Department of Veterans Affairs Secretary Denis McDonough told House lawmakers on Thursday, April 28, 2022, that agency officials are requesting the largest VA budget in history because it will improve or save the lives of millions of veterans. (Sarah Silbiger/AP)

WASHINGTON – Department of Veterans Affairs Secretary Denis McDonough told House lawmakers Thursday that agency officials are requesting the largest VA budget in history because it will improve or save the lives of millions of veterans.

"What the budget really means is health care for an estimated 9.2 million vets, disability and survivor benefits for an estimated 6 million vets and their families, and lasting resting places for an estimated 135,000 heroes and family members," McDonough said during a budget hearing of the House Committee on Veterans' Affairs. "What this budget really means is veterans' lives saved or improved by the work this funding makes possible."

But some House lawmakers questioned whether the $300 billion budget request for fiscal 2023, which begins Oct. 1, will provide services to all veterans.

"Our veteran population is rapidly changing," said Rep. Mark Takano, D-Calif., chairman of the House committee. "As a result, VA must meet the unique needs of various cohorts including women, LGBTQ+, minority, homeless, and deported veterans. So, we must ask: does this budget serve every veteran, everywhere?"

About $161 billion of the $300 billion proposal is mandatory spending, which includes entitlement programs, such as disability compensation. Mandatory spending does not go through the congressional appropriations process.

The remaining amount, $139 billion, is part of the nondefense discretionary budget, and approximately $120 billion of that amount is dedicated to veterans' medical care. The White House proposed the VA receive a 20% increase in funding for medical care in fiscal 2023.

McDonough attributed the 10.5% increase in the budget to health care inflation and increased demand for services.

The White House is requesting about 20% more for medical care, and it cited health care inflation, as well as the lasting effects of the coronavirus pandemic, as major reasons for the boost.

The VA uses modeling similar to what’s used by insurance companies to estimate demands for health care. Based on the agency’s projections, veterans will rely more on the VA for their medical care in 2023, said Laura Duke, chief financial officer of the Veterans Health Administration.

McDonough also said the budget will help the VA get 38,000 homeless veterans into permanent housing by the end of 2022, deliver toxic exposure benefits, and hire workers and invest in technology to improve the speed of claims processing.

Moreover, the budget could help fund local intervention programs that can assist all veterans, but particularly women.

The VA’s proposed budget includes $9.8 billion for women veterans' health care, including an estimated $767 million to support gender-specific care and $134 million for health program efforts.

"Health care to women vets will help us save lives by investing nearly a billion dollars in VA’s groundbreaking research, including [coronavirus] and cancer research that will help us invest in our workforce providing money we need to recruit and retain VA’s great employees," McDonough said. "And it will help us continue to save veterans from [coronavirus], which is still very much a threat for vets across the country.”

The VA has more than 623,000 veteran patients diagnosed with the coronavirus. Of those diagnosed, an estimated 4% to 7% have developed some form of long-term coronavirus symptoms, which can last months.

"VA began to focus on both clinical care and research soon after long [coronavirus] emerged on the scene," said Steven Lieberman, acting deputy undersecretary for health said at a VA news conference on Monday. "Most recently, an enterprise long [coronavirus] integrated project team has been established and is charged with organizing, supporting and reporting the progress of development and diffusion of long [coronavirus] clinical guidance and access to care, support and services for all veterans.”

The VA also announced Monday that it created a fast-track to disability compensation for veterans who developed one of nine rare respiratory cancers because of their exposure to toxic burn pits during overseas deployments. The cancers were added to the department's presumptive list, which lowers the amount of evidence veterans must provide to receive VA benefits.

But Rep. Mike Bost, R-Ill., said during the House hearing that he was alarmed at how little the proposed budget reflects the VA’s and committee's work together to address toxic exposures.

"VA's budget materials say the impact is $1.3 billion this year and $5.6 billion next year," he said. "But the requested increase is much larger than that. More importantly, the American Rescue Plan was supposed to pay for those increases. It just doesn't add up."

The American Rescue Plan is a $1.9 trillion coronavirus relief package that included $17 billion for the VA.

The money included for the VA in the American Rescue Plan was earmarked for veterans’ health care, staffing, suicide prevention, women’s health, telehealth, homelessness, state-run veterans’ homes and improvements to medical facilities. McDonough told Congress last year that the funding was needed because of an increase in demand for health care after veterans deferred appointments during the coronavirus pandemic.

Earlier this month, House lawmakers debated a White House proposal to separate funding for veterans' medical care from the rest of the federal budget — an action that would treat it the same as defense spending and could allow it to grow beyond current limits.

Discretionary spending, which is subject to the congressional appropriations process, is divided into two categories: defense and nondefense. Congress provided about $1.5 trillion in discretionary spending for fiscal 2022, with roughly $782 billion toward defense and about $730 billion going to other areas of the government. Of the $730 billion in nondefense spending, about $117 billion went to the VA.

To address the growing costs of medical care, the White House suggested VA health care be given its own stream of funding, sending a message that veterans' medical care should be treated with the same significance as national defense.

Bost said he's concerned about the Biden administration's proposal to make the VA's medical care its own budget category. He said it could make the agency's spending preprogrammed, and stifle accountability and improvements.

"Our job in Congress, and especially on the VA committee, is to make sure that VA has what it needs to serve veterans well," Bost said in a prepared statement after the hearing. "Our job is also to make sure that the taxpayer dollars that VA is given are used to improve veterans' lives, not just to grow a bureaucracy that keeps veterans frustrated. It's not at all clear to me that the massive funding increases that VA is requesting will do that."