[Senate Hearing 109-217]
[From the U.S. Government Publishing Office]
S. Hrg. 109-217
PENDING HEALTH CARE RELATED LEGISLATION
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
JUNE 9, 2005
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
______
U.S. GOVERNMENT PRINTING OFFICE
21-023 WASHINGTON : 2006
_____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800
Fax: (202) 512�092250 Mail: Stop SSOP, Washington, DC 20402�090001
COMMITTEE ON VETERANS' AFFAIRS
LARRY CRAIG, Idaho, Chairman
ARLEN SPECTER, Pennsylvania DANIEL K. AKAKA, Ranking Member,
KAY BAILEY HUTCHISON, Texas Hawaii
LINDSEY O. GRAHAM, South Carolina JOHN D. ROCKEFELLER IV, West
RICHARD BURR, North Carolina Virginia
JOHN ENSIGN, Nevada JAMES M. JEFFORDS, (I) Vermont
JOHN THUNE, South Dakota PATTY MURRAY, Washington
JOHNNY ISAKSON, Georgia BARACK OBAMA, Illinois
KEN SALAZAR, Colorado
Lupe Wissel, Majority Staff Director
D. Noelani Kalipi, Minority Staff Director
C O N T E N T S
----------
June 9, 2005
SENATORS
Page
Craig, Hon. Larry E., U.S. Senator from Idaho.................... 1
Akaka, Hon. Daniel K., U.S. Senator from Hawaii.................. 3
Salazar, Hon. Ken, U.S. Senator from Colorado.................... 4
Murray, Hon. Patty, U.S. Senator from Washington................. 6
Obama, Hon. Barack, U.S. Senator from Illinois................... 7
Rockefeller, Hon. John D. IV, U.S. Senator from West Virginia.... 8
Thune, Hon. John, U.S. Senator from South Dakota................. 54
Prepared statement........................................... 55
WITNESSES
Nicholson, Hon. R. James, Secretary, U.S. Department of Veterans
Affairs........................................................ 9
Prepared statement........................................... 11
Mooney, Donald, Assistant Director, Veterans Affairs and
Rehabilitation, The American Legion............................ 24
Prepared statement........................................... 25
Cullinan, Dennis M., Director, National Legislative Service,
Veterans of Foreign Wars of the United States.................. 31
Prepared statement........................................... 32
Atizado, Adrian, Assistant National Legislative Director,
Disabled Veterans.............................................. 36
Prepared statement........................................... 37
Blake, Carl, Associate National Legislative Director, Paralyzed
Veterans of America............................................ 43
Prepared statement........................................... 44
Jones, Richard National Legislative Director, AMVETS............. 48
Prepared statement........................................... 49
APPENDIX
Response to written questions submitten by Hon. Daniel K. Akaka
to James R. Nicholson.......................................... 59
PENDING HEALTH CARE RELATED LEGISLATION
----------
THURSDAY, JUNE 9, 2005
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The committee met, pursuant to notice, at 10:06 a.m., in
room SR-418, Russell Senate Office Building, Hon. Larry Craig
(chairman of the committee) presiding.
Present: Senators Craig, Thune, Akaka, Rockefeller, Murray,
Obama, and Salazar.
OPENING STATEMENT OF HON. LARRY CRAIG, U.S. SENATOR FROM IDAHO
Chairman Craig. Good morning everyone and welcome to the
committee. The Senate Committee on Veterans' Affairs will be in
order.
Today, the committee meets to receive testimony on several
legislative proposals that have been introduced by Senators
during the first session of the 109th Congress. We have a total
of 10 items on the agenda today. All of the bills focus on
changes in VA's health care system. They include four bills
from the Ranking Member, Senator Akaka, three bills from
Senator Salazar, one from Senator Obama, and one bill from
Senator Specter. Last, and I certainly hope not least,
legislation that I have introduced.
I am very pleased that the Secretary of Veterans Affairs,
Jim Nicholson, is here this morning to offer VA's views. And I
want to welcome the veterans service organizations as well. I
understand we had some difficulty providing complete language
from some of the bills and because of that the witnesses may be
unable to comment fully on all of today's agenda. I certainly
hope that the witnesses will make every effort to follow up as
quickly as possible with their views so that we might have them
and they will become a part of the committee's record. It is
important that we know the Administration's view about
legislation and what our veterans themselves also think about
these individual legislative proposals.
As I mentioned, I have one bill on today's agenda, S. 1182.
I outlined all of the provisions of the legislation in great
detail in my statement to the Senate when I introduced the
measure so I will not take up a lot of the committee's time
this morning to restate what I have said, but I do want to take
just a moment to highlight some of the important aspects of the
bill.
S. 1182 offers a few important policy markers that I
believe this committee and Congress must discuss and grapple
with during the 109th Congress. The first of these is the
provision of long-term care for our veterans. In S. 1182 I
propose to remove from the law the so-called capacity
requirement that VA maintain the same number of long-term care
beds as it had in operation in 1998. I raise this provision to
my colleagues' attention because I want to make it clear that I
am not suggesting that VA should abandon its institutional
long-term care program. Instead, I view this proposal as the
first step in fostering a discussion about how we can develop a
rational, sustainable and workable program for long-term care
for our veterans that focuses on choices and options rather
than beds and buildings. Of course in saying that, it should
also be pretty clear that the current statutory mandate is not,
in my opinion, a rational, workable program.
I welcome all of my colleagues' views on this discussion. I
know we share a desire to ensure that the best services be
available to our veterans. We also share a desire to make
certain that the resources we devote to the health care system
are spent as effectively as possible with no dollar wasted. I
hope we can move closer toward those goals in VA's long-term
care program.
Second, I want to point out that the provision in S. 1182
would allow VA to provide or pay for the first few days of
hospital care for newborn babies of women veterans who give
birth under VA care. VA claims to offer a comprehensive package
of health care services to enrolled veterans. In my humble
opinion, because the package does not offer any coverage for a
newborn child it is not a comprehensive package for our women
veterans. These brave women make up an increasing part of our
military force and the military is changing in many ways to
reflect this new reality. VA must do the same. I hope this
provision will move us forward in that goal.
Finally, I want to mention the section of S. 1182 that
makes improvements in VA's mental health programs. I know that
many of you on this committee and in the audience have concern
about returning troops and their need for mental health
services. To that end, there have been a number of proposals
put forward by Senators and Representatives to deal with this
issue. All of them have the best intentions in mind.
My approach to this important issue is consistent with my
belief that Congress should not micromanage the VA's care
system. In fact over the past few years, largely on its own
initiative, VA has become one of the Nation's best health care
systems. So my legislation sets forth a few areas which I
believe VA can expand and improve on its past successes in the
provisions on mental health services. I attach a reasonable
amount of money to the effort to make those improvements and I
intend to monitor the progress closely from the committee. I
hope other Members will join me in this approach so we can make
real and necessary improvements while at the same time not
trying to over manage VA's clinical care program to the
detriment of other important needs.
Let me stop there and turn to our Ranking Member first who
has several pieces of legislation that he may wish to speak
about this morning in his opening comments, and then I will
turn to the balance of the committee. With that, let me turn to
Senator Akaka.
OPENING STATEMENT OF HON. DANIEL K. AKAKA,
U.S. SENATOR FROM HAWAII
Senator Akaka. Thank you very, Mr. Chairman. Again I want
to reiterate my pleasure in working with you on this committee
and your staff as well. I feel that we have made tremendous
progress thus far, and of course, we need so much more
together. I want to thank you for this hearing and welcome our
good friends, Secretary Nicholson and Undersecretary Perlin and
General Counsel McClain, as well as our veterans service
organizations who are here.
As we have a full legislative agenda before us today I want
to take just a moment here. Over the last few months I have
introduced several pieces of legislation. They share a common
theme. The goal of each is to make sure that returning service
members get the care they need while continuing to improve care
for veterans already in the system. First is legislation to
allow a full 5 years of VA health coverage to returning service
members without bureaucratic hassles and stringent eligibility
rules. This can further the seamless relationship we talk about
of military personnel from active duty to VA.
