H.R. 4243 would directly appropriate $2.1 billion for the Veterans Choice Program (VCP) and $500 million for infrastructure improvements at the Department of Veterans Affairs (VA). The bill also would expand VA’s authority to enter into leases for medical facilities and enhanced-use leases (EULs). In total, CBO estimates that enacting H.R. 4243 would increase direct spending by $3.8 billion over the 2018-2027 period.
The bill also would increase the amount VA can spend on awards and bonuses for employees; establish procedures for realigning, modernizing, or closing medical facilities; and require training of construction personnel. In total, CBO estimates that implementing H.R. 4243 would cost $720 million over the 2018-2022 period, assuming appropriation of the necessary amounts.
Because enacting H.R. 4243 would affect direct spending, pay-as-you-go procedures apply. Enacting the bill would not affect revenues.
CBO estimates that enacting H.R. 4243 would increase direct spending by more than $2.5 billion and would increase on-budget deficits by more than $5 billion in at least one of the four consecutive 10-year periods beginning in 2028.