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Veterans & Mental Health Bills, Plus Funding Bill Delay

By James Finley
Associate Executive Director and Director of Public Policy
Veterans and Mental Health Bills in Focus

House and Senate conferees began meeting recently to begin negotiations aimed at reconciling each chamber’s Veterans Affairs reform bills (S.2450/HR.4810). The big controversy is over costs and how to find funding to pay for a major expansion of veterans’ care and providers. Each chamber hurried its bill through the floor in late May at the height of the VA scandal, but now cooler heads have taken over after the Congressional Budget Office projected both measures will cost much more than anticipated by their sponsors.

AMHCA and its coalition partners have asked several congressional leaders to make changes in a final bill that, though it would add additional costs, would permit veterans who cannot get timely access from a VA medical center to access TRICARE providers—including clinical mental health counselors and marriage and family therapists. However, no one close to the negotiations has been willing to pick up this cause for the profession, presumably out of a desire not to further increase VA spending.

Negotiators from the House and Senate began talks in late June to reach a compromise on a final bill designed to address the problem of delayed care at VA health facilities. Congressional insiders say their goal is to pass compromise legislation by the end of July, but any deadline is very uncertain at this early point in negotiations.

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Conferees are extremely unhappy and incredulous that cost estimates came in at up to $50 billion a year for veterans’ emergency healthcare. Usually negotiations are cooperative and bipartisan over VA legislation, but the sky-high estimates makes negotiations for the final agreement very difficult. 

Other than costs, the House and Senate versions have relatively minor differences, and a final bill could be passed quickly in the wake of a major scandal. AMHCA supports the addition of TRICARE and VA-eligible providers to the bill, but such a step goes to the heart of the high-cost problem.

Currently the bill would allow veterans a two-year period to seek outside private care from Medicare providers, while the Department of Veteran Affairs cleans up its lengthy waiting lists for care at VA facilities. Veterans who live in rural and frontier areas more than 40 miles away from a VA provider would also be able to access Medicare providers. We will continue to raise our concerns as the negotiations continue. 
Funding Bill Delay Appears Likely

Several days ago the full Senate began to struggle on the floor with one of the annual appropriations bills that funds key government functions, when it immediately became tangled in partisan arguments that culminated in its withdrawal from the floor. Also in late June, the $158 billion Labor/HHS bill—which includes all SAMHSA funding and some funds for Obamacare—stalled in committee. The Labor/HHS bill was placed on hold by the Appropriations Committee Chairwoman Barbara Mikulski (D–Md.) following Republican attempts to force a series of politically painful votes targeting vulnerable Democrats on the committee. Later, other bills were also postponed in committee for the same reason. 

Pulling one appropriations bill from the floor and several in committee is widely viewed as a very bad omen for completing the regular funding cycle for federal agencies by the end of the fiscal year on Sept. 30. The author of the Labor/HHS bill, Sen. Tom Harkin (D–Iowa), said it is likely that Labor/HHS funding will end up in a catch-all must-pass funding package that will be rushed through shortly before elections in November. 

Negotiations Begin on House Mental Health Bills

I reported in the May Advocate that AMHCA and its coalition partners were successful in securing inclusion of our Medicare provider status amendment (S.562/HR.3662) in a Democratic alternative bill—HR.4574—to the highly controversial “Murphy mental health bill” (HR.3717). 

A bipartisan group of House lawmakers met in late June in an effort to identify common ground between the competing major mental health bills introduced this Congress. Leaders of the negotiations, Tim Murphy, PhD (R–Pa.) and Ron Barber (D–Az.), have been asked to break through the partisanship that had overtaken the debate over a mental health bill to respond to growing gun violence in the nation. 

Following their first meeting late in June, Reps. Murphy and Barber expressed optimism about finding agreement on a narrower bill that could garner bipartisan support and pass the House Energy and Commerce Committee. Negotiators are currently discussing areas of potential agreement and are reported to be writing new bill language. 

AMHCA has endorsed the Barber bill (HR.4574) because it includes our Medicare provider status amendment, but we don’t know yet whether this provision is in the current discussion or whether the GOP is willing to include significant new spending items in a narrower compromise.