Today, any active duty service member who is discharged or
separates from active duty following deployment to their Iraqi
theater of combat, even Reservists or Guard who stand down but
remain on duty, will be immediately eligible for VA health care
for a 2-year period. There are good reasons to give returning
service members more than just 2 years. Most notably, it is
clear that 2 years may not be enough time for symptoms related
to PTSD to manifest. Even if symptoms present in the 2-year
timeframe, it might be some time before a service member
decides to seek care. VA opposes this legislation on the
grounds that returning veterans could enter the system like
other veterans. Looking at the proposals in the President's
budget and the decision to cut middle income veterans out of
the system in 2003, I am not as confident and do not want to
take that chance.
We also have legislation before us to specifically address
mental health. I truly believe that VA mental health is in
jeopardy due to budget constraints. Increased demand and flat
line budget increases over the past few years have literally
starved the system. The demand is about to grow. Experts have
conservatively estimated that up to 20 percent of men and women
who are currently serving in Iraq and Afghanistan will require
treatment for a mental illness health issue.
Congress has already recognized the merits of all
specialized programs, including mental health. As such, we
enacted legislation that required VA to retain its ability to
provide services at the levels in place in 1996. Unfortunately,
the VA was not required to adjust this figure for inflation.
Quite obviously, using 1996 dollars in 2005 is not working. As
we are on the precipice of burgeoning demand for care we need
to be talking about real dollars, not 1996 dollars, to get a
true sense of VA's capacity to care for veterans with mental
health needs.
Mr. Chairman, I look forward to working with you on the
days ahead to move the committee's agenda forward, and today I
look forward to the views of our witnesses. Thank you very
much, Mr. Chairman.
Chairman Craig. Senator Akaka, thank you very much for that
opening statement and those pieces of legislation.
Now let me turn to Senator Salazar. The Senator has
introduced three pieces of legislation that are on the agenda
today for hearing. Ken, please proceed.
OPENING STATEMENT OF HON. KEN SALAZAR, U.S. SENATOR FROM
COLORADO
Senator Salazar. Thank you very much, Chairman Craig and
Senator Akaka for putting together this hearing. Thank you,
Secretary Nicholson and Undersecretary Perlin and General
Counsel McClain for being here as well, and all the members of
the veterans service organizations who are here today.
I want to start out by commenting on what I see as a
positive development here in Washington, DC. In my short time
here in Washington I have seen how the poison of partisan
politics can slow down the process on important legislation for
the people of our country. People in Colorado and across the
country are rightly concerned that Congress is sometimes more
interested in partisan infighting than in working together to
make their lives better. This committee, however, Mr. Chairman,
under your leadership I believe is an exception. Members in
this committee do have some important policy differences and
the majority and minority do have different approaches for
fixing some of the problems that our veterans face. But we do
share much more in common than many realize.
We both recognize that the VA is under funded and facing
bigger workloads every year. We recognize that the VA needs to
do more to improve mental health care. We believe that there
are many pockets of rural America where there is not enough
access to veterans health care. We share outrage that hundreds
of thousands of veterans are homeless every night. We see the
need to improve outreach at vet centers to make life easier for
veterans returning from Iraq and Afghanistan, and to extend low
price prescription drugs to more veterans. There is much in
that common agenda.
We will discuss a number of important pieces of legislation
today. Senator Craig's bill has a number of very good
provisions. I would like to see some changes in this bill,
including the VA's nursing home capacity requirements and look
forward to working with you on that legislation. Senator Akaka
has introduced a number of important bills, including one I am
proud to co-sponsor which will improve mental health care
across the spectrum. I urge the committee to pass this
legislation sponsored by Senator Akaka. I also urge the
committee to review and approve Senator Obama's homeless
veterans bill and to embrace the goals of Senator Specter's
prescription drug bill.
I want to thank Senator Craig and Akaka for adding three
simple but straightforward and important bills that I have
introduced to help improve care for rural veterans, expand
services for blinded vets, and to push the VA on its strategic
planning for long-term care. These are three bills that are
roundly supported by the VSO community. They will improve the
lives of thousands of veterans, they are fiscally responsible,
and we can afford them now.
First, let me speak for a minute about Senate bill 1191,
the Vets Ride Act bill for rural vets. This bill would provide
critically needed transportation services in remote, rural
pockets of the country by having the VA partner with veterans
service organizations and State veterans service offices. In
Colorado, the American Legion has partnered with Routt County
State veteran service officers to fulfill this gap and provide
transportation options to veterans across northwest Colorado.
They rent vans, pick up elderly vets and drive them to Grand
Junction to the VA medical center and put together what is
essentially a 300-mile round trip to help these veterans.
Such ad hoc arrangements have developed all over the
country. Although they have community support, many of these
travel arrangements suffer from chronic under funding. This is
an area where a relatively small amount of Federal investment
can result in significantly better care for our Nation's rural
veterans. I urge this committee to support my bill to create a
small grant program to support VSOs and State officials through
this vet ride program.
Second, the blind vets, Senate bill 1190, the Blinded
Veterans Continuum of Care Act improves care for blinded
veterans by increasing the number of outpatient specialists at
VA medical centers. This is another area where a relatively
small Federal investment can make a major difference in the
quality of life for veterans. There are 135,000 blinded
veterans, including 1,400 in Colorado today. For these
veterans, the right type of expert long-term care can mean the
difference between being imprisoned at home, unable to work,
and living independent, rewarding lives. It is literally a
difference between night and day.
In 1996, the VA introduced blind rehabilitation outpatient
specialists at a small number of facilities. These programs
offer training with living skills, mobility, and technology.
They offer outpatient and in-home care. They provide pre-
screening and follow-up care for blind rehabilitation centers.
While the program has grown, there are still not enough of them
to meet the demand. The bill I propose would expand this
successful program and ensure that thousands more blind
veterans have the services they need.
Finally, Mr. Chairman, Senate bill 1189 on long-term care
would require the VA to publish its strategic plan for long
term within the 6 months. Last month at a hearing of this
committee, Undersecretary Perlin and Members of this committee
and myself had an ongoing dialog about the vision for long-term
care that Dr. Perlin so eloquently stated. I believe we need to
move forward and put that vision into a strategic plan.
The CARES Commission recommended that VA develop a
strategic plan for long-term care. More than a year later I
know that the VA is still working on that plan, and I believe
making progress. My bill simply sets a deadline. It also
includes some reasonable but critical requirements on that
plan. For instance, the plan, I believe, should include cost
and quality analysis of the entire spectrum of care for
veterans. A comprehensive plan will not only help the VA but
also help Congress in its oversight of the important challenge
of long-term care for our veterans.
I thank you again, Chairman Craig, for your leadership and,
Senator Akaka, for your participation in leadership of this
committee. Thank you.
Chairman Craig. Ken, thank you for those explanations of
your legislation.
Senator Murray, do you have any opening comments?
OPENING STATEMENT OF HON. PATTY MURRAY, U.S. SENATOR FROM
WASHINGTON
Senator Murray. I do. Thank you very much, Mr. Chairman,
and thank you to all of our panelists for being here today to
testify on these important pieces of legislation.
Mr. Chairman, I really share my colleagues' concern
regarding the need for increased access to health care for our
American veterans and I am really disappointed that inadequate
funding has really led to some severe barriers for health care
for a lot of our veterans. I support many of the proposals that
are before us today, especially Ranking Member Akaka's veterans
mental health care capacity enhancement act.
A few months ago I had the opportunity to visit with some
troops from Washington State in Iraq and they told me their
biggest concern is health care for their families and
themselves once they finish their tour of duty. I have also
held field hearings and I have spoken with veterans from all
over my State about their need for health care. The veterans I
have met with in Washington State have made it very clear that
reductions in mental health resources are coming at the worst
possible time, just as veterans from Iraq and Afghanistan are
returning home with PTSD and other mental health concerns. The
VA does not have the resources available to handle their needs.
I also have some concerns with other parts of the
legislation being reviewed today. Specifically, I just want to
say that I do oppose the provision in S. 1182 that repeals the
Millennium bill's long-term care bed census requirements. This
committee just heard a few weeks ago from Alfie Alvarado-Ramos,
the assistant director of Washington State Department of
Veterans Affairs and president of the National Association of
State Veterans Homes, about the demand that is increasing for
long-term care facilities. The population of veterans over the
age of 85, the most likely to need VA long-term care, is
expected to double over the next 10 years.
