The Department of Veterans Affairs (VA) provides a range of benefits and services to veterans who meet certain eligibility rules; these benefits include medical care, disability compensation and pensions, education, vocational rehabilitation and employment services, assistance to homeless veterans, home loan guarantees, administration of life insurance as well as traumatic injury protection insurance for servicemembers, and death benefits that cover burial expenses. The VA carries out its programs nationwide through three administrations and the Board of Veterans Appeals (BVA). The Veterans Benefits Administration (VBA) is responsible for, among other things, providing compensation, pensions, and education assistance. The National Cemetery Administration (NCA) is responsible for maintaining national veterans' cemeteries; providing grants to states for establishing, expanding, or improving state veterans' cemeteries; and providing headstones and markers for the graves of eligible persons, among other things. The Veterans Health Administration (VHA) is responsible for health care services and medical and prosthetic research programs. The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through the nation's largest integrated health care system. Inpatient and outpatient care are also provided in the private sector to eligible dependents of veterans under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). In addition, the VHA provides health care education and training for physician residents and other health care trainees. The other statutory missions of VHA are to serve as a contingency backup to the Department of Defense (DOD) medical system during a national security emergency, and to provide support to the National Disaster Medical System and the Department of Health and Human Services as necessary. In general, eligibility for VA health care is based on previous military service, presence of service-connected disabilities, and/or other factors. Veterans generally must enroll in the VA health care system to receive medical care. Once enrolled, veterans are assigned to one of eight categories (see Appendix A ). It should be noted that in any given year, not all enrolled veterans obtain their health care services from the VA. While some veterans may rely solely on the VA for their care, others may receive the majority of their health care services from other sources, such as Medicare, Medicaid, private health insurance, and the military health system (TRICARE). VA-enrolled veterans do not pay premiums or enrollment fees to receive care from the VA; however, they may incur some out-of-pocket costs, such as copayments for VA care related to conditions that are not service-connected. In response to the crisis of access to medical care at many VA hospitals and clinics across the country reported in 2014, Congress passed the Veterans Access, Choice, and Accountability Act of 2014 ( P.L. 113-146 as amended by P.L. 113-175 , P.L. 113-235 , P.L. 114-19 , and P.L. 114-41 ). On August 7, 2014, President Obama signed the bill into law. The act, as amended, makes a number of changes to programs and policies of the VHA that aim to increase access and lower wait times for veterans who seek care at VA facilities. Among other things, the act establishes a new program (the Veterans Choice Program) that would allow the VA to authorize care for veterans outside the VA health care system if they meet certain criteria. Congress also provided mandatory funding for the Choice Program, with a total of $10 billion over three years (through 2017). In addition, Section 801(a) of the Choice Act provided an additional mandatory funding of $5 billion to increase veterans' access to health care by hiring more physicians and staff and to improve VA's physical infrastructure. Although these mandatory funds are not part of the regular annual appropriations provided in the MILCON-VA appropriations bill and not shown in the tables of this report, these funds are in addition to the funds provided in the Consolidated and Further Continuing Appropriations Act, 2015 ( H.R. 83 ; P.L. 113-235 ), and the House-passed FY2016 MILCON-VA appropriations bill and the Senate-passed amounts in its version of the FY2016 MILCON-VA appropriations bill. For more details on the VHA's request to Congress to authorize the use of approximately $3.3 billion provided for the Veterans Choice Fund (Section 802 of P.L. 113-146 , as amended) for Veterans' Care in the Community programs, including up to $500 million for Hepatitis C pharmaceutical expenses, and Congress's passage of the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 ( H.R. 3236 ; P.L. 114-41 ), see