Bob 
Filner, for introducing this bill. I'm happy to be a cosponsor of this 
legislation. It is through his leadership, as chairman of the Committee 
on Veterans' Affairs, that we will finally be able to make advanced 
appropriations of the VA's health budget a reality.
  I simply do not believe that it is right that we have lapsed in our 
care for our veterans when they have never lapsed in the defense of our 
country. I do not think that it's right that out of the last 22 budgets 
that we have passed for the VA, 19 of them have been late. Our veterans 
served their country and provided us with the security that we often 
take for granted, and we owe them quality health care.
  Without a predictable and on-time funding source, it is difficult or 
impossible for the VA to provide our veterans with the high level of 
health care and services that they deserve. That is why I led 50 
Members of Congress to demand a provision allowing for advanced 
appropriations in the fiscal year 2010 budget, and we were fortunate 
enough to convince the budget conference committee to support it.
  As a result of allowing for advanced appropriation in the budget, 
tomorrow the Appropriations Committee will hold a hearing on the 
Military Construction and VA spending bill that contains $48.2 billion 
in advanced appropriations for the VA for fiscal year 2011. This 
represents a 15 percent increase over fiscal year 2009 levels and a 
step in the right direction for veterans health care.
  Many people have compared advanced appropriations to a family budget. 
A family needs to know how much their income is before they know what 
they can spend. I think that about sums up why we need this bill. I 
think it's about common sense and being responsible. As a businessman, 
I never tried to make a purchase without knowing what my budget was 
going to be. I had to plan ahead and have a road map for all of the 
company's finances. Because the VA is a direct provider of services, 
they need to have the same ability to plan ahead. It's about delivering 
a quality product.
  I urge my colleagues to take this giant step in improving the VA's 
ability to deliver quality health care services to our Nation's 
veterans.
  Mr. BOOZMAN. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. FILNER. Mr. Speaker, Mr. Hare of Illinois came to us as the 
successor of a legendary member of our committee, Mr. Lane Evans, who 
worked so hard for veterans during his whole career, and our thoughts 
are with him as he faces his disease. Mr. Hare was on our committee. He 
had to go off this year, but we miss him greatly, and he's one of the 
strongest leaders for veterans in our Nation. I yield to him such time 
as he may consume.
  Mr. HARE. Mr. Speaker, I rise in strong support of H.R. 1016, the 
Veterans Health Care Budget Reform and Transparency Act of 2009, and 
let me thank Chairman Bob Filner for introducing this important 
legislation.
  In the 110th Congress, we gave the VA its largest funding increase in 
77 years, and we did it on time. But, sadly, punctual VA funding has 
not always been the case. The VA received it's annual funding for 
health care programs late in the last 19 of 22 years.
  This record of tardiness is deplorable. With the ongoing wars in Iraq 
and Afghanistan, the time to fix this broken system is now. Late 
funding is more than a missed deadline. It is a veteran with 
posttraumatic stress disorder who cannot access a treatment he or she 
needs. It is an injured hero who must wait for a prosthetic. It is a VA 
in disarray at a time when our wounded warriors are counting now more 
than ever on the department's services. That's why in the last 
Congress, I introduced the Assured Funding for Veterans Health Care 
Act. This bill would have replaced the annual appropriated 
discretionary funding for veterans health care with permanent direct 
spending authority.
  Like the bill I introduced, advanced appropriations is the means to 
that end. That end is ensuring veterans receive the best possible care 
from a VA that has access to timely, sufficient, and predictable 
resources. The legislation that we're considering today will do just 
that. It will allow the VA to effectively budget and manage its health

[[Page H7097]]

care programs and services, meaning it can hire the appropriate number 
of doctors, nurses, clinicians, and support staff to meet the demand 
for high-quality care for our veterans. Anything less is unacceptable.
  I'd also like to acknowledge and commend Chairman David Obey and 
Chairman Edwards for their strong proactive leadership in putting in an 
advanced appropriation for VA health care in the fiscal year 2010 
Military Construction and Veterans Affairs Appropriations bill.
  I enthusiastically support H.R. 1016, and I once again want to thank 
Chairman Filner for drafting a bill that would ensure the VA has 
sufficient, timely, and predictable funding.
  Mr. Speaker, I urge all of my colleagues to support this legislation.
  Mr. BOOZMAN. Mr. Speaker, again I would ask that my colleagues vote 
for this bill. I appreciate Mr. Filner's hard work on the bill. I think 
it's a great step in the right direction. And then also I would like to 
thank Ranking Member Buyer for offering a good amendment that I think 
helped the bill also.
  So with that I urge adoption of the bill.
  Mr. Speaker, I yield back the balance of my time.


