[Congressional Record Volume 155, Number 147 (Tuesday, October 13, 2009)]
[Senate]
[Pages S10376-S10378]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    VETERANS HEALTH CARE BUDGET REFORM AND TRANSPARENCY ACT OF 2009

  Mr. DURBIN. Mr. President, I ask the Chair to lay before the Senate a 
message from the House with respect to H.R. 1016.
  The Presiding Officer laid before the Senate a message from the House 
as follows:

                               H.R. 1016

       Resolved, That the House agree to the amendment of the 
     Senate to the bill (H.R. 1016) entitled ``An Act to amend 
     title 38, United States Code, to provide advance 
     appropriations authority for certain accounts of the 
     Department of Veterans Affairs, and for other purposes.'', 
     with the following amendment:
       In lieu of the matter proposed to be inserted by the 
     amendment of the Senate, insert the following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Veterans Health Care Budget 
     Reform and Transparency Act of 2009''.

     SEC. 2. PRESIDENT'S BUDGET SUBMISSION.

       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 medical care accounts of the 
     Veterans Health Administration, Department of Veterans 
     Affairs account:
       ``(A) Medical Services.
       ``(B) Medical Support and Compliance.
       ``(C) Medical Facilities.''.

     SEC. 3. ADVANCE APPROPRIATIONS FOR CERTAIN MEDICAL CARE 
                   ACCOUNTS OF THE DEPARTMENT OF VETERANS AFFAIRS.

       (a) 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 medical care 
       accounts

       ``(a) In General.--For each fiscal year, beginning with 
     fiscal year 2011, discretionary new budget authority provided 
     in an appropriations Act for the medical care accounts of the 
     Department shall--
       ``(1) be made available for that fiscal year; and
       ``(2) include, for each such 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 medical care accounts of the Department for the fiscal 
     year following the fiscal year for which the budget is 
     submitted.
       ``(c) Medical Care Accounts.--For purposes of this section, 
     the term `medical care accounts of the Department' means the 
     following medical care accounts of the Veterans Health 
     Administration, Department of Veterans Affairs account:
       ``(1) Medical Services.
       ``(2) Medical Support and Compliance.
       ``(3) Medical Facilities.
       ``(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.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 113 the following new line:

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

     SEC. 4. COMPTROLLER GENERAL REVIEW OF THE ACCURACY OF VA 
                   MEDICAL CARE BUDGET SUBMISSION IN RELATION TO 
                   BASELINE HEALTH CARE MODEL PROJECTION.

       (a) Review of Accuracy of Medical Care Budget Submission.--
     The Comptroller General shall conduct a review of each budget 
     of the President for a fiscal year that is submitted to 
     Congress pursuant to section 1105(a) of title 31 in order to 
     assess whether or not the relevant components of the amounts 
     requested in such budget for such fiscal year for the medical 
     care accounts of the Department of Veterans Affairs specified 
     in section 117(c) of title 38, United States Code, as added 
     by section 3, are consistent with estimates of the resources 
     required by the Department for the provision of medical care 
     and services in such fiscal year, as forecast using the 
     Enrollee Health Care Projection Model, or other methodologies 
     used by the Department.
       (b) Reports.--
       (1) In general.--Not later than 120 days after 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 Committees on Veterans' Affairs, 
     Appropriations, and the Budget of the Senate and the 
     Committees on Veterans' Affairs, Appropriations, and the 
     Budget of the House of Representatives and to the Secretary a 
     report on the review conducted under subsection (a).
       (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) An assessment of the review conducted under subsection 
     (a).
       (B) The basis for such assessment.
       (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.

  Mr. AKAKA. Mr. President, I am very pleased that the Senate and House 
Veterans' Affairs Committees have worked out an agreement on S. 423 and 
H.R. 1016, the proposed Veterans Health Care Budget Reform and 
Transparency Act of 2009. With the President's signature, this vital 
piece of legislation, which I will refer to as the ``Compromise 
Agreement,'' will authorize, beginning in fiscal year 2011, advance 
appropriations for certain medical care accounts of the Department of 
Veterans Affairs by providing 2 fiscal year budget authority.
  This compromise agreement will provide sufficient, timely, and 
predictable health care funding to those who have sacrificed a great 
deal for this Nation. By ensuring advanced appropriations to the 
medical services, medical support and compliance, and medical 
facilities accounts, VA will be able to better align its funding cycles 
and function more effectively.
  The VA system has experienced recurrent problems with receiving 
proper

