October 19, 2021


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Briefing with Senior State Department Officials On U.S. Engagements at the United Nations and on the Margins of High-Level Week

34 min read

Office of the Spokesperson

Via Teleconference

SENIOR STATE DEPARTMENT OFFICIAL ONE:  Good evening, everyone, and thanks for joining us.  We want to take this opportunity to review today’s proceedings at the UN and on the margins of it, and also to preview tomorrow’s proceedings here in New York for Secretary Blinken.  We’ll do this call on background.  You can attribute what you hear to Senior State Department officials.  Just for your own knowledge, with us today is .  She will have some opening remarks and then we’ll be happy to take your questions.  So with that, I will turn it over to my colleague.

SENIOR STATE DEPARTMENT OFFICIAL TWO:  Thank you, .  All right, colleagues, it is great to be back in New York for the UN General Assembly High-Level Week, the Super Bowl of global diplomacy.  We’ve had some face-to-face meetings, we’ve had some virtual diplomatic engagement, and the Secretary is making the most of his four days here.

Today, in addition to accompanying the President to the General Assembly Hall for this morning’s remarks, he also attended the President’s meeting with Australian Prime Minister Morrison and held his own bilateral meetings with his Turkish and Brazilian counterparts.  While this afternoon’s meeting with Turkish Foreign Minister Cavusoglu went about an hour, the two of them of course discussed Afghanistan at length.  They also talked about Syria, and they had a relatively long conversation about the Caucasus – Armenia, Azerbaijan, Nagorno-Karabakh.

And over to for the Brazilian meeting, which I was not in.

SENIOR STATE DEPARTMENT OFFICIAL ONE:  The Secretary just wrapped up a good meeting with his Brazilian colleague.  The meeting went about 45 minutes, perhaps slightly longer.  There was a discussion there, an extended discussion, of climate, the need to raise our climate ambition around the world if we’re to meet the goals as we approach Glasgow.  There was a discussion of regional migration as well, and a note on the part of the Secretary that Brazil is – our relationship with Brazil is a vital one both in terms of its strategic and economic realm.  Our cooperation with Brazil – there was discussion of it both in the hemisphere and more broadly, especially as we prepare to work with Brazil as a member of the UN Security Council over the next couple years.

SENIOR STATE DEPARTMENT OFFICIAL TWO:  Great.  And tomorrow is going to be another action-packed day of diplomacy, starting with the Secretary’s joint meeting with five Central Asian partner countries – Kazakhstan, the Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan.  This is the C5+1 format, now in its fifth year.  It’s always been a valuable diplomatic platform to increase regional collaboration around a prosperous and secure Central Asia and to address common concerns, but it takes on added salience given the fact that many of these countries are direct bordering neighbors of Afghanistan, so lots to discuss there.  And they’ve also been strong partners in our evacuation efforts.

Other bilateral engagements for the Secretary tomorrow include a meeting with EU High Representative Borrell and Egyptian Foreign Minister Shoukry.  The Secretary will also have a pull-aside with UN President of the General Assembly Abdulla Shahid.  The president – the Secretary will also deliver remarks at the closing session of President Biden’s virtual COVID summit, which focuses on expanding and enhancing our shared efforts to defeat COVID-19.  The White House is obviously doing some more backgrounding on the summit goals.

And tomorrow afternoon the Secretary will attend a virtual G20 foreign ministerial hosted by the Italian chair of the G20 this year, focused on Afghanistan.  We very much appreciate Italy’s role as G20 president, and Foreign Minister Di Maio’s leadership in convening this important dialogue to discuss how to continue supporting the future of Afghan women and girls and their access to education.  That’s the particular focus of the G20, but I think we’ll probably talk about all aspects of the situation in Afghanistan.

Later in the day the Secretary will participate in a trilateral meeting with his foreign counterparts from the Republic of Korea and from Japan.  The Secretary and the foreign ministers will highlight the global scope of the U.S.-Japan-ROK cooperation based on shared values, as well as our commitment to preserving and promoting regional peace, stability, and prosperity in the Indo-Pacific.

