Bush Budget Raises Drug Prices for Many Veterans

The New York Times
February 7, 2005
Bush Budget Raises Drug Prices for Many Veterans
By ROBERT PEAR and CARL HULSE

WASHINGTON, Feb. 6 - President Bush's budget would more than double the co-payment charged to many veterans for prescription drugs and would require some to pay a new fee of $250 a year for the privilege of using government health care, administration officials said Sunday.

The proposals, they said, are in the $2.5 trillion budget that Mr. Bush plans to unveil on Monday. White House officials said the budget advanced his goal of cutting the deficit, which hit a record last year.

"We are being tight," Vice President Dick Cheney said on "Fox News Sunday." "This is the tightest budget that has been submitted since we got here."

The proposals to increase charges to veterans face stiff opposition from veterans organizations, Democratic members of Congress and some Republicans.

Mr. Cheney said the White House had judiciously identified scores of domestic programs to be cut or eliminated. "It's not something we've done with a meat ax, nor are we suddenly turning our backs on the most needy people in our society."

The proposals could provoke months of furious debate on Capitol Hill. Democrats have already indicated that they are poised to pounce on any sign that the Bush administration is stinting on veterans' benefits.

Over all, the president is seeking $70.8 billion for the Department of Veterans Affairs in the fiscal year that begins Oct. 1, say Congressional aides who have seen budget documents from the agency.

The total consists of $33.4 billion in discretionary spending, which is subject to annual appropriation by Congress, and $37.4 billion for entitlements, like disability compensation, survivor benefits and pensions, which are authorized under prior laws.

Health care accounts for almost all of the agency's discretionary spending. Mr. Bush is seeking an increase of 2.7 percent, or $880 million, in such spending.

The president would increase the co-payment for a month's supply of a prescription drug to $15, from the current $7. The administration says the co-payment and the $250 "user fee" would apply mainly to veterans in lower-priority categories, who have higher incomes and do not have service-related disabilities.

The government had no immediate estimate of how many veterans would be affected if the user fee and co-payment proposals were adopted. But veterans' groups said that hundreds of thousands of people would end up paying more and that many would be affected by both changes.

Veterans groups attacked the proposals. Richard B. Fuller, legislative director of the Paralyzed Veterans of America, said: "The proposed increase in health spending is not sufficient at a time when the number of patients is increasing and there has been a huge increase in health care costs. It will not cover the need. The enrollment fee is a health care tax, designed to raise revenue and to discourage people from enrolling."

Mr. Fuller added that the budget would force veterans hospitals and clinics to limit services. "We are already seeing an increase in waiting lists, even for some Iraq veterans," he said.

In Michigan, for example, thousands of veterans are on waiting lists for medical services, and some reservists returning from Iraq say they have been unable to obtain the care they were promised. A veterans clinic in Pontiac, Mich., put a limit on new enrollment. Cutbacks at a veterans hospital in Altoona, Pa., are forcing some veterans to seek treatment elsewhere.

But Cynthia R. Church, a spokeswoman for the Department of Veterans Affairs, defended the administration's record. "Our budget increase from 2001 to 2005 for health care alone has been more than 40 percent," Ms. Church said. "President Bush has kept his commitment to veterans."

The department expects to care for five million people at its hospitals and clinics this year. Under the new budget, the agency will focus on what officials describe as their "core constituency," including veterans with service-related disabilities or low incomes.

The budget also advances previously announced plans to close or scale back some veterans hospitals. Money spent on underused buildings and excess land could be better spent providing care to veterans, the agency said.

Veterans groups want a $3.5 billion increase in the department's health care budget next year, but Congressional aides said the request was unrealistic.

Other budget details came to light over the weekend as well. Sifting through documents, Tobin L. Smith, a policy analyst at the Association of American Universities, which represents 60 large research universities, found a shift in priorities at the Pentagon.

"In the budget request for 2006," Mr. Smith said, "Defense Department spending for science and technology is significantly reduced, while the budget for development, testing and evaluation of major weapons systems increases."

The Pentagon budget provides $10.5 billion for science and technology in 2006, a reduction of $2.5 billion from this year's level, he said.

"We are concerned about that change because it means the Defense Department will be providing less support for university research," Mr. Smith said. "Engineering and computer science will be particularly hard hit."

The new budget will not show the costs of the president's top domestic priority, revamping Social Security to let people divert some of their payroll taxes to individual investment accounts.

To finance the change, Mr. Cheney said, the federal government would need to borrow $750 billion in the next 10 years and "trillions more after that." But, he said, "the personal accounts will themselves provide a significant return for those who hold them, so that they'll get a better deal."

Any effort to restrain spending on veterans programs is sure to provoke strong criticism from Democrats, who contend that the Republican-led Congress and the Bush administration have already shortchanged current and former members of the military.

In recent years, Democrats have been trying to emphasize their support of veterans programs, taking aim at a constituency that has been seen as reliably Republican. The administration's effort has caused some discomfort for Republicans.

In early January, House leaders ousted the chairman of the Veterans Affairs Committee, Representative Christopher H. Smith, Republican of New Jersey, who was seen as a strong advocate of veterans programs and higher spending. Mr. Smith was replaced by Representative Steve Buyer, Republican of Indiana.

Jim Nicholson, the new secretary of veterans affairs, heard many concerns about veterans' health care when he had his confirmation hearing before a Senate committee last month.

Senator Larry E. Craig, Republican of Idaho, chairman of the panel, the Committee on Veterans Affairs, told Mr. Nicholson, "The fiscal environment that you inherit will be considerably less friendly than the relatively flush times the V.A. has enjoyed over the last four years."