House lawmakers say the Veterans Affairs Department's $2.6 billion budget shortfall for this fiscal year is further proof of administrators' incompetence and poor planning.
VA officials have a slightly different take, saying the shortfall is a sign of their extraordinary efforts to get veterans the medical care they need, regardless of the cost.
Either way, the department has a gigantic deficit to fill in the next three months.
And it could get bigger.
It also could mean furloughs, hiring freezes and program cancellations if a solution can't be found.
"We are going to do the right thing for veterans and be good stewards of taxpayer dollars," VA Deputy Secretary Sloan Gibson told members of the House Veterans' Affairs Committee on Thursday. "But to succeed, we need the flexibility to use funds to meet veterans needs as they arise."
Without that, he said, "we get to dire circumstances before August. We will have to start denying care to some veterans."
For months, VA officials have pleaded with Congress to free up billions in money earmarked for the new Veterans Choice Card program, established by lawmakers last year as a way to speed up veterans' access to medical care appointments.
In the last year, VA has seen the number of appointments jump by 7 million, almost one for every veteran enrolled in VA health care. More than half of those new appointments were made with outside physicians, in an effort to speed access.
Only a small portion of those came from the new Choice Card program, with fewer than 107,000 veterans signed up. As a result, Gibson said, VA has overspent on other outside care while leaving billions of dollars for that program untouched.
But it's not the first time VA officials have suggested tapping into the Choice Card funds, a move that has enraged conservatives on Capitol Hill.
The White House suggested reprogramming the funds as far back as February, as part of its fiscal 2016 budget request. VA planners asked for permission to use the funds to patch construction account shortfalls in May.
Lawmakers bristled at the latest suggestion of using the money, even if this time the funds would cover the same types of outside care that the program was designed to facilitate.
They also were enraged that the department is only now informing them of significant shortfalls in this year's budget, with the fiscal year ending Sept. 30.
"I have come to expect a startling lack of transparency and accountability from VA over the last years," said committee chairman Rep. Jeff Miller, R-Fla. "But failing to inform Congress of a multibillion-dollar funding deficit until this late in the fiscal year … is disturbing on an entirely different level."
"What you're seeing is a sea change in the way VA operates," VA Deputy Secretary Sloan Gibson told House lawmakers Thursday. "Historically, we've managed to a budget instead of managing to requirements based on veterans' needs."
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Gibson said officials learned the depth of the problem only in the last few weeks. Part of that problem has been the sudden surge of popularity in VA care, part has been mistakes in predictions and planning.
"What you're seeing is a sea change in the way VA operates," he said. "Historically, we've managed to a budget instead of managing to requirements based on veterans' needs."
Lawmakers were noncommittal on plans to make money available to the department, probing officials for efficiencies or cuts that could open other sources of relief.
VA officials have said they're unsure what moves will have to be made if extra funding can't be found, but said they could include furloughs or program cuts to save money.
They've already warned that without more budget flexibility, VA may need to make across-the-board budget cuts in fiscal 2016 to cover similar issues, which in turn could hurt a range of veterans programs.
Meanwhile, the increase in demand for VA health care services since last fall has boosted the number of medical appointments scheduled 30 days after a veteran's request by almost 75,000, a figure critics said is a concern given the emphasis placed on getting individuals quicker care following last year's scandal.
The percentage of appointments more than a month in the future rose from about 6 percent to 7.5 percent over that range, and VA officials say the average wait time for primary care in their system is only four days.
Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.