I believe the Administration and this committee need to
aggressively look at serious solutions to meet that need and
not back away from our commitment and avoid the problem.
Secretary Nicholson, I looked over your testimony and I am
happy to hear that you do support increased mental health
resources for our veterans, and especially for those soldiers
and sailors and airmen and marines that are returning from
overseas. Over the past month I met with some Guardsmen and
Reservists in Washington State who just got back from Iraq and
many of them commented to me on the need for increased
resources for mental health needs, especially in the area PTSD.
I think it is really vital that we provide the resources to
them and the VA to help them integrate back into our
communities and prevent the long-term psychological and health
damage that can result.
As you know, Mr. Secretary, I supported increased funding
for that and other needs as part of my veterans amendment to
the supplemental, and I was disappointed that the
Administration did not support us on this. I am very concerned
that this committee is going to move with some very important
needed VA programs just to see them under funded by billions of
dollars by the VA, and limiting our ability for veterans to get
access to these program. The current funding reality is a major
reason why I support Senator Johnson's assured funding for
veterans health care act which would make VA health care
funding mandatory.
So with that said, I look forward to your testimony,
Secretary Nicholson, on how the VA is going to pay for these
expanded services while still maintaining our current levels of
service.
Thanks very much, Mr. Chairman.
Chairman Craig. Senator Murray, Patty, thank you very much.
Let me turn to Senator Obama. A bit out of order, but
Senator Rockefeller has agreed here. The Senator has to go to
another committee as soon as he can and yet he has a couple of
pieces of legislation before this committee so, Senator, we
will turn to you.
OPENING STATEMENT OF HON. BARACK OBAMA,
U.S. SENATOR FROM ILLINOIS
Senator Obama. Thank you so much, Mr. Chairman, and let me
thank my senior colleague--senior in experience, not in years--
Jay Rockefeller for letting me go first.
First of all before I begin, let me thank Secretary
Nicholson. He had committed to come to Illinois to talk about
disparities in payments for disability veterans. I just want to
let the committee know that Secretary Nicholson is a man of his
word. He came, met with veterans there, and responded. We very
much appreciate that and we will be working with him diligently
to solve some of those issues.
Mr. Chairman, Ranking Member Akaka, I would like to thank
you for holding this hearing so that this committee can learn
more about pending veterans health care legislation. I am very
impressed with the pieces of legislation that have been
presented by the various Members of the committee. I am also
pleased that a bill that I have introduced, the Sheltering All
Veterans Everywhere Act, or SAVE Act, made it on the docket for
today's hearing.
As many of you know, our Nation's veterans suffer from
homelessness at a rate far higher than the average population.
The VA estimates that more than 250,000 veterans are homeless
on any given night, and that more than 500,000 experience
homelessness at some point each year. That is obviously an
embarrassment to the Nation that veterans who served our
country would find themselves disproportionately in such
circumstances. Male veterans are twice as likely to become
homeless as their non-veteran counterparts. Female veterans are
almost four times more likely to become homeless than their
non-veteran counterparts. Those are remarkable statistics.
The bill I introduced will reauthorize and expand several
important homeless veterans programs. I am proud that the SAVE
Act has the support of more than 10 national homeless and
veterans advocacy groups, groups ranging from the National
Coalition for Homeless Veterans to the Paralyzed Veterans of
America, from the Volunteers of America to the American Legion,
have all endorsed the bill that I have proposed.
I thank very much the Chairman, the Ranking Member, and my
colleagues on the committee for considering this bill. I look
forward to working with my colleagues on this and other
important veterans health care initiatives.
Secretary Nicholson, I understand that you were not able to
prepare a VA position on the SAVE Act in time for this hearing,
so I just want to make sure that you will be willing to submit
for the record VA's position on the bill and look forward to
reading your response. So thank you very much.
Chairman Craig. Senator Obama, thank you. Before you came
in I did make mention that some of the text of the legislation
was not available and that the record will be left open so that
the Administration can produce testimony for these pieces of
legislation for the record.
Senator Obama. Thank you, Mr. Chairman.
Chairman Craig. Now let me turn to certainly one of the
senior Members of this committee, Senator Jay Rockefeller.
Senator.
OPENING STATEMENT OF HON. JOHN D. ROCKEFELLER IV,
U.S. SENATOR FROM WEST VIRGINIA
Senator Rockefeller. Thank you, Mr. Chairman. I will be
extremely brief because I also have to go to a committee
hearing. Actually, just so Secretary Nicholson does not have to
think that all problems are veterans problems, it is
interesting in our aviation transportation security, two-thirds
of all the planes that fly around in the air at any given
moment are private, corporate, individual, or whatever. They
are subject to no security whatsoever. People getting on,
people getting off. It's amazing. So we have spent billions on
the commercial and not a nickel on the other.
I just wanted to pay my respects to the Chairman and to the
Ranking Member; say that I agree very much with Patty Murray
when she indicated about the Millennium Act; express some
reservations on Senator Specter's S. 416; obviously support the
Salazar bills, and the homeless and other bills. But simply
just to say that this all becomes important. I had to make two
more phone calls to West Virginia mothers last night about
soldiers who had been killed. Not wounded, but killed. And it
goes on. They will not be veterans, but this is all going on
and it just makes it tremendously important for us to do the
right thing.
So I wanted to stop by, even if I could only say that. I
thank the Chairman whose leadership is always good, for his
courtesy, and I thank the Secretary.
Chairman Craig. Jay, thank you very much.
Now let us turn to our first panel. In part, they have been
introduced by other of our colleagues, but let me formally
welcome to the committee and our first panel, the Honorable Jim
Nicholson, Secretary of Veterans Affairs. He is accompanied by
the Honorable Jonathan Perlin, Undersecretary for Health, and
the Honorable Tim McClain, General Counsel to the Veterans
Affairs or the Administration. We thank you for being here.
Mr. Secretary, please proceed.
STATEMENT OF HON. R. JAMES NICHOLSON, SECRETARY,
U.S. DEPARTMENT OF VETERANS AFFAIRS
Secretary Nicholson. Thank you, Mr. Chairman, and good
morning Senator Salazar, Senator Murray. I appreciate your
being here. I also would mention that I have to be very careful
this morning because my sister is also here visiting from
Colorado as part of Senator Allard's----
Chairman Craig. Why don't you introduce her to the
committee?
Secretary Nicholson. All right, there she is. We call her
Bunny.
Chairman Craig. Good morning; welcome.
Also, before you proceed, somebody brought a pipe organ in
with them. Would you turn it on vibrate? Thank you.
Please proceed.
Secretary Nicholson. Just to mention, my sister is a very
respected advocate for children, used to be in Colorado, now
nationally. She lectures nationally and I am very proud of her.
With your permission, Mr. Chairman, I would like to
summarize my written testimony and submit the full text of my
remarks for the record.
Chairman Craig. Without objection, your full comments will
be a part of the record.
Secretary Nicholson. This year marks the Department of
Veterans Affairs' 75th anniversary. The creation of the
Veterans Administration in 1930 was a watershed event for
America's citizen soldiers. VA's birth represented the
realization of the four pillars of President Lincoln's promise:
the steel and stone of VA facilities where veterans receive the
care and benefits they earned in freedom's defense, the
compassion and commitment of VA employees to serve their fellow
citizens who had selflessly served them, the law of the land as
legislated for veterans by the Congress of the United States on
behalf of a grateful Nation, and the stewardship of the Chief
Executive and Commander in Chief sworn to care for him and her
who shall have borne the battle.
I am taking the liberty of mentioning our 75th anniversary,
Mr. Chairman, one, because I am proud to lead such a fine and
honorable organization, and two, because even after 75 years it
is clear as I read the legislation you and your colleagues are
proposing that the Congress and VA, despite some differences,
are still partners and advocates for our Nation's veterans.
Mr. Chairman, we are certainly in step with provisions of
the Veterans Health Care Improvements Act of 2005. My written
response reflects that harmonious occasion when legislators and
the White House are able to plow common ground together. I
commend you, Mr. Chairman, for your prescience in creating and
crafting legislation that will certainly benefit America's
deserving veterans, young and old, who depend on my department
to be there for them fairly, compassionately, and sensibly.
