H.R. 5999, Veteran Opioid Emergency Treatment Act

Bill Summary

H.R. 5999 would require the Department of Veterans Affairs (VA) to provide opioid antagonists—medications that block the effects of opioids—to veterans without a prescription. The bill would eliminate copayments for those medications. The bill also would extend the higher rates for fees that VA charges borrowers for home loan guarantees.

Estimated Federal Cost

The estimated budgetary effects of H.R. 5999 are shown in Table 1. The costs of the legislation fall within budget function 700 (veterans benefits and services).

Basis of Estimate

For this estimate, CBO assumes that H.R. 5999 will be enacted in fiscal year 2026and that outlays will follow historical spending patterns for affected programs.

Provisions That Affect Direct Spending and Spending Subject to Appropriation

H.R. 5999 would require VA to furnish opioid antagonists to veterans without a prescription.

VA distributes naloxone and other opioid antagonists to veterans through several avenues, such as the department’s pharmacies, health care providers, and mobile medical units. CBO anticipates that eliminating the requirement to have a prescription would expand access to those medications and increase the number of doses provided. VA could provide more doses to veterans enrolled in the VA health care system than it can under current law, and it also could provide them to veterans who are not enrolled. CBO estimates that, under H.R. 5999, VA would provide about 8,000 additional doses each year at an average cost per dose of about $50. In total, providing those medications would cost $4 million over the 2026-2036 period, CBO estimates.

VA uses several appropriation accounts to pay for the costs of health care, disability claims processing, medical research, and information technology modernization. One of those accounts, the Toxic Exposures Fund (TEF), is a mandatory appropriation that can be used to pay for some of the costs of those activities if they support veterans who were exposed to toxic substances or environmental hazards.^[1] The other accounts are discretionary appropriations. H.R. 5999 would affect health care that benefits veterans with and without toxic exposures; therefore, enacting the bill would increase direct spending from the TEF as well as spending subject to appropriation. CBO allocates the estimated costs of legislation between the TEF and the discretionary appropriation accounts on the basis of the portion of all funding for those activities that are projected, in CBO’s baseline, to come from the TEF.

On that basis, CBO estimates that over the 2026-2036 period, implementing the requirement under H.R. 5999 to furnish opioid antagonists to veterans without a prescription would increase direct spending by $1 million and spending subject to appropriation by $3 million.

Direct Spending

In addition to making changes to VA health care, H.R. 5999 would affect direct spending by extending higher fees for VA home loan guarantees.

The bill would extend—for less than two weeks—the higher fees that VA charges borrowers for its loan guarantees. VA provides loan guarantees to lenders that allow eligible borrowers to obtain better loan terms—such as lower interest rates or smaller down payments—to purchase, construct, improve, or refinance a home. VA typically pays lenders up to 25 percent of the outstanding mortgage balance if a borrower’s home is foreclosed upon. Those payments, net of fees paid by borrowers and recoveries by lenders, constitute the subsidy cost for the loan guarantees.[2] That subsidy cost is paid from mandatory appropriations and thus is recorded in the budget as direct spending.

Under current law, the rates for most of the fees that borrowers pay average about 2.3 percent of their loan amount; for loans guaranteed after June 9, 2034, that average will drop to about 1.2 percent. The bill would extend the higher rates through June 18, 2034. CBO estimates that extending the higher rates for such a short duration would not significantly change direct spending because most borrowers could delay their closing date to avoid paying the higher fee rates.

Spending Subject to Appropriation

In addition to requiring VA to provide opioid antagonists without a prescription, the bill would eliminate copayments for those medications. Copayments to VA are recorded as discretionary collections and decreases in those collections are classified as increases in spending subject to appropriation.

Under current law, veterans who are at high risk for overdose of a specific medication or substance can get opioid antagonists from VA without a copayment. Other veterans are exempt from all copayments because they have significant service-connected disabilities. Thus, CBO expects that very few veterans who will otherwise make copayments under current law would be exempt under the bill. On that basis, CBO estimates that waiving copayments for opioid antagonists would increase spending subject to appropriation by less than $500,000 over the 2026-2036 period.

Pay-As-You-Go Considerations

The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. The net changes in direct spending outlays that are subject to those pay-as-you-go procedures are shown in Table 1.

Increase in Long-Term Net Direct Spending and Deficits

CBO estimates that enacting H.R. 5999 would not increase net direct spending or on‑budget deficits in any of the four consecutive 10-year periods beginning in 2037.

Mandates

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.

Estimate Prepared By

Federal Costs: 
Noah Callahan (for veterans’ health care)
Paul Holland (for veterans’ home loans)

Mandates: Brandon Lever

Estimate Reviewed By

David Newman
Chief, Defense, International Affairs, and Veterans’ Affairs Cost Estimates Unit

Kathleen FitzGerald 
Chief, Public and Private Mandates Unit

Christina Hawley Anthony
Deputy Director of Budget Analysis

Estimate Approved By