the " FY2015 VHA Budget Shortfall " section below. In FY2016, the VA estimates that there will be approximately 21.4 million living veterans who served during World War II, Korea, Vietnam, and the Gulf War (which includes Operation Desert Shield/Operation Desert Storm and Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn [OEF/OIF/OND]), along with those who served in various other military operations and in peacetime. Of this number, approximately 9.4 million are estimated to be enrolled in the VA health care system (see Table 1 and Table 2 ) in FY2016. Table 1 provides the total living veteran population, the number of veterans enrolled in the VA health care system, and the number of veteran and non-veteran patients (such as certain dependents of veterans) for each year from FY2000 through FY2016 (note that FY2015 and FY2016 are estimates). As shown in Table 1 , between FY2000 and FY2016, the total veteran population decreased by 14% and the number of veterans enrolled in the VA health care system increased by 90.1%, from about 4.9 million enrollees to approximately 9.4 million enrollees. Furthermore, compared with the total living veteran population, the proportion of veterans enrolled in the VA health care system increased from 18.5% in FY2000 to 44% in FY2016. Table 2 provides the unique veteran enrollees, arranged by priority group from FY2012 through FY2016. For FY2016, VHA estimates that it will treat about 6.2 million unique veteran patients; of these, VA anticipates treating more than 844,000 Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans (see Table 3 ). In FY2016, OEF, OIF, and OND patients would represent approximately 12.3% of the overall patients served by the VA (see Table 3 ). Between FY2012 and FY2016, the number of unique veteran patients treated by the VA will have grown by 9%. The VHA also provides medical care to certain non-veterans; in FY2016, this population is expected to increase by more than 11,000 patients over the FY2015 level. In total, including non-veterans, it is estimated the VHA will treat nearly 6.9 million patients in FY2016, a slight increase of 1.8% over the number of patients treated in FY2015 (see Table 3 ). Between FY2012 and FY2016, the number of patients (both veteran and non-veteran) treated by the VA will have grown by 8.9%. The rest of this report focuses on appropriations for VHA. It begins with a brief overview of VHA's budget formulation, a description of the accounts that fund the VHA, and a summary of the FY2015 VHA budget. The report ends with a section discussing recent legislative developments pertaining to the FY2016 VHA budget. To understand annual appropriations for the Veterans Health Administration (VHA), it is essential to understand the role of advance appropriations. In 2009, Congress enacted the Veterans Health Care Budget Reform and Transparency Act of 2009 ( P.L. 111-81 ), authorizing advance appropriations for three of the four accounts that compose the VHA: medical services, medical support and compliance, and medical facilities. The fourth account, the medical and prosthetic research account, is not funded with an advance appropriation. P.L. 111-81 also required the Department of Veterans Affairs to submit a request for advance appropriations for VHA with its budget request each year. Congress first provided advance appropriations for the three VHA accounts in the FY2010 appropriations cycle; the Consolidated Appropriations Act, 2010 ( P.L. 111-117 ), provided advance appropriations for FY2011. Subsequently, each successive appropriation measure has provided advance appropriations for the VHA accounts: the Department of Defense and Full-Year Continuing Appropriations Act, 2011 ( P.L. 112-10 ), provided advance appropriations for FY2012; the Consolidated Appropriations Act, 2012 ( P.L. 112-74 ), provided advance appropriations for FY2013; the Consolidated and Further Continuing Appropriations Act, 2013 ( P.L. 113-6 ), provided advance appropriations for FY2014; the Consolidated Appropriations Act, 2014 ( P.L. 113-76 ), provided advance appropriations for FY2015; and the Consolidated and Further Continuing Appropriations Act, 2015 ( H.R. 83 ; P.L. 113-235 ), provided advance appropriations for FY2016. In addition, the Consolidated and Further Continuing Appropriations Act, 2015 ( H.R. 83 ; P.L. 113-235 ), amended 38 U.S.C §117 and included three more accounts to the Advance Appropriations list of accounts. Currently, three mandatory VA accounts exist under the Veterans Benefits Administration (VBA): compensation and pensions, readjustment benefits, and veterans insurance and indemnities are authorized to receive advance appropriations.