Finally, the Secretary will join a P5 meeting with his counterparts from the UK, France, and China, and Russia.  So it’s been a very high – busy High-Level Week.  That last meeting, the P5, is hosted by the secretary-general of the UN, Guterres.

Over to

SENIOR STATE DEPARTMENT OFFICIAL ONE:  Great.  With that, we’ll be happy to take your questions.  Operator, if you want to repeat the instructions for asking a question.

OPERATOR:  Thank you.  If you would like to ask a question today, press 1 and then 0 on your telephone keypad, and also please wait to begin your question until your line has been confirmed to be open.  The command, once again, is 1 followed by 0.


OPERATOR:  That line is open.  Please, go ahead.

QUESTION:  Hi, thanks for doing this call.  Can I just follow up on a couple of things that you said?  , you’re mentioning – you talk about the Brazil bilat.  With so many countries here, what is the reason for picking Brazil?  Is there something specific you’re looking for them or that you think you can work with them on?  Climate – do you see any progress there in terms of the President’s climate goals?  And with COVID and Bolsonaro’s unique views on COVID, is that something that came up there?

And , I was noticing you mentioned in the Turkey bilat the Caucasus, Nagorno-Karabakh.  Could you elaborate on that a little bit more?  Was there some hope for some progress there, perhaps also the issue that Armenia has raised recently about Russian border troops?  Is that something that came up?

Thank you.

SENIOR STATE DEPARTMENT OFFICIAL ONE:  Thanks, Shaun.  So I’ll start on Brazil.  As I said in the opening remarks, the Secretary remarked at the outset of his meeting with his Brazilian counterpart that the strategic and economic relationship between our two countries is vital.  The cooperation implicates both regional interests but then well beyond with the UN Security Council angle and with the size and the heft of our economies and the role we play on the international stage.  That, of course, includes climate.

There was an extended discussion of climate.  The discussion on climate was probably the longest element of that session.  The Secretary made the point that when countries as large and when countries that are – that emit as much as our two countries do, when we make bold, ambitious goals that other countries take notice.  And so Brazil’s ability and willingness to raise its climate ambitions would not only be a net positive as we head towards Glasgow, but also the world would take notice and it would galvanize additional action as well.

There are other hemispheric challenges we face, including that of migration.  There was a discussion of migration and the ways in which we can work together on that challenge.  And then there was a discussion of deepening our economic ties as well.  There was a discussion of COVID.  Clearly, it is a priority of ours.  We know that – and the Secretary consistently makes the point that if Americans are to be safe, if people are to be safe anywhere, we need to tackle this everywhere.  And so there was a discussion of Brazil’s efforts to tackle the virus at home and to contribute to the global effort to confront the virus around the world.

I’ll turn it over to .

SENIOR STATE DEPARTMENT OFFICIAL TWO:  Great.  So I think you know that in the wake of the Armenia-Azerbaijan war earlier this spring, the U.S. has tried to be helpful in supporting a peace and reconciliation conversation between the two of them.  We participated in a swap of – we midwifed a swap of some demining maps that the Armenians turned over to the Azerbaijanis in the disputed territory for the release of some detainees.

So the question now becomes whether, with U.S. support, with other Minsk Group countries’ support, with Turkey’s support, we can do more to facilitate a de-escalation of tensions between the two, both along the border, with regard to remaining detainees, with regard to remaining mines, and then take some – see them – help them take some small steps which might lay the path towards a larger peace and reconciliation process.

So the Secretary made clear to Turkey, which has been very much involved in this and is a neighbor, that we are prepared to be helpful if we can be.  We are also at a level below the Secretary having bilateral meetings with the Armenians and the Azerbaijanis this week and making the same offer there.


OPERATOR:  Thank you.  That line is open.

QUESTION:  I’d like to go to Afghanistan.  I’m wondering, first of all, if you expect the Secretary to address at G20 what are his thoughts on how to deal with the Taliban now.  And the Taliban have written to the UN asking for credentials.  They want to speak at this General Assembly.  I understand the U.S. is on the Credentials Committee, so I wonder if you think that’s a good idea.

