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The fifth independent budget.

At the beginning of every calendar year the President presents to Congress his proposals for government spending in the next fiscal year. The President's budget specifies how much money will be available for all federal programs, including veterans' benefits and the Department of Veterans Affairs (VA) health care system.

The administration has to work under the restraints imposed by the deficit and must control spending to meet budget targets. Spending for most entitlements (mandatory benefits for certain individuals) cannot be cut, and national defense is both essential and a costly priority for this administration. Discretionary domestic spending is therefore the primary target for reductions by the Office of Management and Budget (OMB) in its drive to balance the government's books.

Figure 1 is taken from the President's budget and shows how the administration plans to distribute our money in Fiscal year (FY) 1992.

The development of the President's budget is a complicated process. Early in each fiscal year, each department and agency in the government calculates how much money it needs to accomplish its mission in the coming year and submits its own budget to OMB. OMB then has to put all these figures together into a national budget.

Working toward the deficit-reduction targets agreed to by Congress and the President, OMB usually has to reduce the budgets submitted by the agencies. VA budgets have been held so low that the department cannot possibly deliver the services and health care to which veterans are entitled by law. The agencies are not in a position to argue with OMB; they are in the President's branch of the government, and they must do as OMB says.

Each year since 1988, PVA has joined forces with American Veterans of World War II, Korea, and Vietnam (AMVETS); Disabled American Veterans (DAV); and Veterans of Foreign Wars (VFW) to produce an Independent Budget. Their objective is to counter OMB's shortsighted plan and to set true budget priorities that will meet veterans' needs in full.

The Independent Budget is published at the same time each year as the President's budget. It is given to every senator, to every member of the House of Representatives, to the staff of the House and Senate Committees on Veterans' Affairs, to the Budget Committees, and to the Appropriations Committees. Altogether, 6,000 copies have been distributed nationwide to organizations and individuals interested in sustaining and improving the VA health care system and VA's services to veterans. Congress has come to depend on the Independent Budget as a valued source of credible information and as an objective counterpoint to the administration's budget requests.

Each year's Independent Budget becomes a foundation for PVA's legislative agenda. VA's problems and shortcomings are specified in detail, along with the solutions and resource requirements needed for corrective action.

The Independent Budget lists proposals for legislation and specifies PVA's position on the major issues. With the publication of the Independent Budget, everyone on Capitol Hill and in the veteran community knows where PVA and the other three sponsoring-VSOs stand. The Independent Budget gives a focus to the veteran community's opposition to funding shortfalls in benefits and health care. When four veterans' service organizations--AMVETS, DAV, PVA, and VFW--speak together, the President and Congress have to listen.

The Independent Budget is needed, now more than ever. Veterans' benefits are threatened, and the VA health care system is in trouble. The quality and timeliness of servicing veterans' benefits claims has never recovered from the disastrous budgets of the late 1980's. The quality and quantity of VA health care have deteriorated.


The FY 1992 Independent Budget also airs objections to certain decremental provisions of last year's budget-reconciliation agreement. Some benefits were singled out for cuts to meet the assigned VA budget savings of $ 620 million for FY 1991 and $3.35 billion for fiscal years 1991-1995.

The Independent Budget describes these reductions as "onerous, discriminatory, and unnecessary." Veterans' entitlement programs were singled out for more severe reductions than many other federal programs. While this legislation targeted certain veterans' programs for cuts, benefits for other federal beneficiaries in similar circumstances were actually enhanced. The Independent Budget, in calling for the repeal of these cuts, describes alternative strategies for meeting deficit reduction targets, while avoiding the imposition of inequitable sacrifice on the nation's veterans.

By way of the Independent Budget, the four service organizations are requesting repeal of those provisions of last year's budget agreement that infringe upon longstanding veterans' entitlements, including compensation limitations for certain incompetent veterans and their survivors, the exaction of copayMents for prescriptions, copayments for medical care, and the elimination of headstone and plot allowances for eligible veterans who are not buried in national cemeteries.

In lieu of the above decreMental provisions, and in accordance with rules contained in the congressional budget agreement, the Independent Budget identifies alternative sources of savings through transfers of budget authority from Benefit Programs to the discretionary General Operating Expenses (GOE) account. The budget document describes in detail how the projected attrition in compensation and pension rolls, efficient third-party medical-care cost recoveries, income matching for legitimate program purposes, and administrative and program reforms in the Home Loan Guaranty Program would more than meet OMB's deficit-reduction targets.


VA hospital administrators, caught between growing demand and shrinking resources, have been forced to cannibalize their resource base by bed closures, by delaying the purchase of needed replacements for worn-out and obsolete equipment, by canceling clinical programs, by operating with inadequate staff, and finally, by denying some patient access.

Through the efforts of VA Secretary Derwinski and the intervention of the congressional Veterans' Affairs Committees, VA was able to get a substantial increase in the FY 1991 budget. However, because of the spiraling inflation in health care costs, that increase just allowed VA to "tread water."

The administration takes satisfaction in having proposed for a second year a $1 billion increase in the VA budget appropriation for medical care. While this increased support is appreciated, in reality not one penny of this augmentation will go toward eliminating an annual multi-million-dolar budget shortfall or to providing any increased medical care for veterans. All of that billion dollars and more will be totally consumed by inflation.

Based on calculations documented in the Independent Budget, the President's proposed $13.287 billion budget for VA medical care in FY 1992 will assure another $730 million shortfall. The accompanying table provides a graphic illustration of what the system's absorption of budget shortfalls, over recent years, has done to patient-care workloads.

The provision of backup medical support to the Department of Defense (DOD) during military contingencies is one of the department's four congressionally mandated missions. In recent years this function has received little attention and has not been taken into account in the budget process. VA planning has been based on the assumption that there would be no more war. Meanwhile, the size of the military medical care system has been reduced to the point that it


cannot be expected to provide treatment for the combat casualties that would result from a major engagement of ground forces. Operation Desert Storm has brought the attention of the media and the American public to the health care system and concern over just how well VA, in its present condition, can respond to such an emergency.

The known staffing shortage in VA medical centers was aggravated by the call-up of 2,000 doctors, nurses, and technicians. Throughout Operations Desert Shield and Desert Storm, PVA has voiced the concern that a hospital system with a multimillion-dollar backlog of unpurchased but necessary equipment could not possibly cope with a massive number of combat casualties. That concern was specifically addressed to the state of readiness and condition of VA SCI centers. The VA health care system cannot be starved in peacetime if it is to be of any value to the military in wartime.


Now that the FY 1992 Independent Budget is published and distributed to the PVA chapters, the organization's national legislative staff as well as the staffs of AMVETS, DAV, and VFW will go to work. They will make sure that members of Congress know what the Independent Budget says on the issues. They will work with key congressional staff to help them understand veterans' concerns. In the offices where legislation is written to be introduced in the House and the Senate, thumbworn copies of the Independent Budget will be at hand.
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Title Annotation:Paralyzed Veterans of America and other veterans' service organizations have provided a plan to set budget priorities
Author:Carswell, John
Publication:PN - Paraplegia News
Date:Apr 1, 1991
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