Your legislation addresses the same issues President Bush
identified as needing timely and equitable corrections in order
to level the playing field of out-of-pocket reimbursements for
emergency care costs. Consistency and fairness must go hand-in-
hand and we fully support your efforts on our veterans behalf.
Mr. Chairman, you and I know all too well the impact PTSD
and other mental health disorders have not only had on
servicemen and women who bear that burden, but also on their
families, and their friends, employers, and the communities who
look to us for compassionate care for their loved ones and
fellow citizens. Any legislative path that we can travel to
help alleviate mental health suffering of our young men and
women returning from their overseas duties is a path we must
take, and I commend you for paving that path with durable and
considerate legislation.
Mr. Chairman, I also want to applaud you for understanding
the mechanics of my department, how we accomplish the good work
we do, and how certain laws have impeded our ability to fulfill
our health care promise to our veterans. Your bill repeals two
laws that are outdated, unnecessary, and costly to VA's
mission. Most importantly, your legislation removes the
barriers to caring for veterans where they may need care the
most, at home or in settings of their choice.
With respect to Senate bills 481, 614, and 716, Mr.
Chairman, we either do not concur with the assumptions on which
the legislation is based, or we take issue with the
consequences of the legislation, or we believe that we are
already providing veterans with the services proposed in the
bill, rendering redundant the legislative intent. In the
interest of time I will reserve my comments on our specific
differences should the Members of the committee have questions
following my statement.
Finally, Mr. Chairman, there are several additional draft
bills that we have not yet had an opportunity to carefully
review. One is titled the Sheltering All Veterans Everywhere
Act. While I cannot comment on the specific bill, I do want to
state for the record that VA is a relentless advocate for
stemming, reversing, and eliminating the tide of homelessness
that overwhelms literally hundreds of thousands of veterans
every year. The Department of Veterans Affairs devotes more
than $1.1 billion every year to provide health care services to
more than 100,000 homeless veterans. The Veterans Health
Administration has provided specialized services to 300,000
veterans under its homeless-specific programs.
Mr. Chairman, 11 years ago in 1994, VA began awarding funds
under the Homeless Grant and Per Diem Program. By the end of
this fiscal year we will have awarded approximately $90 million
in funding to 350 organizations to create 10,000 transitional
housing beds, more than 40 service centers, and 100 vans for
transportation. We would not be so successful without the
partnerships we have forged with businesses, communities, and
faith-based non-profit organizations. I will put our record of
compassionate care for homeless veterans up to any bright light
inspection. I am proud of our record on behalf of homeless
veterans, and the VA always is a champion for any man or woman
who is outside looking in. In fact, I currently chair the
intergovernmental agency for homelessness in the Federal
Government.
Mr. Chairman, the VA is moving at a very brisk pace these
days. We are leading in health care. We are ahead of the curve
in the use of new electronic records management technologies.
We are exploring innovative rehabilitation therapies and
prosthetics. We are expanding our community care base. We are
in a major facilities realignment and expansion. We are more
sensitive than ever to our aging veterans' needs. We are
developing new employment opportunities for our veterans
returning from Southwest Asia. We are honoring our fallen
veterans and we are providing benefits and compensation in
record amounts.
Our good works are too many to enumerate in the time I have
left, but let me just say in closing that as we look back over
the last 75 years of service to America's veterans, VA's
success would not have been possible without the bonds of
cooperation between the Congress and the Administration.
William Wrigley once said, when two men in a business always
agree, one of them is unnecessary. Mr. Chairman, over the years
there have been many collegial disagreements about process
between our respective institutions. But those differences, in
the end, strengthened our mutual progress to care for him and
her who bore the battle.
Thank you, Mr. Chairman. I would be pleased to answer any
questions you or the committee members may have.
[The prepared statement of Mr. Nicholson follows:]
Prepared Statement of Hon. R. James Nicholson, Secretary, U.S.
Department
of Veterans' Affairs
Good afternoon Mr. Chairman and Members of the committee:
I am pleased to be here this morning to present the Department's
views on several different bills being considered by the committee.
They cover a wide range of subjects related to VA's provision of health
care services to veterans.
veterans health care improvements act of 2005
Mr. Chairman, I will begin by commenting on your draft bill that
includes an array of provisions, many of which would carry out
proposals that were included in the President's budget submitted to
Congress earlier this year. We strongly support enactment of this
measure and we appreciate your inclusion of provisions to carry out the
President's plans for assisting veterans and for assisting the
Department to carry out its mission.
One major provision in the bill would expand VA's authority to
assist with payment for emergency-care costs that veterans incur in
private hospitals. As you may know, a major study found that veterans
with cardiac emergencies, despite having health insurance, often
deliberately forgo emergency treatment at the closest community
hospital (where they might incur out-of-pocket expenses) in favor of
receiving care from the nearest VA facility at no or minimal cost.
Delaying needed emergency medical treatment can jeopardize their health
status and hinder the Department's ability to timely and successfully
manage their emergent medical conditions. Under current law, a veteran
who obtains emergency care in the private sector for a nonservice-
connected condition is not eligible for VA reimbursement for the
related expenses if the veteran has any insurance or other coverage for
the cost of the care, in whole or in part. Your proposal would amend
the law to enable the Department to reimburse a veteran for out-of-
pocket expenses not covered by insurance or other coverage, thereby
ensuring that veterans, whether insured or not, have consistent access
to optimal care for emergency health conditions.
Unfortunately, the stress of combat leaves scars on many veterans.
Your bill contains several new authorities that will help assist us in
caring for those returning from overseas who are suffering from PTSD
and other mental health disorders. The bill also contains a provision
to exempt former POWs from having to pay co-payments in connection with
the receipt of extended-care services, and a second provision to exempt
veterans from co-payments for hospice care in a hospital or at home.
These provisions will be extremely beneficial to the affected veterans.
The bill would also authorize time-limited care for newborn children
when veterans deliver the children under VA auspices.
Finally, Mr. Chairman, your bill contains two provisions that would
repeal laws that have seriously hindered our efforts at VA to provide
veterans with high-quality care by the best and most cost-effective
means. The bill would repeal a law that requires VA to maintain at
least the same staffing and level of extended-care services in
Department facilities as was provided in fiscal year 1998. That law has
seriously limited our ability to provide or pay for extended care
services for veterans in a variety of institutional and non-
institutional settings outside VA, including private nursing homes in
the community and State nursing home facilities. As you know, many
veterans prefer to remain in their homes and communities, and it is
often cost-effective to provide care in those settings. Your bill would
also repeal an old law that generally bars the Department from using
appropriated funds to compare the costs of providing services directly,
or by contract, which impedes our ability to obtain the best possible
value for veterans. On a government-wide basis, public-private
competitions completed in FYs 2003 and 2004 are estimated to generate
savings, or cost avoidances, for the taxpayer of more than $2.5 billion
over the next 3 to 5 years. The tailored and responsible use of
competitive sourcing at VA will help the Department free up resources
that can be dedicated to our veterans.
S. 481
Several years ago, Congress enacted a law authorizing VA to provide
treatment to veterans returning from combat service for conditions that
might be related to that service, even when there is not sufficient
evidence to conclude that the condition is attributable to service. VA
can provide that treatment for a 2-year period following release from
service, during which it would be expected that the veteran might apply
for service-connection for the condition.
S. 481 would extend the period of eligibility under this law from 2
years to 5 years. Apparently, the intent is to ensure that a combat
veteran can continue receiving VA care for 5 years, rather than just 2
years. We do not believe this measure is necessary.
The current 2-year post-combat eligibility period provides ample
opportunity for a veteran to apply for enrollment in the VA system.
When such a veteran does enroll, VA places that veteran in enrollment
priority category 6 during the 2-year period, and provides cost-free
care for any disorder that may be attributable to the combat service.
VA will also provide care for any other disorder, but the veteran would
be charged any co-payments that may apply based upon the veteran's
income. At the end of the 2-year period, the veteran could continue
receiving VA care, but would be placed in the appropriate priority
group, and might be subject to co-payments for all care.