SENIOR STATE DEPARTMENT OFFICIAL TWO:  We do expect the Secretary will make an intervention at the G20.  I think you’ll recall that about two weeks ago he hosted a broad bilateral meeting of Afghanistan’s neighbors and stakeholders and likeminded with us along with Foreign Minister Maas when he was in Germany.  The G20 meeting will have some of the same participants but will also have a different selection of countries.

And from our perspective, it’s very important to ensure that we keep countries together in support of the principles that were in the UN Security Council resolution on Afghanistan with regard to international expectations of the Taliban: that they will continue to promote and allow free movement of people, that they will allow and support humanitarian assistance both by UN agencies and by NGOs, and that they will live up to commitments that they’ve made to counterterrorism, whether it’s coming from ISIS-K or whether it’s coming from al-Qaida.  So we have quite a bit to talk about to assess where we are in those commitments that the Taliban have made, and particularly now that we have an interim government in place.

Sorry, with regard to the Afghan request for credentials, as you said, Michele, there is a Credentials Committee.  We are on it.  It will take some time to deliberate, and so you will – we will obviously follow this issue closely and deliberate along with other members of the Credentials Committee.


QUESTION:  Hi there.

OPERATOR:  Your line is (inaudible).

QUESTION:  Yeah, hi.  Can you hear me?  Hello?

SENIOR STATE DEPARTMENT OFFICIAL ONE:  Go ahead, Matt.  We’ve got you.

QUESTION:  Yeah, okay.  Very brief:  What happened to the transatlantic Quad meeting that was supposed to be tomorrow – the UK, France, Germany, U.S.?

SENIOR STATE DEPARTMENT OFFICIAL TWO:  We did have a Quad at my level today.  I think that schedules got in the way of that at the ministerial level, but a lot of those countries are going to see each other in other formats both at the – they’ll all see each other at the G20 meeting and at least the P3 will all be part of the secretary-general’s P5 meeting tomorrow night.


OPERATOR:  Your line is open.

QUESTION:  Hi, thanks for doing this.  Hi, guys.  Thanks for doing this.  Any reaction to Raisi’s speech today?  Does it change your understanding of Iran’s view of the nuclear talks at all?

SENIOR STATE DEPARTMENT OFFICIAL ONE:  Thanks for that, Michael.  So we obviously took note of his speech.  I think what we’re going to be looking for is less in terms of rhetoric and more in terms of actions, what we see from the Iranians, including in terms of their willingness to re-engage in the Vienna context in the coming weeks.  We took note of the statement from the Ministry of Foreign Affairs regarding a potential timeframe there.  We continue to believe that we need to re-engage in the Vienna context as soon as possible.

The Secretary has consistently made the point that while we continue to believe that a mutual return to compliance with the JCPOA is manifestly in our interests and that it verifiably and permanently prevents Iran from ever obtaining a nuclear weapon, this is not an exercise that can go on indefinitely.  As the clock drags on, the advantages that the JCPOA originally conveyed are degraded as Iran continues to spin advanced centrifuges and engage in activity and conduct that is prohibited under the 2015 agreement.

So we will – the Secretary will have an opportunity to speak to and has had an opportunity to speak to some of his P5+1 counterparts this week.  There is consensus within the P5+1 context on this and we’ll be waiting to see what the Iranians are willing to do when it comes to Vienna going forward.

We’ll go to Humeyra Pamuk.

OPERATOR:  Thank you.  That line is open.

QUESTION:  Hello, hi.  Thank you for doing this.  I have two questions, but I just want to follow up on a couple of colleagues’ question as well.

So , can I – can we just clarify, is the transatlantic Quad meeting off now?  And you mentioned scheduling issues.  Does that have anything to do with the current sort of disagreements or, let’s call it, crisis between France and United States?

And piggybacking on that, we had asked earlier this week whether Secretary will have a bilateral with Le Drian.  We were told that the schedule was dynamic.  What is the latest?  Is there going to be a bilateral?

