Eligibility Is for All Exposed to Toxic Substances
XVIII Airborne Corps Main Command Post at “Dragon City” near Dhahran, Eastern Province, Saudi Arabia. The photograph shows the corps historian at work in M-17A1 protective mask during an Iraqi SS-1B SCUD attack in January 1991. (XVIII Airborne Corps photograph DS-F-128-19 by PFC John F. Freund)
WASHINGTON, DC — VA has dramatically accelerated the healthcare provision of the PACT Act, opening healthcare enrollment to hundreds of thousands of veterans who might have been exposed to toxic substances during their service.
At the same time, proposed legislation from Republicans looks to restructure PACT Act funding—a move that VA strongly opposes and that some Democrats are saying is a back-door way to roll back the milestone legislation.
The healthcare provisions of the PACT Act were originally structured, so different classifications of veterans became eligible on a staggered schedule through 2032. A clause in the legislation allows the VA secretary to accelerate that timeline, however. In February, President Joe Biden ordered the VA secretary to do just that, effectively pulling out the stops and giving veterans access to healthcare up to eight years earlier than scheduled.
This expansion of care means that all veterans who served in the Vietnam War, the Gulf War, Afghanistan, any theaters in the Global War on Terror or any other combat zone after 9/11 will be eligible to enroll directly in VA healthcare without first applying for VA benefits. Additionally, veterans who were never deployed but were exposed to toxins or hazards while training or on active duty in the United States will also be eligible to enroll. That includes veterans who worked with chemicals, pesticides, lead, asbestos, certain kinds of paints, nuclear weapons, X-rays and more.
More than 100,000 new veterans have enrolled in VHA under the PACT Act since August 2022 out of a total of 500,000 total new enrollees. VA has previously estimated that an additional 21,000 are expected to enroll in 2024, but this estimate was before the new accelerated timeline.
The cost of much of this new care will come out of a funding provision in the PACT Act—the Cost of War Toxic Exposures Fund (TEF). The TEF is a yearly mandatory funding account that can only be used on healthcare, benefits, and infrastructure that directly relate to the needs of toxic-exposed patients. The account was provided $20 billion for FY 2024.
Current legislation introduced by House VA Committee Chairman Mike Bost (R-IL) would dramatically restructure that funding system. The bill would create a set increase in the fund through 2033 and then require VA to propose the next 10 years of funding, for which it would receive “special consideration in Congress.” Most notably, how the bill is currently written would move the TEF from mandatory to discretionary funding.
The PACT Act’s creators designated TEF as mandatory funding in order to ensure that the fund and the veterans it benefits would not be threatened by congressional infighting or the nearly-inevitable delays in passing the annual budget.
However, according to congressional rules, any new mandatory funding must be offset elsewhere in the budget and many new pieces of legislation have mandatory funding components. The Congressional Budget Office (CBO) scores each piece of proposed legislation—essentially producing a price tag for how much the bill will cost to be implemented.
According to Bost, not only does putting TEF as mandatory funding eat up much of the committee’s ability to find offsets, but CBO also is “double-counting” veterans being served by the fund, counting their care in both TEF and VHA’s mandatory healthcare budget.
“If we don’t solve the mandatory cost problem and restore this committee’s ability to legislate, sooner or later VA will ground to a halt. There will be legislation that you need that we can’t pass,” Bost told VA officials at a hearing on the bill last month.
VA’s Chief Financial Officer Jon Rychalski was direct in his response.
“I believe that Congress created this problem, and Congress is going to have to solve it,” he said. “Congress did not ask us for our opinion for creating TEF for mandatory funding at that time, but now they’re asking us to fix it. So I guess we’ll see how that works.”
The comment drew laughter from the committee members, but Rychalski followed it up with a bluntly negative assessment of Bost’s bill.
“I think the elephant in the room is that, if discretionary funding were possible, it would have been used initially,” he said. “The problem is discretionary funding was not available, which is why they used mandatory. Which is what makes me skeptical that you’ll be able to turn this into discretionary funding, and we’ll see those funds.”
Bost’s proposed funding structure also would cut the total amount of TEF funding in upcoming years, Rychalski added, as well as narrow VA’s ability to expand the PACT Act as new presumptives are discovered relating to toxic exposure.
“It’s premature to narrow the scope, sunset this and put caps at this point in time. We just don’t know. We need a guaranteed source of funding,” he said.
Democrats on the committee were skeptical, not only of the bill but also of Bost’s underlying intentions. Ranking Democrat Rep. Mark Takano (D-CA) pointed out that Bost was a vocal opponent of early drafts of the PACT Act and accused him of using this legislation as a way to wind back the PACT Act after the fact.
“The majority is proposing to hamstring that fund less than 2 years after the PACT Act became law by capping appropriations and narrowing its purpose,” Takano declared. Later he added, “This would inject a great deal of uncertainty into the system, as VA could not count on funding being available in any given year.”
As it is currently structured, the TEF fund is an exceptional success, Rychalski told the committee. Having dedicated funding like TEF has allowed VA to double benefits claims production and cut the expected backlog in half. It also is what has allowed VA to accelerate its healthcare enrollment so dramatically.
“This has been a real success,” he said. “In all the years I’ve worked in government, this is probably the most successful [program] I’ve seen.”