S. 614
Mr. Chairman, S. 614 is a bill that is identical to a measure that
was considered during the 108th Congress, when the Department voiced
its opposition. It would provide all Medicare-eligible veterans with a
new prescription drug benefit through VA. Specifically, the bill would
provide this new benefit to Medicare-eligible veterans with a
compensable service-connected disability. It would be in addition to
the health care benefits they are currently eligible to receive from
VA. Those who do not have a compensable service-connected disability
could choose to receive the new prescription drug benefit in lieu of
all other VA health care benefits.
Before this committee last year, Deputy Secretary Mansfield
testified that it is not clear how the VA benefit proposed in this bill
would interact with the new Medicare benefit. As you know, we are now a
year closer to full implementation of that new Medicare benefit. We
continue to have the same concerns. Mr. Mansfield also stated that the
proposal could have significant effects on other public and private
health care programs by jeopardizing the current discount prices VA
receives on pharmaceuticals. That concern also remains. Additionally,
enactment of this measure could encourage situations where a veteran is
receiving care and prescriptions from VA, and from outside sources,
yielding increased costs, increased confusion, and decreased patient
safety. Accordingly, I again must say that we cannot support this bill.
S. 716
I next turn to S. 716, which deals with VA's outreach to veterans
returning from Operation Enduring Freedom and Operation Iraqi Freedom
(OEF/OIF) regarding services they can receive from VA's Readjustment
Counseling Program and other VA mental health programs. The bill would
specify that VA may provide bereavement counseling to the families of
those who die in active military service. We fully support the intent
of S. 716, and in fact are currently carrying out most of its
requirements. That being the case, enactment of the bill is
unnecessary.
Specifically, S. 716 would require that VA employ 50 new
individuals, all of whom must be veterans of either Operation Enduring
Freedom or Operation Iraqi Freedom, to provide outreach to other
veterans when they return from service in those operations. As we have
previously advised the committee, last year VA employed and trained an
additional 50 veterans from the ranks of those recently separated from
OEF/OIF to work in Vet Centers providing outreach, and we have
committed to hiring an additional 50 veterans this year. The 50 persons
hired last year were all given career-conditional appointments. That
means that these veterans can expect to retain their employment. This
bill further provides that any limitation on the duration of employment
for these employees is terminated, and it would require that the
additional 50 appointments that we make this year also receive career-
conditional appointments. The latter provision is imprudent.
We do not intend to terminate any of the positions in question, but
at the same time we do not expect that the conflicts in Central Asia
will continue indefinitely. We hope the day will come when we will no
longer have to undertake the outreach contemplated by this bill. If the
need for these positions ends at some point in the future, the
employees would likely move into other positions in VA, or be
eliminated by attrition. However, to permit wise and efficient
stewardship of the Department, we urge amendment of this legislation so
as not to restrict the nature and duration of the appointments we make.
S. 716 would also more explicitly provide that VA has authority to
provide bereavement counseling for the families of deceased active duty
servicepersons, including parents, and that VA can provide the
counseling in Vet Centers. In August 2003, former Secretary Principi
directed that Vet Centers develop a program to provide such bereavement
counseling, and we are now actively providing that service. In the
operation of that program, we have permitted counseling various members
of the family, including the parents of the deceased. Since the
inception of the program, the families of over 365 servicepersons who
have died on active duty have been referred to the Vet Centers for
counseling assistance, and the Centers have provided services to over
555 family members. The average number of counseling sessions provided
to each family member has been six. Program clinical experience has
been that most families need a supportive therapeutic environment to
assist them in processing the immediate stages of grief and to
stabilize their situation sufficient to mobilize their own coping
resources.
Finally, S. 716 would authorize $180 million to be appropriated for
the provision of readjustment counseling and related mental health
services through Vet Centers. In the current fiscal year, VHA allocated
a total of $94 million for all Readjustment Counseling Service
activities. We estimate that the additional services that this bill
would direct, and that we are in fact already implementing, will
require only about $8 million. There is no necessity or justification
for nearly doubling the amount we spend on Readjustment Counseling
Service.
Mr. Chairman, the agenda for today's hearing also includes three
additional draft bills identified as the ``Mental Health Capacity
Enhancement Act of 2005,'' the ``Neighbor Islands Veterans Health Care
Improvements Act,'' and the ``Sheltering All Veterans Everywhere Act.''
Because we received copies of these draft bills only very recently, we
do not have cleared positions on the measures. We will provide written
comments on those bills for the record.
Mr. Chairman, this completes my prepared statement. I would be
happy to answer any questions you may have.
Chairman Craig. Mr. Secretary, thank you for those opening
comments and we will have a series of questions to address some
of these legislative issues.
You mentioned, Jim, the importance of changing the law to
ensure that veterans who use community facilities for emergency
care are treated the same financially as those who use the VA
center. Is VA confident that the criteria you will use to
define an emergency will be fair enough to ensure veterans are
not unreasonably denied coverage, but tight enough to ensure
that we do not begin providing all primary care in emergency
room settings? It is a fine line.
Secretary Nicholson. That is a very good question, Mr.
Chairman. First, let me say that the spirit of this is to cover
that situation which is occurring in increasing numbers where a
veteran has become so accustomed to service in a VA hospital,
and he may even have insurance or other benefits, but
experiences an emergency condition and is insistent that he go
to a VA hospital for treatment, either because of the comfort
level, and/or because of his fear that this is going to be too
expensive if he goes to a nearby private hospital. We are
seeing an increasing number of situations like that, so this
would cover that and give them the confidence that they can go
to that nearest hospital and get the most immediate emergent
care and it would not be a cost burden on them.
Your question is a good one: Would they take advantage of
this and would that become the way that they start going for
normal emergency room care. And the answer to that is that
there is a standard in medicine which is called the reasonable
review criteria and a veteran would have to have a serious
condition, the most prevalent of which would be chest pains,
indicating serious possibilities. He could not go there for a
flu shot, he could not go there for a cold. It would not cover
that. That would not fulfill that reasonable review criteria
that they apply to this.
Chairman Craig. I know that we will be concerned about
that, that it would be, as I have said, good enough to work and
yet not so good that that becomes the primary care approach for
our veterans. Choices will need to be made in this instance.
Obviously, with the introduction of my legislation, 1182,
and concern about long-term care, already some of my colleagues
have spoken to that and it does remove the capacity requirement
for long-term care beds. I, for one, believe we should work
toward establishing a program of long-term care services, not
just a bed count. I said in my opening comments, I used the
phrase focusing on choices and options instead of buildings and
concrete. We, and certainly the Veterans Administration, over
the years have gotten involved in building an awful lot of
buildings. Therefore, then the political base to support them
comes up, even though some of them might be half full and not
serving the purpose that they did 20 or 30 or 40 years ago. We
get bound up in that.
So I guess my concern and my question is: Does VA share the
basic belief reflected in 1182? And if so, and I think you have
made some comment on that, can you share with the committee
some of the thoughts and considerations of what should be
included in such a program if, obviously, our approach is
toward long-term care but we are not going to put hundreds of
millions of dollars into beds and facilities?
Secretary Nicholson. Again, I think a very good question,
an important one, because I think the answer is that this
should be determined not by some mechanistic set number but by
the need and by the imperative that we provide the right care
at the right place. The standard I think now in long-term care
is for it to be as least restrictive as possible, and yet for
it to be adequate, and to have people be as close as they can
to their regular habitat, their family, their friends, their
community. To the extent that we can facilitate that, and that
ability is growing, the new tools that we have for telemedicine
and communication, and there are clinic programs so that the
need, at least some objective number to fill beds we do not
think is appropriate.
Chairman Craig. Thank you very much. Let me turn to my
colleague, Ranking Member Senator Akaka.
Danny.
Senator Akaka. Thank you very much, Mr. Chairman.
Secretary Nicholson, Senators Salazar, Murray and
Rockefeller and I have new mental health legislation. In
fairness, I know that you did not receive this legislation with
much advance time, and I think VA would be most concerned with
the provision to adjust capacity requirements for inflation and
I mentioned that in my statement. The goal is to use current
year dollars rather than 1996 dollars for determining if VA is
meeting its specialized care requirements.