And since we have you today – because I don’t think we’ve gotten the chance to ask this to anyone in a briefing setting – how did that crisis came to where it is?  Was this like a miscalculation by the U.S.?  Was the State Department one way or the other blindsided by the White House and didn’t quite see that France would be very angry with this move?  And what are you planning now to (inaudible)?  Because it’s clear that they are waiting for some U.S. overtures.  Thank you.

SENIOR STATE DEPARTMENT OFFICIAL ONE:  Hey, Humeyra.  Just some of your questions – your last question in particular is, I think, beyond the scope of this call.  We’ll have other opportunities to address it.  But I’ll turn it over to my colleague to discuss the events today and tomorrow.

SENIOR STATE DEPARTMENT OFFICIAL TWO:  So just to say, as you know, the White House has made clear that President Biden expects to speak with President Macron relatively soon.  As I said earlier, we expect that Secretary Blinken will see Foreign Minister Le Drian both at the P5 ministerial tomorrow and the G20 is virtual, but they will certainly be in the room tomorrow at the P5 ministerial and have a chance to exchange views on a number of things.

With regard to whether we end up needing a quad or having a quad later in the week, as you said, schedules are always dynamic.  I think the question is going to be whether it’s needed.  And I would expect that the Secretary and the foreign minister will have a chance to exchange views at some point over the course of the week.

SENIOR STATE DEPARTMENT OFFICIAL ONE:  We will go to Jennifer Hansler.

OPERATOR:  That line is open.

QUESTION:  Hi, thank you so much for doing this.  On the Borrell meeting, who requested that meeting with whom?  Did that come about because of this crisis with France?  Borrell has said that they were not informed of the August deal ahead of time.

And then on the C5 meeting, are you looking for new particular commitments when it comes to Afghanistan from those countries?  Thank you.

SENIOR STATE DEPARTMENT OFFICIAL TWO:  I would say on the Borrell meeting, we had been planning a bilateral visit by the foreign minister to Washington sometime this fall, and I think that will go forward as well.  But there’s always a lot to talk about, so to have an exchange with him here is also very useful.  I think you know we have the Trade and Technology Council meeting next week with the EU.  We also met with the EU here at Deputy Secretary Sherman’s level and at political director level.  So those conversations are very dynamic, to use the word of the evening.


OPERATOR:  That line is open.

QUESTION:  Hi, thank you so much for having this.  I just wanted to ask, again, wondering if you have any clarity on whether there would be any bilateral interactions with Secretary Blinken or the French foreign minister at the UN or any – would Secretary Blinken visit Paris, would Minister Le Drian visit Washington anytime soon, or when we might have this long-delayed call with the two presidents?  Because some of us are wondering to what degree this is sort of a medium- to longer-term decline in relations with America’s oldest ally, as we so often call it.  Thanks.

SENIOR STATE DEPARTMENT OFFICIAL TWO:  I think we’ve been through this one a couple of times already in this round.  Watch this space.  The presidents are going to speak and the Secretary and foreign minister will have ample opportunity as well over the course of the week.  Thanks.


OPERATOR:  That line is open.

SENIOR STATE DEPARTMENT OFFICIAL ONE:  Barbara, do we have you?  Sounds like we may not have Barbara.  Let’s go to Joel Gehrke.

OPERATOR:  Joel Gehrke’s line is open.

QUESTION:  Hi, thank you for doing this and taking my question.  I just wanted to follow up on some of my colleagues’ – on this question of U.S.-EU relations and in the context of France.  The EU has put out that they have postponed – they wanted to postpone preparations for a meeting that was on Wednesday’s agenda, to prepare for the Trade and Technology Council.  It’s not – I’m not – one, can you confirm that, and are you concerned that this dispute with France then could in any way jeopardize or interfere with your ability to proceed with that Trade and Technology Council meeting?  Is that the same thing as the transatlantic Quad meeting that came off the agenda, apparently?

