The Biden administration in May submitted its first budget proposal for the Department of Veterans Affairs. At a recent congressional hearing, AFGE Senior Policy Counsel Richard Loeb testified before the House Committee on Veterans’ Affairs on President Biden’s budget request for Fiscal Year 2022.
“The VA is at a crossroads,” Loeb testified. “After more than a year fighting on the frontline of the COVID-19 pandemic, the next year will be critical for the future of the VA and its world-class, veteran-centric care.”
Here are 5 takeaways from the testimony, including our position on the budget proposal:
1. AFGE is generally pleased with the budget request
The request represents a 10% increase in funding for the VA and departs from the previous administration’s agenda of starving the internal operations of the VA and favoring private-sector providers.
Biden’s budget request calls for investment in various areas that would build in-house capacity, including staffing, facility building and maintenance, medical and mental health care, veterans benefits, and claims processing.
The budget also creates an office within the VA to promote diversity and inclusion.
“AFGE has worked to shed light on racial disparities and systemic racism within the VA. In 2019 we conducted a survey on management selection that found only 2.5% of African American applicants were selected for management positions at the VA.”
2. The VA should rely less on private-sector providers
VA privatization received support because the VA was not adequately funded to meet the demands of veterans. The VA under the previous administration, for example, left 50,000 positions unfilled. Veterans had to wait too long for appointments for treatment.
Instead of expanding private care, the VA should consider using in-house health care services as much as it can. Since the 2018 passage of the Mission Act, which opened the door to privatization of the country’s largest health care system, the results validated AFGE’s warnings and concerns about the agency’s overreliance on private-sector providers.
Fraudulent billing, scandals, inferior treatment, and uncontrolled costs were just some of the issues associated with private-sector providers.
The FY2022 budget calls for $17.1 billion in advanced appropriations for this so-called “community care” privatized care and $24.2 billion in advanced funding for FY 2023. These enormous figures would be far better spent on improving and expanding in-house capacity at the VA.
“There is a place for private sector providers in the VA health care system, but it should only be to supplement a high-quality in-house VA capacity, NOT to replace it.”
3. There should be more accountability from private-sector providers
If Congress continues to send veterans to private providers, it should mandate more accountability from these providers.
The Mission Act, for example, stipulates that wait time for veterans seeking appointments for treatment with a private provider is to not exceed 30 days. However, veterans had to wait on average 50 days for an appointment.
Then there are improper payment rates by two official VA third-party administrators of the private care program – TriWest and Health Net. The contractors charged the government for overhead 24%, twice the rate of other private sector health care administrators.
AFGE suggests that Congress use the contract cost principles used by the Federal Employees Health Benefits (FEHB) Program to control private provider health care administrative costs. FEHBP uses the Federal Acquisition Regulation (FAR) to determine the allowability and allocability of costs claimed by contractors.
Congress must also make sure that the VA’s in-house medical accounts are not merged with the private provider accounts under any circumstances.
4. Review of in-house facilities closure should be postponed
The budget calls for $5 million for the Mission Act’s Asset and Infrastructure Review (AIR) Commission to review VA facilities and departments for closure, improvement, and construction.
It’s remarkable that VA employees were able to courageously serve our veterans despite the damage done to the VA’s internal capacity and employee morale during the past four years. Now that the administration has plans to invest in the VA’s in-house capacity, the White House and Congress should delay this review so that the VA and veterans can reap benefits from these investments. We should not rush to privatize even more functions and allow the AIR Commission to cherry pick departments for privatization, jeopardizing the VA’s holistic approach to providing care to veterans who usually require treatment for complex physical and psychiatric issues.
5. VA health care professionals need full workplace rights
AFGE urges Congress to pass the VA Employee Fairness Act, which would extend full collective bargaining rights to the VA’s Title 38 workforce.
While VA employees have had collective bargaining rights since 1991, certain workers don’t. Due to the VA’s narrow interpretation of their collective bargaining rights under the law, Title 38 clinicians, including doctors, physician assistants, dentists, registered nurses, optometrists, podiatrists, and expanded-function dental auxiliaries are not allowed to raise grievances about things like staffing shortages or to challenge management violations of pay laws or the VA’s own policies.
“The VA must correct past mistakes and extend full collective bargaining rights and representational rights to its Title 38 workforce. Medical professionals in the private sector have full collective bargaining rights, equivalent to those of workers in other occupations. Only the VA deprives medical professionals of full union rights. Without addressing these issues, the VA will never be able to fully become an employer of choice for medical professionals.”
VA also needs to restore official time for title 38 employees. In April 2019, then VA Secretary Robert Wilkie prohibited these employees from using official time to represent and defend their coworkers. As a result, Title 38 union reps have been forced to take leave and work off the clock to perform their duties for the last two years.