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The omnibus bills then can be shaped by final compromises between the two chambers and passed relatively quickly, often by voice vote, so lawmakers can move on to other late, more politically sensitive business.
Standing athwart those plans, however, is Sen. Tom Coburn, R-Okla., a family physician whose top goal as a lawmaker has been to slow the rising tide of debt caused, he says, by colleagues who are willing to pass or spend whatever is necessary to assure their re-election.
Coburn frequently uses his prerogative as a senator to put a hold on bills -- in this case a $3.7 billion packet of health care initiatives called the Caregivers and Veterans Omnibus Health Services Act of 2009 (S. 1963).
The bill's centerpiece is unprecedented support for family caregivers of severely wounded veterans, those injured since the Sept. 11, 2001, terrorist attacks. The caregivers would be paid a stipend based on hours and level of care. The Department of Veterans Affairs would ensure caregivers are properly trained and have their own medical coverage that includes stress counseling, if needed. The VA also would pay for replacement caregivers when family members seek respite from their care obligations.
The idea is to give more severely wounded veterans an option other than institutional care.
"This legislation forges a new paradigm of long-term care for our severely wounded warriors, one that acknowledges and fully supports the vital role of the family caregiver" in successful rehabilitation, leaders of 21 veterans' groups said in an Oct. 21 letter urging passage of the bill.
But Coburn has refused to allow it to come to a floor vote. His spokesman, John Hart, said the senator's biggest concern is that the Senate doesn't intend to pay for the bill with an offset of current spending or higher taxes, so its passage will add to annual budget deficits and the national debt.
Coburn "believes strongly if we don't start paying for things, we're not going to have a country left to defend," Hart said. "He says we are waterboarding the next generation with debt and somebody has to stand up and say, 'Let's cut it out.' "
The Senate Veterans Affairs Committee acknowledges that money hasn't been found to cover at least $2.8 billion of the bill's $3.7 billion projected cost over the next five years, including money for the caregiver provisions, which would total $1.7 billion through fiscal 2014.
But Sen. Daniel Akaka, D-Hawaii, chairman of the committee, argues that the Iraq and Afghanistan wars also haven't been "paid for" and proper care of wounded veterans is just another necessary cost of war.
Another reason Coburn blocks the bill, Hart said, is because it isn't fair to extend caregiver benefits to those wounded in Iraq and Afghanistan but not to those severely injured in the Persian Gulf War, Vietnam or earlier conflicts.
Finally, Coburn believes the VA isn't "making smart use of existing benefits, and therefore avoiding duplication," Hart said. "This is legislation very popular for politicians to put forward for Veterans Day. But we need to produce a higher quality of care rather than press releases."
He said Coburn will introduce alternative legislation because he supports the goals of the bill.
A senator can't delay action on a bill indefinitely. It's effective only when leadership seeks passage of popular bills by unanimous consent rather than by scheduling time-consuming floor debate. To get around Coburn's hold,Majority Leader Harry Reid has placed S. 1963 on the Senate calendar, which could mean up to 60 hours of debate during which Coburn can make his points publicly to colleagues and C-Span cameras.
SURVIVOR BENEFIT UPDATE
Last week's column on the Survivor Benefit Plan used analysis from the think tank CNA as presented in a September memo to the deputy commandant of the Marine Corps. After several readers questioned those figures on Survivor Benefit Plan costs and benefit, CNA analyst Anita Hattiangadi reviewed the material and found two significant errors.
In the example of a typical 40-year-old military retiree who dies at age 65, he will have paid a total of $47,703 in survivor benefit premiums, not $62,000. What the $62,000 actually represents is the most premiums the retiree would have to pay regardless of when he dies, Hattiangadi said.
Also, the $401,897 figure given for total payments that a retiree's widow would receive if she were to live just seven years past his death, until age 70, was incorrect. The correct amount is $241,000. The larger figure should have been labeled by CNA as total survivor benefits paid to the 63-year-old surviving spouse if she lived to age 85, her typical life expectancy.
Hattiangadi said her "main point still holds: SBP is a great deal for service members and their families." She referred to a more thorough cost-benefit analysis and its relative value prepared by the Defense Department's Office of the Actuary. Find that analysis at www.actuary.defense.gov/program/sbpsubsidy09.xls.