And then just on the Afghanistan side, I wonder what – if you could give any more clarity on the meeting tomorrow with Tajikistan and some of the other regional countries.  Obviously, Tajikistan has a history of support for Taliban opposition back – all the way back to the ‘90s.  I wonder if there’s any – is there going to be any conversation about providing humanitarian aid or perhaps even support for the opposition in Panjshir at the meeting tomorrow?

SENIOR STATE DEPARTMENT OFFICIAL TWO:  Just to say first on the EU, we do expect the meeting in Pittsburgh to go forward next week.  I would make a broader point here, which is the Trade and Technology Council is designed to do many things: obviously to coordinate global positions on trade and on technology and keeping the tech space open for democracies and freedom and working against its abuse by autocracies; but equally important, the Trade and Technology Council is a way of docking the U.S.-EU relationship more tightly into the Asia Pacific and talking about some of the trade concerns that we have – all of us – with the way China does business, our concerns about China’s approach to technology, et cetera.

So I would argue that for countries in the EU that we are hoping to involve more deeply in our Asia Pacific strategy, having the TTC is essential to that.  And we very much welcome the leadership that France has traditionally played in the Asia Pacific and that we have this vehicle, not just on the bilateral side but now on the multilateral side with the EU, to talk about all these issues and to strengthen the connection between what we’re trying to do in the transatlantic space to protect freedom and open, rules-based order and what we’re trying to do in the Indo-Pacific as well.

With regard to the C5, you know that – obviously Afghan – three of the countries in the C5 directly border Afghanistan.  All of them have had lots of issues to think about and lots of concerns with regard to migration, with regard to control of terrorism, with regard to their  borders.  A number of them have been helpful to us.  I think actually every single one of them has been helpful to us as we’ve tried to help citizens and Afghans at risk and LPRs get out of the country, whether it was directly or whether it was with refueling, et cetera.  So the neighborhood has changed dramatically, and so it’s a really key moment for us to concert views with those countries about how to strengthen security, how to strengthen our joint approach to the humanitarian issues, and to hear their views on what their neighborhood feels like and what they’re concerned about going forward.

SENIOR STATE DEPARTMENT OFFICIAL ONE:  Let’s go the line of Nike Ching.

QUESTION:  Thank you.  Can you hear me?

OPERATOR:  Your line is open.


QUESTION:  Yes, thank you.  , can I please ask about North Korea?  What is the U.S. looking for from the trilateral with Japan and Korea, especially after recent satellite images are showing North Korea is expanding a uranium enrichment plant at its main Yongbyon nuclear complex?  And separately, is there a U.S. reaction to Chinese leader Xi Jinping’s remarks, where he said there is a need to pursue dialogue over confrontation?  How likely is a meeting between President Biden and Xi Jinping on the margins of G20 summit?  Is there a hurdle for talks?  Thank you very much.

SENIOR STATE DEPARTMENT OFFICIAL TWO:  Well, so I guess I would say that the trilateral is well timed, given the missile tests that we’ve seen just last week, it’s a good opportunity to concert views in the wake of that.  I would say more broadly that the cadence of these trilateral meetings is increasing, and it’s proved to be a very effective mechanism for sharing views, concerting positions, both with regard to the DPRK but also with regard to the Indo-Pacific and China more – and China.  So I think it’ll be a useful meeting tomorrow.  And obviously, I have nothing to announce on a potential meeting between President Xi and President Biden.

SENIOR STATE DEPARTMENT OFFICIAL ONE:  We’ll take – we’ll try to take one final question again from Barbara Usher.  We’ll see if her line is working now.

QUESTION:  Can you hear me?


QUESTION:  Oh, fantastic.  Just to clarify on the question of the Taliban credentials, , you said the committee will take some time to deliberate.  Are you expecting it to take longer than the end of the – this UN General Assembly, in other words, so that the opportunity for the Taliban to speak would not come up either way?

And one other question with regards to the EU reaction to the – to France’s anger over the Australia deal, do you have a reaction to the comments made here with Borrell saying that the U.S. stood in solidarity with France and felt it was something that affected all Europeans, and Charles Michel saying there had been a clear lack of transparency and loyalty – in other words, that this was bigger than France?  Thank you.

