[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Senate]
[Pages 20995-20996]
[From the U.S. Government Publishing Office, www.gpo.gov]


    VETERANS HEALTH CARE BUDGET REFORM AND TRANSPARENCY ACT OF 2009

  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the 
Senate proceed to the immediate consideration of Calendar No. 101, S. 
423.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 423) 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.

  There being no objection, the Senate proceeded to consider the bill.
  Mr. AKAKA. Mr. President, I am very gratified that the Senate is 
acting on S. 423, the proposed Veterans Health Care Budget and 
Transparency Act of 2009. This bill would authorize, beginning in 
fiscal year 2011, advance appropriations for certain medical care 
accounts of the Department of Veterans Affairs by providing two fiscal 
year budget authority.
  The Committee on Veterans' Affairs held a hearing on pending health 
care legislation on April 22, 2009, during which the Committee received 
testimony on S. 423. Support for this bill was voiced by the Department 
of Veterans Affairs, Disabled American Veterans, American Federation of 
Government Employees, and Paralyzed Veterans of America. The Committee 
ordered the bill reported on May 21, 2009. The Committee report--S. 
Rpt, 111-041--was filed on July 8, 2009.
  In 19 of the past 22 fiscal years, final VA appropriations have been 
enacted late and requests for supplemental appropriations for VA health 
care have increased in frequency during recent years. Over the past 7 
years, final VA appropriations were late approximately 3 months on 
average. While there has been some impact on the timeliness and overall 
quality of VA care from these financial and management difficulties in 
the past, there is a serious concern that continued funding problems 
could significantly weaken the quality of veterans' health care. 
Providing sufficient, timely and predictable funding to the VA health 
care system would mitigate these dangers and allow VA administrators 
and directors to more efficiently and effectively provide medical care 
to veterans.
  Advanced funding would allow the VA to function more effectively, to 
better align with funding cycles, and to avoid annual partisan 
political maneuvering. Through appropriating funds in advance to the 
medical services, medical support and compliance, and medical 
facilities accounts, we can avoid any disruption to the provision of 
adequate and timely health care to those who have sacrificed a great 
deal for this nation.
  I understand that authorizing advanced appropriations is a serious 
endeavor and as such have made sure this legislation also enhances 
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 and any other model or methodology used to 
measure health care expenditures. The study would cover the five fiscal 
years included in each budget submission; however, the focus is 
intended to be upon the fiscal year for which the advance appropriation 
would be made. These reports would be submitted to the appropriate 
committees of Congress no later than the date on which the President 
submits the budget request for the following fiscal year.
  This bill has received support from a myriad of organizations 
including The Partnership for Veterans Health Care Budget Reform, The 
Independent Budget Veterans Service Organizations, The Military 
Coalition, and the American Federation for Government Employees. I 
thank them for their efforts and ongoing commitment to this 
legislation.
  I thank the many Senators who have cosponsored this legislation, 
including Committee members Senators Burr, Rockefeller, Murray, 
Sanders, Brown, Tester, Begich, Burris, Specter and Isakson. I am also 
delighted that Senator Snowe was an original cosponsor of this bill and 
has worked hard in support of it.
  Mr. President, this legislation will bring much needed stability and 
predictability to the VA health care system and consistent, high-
quality health care to the veterans and I am delighted with today's 
action by the Senate.
  The bill was ordered to be engrossed for a third reading and was read 
the third time.
  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the 
Senate proceed to Calendar No. 129, H.R. 1016, the House companion; 
that all after the enacting clause be stricken and the text of S. 423 
be inserted in lieu thereof; the bill, as amended, be read a third time 
and passed; the motions to reconsider be laid upon the table; that upon 
passage of H.R. 1016, S. 423 be returned to the calendar, with no 
intervening action or debate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment was ordered to be engrossed and the bill to be read a 
third time.
  The bill (H.R. 1016), as amended, was read the third time and passed, 
as follows:

                               H.R. 1016

       Resolved, That the bill from the House of Representatives 
     (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.'', do pass with the following amendment:
       Strike out all after the enacting clause and insert:

     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 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.''.

[[Page 20996]]



     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.

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