Mr. Secretary, what is your view of this?
Secretary Nicholson. Yes, Senator, I would say that we
would like to have more time to analyze this and to think about
it. We have stepped up our program on mental health in our
request for next fiscal year an additional $100 million
requested for this. We screen every veteran at enrollment for
PTSD. We screen every veteran at their annual physical for
PTSD. Our clinics are providing screening and referral
services. We have over 850 of them, plus over 200 vet centers.
So there is a lot being done.
It is a concern. It is a priority of ours, because as we
have heard already this morning about the anticipation of this
being problematic from those returning from Operations Iraqi
and Enduring Freedom. I was over there myself a few weeks ago
with the Chairman and some other Members of Congress talking to
troops and commanders, and there is an anticipation that we
need to get on top of this and intercept it early and treat it
early because that is the best way to deal with it.
Senator Akaka. Undersecretary Dr. Perlin, back at your
confirmation hearing I asked you where the mental health
strategic plan was and you indicated it was forthcoming at that
time. This is a critical document. As I understand it, it sets
forth an agenda for mental health which has been lacking up to
this point. Given the growing and even burgeoning demand for
mental health, we need this plan. If it is being held up at
OMB, I certainly would like to know about that.
Dr. Perlin, when will we be receiving that report?
Dr. Perlin. Senator, thank you very much for your
endorsement of the mental health strategic plan. I am very
proud of this plan that takes its roots from the President's
new Freedom Commission on Mental Health, which seeks a new
vision which looks not to maintenance of patients with mental
illness but to restoration of function and recovery. It is a
very bold plan and I am proud to tell you that that plan can be
shared now. We will make sure that you have a copy of that
plan.
The plan is being used in the system as a working document,
and with Secretary Nicholson's encouragement, the additional
$100 million in the budget for 2005, another $100 million in
2006 are focusing on the high priority areas you and Chairman
Craig and others on this committee have mentioned: PTSD,
outreach to OIF and OEF veterans. My own personal focus is on
increasing access to specialty mental health care services,
increasing access to substance use treatment, and increasing
access for community health services for individuals with
serious mental illness like schizophrenia, psychosis, with a
program we call mental health intensive case management which
is known as assertive case management in the community.
So we will get you that this afternoon.
Senator Akaka. Thank you very much.
Mr. Chairman, I have other questions but my time is almost
up.
Chairman Craig. We will return for a second round.
Senator Salazar.
Senator Salazar. Thank you very much.
Secretary Nicholson, I would like your reaction to the
legislation that I introduced in three bills that I talked
about 1189, 1190, and 1191. Let us take them one at a time.
One, the rural VSO assistance for vet rides. A simple bill.
Basically, it would provide grant money to VSOs to help
especially in the transportation of vets who live far away from
where they can receive their medical care. I have seen it
happen firsthand in our native State of Colorado up in the
northwestern part of the State. I would hope that you would be
able to support this legislation.
Secretary Nicholson. Senator Salazar, I appreciate the
spirit behind the legislation and, again, we have not had
enough time with this so we do not have a final cleared
position on this, but I want you to know that there is a great
deal of this going on and there has been for a long time. The
VSO community has been providing this. The Disabled American
Veterans in particular, with the assistance of Ford Motor which
provided vans, provide literally hundreds of thousands of trips
for veterans to go for medical care in this country every year.
It is being done by people who are volunteers. They have the
compassion and the feeling for what they are doing. There may
be exceptions out there, but in general our read on it is that
it is working pretty darn well and that we do not need Federal
Government intervention of money into that relationship.
Senator Salazar. Let me just say, I would appreciate
getting a formal response from you on this, but I will tell you
that I think what the VSO organizations do out there, Secretary
Nicholson, is a wonderful, compassionate work on behalf of our
veterans and I certainly applaud everything that they do. But I
can tell you when I talk to Jim Stanko up in Steamboat,
Colorado and he tells me about their efforts in terms of trying
to serve that whole northwestern part of Colorado and taking
the vets down into Grand Junction, that it would be helpful if
they did have some financial assistance. I know that there are
many things that we will do and that you are currently doing
with the non-profit community and with the private sector to
bring assistance to them, but I think just a little bit of
money here can go a long way. This is not asking for a lot, but
I think these kinds of grants can help incentivize the good
work that is already going on and even make it better. So I
would appreciate it if you would keep an open mind and
hopefully support the legislation.
Let me quickly, speak on 1189 on long-term care. When Dr.
Perlin and I had this conversation here a month or so ago we
talked about the creation of this long-term strategic plan. The
legislation I have introduced, 1189, will simply put a deadline
in place when we would have that plan put together 6 months
out, 180 days out. I think for all of us who have worked in
many different kinds of processes and different kinds of
situations, there is nothing like a deadline to get to the
result. So I would also appreciate it if this is something that
you would support.
Secretary Nicholson. Again, Senator, because of the time
constraints, we have not fully completed our review of it or
our analysis so we do not have a position. We do appreciate the
spirit of it. We are now gathering actuarial data. We have some
new tools with which to do that that we have not had in the
past. And we have an ongoing CARES process, the 18 locations
are still being studied, and we will plan to synergize this new
actuarial data with what we learn in those 18 cases and
certainly plan to come back to you with that.
Senator Salazar. I would appreciate it. I think at the end
of the day there are constraints that we will all face that we
may not be able to get to our ideals because of fiscal
constraints. But I think having that kind of long-term plan
that gives us the cost-benefit analysis of the different
options would be helpful to us as we struggle with the issue of
long-term care with respect to our veterans.
I know my time is up but there was another piece of
legislation that we----
Chairman Craig. Why don't you complete so that we will have
your three pieces?
Senator Salazar. Thank you very much, Senator Craig.
That is the legislation numbered 1190 with respect to
blinded vets. I called it the Blinded Veterans Continuum of
Care Act of 2005. It essentially would put in an additional
effort for us to address the major problems that our blinded
vets face here in our Nation. I know you have not had an
opportunity yet to review that legislation but I also think
that it is a very important piece of legislation that would
address the very specific and very difficult challenges that
are faced by our over 100,000 blinded veterans in our Nation.
Secretary Nicholson. Again, I appreciate your concern about
blind veterans. It is certainly shared. We are analyzing your
legislation. I do want you to know that we have, in 99 of our
medical centers, a visual impairment team right now. We are
incentivizing some of our other facilities to do outpatient
blind rehabilitation care, which is a change. For some more
reason the incentive ran the other way, which was to admit
them, make them an inpatient. That cut down capacity because it
was limited by beds. That is not necessary that we are changing
that to incentivize seeing them as outpatients. We also are
recruiting some additional blind rehabilitative specialists.
This is a very narrow specialty, and that will, I think, result
in us having enhanced ability in the relatively few places that
we do not yet have it.
So we are doing quite a lot there. We will respond to you
in a more specific way with respect to your legislation. We,
generally I would say, Senator Salazar, think that it might be
overly specific. We do not think we need that specificity. But
we share the principle.
Senator Salazar. I would appreciate your taking a
thoughtful look and having an open mind. I do know that where
we have these programs for blinded vets within the system they
are working very well. My own sense is that this bill would
help us do an even better job and I would very much appreciate
you taking a look at it. Again I am going to ask you for your
support.
Chairman Craig. Ken, thank you very much.
Let me state again for the record the administration has
not yet been prepared to give full testimony on some of these
for purposes of OMB clearance and all of that. I wanted to
accelerate the process, and that is why these items are on the
agenda today. I do not think it should be viewed as somebody
did not do their homework. That is not the case at all here,
whether it is on our side of the issue or the administration's
side of the issue. I wanted to get these pieces of legislation
active in the process.
We will have another hearing in 2 weeks on the balance of
the legislative package of members that brought it before us,
and that will be a similar environment at that time for that
purpose, to make all of this active for consideration, and/or
for combination as we do markup and other pieces, move forward.
As we know, sometimes they may not be stand-alones. We might be
able to effectively combine pieces to share in, so I think it
was important to say that for the record of the committee.
Senator Murray.
Senator Murray. Thank you very much, Mr. Chairman.