SENIOR STATE DEPARTMENT OFFICIAL TWO:  Just to say that the Credentials Committee generally has taken some time.  I’m not going to predict how long it’s going to take this time.  I would note that the broader General Assembly goes on for some three months.  High-Level Week, obviously, is just this week, and I don’t expect this issue to be resolved within High-Level Week.  But – so watch this space.

I think in all of our conversations today with the EU, we’ve obviously been hearing them with regard to the concerns of their member state, which is absolutely natural.  But we’ve also been hearing them on their interest in continuing and deepening and broadening the dialogue that we have started intensively with them now on China and on collaboration that we can have with all the member states with regard to the Indo-Pacific.  So I think we’ve got a lot of good work we can do together and we’d like to move forward with it.

SENIOR STATE DEPARTMENT OFFICIAL ONE:  Great.  That concludes this evening’s call.  We, just for your planning, will plan to do a similar call tomorrow.  We will send around information regarding that tomorrow during the day.

As a reminder, this call was on background, attributable to senior State Department officials. And we will talk to you tomorrow.  Thank you very much.

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    The Department of Veterans Affairs (VA) estimates it will provide health care to 5.8 million patients with appropriations of about $41 billion in fiscal year 2009. It provides a range of services, including primary care, outpatient and inpatient services, long-term care, and prescription drugs. VA formulates its health care budget by developing annual estimates of its likely spending for all its health care programs and services, and includes these estimates in its annual congressional budget justification. GAO was asked to discuss budgeting for VA health care. As agreed, this statement addresses (1) challenges VA faces in formulating its health care budget and (2) issues surrounding the possibility of providing advance appropriations for VA health care. This testimony is based on prior GAO work, including VA Health Care: Budget Formulation and Reporting on Budget Execution Need Improvement (GAO-06-958) (Sept. 2006); VA Health Care: Long-Term Care Strategic Planning and Budgeting Need Improvement (GAO-09-145) (Jan. 2009); and VA Health Care: Challenges in Budget Formulation and Execution (GAO-09-459T) (Mar. 2009); and on GAO reviews of budgets, budget resolutions, and related legislative documents. We discussed the contents of this statement with VA officials.GAO's prior work highlights some of the challenges VA faces in formulating its budget: obtaining sufficient data for useful budget projections, making accurate calculations, and making realistic assumptions. For example, GAO's 2006 report on VA's overall health care budget found that VA underestimated the cost of serving veterans returning from military operations in Iraq and Afghanistan. According to VA officials, the agency did not have sufficient data from the Department of Defense, but VA subsequently began receiving the needed data monthly rather than quarterly. In addition, VA made calculation errors when estimating the effect of its proposed fiscal year 2006 nursing home policy, and this contributed to requests for supplemental funding. GAO recommended that VA strengthen its internal controls to better ensure the accuracy of calculations used to prepare budget requests. VA agreed and, for its fiscal year 2009 budget justification, had an independent actuarial firm validate savings estimates from proposals to increase fees for certain types of health care coverage. In January 2009, GAO found that VA's assumptions about the cost of providing long-term care appeared unreliable given that assumed cost increases were lower than VA's recent spending experience and guidance provided by the Office of Management and Budget. GAO recommended that VA use assumptions consistent with recent experience or report the rationale for alternative cost assumptions. In a March 23, 2009, letter to GAO, VA stated that it concurred and would implement this recommendation for future budget submissions. The provision of advance appropriations would "use up" discretionary budget authority for the next year and so limit Congress's flexibility to respond to changing priorities and needs. While providing funds for 2 years in a single appropriations act provides certainty about some funds, the longer projection period increases the uncertainty of the data and projections used. If VA is expected to submit its budget proposal for health care for 2 years, the lead time for the second year would be 30 months. This additional lead time increases the uncertainty of the estimates and could worsen the challenges VA already faces when formulating its health care budget. Given the challenges VA faces in formulating its health care budget and the changing nature of health care, proposals to change the availability of the appropriations it receives deserve careful scrutiny. Providing advance appropriations will not mitigate or solve the problems we have reported regarding data, calculations, or assumptions in developing VA's health care budget. Nor will it address any link between cost growth and program design. Congressional oversight will continue to be critical.
