FIGURE 6-1 VA organizational chart for tobacco-control responsibilities.

FIGURE 6-1 VA organizational chart for tobacco-control responsibilities.

SOURCE: Adapted from VA (2008c).

VHA is a discretionary program and thus relies on annual budget appropriations from Congress. The number of veterans enrolled in VA health care grew from 4.18 million in 1999 to 7.42 million in 2004, and VA’s medical budget grew from about $20 billion in 1999 to about $28 billion in 2004 (Congressional Budget Office, 2005). If, in a given year, VA does not have sufficient funds to care for all enrollees, care is allocated to higher-priority groups first; when necessary, VA can freeze enrollment of veterans in lower-priority groups. The Congressional Budget Office notes that only a small fraction of eligible veterans are enrolled in the VA health-care system; about 20% of veterans in priority groups 7 and 8 were enrolled in 2004 (Congressional Budget Office, 2005). Many veterans are enrolled in private health-insurance programs through their employers or receive Medicare or Medicaid; some veterans have no insurance but have not enrolled in the VA system. Over 78% of



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