[[Page S10377]]

and timely appropriations. Funds for VA have been appropriated late in 
19 of the past 22 years, and in the past 7 years, such appropriations 
were only received, on average, 3 months after the commencement of the 
new fiscal year. In testimony provided to the Senate Committee on 
Veterans' Affairs in conjunction with a hearing in July of 2007, James 
Dudley, a former director of the Richmond VA Medical Center, wrote that 
as a VA hospital administrator he dealt with the ``uncertainty of 
sufficient resources to meet the needs of the veteran population.'' He 
went on to say that, ``Our primary concern was always quality of care 
so we delayed maintenance, construction or equipment purchases to 
ensure that the patients were cared for.''
  Also, because of the uncertainty, requests for supplemental 
appropriations for VA health care have also increased in frequency 
during recent years. This compromise agreement will represent a step in 
the right direction, as VA administrators and directors will be able to 
more efficiently service veterans with adequate and stable funding to 
the VA health care system.
  I recognize mandating a 2-fiscal year budget authority is a serious 
undertaking, and as such, have worked to have the compromise agreement 
lead to enhanced oversight of the VA health care budget process. The 
Comptroller General of the United States will be required to conduct a 
study of adequacy and accuracy of the budget projections made by VA's 
enrollee health care projection model or any other model or methodology 
used to measure health care expenditures, for each fiscal year of the 
budget request. The Comptroller General's report would be submitted to 
both the Senate and House Veterans' Affairs Committees no later than 
120 days after the date on which the President submits the budget 
request for the coming fiscal year.
  Advanced funding is a concept that has been endorsed by The 
Partnership for Veterans Health Care Budget Reform, an organization 
made up of nine major veterans service organizations--The American 
Legion, American Veterans, Blinded Veterans Association, Disabled 
American Veterans, Jewish War Veterans of the USA, Military Order of 
the Purple Heart of the USA, Inc., Paralyzed Veterans of America, 
Veterans of Foreign Wars of the United States, and Vietnam Veterans of 
America, Inc. It is also endorsed by The Independent Budget; The 
Military Coalition, an organization of 35 veterans and military service 
organizations; and the American Federation for Government Employees.
  I appreciate the support from our colleagues who have cosponsored 
this legislation, including Veterans' Affairs Committee members 
Senators Burr, Rockefeller, Murray, Sanders, Brown, Tester, Begich, 
Burris, Specter, and Isakson. I am also grateful to Senator Snowe for 
serving as an original cosponsor.
  This legislation will allow the government to honor its obligation to 
provide high quality, consistent, and adequate health care to the 
Nation's veterans and I am gratified will soon become public law.
  I ask unanimous consent that the Explanatory Statement for this 
legislation be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

   EXPLANATORY STATEMENT SUBMITTED BY SENATOR AKAKA, CHAIRMAN OF THE 
       SENATE COMMITTEE ON VETERANS' AFFAIRS, REGARDING H.R. 1016

    Veterans Health Care Budget Reform and Transparency Act of 2009

       H.R. 1016, as amended, the ``Veterans Health Care Budget 
     Reform and Transparency Act of 2009,'' reflects a Compromise 
     Agreement reached by the Senate and House Committees on 
     Veterans' Affairs (the Committees) on the following bills 
     reported during the 111th Congress: H.R. 1016, as amended 
     (House bill); S. 423 (Senate bill). H.R. 1016, as amended, 
     passed by the House of Representatives on June 23, 2009. The 
     text of S. 423 passed the Senate as a substitute amendment to 
     the House bill on August 6, 2009.
       The Committees have prepared the following explanation of 
     H.R. 1016, as further amended to reflect a compromise 
     agreement between the Committees (Compromise Agreement). 
     Differences between the provisions contained in the 
     Compromise Agreement and the related provisions of the Senate 
     Bill and the House Bill are noted in this document, except 
     for clerical corrections, conforming changes made necessary 
     by the Compromise Agreement, and minor drafting, technical, 
     and clarifying changes.


                         SECTION 1. SHORT TITLE

       Both the House bill (section 1) and the Senate bill 
     (section 1) would provide the short title as the ``Veterans 
     Health Care Budget Reform and Transparency Act of 2009.''
       The Compromise Agreement contains this provision.


                SECTION 2. PRESIDENT'S BUDGET SUBMISSION

       The House bill (section 3) would amend section 1105 of 
     title 31, United States Code, to require the President to 
     submit information on the estimates of appropriations for the 
     fiscal year following the fiscal year for which the budget is 
     submitted for the Medical Services, Medical Support and 
     Compliance, Medical Facilities, Information Technology 
     Systems, and Medical and Prosthetic Research accounts of the 
     Department of Veterans Affairs.
       The Senate bill contains no similar provision.
       The Compromise Agreement contains the House provision but 
     modifies it to require information on the estimates for three 
     accounts: the Medical Services, Medical Support and 
     Compliance, and Medical Facilities accounts.