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  • Priority Open Recommendations: Social Security Administration
    In U.S GAO News
    What GAO Found In April 2020, GAO identified seven open priority recommendations for the Social Security Administration (SSA). Since then, SSA has implemented four of those recommendations by: (1) updating its system to ensure waivers for Disability Insurance overpayments over $1,000 are processed correctly; (2) taking steps to address Disability Insurance overpayments that result from the concurrent receipt of Federal Employees' Compensation Act benefits; (3) establishing an Enterprise Risk Management framework and council to address cyber risks in the context of other risks and their potential impact on SSA's mission; and (4) strengthening oversight of representative payees to help ensure they are managing beneficiary funds appropriately. In May 2021, GAO identified one additional open priority recommendation for SSA, bringing the total number to four. These recommendations involve the following areas: ensuring program integrity; and protecting vulnerable beneficiaries. SSA's continued attention to these issues could lead to significant improvements in government operations. Why GAO Did This Study Priority open recommendations are the GAO recommendations that warrant priority attention from heads of key departments or agencies because their implementation could save large amounts of money; improve congressional and/or executive branch decision-making on major issues; eliminate mismanagement, fraud, and abuse; or ensure that programs comply with laws and funds are legally spent, among other benefits. Since 2015 GAO has sent letters to selected agencies to highlight the importance of implementing such recommendations. For more information, contact Elizabeth Curda at (202) 512-4040 or curdae@gao.gov.
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  • COVID-19: Implementation and Oversight of Preparedness Strategies at Veterans Affairs Medical Centers
    In U.S GAO News
    What GAO Found Beginning in January 2020, the Veterans Health Administration (VHA) took actions to help the Department of Veterans Affairs medical centers (VAMC) prepare for COVID-19. VHA's Office of Emergency Management facilitated the development of VHA's COVID-19 Response Plan, which defined preparedness strategies for VAMCs to mitigate the effects of COVID-19. According to VHA, preparedness refers to the development of plans, resources, and capabilities to manage and recover from the effects of emergencies. Plans for the safety of staff and patients, identification of sufficient supplies and capacity, and coherent communication were among the identified strategies. VAMCs began implementing these strategies in February 2020. Officials from four selected VAMCs reported using similar approaches to implement VHA's preparedness strategies, such as developed plans for screening and testing; trained staff on personal protective equipment (PPE) use; identified the capability to expand beds in the event of a patient surge; conducted problem solving activities to identify gaps in response capabilities; counted PPE and calculated consumption rates; and communicated safety information to patients. VHA oversaw VAMCs' implementation of COVID-19 preparedness strategies by collecting data on the VAMCs' efforts and holding VHA-wide conference calls. VHA's Healthcare Operations Center (HOC) worked with Veterans Integrated Service Networks (VISN) to gather data from VAMCs on a daily basis. HOC Data Collection on COVID-19 Preparedness Strategies Implemented at VAMCs The VHA-wide conference calls included officials from VHA Central Office, VISNs, and VAMCs, among others, and focused on the data collected. Some topics discussed included the number of VAMC staff able to provide PPE training and VAMC plans to screen staff and patients for COVID-19. VHA-wide calls were also a way to discuss data collection challenges and for VAMCs and VISNs to share best practices. In addition to the preparedness issues in this report, GAO expects to continue examining VHA's actions to address COVID-19. Why GAO Did This Study VHA provides health care to more than 10 million veterans each year, offering a range of services at approximately 170 VAMCs nationwide. In January 2020, components of VHA's emergency management system began coordinating the agency's efforts to prepare for the COVID-19 pandemic so VAMCs could continue the delivery of services while maintaining the health and safety of patients and