Don't Expect the VA to Improve Overnight

For anyone still under the impression that the embattled Veterans Affairs Department will be able to turn itself around quickly, think again.

Instead, acting VA Secretary Sloan Gibson told members of the Senate Veterans Affairs Committee on Wednesday that it would take years for the department to rights its wrongs.

"I believe in as little as two years the conversation can change. That the VA can be the trusted provider for care and benefits," Gibson said.

Gibson ticked off a list of issues currently facing the VA: a culture of intimidation, an overfocus on metrics, and a lack of clinical staff and accountability. To help overcome these challenges, the VA will request an additional $17.6 billion for fiscal years 2014 through 2017 to help fill gaps in medical care and IT and add new VA facilities. It would also include the money to hire an additional 10,000 clinical staff, including 1,500 physicians.

"We haven't historically managed to requirements, we've managed to a budget number," he said. "... I will not hold back on asking for resources. … [But] I don't want a penny in there that we couldn't justify."

The VA's budget has grown in recent years from $100 billion in 2009 to $154 billion in 2014. But veteran advocates have long criticized what they view as an entrenched practice within VA leadership to be hesitant to ask for additional resources.

And senators seemed to acknowledge that the department requires more than a short-term fix. Committee Chairman Sen. Bernie Sanders warned: "While it's important we put out the current fire, unless we effectively deal with the long-term capacity problems, we'll be back here year after year."

But how senators will move forward—and if more money is needed–remains unclear.

"This committee has been, I think, very, very generous to the VA," said Sen. Mike Johanns, R-Neb. "... It was almost like we would salute when [former VA Secretary Eric Shinseki] said what he needed, and out the door he would go with more money."

Johanns said that instead of more money, the VA needs more competition from private care.

Gibson's appearance before the committee comes as the VA has been embroiled in scandal in recent months from allegations that staffers within the VA's health care agency cooked the books on how long veterans waited before they received a medical appointment. The VA Inspector General is still investigating approximately 70 VA locations. Gibson said the investigations are scheduled to wrap up by mid-August.

That scandal has spread in recent weeks to allegations of retaliation against whistleblowers and suspicious data in the VA's disability claims process.

"The culture that has developed at VA and the lack of management accountability is reprehensible. It will not be tolerated," said Republican Sen. Richard Burr of North Carolina.

Members of a conference committee are now trying to reach an agreement on legislation that would expand veterans' access to non-VA care to make sure more veterans get timely access to care.

Though reforming the VA has bipartisan support, lawmakers are currently squabbling over how much the legislation should cost. Sanders—echoing a broad statement this week from House Veterans Affairs Committee Chairman Jeff Miller—said he believes the committee can "reach an agreement very soon."

The CBO released a revised estimate last week on how much the Senate's VA bill would cost. The organization said the legislation would cost $38 billion a year—down from its preliminary estimate of $50 billion.

Democratic Sen. Jon Tester said he is "very concerned that this conference committee will end up taking a step backward for veterans' health care. … We need to make sure we step up to the plate, give them the resources they need, and then hold them accountable."