SECTION 3. ADVANCE APPROPRIATIONS FOR CERTAIN MEDICAL CARE ACCOUNTS OF 
                  THE DEPARTMENT OF VETERANS AFFAIRS.

       The House bill (section 4) would amend title 38, United 
     States Code, to add a new section providing authority, 
     beginning with fiscal year 2011, for the provision of advance 
     appropriations for the Medical Services, Medical Support and 
     Compliance, Medical Facilities, Information Technology 
     Systems, and Medical and Prosthetic Research accounts of the 
     Department of Veterans Affairs. The new section would require 
     the Department of Veterans Affairs to provide additional 
     detailed budget estimates in support of advance 
     appropriations for these accounts in the annual information 
     it provides to Congress in support of the Department's budget 
     request. The House bill would also require a report to be 
     submitted annually to Congress, no later than July 31 of each 
     year, on the sufficiency of the Department's resources for 
     the fiscal year beginning after the date of the submission of 
     the report for the provision of medical care and include 
     estimates of the workload and demand data for that fiscal 
     year.
       The Senate bill (section 3) would amend title 38, United 
     States Code, to add a new section providing that, beginning 
     with fiscal year 2011, new discretionary budget authority for 
     the provision of advance appropriations for the Medical 
     Services, Medical Support and Compliance, and Medical 
     Facilities accounts of the Department of Veterans Affairs, 
     shall be made available for the fiscal year involved, and 
     shall include new discretionary budget authority for such 
     accounts that become available for the first fiscal year 
     after such fiscal year.
       The Compromise Agreement contains the House provision 
     modified to include only the three accounts specified in the 
     Senate bill.


  SECTION 4. COMPTROLLER GENERAL REVIEW OF THE ACCURACY OF VA MEDICAL 
   CARE BUDGET SUBMISSIONS IN RELATION TO BASELINE HEALTH CARE MODEL 
                              PROJECTION.

       Both the House bill (section 5) and the Senate bill 
     (section 4) would provide for enhanced oversight of the 
     Department of Veterans Affairs budget process by requiring 
     the Comptroller General to conduct a study of the adequacy 
     and accuracy of baseline model projections for health care 
     expenditures. Both the House bill and Senate bill would 
     require the Comptroller General to submit reports on the 
     dates in 2011, 2012, and 2013 that the President submits a 
     budget request for the next fiscal year, to appropriate 
     Committees of Congress and to the Secretary of Veterans 
     Affairs, containing statements of whether the amounts 
     requested in the budget by the President are consistent with 
     anticipated expenditures for health care in such fiscal year 
     as determined utilizing the Enrollee Health Care Projection 
     Model, its equivalent, or other methodologies.
       The Compromise Agreement contains this provision modified 
     to require the annual reports to be submitted not later than 
     120-days after the submission of the President's budget and 
     to include an assessment of the review conducted by the 
     Comptroller General as to whether or not the relevant 
     components of the budget request are consistent with the 
     estimates of the Department of Veterans Affairs for the 
     provision of medical care and services. The Committees have 
     selected a 120-day deadline to give the Comptroller General 
     sufficient time to review the President's budget following 
     its submission and to, at the very least, inform the 
     deliberations of the House and Senate Appropriations 
     Committees prior to their consideration of VA appropriations 
     bills. However, it is the Committees' desire that, 
     notwithstanding the 120-day deadline, the reports under this 
     section be submitted as quickly as possible after submission 
     of the President's budget request so as to be useful by the 
     Committees in meeting their responsibilities under the 
     Congressional Budget Act of 1974 to provide views and 
     estimates on matters within their jurisdiction to the House 
     and Senate Budget Committees, as well as during deliberation 
     on annual Congressional budget resolutions.


                         PROVISIONS NOT ADOPTED

       Section 2 of the House bill would express the Sense of the 
     Congress that the provision of health care services to 
     veterans could be more effectively and efficiently planned 
     and

[[Page S10378]]

     managed if funding was provided for the management and 
     provision of such services in the form of advance 
     appropriations.
       Section 2 of the Senate amendment expresses Congressional 
     findings which support the need for enactment of advance 
     appropriations for VA medical care.

  Mr. DURBIN. Mr. President, I ask unanimous consent that the Senate 
concur in the House amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________