Nobody knows how much a massive health care package earmarked for veterans affected by military toxic exposure will cost -- and Republicans want a price tag and further analysis from the Department of Veterans Affairs before the bill moves forward.
The House and Senate Veterans Affairs committees are trying to pass legislation that would provide care and disability compensation for a half-century's worth of veterans sickened by burn pits and other environmental toxins on duty. It's now the best chance for passage such a bill has ever had, but concerns over cost and a perceived lack of support from the VA are threatening to stall progress.
The key to a legislative package is language that would create a presumptive service connection to veterans suffering from a long list of diseases who were exposed to burn pits during deployments. Without such a presumption, it's often difficult for veterans to link their medical conditions to their service and prove to the VA they served near burning garbage. Under the proposed presumption policy, veterans would only need to prove they served overseas to establish a service connection for their condition.
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VA data shows veterans of the post-9/11 wars are twice as likely as non-deployed veterans to file claims related to cancer, and three times more likely to suffer respiratory issues. VA estimates 3.5 million veterans have been exposed to burn pits since 1990. That means legislation covering their conditions would be one of the largest health care bills passed in years, and would come with a hefty price tag.
Rep. Mike Bost, R-Ill., the top Republican on the House VA committee, told Military.com his goal is to get a bill to President Joe Biden's desk this year. Bost and other lawmakers, feel urgency to get a bill passed, fearing a repeat of the Agent Orange debate. Vietnam veterans who say they were sickened by the chemical defoliant waited decades for legislation connecting their conditions with military service. Lawmakers and veterans advocates largely agree that this is the year to act on toxic exposures.
However, Bost says the VA still needs to give Congress at least a loose idea of the cost. Considering the scope of the bill, trimming the fat and fine-tuning the details could be critical to its passage.
"We don't want a bill that ends up being so expensive it falls under its own weight," Bost said Wednesday.
Bost also sent a letter to VA Secretary Denis McDonough Wednesday asking for "formal views and cost estimates" on each of the 15 toxic exposure bills the House is considering for inclusion in a larger health care law.
A spokesman for VA said the department is in communication with Bost's office and is "actively working to determine the cost and resource implications" of a new major toxic exposure law.
"VA continues to work diligently and proactively to seek every avenue possible to develop a process with the utmost rigor where presumptives for toxic exposure can be determined in a more expedient and holistic manner for veterans," the spokesman said in a statement to Military.com.
Yet Bost thinks the VA delaying a complete analysis could bog the process down and put Congress at risk of not getting the details right.
"That's the danger, that's why the administration needs to work with us," Bost said. "My biggest fear is that it gets snagged that way."
Yet the House doesn't have to have VA's input or cost analysis to move forward. House Veterans Affairs Committee Chairman Mark Takano, D-Calif., said the agency has given lawmakers some input and he plans to announce a toxic exposure package next week.
"Veterans have waited far too long for relief from toxic exposure," Takano said in a statement to Military.com. "We welcome VA's participation and they have provided input on many of the provisions being considered, but this is the cost of war that Congress should recognize. That's why the committee is unveiling legislation next week to reform VA's presumptive decision making process and address this issue once and for all, so we no longer have to address this disability by disability and location by location."
Bost, like other lawmakers pushing the bill, say the price tag ultimately doesn't matter, and that the final measure will simply amount to the government paying its war tab. It's not clear, though, that all lawmakers feel this way.
After the Senate and House pass their versions of the toxic exposure package, the two chambers will need to come together to work out the differences in the two bills and pass a final version for the president to sign into law.
Sen. Jon Tester, D-Mont., who chairs the Senate Veterans Affairs Committee, said in a hearing Wednesday that he would not put a toxic exposure package onto the floor for a full chamber vote without the full support of Sen. Jerry Moran, R-Kansas, the committee's top Republican.
"We'll work this out, we'll work together. We need your help and you have the opportunity to help us now. Please engage with us to make sure we have a bill that's functional," Moran said during the confirmation hearing for VA officials.
However, Tester suggested the committee may have to move forward without VA's input.
"I think we have to set the mark in the sand," Tester said at a confirmation hearing for the VA deputy secretary. "If we don't, come October … we won't have kicked the ball forward."
-- Steve Beynon can be reached at Steve.Beynon@military.com. Follow him on Twitter @StevenBeynon.
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