Will cost scuttle vets bill?

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Congress is running out of time to hammer out a Veterans Affairs reform bill, and its estimated cost is making the job more difficult.

The Congressional Budget Office (CBO) has estimated that the Senate’s proposal to improve veterans' healthcare could cost as much as $50 billion annually, a figure supporters insist is wildly inaccurate.

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The Senate bill authorized the construction of more than two dozen medical facilities and called for $500 million to hire new doctors to ensure veterans receive speedy care. The hiring surge is aimed at bringing down the number of veterans who are waiting at least 90 days for an initial doctor visit despite a previous VA goal of getting them care within 14 days.

A similar bill passed by the House would cost at least $44 billion over five years, according to the nonpartisan CBO. Members have written off that estimate as unrealistic as well.

Lawmakers in both chambers are now meeting as part of a conference committee to finish a joint bill that must be approved by both the House and the Senate. They hope to get it done before the August recess, after which it will be difficult to move anything through Congress.

Republicans and Democrats alike have sought to downplay the CBO figures, saying they are irrelevant because a final bill has yet to be written. They’ve expressed confidence that the final product to emerge out of conference will be a less expensive bill.

But fights over how to pay for expenditures have sunk bills before, and Republicans and Democrats are split over how to handle the VA bill’s costs, with the GOP saying offsetting spending cuts should be found and Democrats calling for the bill to be passed as emergency legislation, with its costs added to the deficit.

Sen. Bernie Sanders (I-Vt.), chairman of the Senate Veterans’ Affairs Committee and one of the architects of the Senate bill, on Wednesday held firm that the eventual bill, regardless of cost, should be considered emergency legislation.

“I think the vast majority of this body feels that way,” he told The Hill, noting that final passage of the VA measure followed a 75-19 vote to waive a budget point of order against the bill.

But that point of order was approved before the CBO said the Senate bill could add as much as $50 billion in health spending annually.

Sanders and other lawmakers have several objections to the preliminary CBO report, which assumes that millions of veterans not yet enrolled in the department’s system would seek VA care if the legislation were enacted.

Lawmakers argue the VA is overestimating the number of people that will seek care under the bill. 

“No one really knows what the number will be,” he said, calling the CBO assessment “a lot of guess work.”
 
The CBO also projected that the more than eight million veterans already enrolled in VA care would seek to increase their use of medical care by about 75 percent, given the new mandate on quicker access and the convenience of being able to visit local providers.
 
Sanders said that the CBO also presumed the VA would pay “substantially higher” contract rates to private care providers than allowed under Medicare, which he deemed “incorrect.”

He said the final conference report will likely cost more than his estimate of a few billion dollars, but not as much as the CBO’s score.

The CBO admitted in its partial findings that the budgetary effects of both bills were “highly uncertain” due to difficulty in predicting how veterans would react to getting greater access to private care.

A spokeswoman for the CBO declined to comment on this story.

Republicans in the Senate have backed Sanders in arguing that the CBO score is misleading.

The budget office “didn’t do a good job” in scoring the bill, according to Sen. Tom Coburn (R-Okla.), a deficit hawk.

But Coburn and other Republicans split with Sanders in saying that offsetting spending cuts should be used to pay for the costs of the VA bill.

Coburn on Wednesday downplayed the idea that those differences could scuttle a bill both sides want to reach President Obama’s desk.

“I’m not even looking at that yet until we get a reasonable score and you’re not going to get a reasonable score until you figure out what’s going to come out of the conference,” he told The Hill. “None of the previous CBO scores matter.”

House Veterans’ Affairs Committee Chairman Jeff Miller (R-Fla.) on Tuesday told reporters he would push the CBO for a “realistic” cost estimate.
 
“We want to try to find the offsets necessary to pay for the legislation,” he said after the conference panel’s inaugural meeting, saying the funding may come from cutting parts of the federal budget.