After a Long Delay, Congress Approves a Bill to Provide Care to More Vets, Grow VA Workforce and Establish New Facilities

A measure to expand benefits offered to veterans who became sick after exposure to burn pits while on active duty is set to become law after the Senate approved the bill on Tuesday, which will also authorize sweeping new authorities to hire and keep employees to handle the resulting uptick in usage of the government health care system.

The Honoring our Promise to Address Comprehensive Toxics (Honoring Our PACT) Act (S. 3373), which will presume, for the purposes of eligibility for care at the Veterans Affairs Department, that 23 respiratory illnesses contracted by veterans are related to burn pits used in the military, now heads to President Biden for his signature. The measure won, nearly lost, then regained bipartisan support after Senate leaders reached a breakthrough agreement earlier this year. Veterans advocates estimate millions of veterans could potentially become newly eligible for VA care under the legislation, leading lawmakers to include in the measure provisions to boost hiring, recruiting tools, pay and bonuses for the department.

The bill has been years in the making, as advocates and some lawmakers have pushed for recognition that exposure to the fires the military has used to dispose of toxic and other wastes causes cancer and other illnesses. All veterans claiming related illnesses will have access to new exams at VA, which will establish a working group on how the department will handle toxic exposure claims going forward.

The legislation survived several near defeats, despite lawmakers overwhelming voicing support for the bill's intent. In June, the Senate passed the measure with all Democrats and a majority of Republicans supporting it. Due to a procedural issue, the Senate was forced to vote on the bill again. Twenty-six Republicans switched their vote, leading the measure to fall short of the 60 votes required for passage. Those lawmakers cited a provision that moved $400 billion in VA funding from the “discretionary” part of the budget that is newly appropriated every year to the “mandatory” side, saying it would free up more funds in the future for Democrats to push unrelated priorities. The provision was not new, leading some Democrats to question whether Republicans were exacting revenge after the majority party unveiled their much-anticipated tax reform and climate spending bill. 

Senate Majority Leader Chuck Schumer, D-N.Y., allowed for a vote on an amendment introduced by Sen. Pat Toomey, R-Pa., that would have shifted the funds back to the discretionary part of the budget, but the measure was defeated. VA Secretary Denis McDonough had warned the amendment, which set caps on spending for health care related to burn pits,fw would lead to a rationing of care for veterans. 

The larger bill authorizes leases for 31 new medical facilities at VA to help accommodate the expected surge in patients, which is expected to cost nearly $1 billion. The Congressional Budget Office found the slew of pay and other human resources changes would come with a $5.7 billion price tag over the next decade.

The bill will authorize the department to buy out the contract of health care professionals to recruit them to VA, so long as they make a four-year commitment to the department. VA will have $40 million per year for the buyouts. VA’s health care employees will be eligible for pay boosts worth 50% of their base salaries, up from the current cap of 30%. Overall pay would be capped at level two of the Executive Service pay scale, which is currently $203,000 per year. McDonough has called lifting the pay caps essential for VA’s recruiting and retention efforts and has aggressively pushed Congress to pass the reform.

The buyouts for recruiting private sector staff caused an initial sticking point earlier this summer, as the provision makes the benefit tax-free and any change to tax law must originate in the House. While the House previously passed its own version in the PACT Act, that benefit was added on the Senate side. Ultimately the House passed a revised version of the bill that struck the tax portion of the new benefit and sent it back to the Senate, where it was expected to sail through. Instead, dozens of Republicans who voted to approve the bill just weeks earlier decided to vote against it. 

The measure would waive pay caps for any employees whose facility closes, potentially creating widespread use of retention incentives as VA is in the midst of an effort to close or consolidate hundreds of medical centers and clinics around the country. It would also waive the caps for employees providing care to burn pit victims. McDonough has implemented initiatives to boost eligibility for child care subsidies, increase retention incentives and create new career paths that will lead to more opportunities for promotions and raises.

The bill will waive the overall bonus cap of $360 million currently set for VA for the next two years. It will make the process easier for doling out recruitment and retention incentives and allow for pay bumps for employees with critical skills. It will also authorize VA to pay up to $100,000 for an employee’s student loan repayments and to hire recent graduates on an expedited basis.

VA will now create a rural recruiting strategy in consultation with each medical center and outpatient clinic. The department will work with the Office of Personnel Management to establish qualifications for every human resources professional and standardize performance metrics for them. It will also limit requirements for applying veterans preference for housekeeping aides, which House lawmakers called “one of the most understaffed and hardest to hire positions in VA facilities across the country.”

President Biden has already praised the bill and encouraged lawmakers to act expeditiously to pass it. Biden has speculated his son Beau, who died from brain cancer after serving overseas near burn pits, was impacted by toxic exposures.