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). The VHA is also a provider of 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 out-of-pocket costs 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, Congress passed the Veterans Access, Choice and Accountability Act of 2014 ( P.L. 113-146 as amended by P.L. 113-175 and P.L. 113-235 ). 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 healthcare by hiring more physicians and staff and to improve VA's physical infrastructure. These amounts are not reflected in the tables of this report nor is it discussed in the legislative developments pertaining to the FY2015 VHA budget. In FY2014, there were approximately 21.9 million living veterans in the nation whose service ranged from World War II, Korea, Vietnam, the Gulf War (which includes Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND)) and the intervening periods. Of this number approximately 9.1 million were estimated to be enrolled in the VA health care system (see Table 1 ). From FY2011 through FY2014 the total number of enrollees has increased by 6.3%. Of the total number of enrolled veterans in FY2014, VA anticipated treating approximately 5.9 million unique veteran patients (see Table 2 ). For FY2015, VHA estimates that it will treat about 6 million unique veteran patients, and of these, VA anticipates treating more than 757,000 Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans. In FY2015, OEF, OIF, and OND patients would represent approximately 11.2% of the overall patients served by the VA. VHA also provides medical care to certain non-veterans; in FY2015 this population is expected to increase by more than 14,000 patients over the FY2014 level. In total, including non-veterans, it is estimated the VHA will treat nearly 6.7 million patients in 2015, a slight increase of 1.9% over the number of patients treated in FY2014 (see Table 2 ). Between FY2011 and FY2015, the number of patients treated by VA has grown by 9.3%. The total number of outpatient visits, including visits to Vet Centers, reached 91.7 million during FY2013 and is projected to increase to approximately 94.6 million in FY2014 and 97.2 million in FY2015. 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 FY2014 VHA budget. The report ends with a section discussing recent legislative developments pertaining to the FY2015 VHA budget. In order 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 comprise 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; and the Consolidated Appropriations Act, 2014 ( P.L. 113-76 ) provided advance appropriations for FY2015. The Consolidated and Further Continuing Appropriations Act, 2015 ( H.R. 83 ; P.L. 113-235 ) provides advance appropriations for FY2016. Additionally, 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. This authorizes advance appropriations for three mandatory VA programs within the Veterans Benefits Administration (VBA): compensation and pensions, readjustment benefits, and veterans insurance and indemnities. Beginning with the FY2016 MILCON-VA Appropriations bill, those accounts would receive advance appropriations for FY2017 in addition to the three VHA accounts that are already authorized to receive advance appropriations. Under current budget scoring guidelines, advance appropriations of budget authority are scored as new budget authority in the fiscal year in which the funds become newly available for obligation, and not in the fiscal year the appropriations are enacted. Therefore, throughout the funding tables of this report, advance appropriations numbers are shown under the label "memorandum" and in the corresponding fiscal year column. For example, the Consolidated and Further Continuing Appropriations Act, 2015 ( H.R. 83 ; P.L. 113-235 ) provides advance appropriations for the medical services, medical support and compliance, and medical facilities accounts for FY2016. Funding shown for FY2015 does not include advance appropriations provided in FY2015 by P.L. 113-235 for use in FY2016. Instead, the advance appropriation provided in FY2015 for use in FY2016 is shown in the memorandum in the FY2016 column. The VA budget includes both mandatory and discretionary funding. Mandatory accounts fund disability compensation, pensions, vocational rehabilitation and employment, education, life insurance, housing, and burial benefits (such as graveliners, outer burial receptacles, and headstones), among other benefits and services. Discretionary accounts fund medical care, medical research, construction programs, information technology, and general operating expenses, among other things. Appendix B provides enacted appropriations from FY1995 to FY2014 for the VA, including all three administrations that compose the VA: VBA, VHA, and NCA. Figure 1 provides a breakdown of FY2014 budget allocations for both mandatory and discretionary programs.