Veterans' Affairs

The proposed Veterans' Millennium Health Care Act should help the Department of Veterans Affairs (VA) provide care for veterans in more appropriate settings, reduce per-patient costs, increase the number of its patients, and reduce its reliance on appropriations. The bill's facility realignment and cost-sharing provisions would help VA reduce budget pressures and generate the resources needed to serve more veterans and enhance their benefits. Its long-term care provisions appear to be designed to reduce variability in veterans' access to care, addressing GAO's concern about the potential adverse effect of VA's transformation on the equity of veterans' access to care. On facility services realignment, the bill requires (1) VA to develop enhanced-service plans to address veterans' health care needs, (2) VA's stakeholders to participate in plan development, and (3) VA to use efficiency savings locally. On long-term care, the bill (1) requires the development of a national program of services, (2) increases the percentage of VA's budget for noninstitutional services, and (3) mandates coverage for services for certain higher-priority veterans. The bill's cost-sharing provisions address prescription drugs, outpatient services, long-term care, and certain high-cost supplies.

GAO noted that: (1) the draft bill's facility service realignment, long-term care, and cost-sharing provisions should help facilitate VA's continuing transformation of its health care system and address concerns that GAO has previously reported to Congress; (2) these proposals, in combination with VA's enrollment process, provide a rational framework for helping VA address the increasing health care needs of an aging population of higher-priority veterans while operating within available resources; (3) however, even with this enabling legislation, achieving these multiple goals will be a challenge to VA because of their complexity and far-reaching implications; (4) more specifically, the combination of proposed changes should help VA provide care for veterans in more appropriate settings, as well as help VA achieve its stated goals of reducing per-patient costs, increasing the number of its patients, and reducing reliance on appropriations; (5) facility realignment and cost-sharing provisions are consistent with options GAO has suggested to help VA reduce budget pressures and generate the resources needed to serve more veterans and provide enhanced benefits; and (6) long-term care provisions appear designed to reduce variability in veterans' access to such care systemwide, which addresses, in general, GAO's concern about the potential adverse effect of VA's transformation on the equity of veterans' access to care.