staff. The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report describes VHA efforts to prepare for COVID-19, including (1) how selected VAMCs implemented VHA's COVID-19 preparedness strategies; and (2) the steps VHA took to oversee VAMCs' implementation of preparedness strategies. GAO reviewed VHA plans, policies, and guidance related to COVID-19 preparedness, including VHA's COVID-19 Response Plan. GAO interviewed officials at four VAMCs, a nongeneralizable sample selected based on hospital complexity and geographic diversity, as well as officials from their associated VISNs. GAO also interviewed officials from VHA's Central Office, Office of Emergency Management, HOC, and other VHA offices. GAO provided a draft of this report to VA. In response, VA provided one technical comment, which was incorporated as appropriate. For more information, contact A. Nicole Clowers at (202) 512-7114 or clowersa@gao.gov.
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  • Prescription Drugs: Department of Veterans Affairs Paid About Half as Much as Medicare Part D for Selected Drugs in 2017
    In U.S GAO News
    GAO found that the Department of Veterans Affairs (VA) paid, on average, 54 percent less per unit for a sample of 399 brand-name and generic prescription drugs in 2017 as did Medicare Part D, even after accounting for applicable rebates and price concessions in the Part D program. GAO also found that 233 of the 399 drugs in the sample were at least 50 percent cheaper in VA than in Medicare, and 106 drugs were at least 75 percent cheaper. Only 43 drugs were cheaper in Medicare than in VA. The percent difference in price between the two programs was greater on average for generic drugs. Specifically, VA's prices were 68 percent lower than Medicare prices for the 203 generic drugs (an average difference of $0.19 per unit) and 49 percent lower for the 196 brand-name drugs (an average difference of $4.11 per unit). Average Per-Unit Net Prices Paid by Department of Veterans Affairs and Medicare Part D for Selected Drugs, 2017 Note: GAO's sample of 399 drugs included the top 100 brand-name and generic drugs in Medicare Part D in 2017, by: (1) highest expenditures; (2) highest utilization (by quantities dispensed); and (3) highest cost-per use. Per-unit prices are weighted to reflect differences in utilization in the two programs. Medicare prices reflect expenditures after accounting for rebates and other price concessions. While there are many factors that impact prices in the complex drug market, GAO identified several key program features that may contribute to the consistent price differential between VA and Medicare Part D. For example, Medicare's beneficiaries are divided among numerous prescription drug plans, which each negotiate drug prices with manufacturers. In contrast, VA is a single integrated health system with a unified list of covered drugs—thereby possibly strengthening its bargaining position when negotiating. In addition, VA has access to significant discounts defined by law, and can then negotiate further for lower prices. These discount prices are not available to Medicare Part D plans. GAO provided a draft of this product to HHS and VA for comment. Both agencies provided technical comments, which GAO incorporated as appropriate. In 2017, combined, Medicare Part D and VA accounted for approximately $105 billion in prescription drug sales—nearly one-third of total U.S. expenditures—and covered nearly 52 million individuals. The two programs use different methods to pay for prescription drugs. Medicare reimburses Part D plan sponsors, which in turn pay pharmacies to dispense drugs. VA primarily uses a direct purchase approach to acquire drugs from manufacturers. GAO was asked to examine differences in the amounts major federal programs paid for prescription drugs. This report: (1) compares average unit prices for prescription drugs in Medicare Part D to those in the VA; and (2) describes factors affecting prices in the two programs. GAO analyzed (1) CMS data for Medicare Part D payments to retail pharmacies as well as rebates and other price concessions Part D plans received and (2) VA drug purchasing data. These data were from 2017, the most recent data available at the time of GAO's analysis. To select a sample of drugs GAO identified the top 100 brand-name and 100 generic drugs in Medicare Part D in 2017 for three categories: (1) highest expenditure, (2) highest utilization, and (3) highest cost-per use. In total, this yielded 399 non-duplicate drugs (203 generic and 196 brand-name), which represented 44 percent of Medicare Part D spending in 2017. GAO compared weighted average unit prices for these drugs. GAO interviewed CMS and VA officials, and reviewed academic and government reports to understand factors that may affect prices in the two programs. For more information, contact John Dicken at (202) 512-7114 or dickenj@gao.gov.
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