Pent up demand for VA services driving record 2022 budget request, agency says

The Department of Veterans Affairs also envisions additional funding for its electronic health record modernization program, accountability office and diversity...

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Congress has turned its attention to funding for a new year with a new administration, but in many ways the conversations about the budget at the Department of Veterans Affairs remain eerily similar to years past.

If the new administration gets its way, VA is on track for another record budget next year, nearly $270 billion, a 10% increase over 2021 funding levels. That’s after VA got a record $245 billion this year, plus emergency funding through the Coronavirus Aid, Relief and Economic Security (CARES) Act and the American Rescue Plan.

For Democrats, the department’s budget gives more attention to certain VA offices and programs they say have been underfunded and unattended to in recent years.

The Biden administration, for example, is asking for a 92% increase in funding for VA’s suicide prevention program and a 14.5% increase in the department’s homelessness program.

It’s also recommending a 26.8% increase in funding for major and minor construction projects at VA, which the department said should cover the most critical infrastructure needs and some new building projects and upgrades. The department’s facilities are, on average, 58 years old, with 69% of VA facilities 50 years old or more.

The 2022 budget request includes funding for a 5% increase in staff at VA next year, on top of the additional 16,000 employees the department hired during the pandemic.

“VA can build new facilities, but if it does not have the workforce to staff them, it cannot deliver on its promises to veterans,” Mark Takano (D-Calif.), chairman of the House Veterans Affairs Committee, said Tuesday at a hearing on the department’s 2022 budget proposal.

But for Republicans, the 2022 proposal is yet another record budget request after several years of record funding requests for the VA.

“We have never asked the VA to do more with less,” Mike Bost (R-Ill.), ranking member of the House Veterans Affairs Committee, said. “VA’s biggest budget increases have come in the last two years. The CARES Act and the American Rescue Plan added tens of billions of dollars to the largest regular appropriation VA has ever received. The time has come to ask: When VA will be adequately funded?”

VA Secretary Denis McDonough said the increase is due, in part, to an anticipated influx of veterans seeking medical care as the COVID-19 pandemic eases in the United States.

“We’ve now seen in March, April and May significant surge in demand for services in direct care, that is in VA-provided care, and community care, so much so that we’re watching very closely what that means for the overall budget number,” McDonough said. “This one is not hypothetical. We’re in the midst of a bow wave of care. We’re seeing demand for that care in both channels.”

Funding grows for VA EHR modernization

The Biden administration is recommending $2.7 billion for VA’s electronic health record modernization program, on top of $4.8 billion for the department’s Office of Information and Technology.

The 2022 request for VA’s EHR is $56 million above what the department received for the initiative this year. The department said the additional funding will support EHR deployment at additional sites, as well as infrastructure upgrades needed to support the new system at VA medical facilities.

The immediate path forward for the EHR, however, is still up in the air. VA is wrapping up the initial phase of its strategic review of the EHR program, which the department launched back in March after hearing concerns from staff on the ground at the first go-live site in Spokane, Washington.

“We are looking at some structural questions, including how we’re structured to oversee this. We are not revisiting the relationship with DoD on this. We do have to have much more candor with one another and then with ourselves, frankly, about what precisely we need and what we require from the Cerner system,” McDonough told the committee. “How we train and how we rack up requirements [and] how we govern and how we manage this process need some work. Those are internal issues.”

The department was supposed to deploy the EHR to a second site in Columbus, Ohio, but the timing of that launch is “still a big open question for us,” McDonough added.

More resources for diversity and inclusion and VA’s accountability office

The Biden administration also requested $26.5 million for VA’s Office of Accountability and Whistleblower Protection (OAWP), a $3.8 million increase over current year funding. The budget would also add 27 more employees at OAWP.

OAWP issued 99 recommendations for disciplinary action last year, but VA management officials only implemented about half of them. That track record — although it’s improved — is concerning to some House members.

“Why increase this program by this amount of money and add 27 more [employees] when what we’re currently doing doesn’t seem to be working?” Rep. Tracey Mann (R-Kan.) said.

“I hear from that office, which has not yet been fully staffed since you all enacted it several years ago, that it needs more people. I take their word for that,” McDonough said. “But we also have a governance and management issue. We have to figure out why there’s such a disconnect — and this is on me — between the investigators in OAWP and the responsible management officials, and why is it that either the recommendations aren’t what the management officials think needs to happen or the management officials are ignoring the recommendations? We just have to increase that oversight, and that’s something that’s on me and my general counsel. We are actively working this.”

Beyond the additional funding for VA’s accountability office, the 2022 budget would also provide more funding for the department’s diversity and inclusion initiatives.

VA recently consolidated its diversity and inclusion office with its Office of Resolution Management. The 2022 budget would add $12.9 million and an additional 74 employees to VA’s new Office of Resolution Management, Diversity, and Inclusion.

VA stood up a diversity, equity, inclusion and accessibility task force, which is preparing recommendations to McDonough on ways to improve.

In addition, multiple members of the House VA committee urged McDonough to restore official time to Title 38 medical professionals at the department, which the previous administration eliminated.

The American Federation of Government Employees has been anxious for VA to restore official time to medical professionals, even after McDonough did so for much of the workforce at the rest of the department.

“It’s under active consideration. We’re talking about this, let’s say robustly,” McDonough said. “I hope to have some news for you soon. This is obviously a critically important issue. We also are looking at a raft of litigation that goes back to the last four-and-a-half or five years. I’m really hoping that we can resolve all these issues so we can get back to restoring labor-management relations.”

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