Senators introduce legislation to authorize delayed VA medical leases

mark warnerU.S. Sen. Mark Warner (D-VA) led a bipartisan group of 18 senators seeking to improve veterans’ access to healthcare by introducing the Providing Veterans Overdue Care Act to authorize leases for 24 Department of Veterans Affairs medical facilities in 15 states. Most of the leases have been pending congressional approval for more than a year.

Under law, the Department of Veterans Affairs (V-A) must receive specific legislative authorization to lease medical facilities with average annual rental payments in excess of $1 million. However, since 2012, Congress has not, through a regular process, authorized any V-A major medical facility leases, hampering the ability of the V-A to provide much-needed health care and services to veterans around the country. Today’s legislation will authorize 18 overdue leases from FY 2015 and FY 2016, as well as six facilities that need to be authorized in the rapidly approaching 2017 fiscal year. The 24 leases are located in states with an estimated 11 million veterans.

Among the leases that are included in the legislation is a 155,000 square foot outpatient facility in Hampton Roads, Va., which has one of the fastest-growing veterans populations in the country. Patient visits in Hampton’s service area increased by 30.5 percent from 2011 to September 2014, while the national average across the V-A system was 8.6 percent.

“Not that long ago, the V-A medical facility in Hampton Roads, Va., had some of the longest wait times in the country for veterans attempting to access the care they have earned.  I worked closely with the local leadership – including several in-site visits – to reduce wait times and ensure that veterans are able to access medical services in a timely manner,” said Sen. Warner. “But the doctors, nurses, physician assistants, social workers, and support staff at Hampton VAMC are doing what they can with the resources they’ve got to manage a patient workload that has grown at nearly four times the national average. For too long now, they’ve been waiting for Congress to authorize an additional outpatient facility that will give the V-A additional capacity to treat the growing veterans population in the region. I am frankly astounded that at a time when so much attention is focused on how to improve access to care at the V-A, Congress has failed to take what is really a very simple step in approving two-dozen badly-needed medical facilities. While there’s certainly more we can and should do to improve services for veterans at the V-A, this is a good start. It’s not a partisan issue: it’s a simple matter of doing right by our nation’s veterans.”

One reason for the delay in congressional authorization has been a recent change in the way that the Congressional Budget Office (CBO) scores these leases. Prior to 2012, the V-A classified major medical facility leases as operating leases and recorded the obligations on an annual basis in an amount equal to the lease payments due in that year, and the CBO used V-A’s classification to score the legislation.

In 2012, CBO determined that budget authority for these leases, many of which cover a 20-year period, should be recorded up front when the leases are initiated and the acquisition occurs, not when the debt is repaid. As such, scoring for legislation that authorized these leases increased significantly, even though actual spending would not increase and the leases are ultimately subject to annual appropriations. Sen. Warner and his colleagues have previously urged the Senate Committee on Veterans’ Affairs not to delay further on the lease authorizations.

The scoring change has contributed to congressional inaction on authorizing any V-A major medical facility leases. Currently, 18 leases in 12 states from fiscal years 2015 and 2016 have been pending authorization in Congress for more than one year. The CBO scores the overall cost of these 18 leases at $904 million. The 18 leases that are pending from FY 2015 and FY 2016 are:

  • Ann Arbor, MI – Outpatient Clinic
  • Birmingham, AL – Outpatient Mental Health Clinic
  • Birmingham, AL – Outpatient Specialty Clinic
  • Boston, MA – Research
  • Charleston, SC – Research
  • Daytona Beach, FL – Outpatient Clinic
  • Denver, CO – Chief Business Office Purchased Care
  • Gainesville, FL – Outpatient Clinic
  • Hampton Roads, VA – Outpatient Clinic
  • Mission Bay, CA – Research
  • Missoula, MT – Outpatient Clinic
  • Northern Colorado, CO – Outpatient Clinic
  • Ocala, FL – Outpatient Clinic
  • Oxnard, CA – Outpatient Clinic
  • Pike County, GA – Outpatient Clinic
  • Portland, ME – Outpatient Clinic
  • Raleigh, NC – Outpatient Clinic
  • Santa Rosa, CA – Outpatient Clinic

In addition, the legislation will authorize six leases for FY 2017:

  • Corpus Christi, TX – Replacement Outpatient Clinic
  • Jacksonville, FL – Replacement Outpatient Clinic
  • Pontiac, MI – Replacement Outpatient Clinic
  • Rochester, NY – Replacement Outpatient Clinic II
  • Tampa, FL – Replacement Lakeland Outpatient Clinic
  • Terre Haute, IN – Replacement Outpatient Clinic

In addition to Sen. Warner, the legislation is co-sponsored by Sens. Michael Bennet (D-CO), Barbara Boxer (D-CA), Richard Burr (R-NC), Susan Collins (R-ME), Steve Daines (R-MT), Cory Gardner (R-CO), Kirsten Gillibrand (D-NY), Tim Kaine (D-VA), Angus King (I-ME), Ed Markey (D-MA), Bill Nelson (D-FL), Gary Peters (D-MI), Chuck Schumer (D-NY), Debbie Stabenow (D-MI), Jon Tester (D-MT), Thom Tillis (R-NC), and Elizabeth Warren (D-MA). Text of the legislation is available here.

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