As I said in my opening statement, I represent thousands of
returning guardsmen from Iraq and Afghanistan in my State, and
I am very concerned about the fact that we do not have current
mental health capability to serve our current veterans, let
alone these men and women who are returning. As you just said,
you have been over there, you know that there is going to be a
high rate of need for help with those men and women who are
returning for mental health, PTSD. Both Chairman Craig's and
Senator Akaka's bills expand mental health resources, and in
your testimony you mentioned Chairman Craig's mental health
provisions as extremely beneficial.
Given your support of those provisions, do you believe that
there are other efforts that should be pursued to increase
mental health access for our veterans, especially those who are
just coming back now from Iraq and Afghanistan?
Secretary Nicholson. We are continually looking at that,
trying to assess it and make sure that we have what we need
because of the priorities, and also because what we have
learned about this in the Vietnam experience particularly in
that there seems to be a latent period for many of these----
Senator Murray. I think particularly for guardsmen and
women because they come home, they just want to get out. They
answer the questions and go out to their communities far away
from a regular military facility, and that is when they start
having problems and do not have access.
Secretary Nicholson. Well, we are trying to mitigate that
with an outreach effort that we have going. We have teams going
to the points of deployment, that is, deployment back, in
mobilization I guess I should say, and we actually have people
in Germany. We have these seamless transition teams that also
have members of the military on them. This was one of the
things that we talked about in Iraq, was using the chain of
command more to make sure that the young trooper down in the
squads knew and was listening, because they get pretty focused
on going home and getting back, that they are eligible for
certain VA benefits, and inform them as to how they can access
them. So we are making very robust efforts to inform them.
Senator Murray. Is there anything we can do as part of any
of these initiatives to help prevent veterans with PTSD from
stopping to seek care?
Secretary Nicholson. To help them do what?
Senator Murray. The veterans who stop seeking care, is
there anything we can do? Because many of them choose not to
continue to get care, and then develop larger problems later.
Secretary Nicholson. I think that is a really good
question, and it has broader implications in my opinion than
maybe even you intend, because of the benefit side of the VA as
well, because people who end up being permanently impaired from
a mental condition, just like a physical condition, are
entitled to benefits and compensation. What we are looking at
is to make sure that these individuals do go to therapy, and
will subject themselves. We have not implemented this, I do not
want it to sound like it is a done thing, but it is something
we are looking at, so that they go to rehabilitation therapy
and they get into a program before we make a final adjudication
of their final condition. So their incentive is there, and I
think that is going to help.
Senator Murray. Interesting, OK.
As I mentioned earlier, few of these programs will become a
reality without adequate funding for veterans funding. And we
know that when adjusted for inflation the VA is spending 25
percent less per patient than it did in fiscal year 2000.
Veterans are having to wait 3 years for surgery today. In my
home State at the American Lake Facility, you can only get an
appointment if you are 50 percent or more service connected
disability, and in Puget Sound, as of January, there was an $11
million deficit that is forcing a lot of our VA hospitals not
to fill some vacant positions. Every indication is that we do
not have enough funding for our current services.
It is just not right and it is not what the veterans are
promised. As you know, I am very concerned about it. We are now
talking about adding some new programs, programs I strongly
support, but I am unsure that they will ever get off the ground
if we do not have adequate funding for them.
So I would just like to ask you, Mr. Secretary, if we were
to pass some or all of today's bills into law, would you
request additional funding to make Chairman Craig's mental
health problems--provisions and other provisions a reality?
[Laughter.]
Senator Murray. What did I say?
Chairman Craig. My mental health problems.
[Laughter.]
Senator Murray. No. He is from Idaho, my next door neighbor
State. I apologize.
Chairman Craig. It is not unusual. I have been accused.
Please proceed.
Senator Murray. His mental health provisions in his bill.
Thank you.
Secretary Nicholson. We do not think it will cost much to
fix Chairman Craig.
[Laughter.]
Secretary Nicholson. When I took this job, you know, the
President's charge to me was to take care of our veterans, so
my answer to that is that when and if I am convinced that we do
not have what we need to fulfill our mission, I will be part of
requesting more resources to do that.
Senator Murray. Specifically, if I were to introduce an
amendment in the Military Construction and Veteran Affairs
Subcommittee to increase funding for VA's mental health
programs that are included in today's bills, would you support
those?
Secretary Nicholson. I could not answer that right now,
Senator. I would have to have a lot more information about your
bill and how it would fit with what we are doing. As we have
said, we have an additional 100 million in this budget for 2006
for mental health and that goes on top of--Dr. Perlin, we are
spending on mental health specifically, what?
Dr. Perlin. Yes, Mr. Secretary. For patients with
definition of mental illness as statutorily defined, it is $2.2
billion. When you look at all expenses for just mental health
it is in excess of $3 billion. When you look at all health care
for patients with mental illness, it is in excess of $10
billion. And the 2005 budget, as the Secretary has indicated,
will increase by 100 and in 2006 again by 100 million.
Senator Murray. Let me ask you. The House Military Quality
of Life and VA passed onto the House floor 2 weeks ago, and it
set aside 2.2 billion for specialty mental health care. Do you
support that level of funding?
Secretary Nicholson. What we think we have at an adequate
level right now is what we have submitted in the 2006 budget,
which is that increase of 100 billion.
Senator Murray. It is hard to understand. If we are to pass
Chairman Craig's bill, I assume you realize that we will need
increased funding, correct?
Secretary Nicholson. No, I am not sure. I am not sure of
that.
Senator Murray. I find it difficult to understand how we
increase services. We already are behind how we pay for that.
So I hope that, Mr. Chairman, as part of our discussion, we
talk about how we are going to pay for the increased services.
We have more people returning from Iraq and Afghanistan. They
are going to need these services. We cannot just expect the
already long lines to incorporate all these people into them
and not have a real challenge out there, and I think we have to
discuss the funding of this.
Chairman Craig. Senator Murray, I appreciate that line of
questioning, and I think that if 1182 become law, you and I and
Secretary Nicholson are going to sit down and spread it out and
look at it and see how it gets implemented, plain and simple.
And if it cannot be implemented at current resources, then we
will look for new ones, because I think we all show--I think
our sensitivity to this issue is real and important, and we
will move it forward.
Senator Murray. I just do not want promises out there that
we are not keeping when we do not fund them.
Chairman Craig. I hear you. Thank you.
Senator Thune has left us. Let me ask a couple more
questions of this panel before we move to our next panel.
I recently had the opportunity, Mr. Secretary, to review in
more detail S. 614, Senator Specter's Prescription Drug
Assistance Act. Arlen is not here this morning to speak for
himself or the legislation, but I understand that VA was
opposed to this legislation last year and is again this year,
basically on the grounds that we do not know how such a program
would interact with other prescription drug programs. However,
I would like to begin to study exactly how those interactions
might take place and see whether it might not be an interesting
approach to managing some of our outpatient population.
I guess my question of the Department is, is the Department
willing to spend a little more time and effort this year to
analyze a drug-only benefit and how it might work with the new
Medicare drug program or private prescription drug coverage,
how all of those might interact in this particular case?
Secretary Nicholson. Mr. Chairman, as you know, this has
been looked at before, and our view is that this will not do
what I think is a well-intentioned goal. There are several
parts to it. Number 1, it would not be cost neutral, and it
would end up becoming cost prohibitive to patients if it was
going to be put on a pay as a cost which is also in the
legislation.
The reasons are that we have these huge facilities that are
needed to support issuing pharmaceutical prescriptions. They
are called CMOPs, Consolidate Mail of Pharmaceuticals, huge
facilities. I think we have six of them throughout the United
States. I visited one in Chicago recently. They are very
expensive capital items. This would need tremendous IT support.
There would be many more pharmacists needed, labor intensive,
and probably most nettlesome is the fact that we would have to
have a much broader inventory of pharmaceuticals on hand
because the formulary that the VA follows in the tests that
have been done of this, have not been followed by the
prescribing physicians. So that when the veteran comes with his
prescription, in many cases, a high incidence, cannot fill it
because we do not use those kinds of drugs. We have generally
similar but not the same in our formulary. Because we have a
set formulary we have been able to buy pharmaceuticals at a
very attractive price, deeply discounted, and that is in large
measure because of this fixed formulary. In fact, I was just
looking at a number I had here on a note, that in that pilot
program, 47 percent of those prescriptions did not follow our
formulary.