                             General Leave

  Mr. FILNER. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on H.R. 1016, as amended.
  The SPEAKER pro tempore (Mr. Klein of Florida). Is there objection to 
the request of the gentleman from California?
  There was no objection.
  Mr. FILNER. Mr. Speaker, I think as we approach the July 4 holiday, 
this is an appropriate way to say thank you to our Nation's veterans. 
As I said earlier, this is one of the most significant steps, if not a 
revolutionary step, taken for veterans in the budgeting process. This 
will assure that one of the largest health systems in the world, if not 
the largest, will have, in fact, funding available on time and in the 
need that is required for our Nation's veterans.
  So I urge my colleagues to unanimously support this bill, H.R. 1016, 
as amended.
  Mr. BUYER. Mr. Speaker, I rise in opposition to H.R. 1016, as 
amended, a bill to amend title 38, United States Code, to provide 
advance appropriations authority for certain medical care accounts of 
the Department of Veterans Affairs, VA, and for other purposes.
  In my view, it is premature for the House of Representatives to 
consider this legislation.
  The bill was not considered by the Subcommittee on Health, to which 
it was referred, nor was there a full Committee legislative hearing, so 
the Administration has not provided its official analysis.
  On April 29, 2009, we did hold a full Committee oversight hearing on 
the future funding of VHA. At this hearing, concerns were raised about 
not including the ``Information Technology Systems'' and the ``Medical 
and Prosthetic Research Accounts'' in an advance appropriations bill.
  The Secretary of Veterans Affairs, the Honorable Eric K. Shinseki, 
testified that information technology is very much integrated into the 
medical care activities and should be included so that VA is not 
hindered in its ability to provide health care services and operate new 
facilities.
  Additionally, the Congressional Research Service, CRS, testified that 
funding information technology under a separate, annual appropriation 
could create a situation where VA would not be able to purchase 
computer software even though it had procured medical equipment that is 
reliant on such software.
  CRS noted potential difficulty for VA in procuring the necessary IT 
infrastructure for the opening of new clinics, as well as difficulties 
that could arise in VA research due to a mismatch between accounts.
  I was pleased that during the Committee markup, my amendment was 
adopted to include the IT, and medical and prosthetic research accounts 
to address these issues.
  However, the Government Accountability Office, GAO, also expressed 
reservations about its possible role in an advance appropriations 
proposal. In a written response of June 17, 2009, to one of my hearing 
questions, GAO made a strong statement which leads me to believe that 
section 5 of the amended bill is not workable. This section would 
require GAO to obtain budgetary information from VA before the 
department makes its fiscal year budget request. GAO questioned whether 
it could conduct the required studies before the President's budget 
request is submitted to Congress. GAO cited significant challenges in 
obtaining, evaluating, reporting on the relevant budgetary and 
technical information.
  GAO indicated that its role in the process would be inadvisable 
because executive agencies have consistently resisted releasing 
detailed information about the President's budget prior to its 
submission to Congress.
  Again, VA's official views on this issue are currently unknown, and 
this issue should have been addressed before H.R. 1016, as amended, was 
reported to the House.
  There is nothing before us to indicate that the administration is 
agreeable to this arrangement.
  The failure to follow regular order and the unnecessary haste with 
which this legislation is being advanced results in the House being 
asked to pass obviously flawed legislation, and I urge my colleagues to 
oppose H.R. 1016, as amended.
  Mr. MICHAUD. Mr. Speaker, I rise in strong support of the Veterans 
Health Care Budget Reform and Transparency Act of 2009.
  I am here today as an original co-sponsor of this legislation. I 
would like to express my appreciation for all of the Chairman's hard 
work on it.
  This bill accomplishes a simple, but a crucial goal we all share: To 
provide timely funding for veterans health care.
  I represent a district in a state of 1.3 million people. Out of that 
number, I am proud that over 155,000 veterans call Maine home.
  Maine is a state that works hard to honor its veterans.
  The talented and dedicated professionals at Maine's Togus VA Medical 
Center do terrific work. So do our community based outpatient clinics 
and all of VA's partners.
  But too often in recent history, VA's ability to provide the best 
possible care has been hamstrung by the appropriations process.
  In some cases, VA has not been funded until after the beginning of 
the fiscal year.
  As a result, maintenance of facilities, cost saving investments in 
technology, and ultimately care for veterans was delayed or put in 
jeopardy.
  This cannot be allowed to occur when we are dealing with the health 
care of our veterans.
  There must be a timely, sufficient, and predictable funding stream. 
And that is exactly what this legislation is designed to achieve.
  Passage of this legislation today is a huge step forward and will 
help make sure all veterans have access to the best possible health 
care.
  I urge all of my colleagues to support this bill.
  Mr. FILNER. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Filner) that the House suspend the rules 
and pass the bill, H.R. 1016, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. THOMPSON of Pennsylvania. Mr. Speaker, while I support the 
purpose of this bill, I object to the vote on the ground that a quorum 
is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.
  The point of no quorum is considered withdrawn.

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