This also, we think, could threaten this VA's favored
pricing structure that we now have. Another problem that we
have--and Dr. Perlin could speak to this better than I--but the
VA likes to think of itself as providing comprehensive health
care to its patients, and in a holistic approach, so that if a
person has problems, we want to know about it, we have the
electronic health record that is imputed into and available all
over the world literally, so a doc that is seeing one of these
veterans wherever he or she is, can see what is going on and
then they can prescribe. Where if we got into becoming just an
issuer of pharmaceuticals we would lose that comprehensive care
that we have with our patients.
So on balance, we think it is problematic.
Chairman Craig. Well, we will leave the question at that.
Let me turn to Senator Akaka for any additional questions
he may have.
Senator Akaka. Thank you, Mr. Chairman.
Mr. Secretary and Dr. Perlin, I direct this question to
both of you. I recently introduced legislation regarding health
care access issues in Hawaii. While I understand that, again,
you had not had enough time to officially comment on the
substance of this bill, I would like to know why on a more
general level the clinics in my State are not in compliance
with the Millennium Bill requirements that relate to non-
institutional long-term care such as home care. We have very
few nursing home beds in my State. Nearly all of the veterans
in those beds are highly service-connected, so the relief you
are seeking by way of the chairman's bill would not free up
resources for home care. Can you please address this question,
Mr. Secretary and Dr. Perlin?
Secretary Nicholson. Yes, sir. Thank you, Senator. I am
going to ask Dr. Perlin to respond to this. He has some
specific objective numbers about the situation in your State in
the various locations.
Dr. Perlin. Thank you, Senator Akaka for the question. I
want to get back with you with a full report on the numbers,
but I have that interest in making sure that veterans of Hawaii
get the appropriate care. Understand in terms of long-term
care, that we have 60 beds at the center for aging on Oahu,
which serves veterans throughout the system and is actually, to
the best of my understanding, operation within the provisions
of the Millennium Act.
Senator Akaka. I think you understand the problem that we
are looking at.
Mr. Secretary, in your statement you indicated that at the
end of the 2-year period afforded to combat veterans for easy
access, a veteran could continue receiving VA care, but would
be placed on the appropriate priority group. That was your
statement. Does this not imply that in fact a veteran who had
been receiving care for those 2 years could effectively be out
of the system if they did not have an adjudicated service
connected disability and they had modest income?
Secretary Nicholson. Yes. Senator Akaka, we have looked at
that. We would like to have more time to do that. We understand
the spirit of your legislation and its intent. Let me make a
few points about it.
No. 1, any veteran, any reserve component, active duty
person that is in the theater who comes back is eligible for
full VA medical access for 2 years without being charged the
medical care co-payment. If they have any service connected
impairment, their care will continue right on, indefinitely, as
you know, for life. And once they are enrolled they become a
Category 6, and at that point they receive cost free care for
any disorder attributable to that combat theater experience.
If the 2 years is up and they are in an ongoing treatment,
that will continue indefinitely. And then they all, after 2
years, may continue to receive VA care as enrolled veterans. So
in short then, we really right now, subject to thinking about
this some more, do not see a need for this legislation.
Senator Akaka. First, I want to commend Senator Salazar for
his long-term care legislation. Along those lines, Secretary
Nicholson, I am curious as to how VA arrived at the conclusion
that the institutional long-term care bed census requirement
should be eliminated when we have yet to see the long-term care
strategic plan. Do we need to know how many beds are necessary
before we start to eliminate beds?
Secretary Nicholson. That is a fair question, Senator
Akaka, and we had some discussion about this earlier. We think
the guiding principle here should be the need, not some
objective number, but what do we need? And we are working on
that. We are studying 18 more locations in the CARES process
right now, and we have some new actuarial tools that are going
to help us make long-term care projections, that we are
synergizing into the results of that second round of CARES
study.
But to the point, to the principle, we are trying to
redirect long-term health care so that the beneficiaries, the
patients can get it either in their home or closer to where
they live or have lived, nearer their family, their friends,
their church, people they are used to. And that is not new.
That has been an ongoing process which has driven down the
number of bed occupancy in our long-term facilities, and it is
working very well, using also the new opportunities of
telemedicine. So when we get this new CARES round 2 finished, I
think we will be in a good position to make some projections.
Meanwhile, we do not think we should be bound to some
number that has been derived because it is mechanical, it does
not relate really to what is going on.
Dr. Perlin, do you have anything you would like to expand
on that?
Dr. Perlin. Thank you, Mr. Secretary. That has been our
experience. As we have been able to deploy more home-based care
and community care, we have actually found that we move
patients to those sorts of environments. In fact, in our VA
nursing home beds, we are actually artificially elevating the
population, the census, by holding network directors
accountable for maintaining patients to a certain number. We
believe that the patients should go to the long-term care
institutional or non-institutional depending on need not roll,
and in fact, our VA care, we want to make sure it is always
there for the very aggressive rehabilitation after
hospitalization for those individuals who have special needs
like spinal cord injury or mental illness, or are on a
ventilator. So that our beds become a very special set of beds
for those individuals which require staffing at a level and
with the skills that simply would not be available in
community.
It is the addition though that because patients with family
members around want to be in communities--even when I say to a
patient that I may have, ``You know, we have a beautiful
nursing home here in Washington,'' or when I used to see
patients in Richmond, they say, ``Well, we live 45 miles away,
80 miles away, and really do not want dad, mom, brother,
sister, whomever, or parent, at a facility that is very
distant.''
So we actually know now that there we are actually
requiring veterans to be in those beds simply to meet a
legislative mandate, not because of need.
Senator Akaka. Thank you very much for your responses.
Mr. Chairman, thank you.
Chairman Craig. Senator Akaka, thank you very much.
Mr. Secretary, Dr. Perlin, we again thank you all very much
for your testimony this morning. We will look forward to your
additional comments as it relates to this other legislation,
and that will become a part of our record. So again, thank you
very much for your presence.
Secretary Nicholson. Thank you, Mr. Chairman, Senator
Akaka.
Chairman Craig. I look forward to our continuing work.
Now we will ask our second panel to come forward, please.
[Pause.]
Chairman Craig. If we could ask our second panel to get
seated and the room to be cleared so we can proceed, please,
cleared of those who are leaving or planning to leave.
Let me welcome the second panel of veterans service
organizations, and introduce them. We are pleased that Donald
Mooney, Assistant Director of Veterans Affairs and
Rehabilitation for the American Legion is with us; Dennis M.
Cullinan, Director, National Legislative Service, Veterans of
Foreign Wars; Adrian Atizado, Assistant National Legislative
Director, Disabled American Veterans; Carl Blake, Associate
National Legislative Director, Paralyzed Veterans of America;
and Richard Jones, National Legislative Director for AMVETS.
Donald, we will ask you to proceed, please.
STATEMENT OF DONALD MOONEY, ASSISTANT DIRECTOR, VETERANS
AFFAIRS AND REHABILITATION, THE AMERICAN LEGION
Mr. Mooney. Thank you, Chairman Craig, Senator Salazar. The
American Legion appreciates this opportunity to express our
views on the many important bills being considered today by the
committee. We also appreciate the ability to supplement the
written record with our views because of the late arrival of
some of the draft legislation to our offices.
Chairman Craig. Yes. To all of you, that will stand as it
did for the first panel. The record will remain open so that we
can get an inclusive amount of testimony on these pieces. Thank
you.
Mr. Mooney. Thank you, sir. On the first bill we are
commenting on today, is the Veterans Health Care Improvements
Act of 2005. The Millennium Health Care Act of 1997 required VA
to maintain its in-house nursing home bed inventory at the 1998
level. However, this capacity has significantly eroded, rather
than been maintained. The President's budget request projected
only 9,975 beds in fiscal year 2006, a 27 percent decrease from
the Mill Bill mandate. This language was rejected in the House
Military Quality of Life and Veterans Affairs Appropriations
bill. Simply put, VA does not know what its future long-term
capacity will need to be. The American Legion supports Senator
Salazar's bill to accomplish this within 6 months.
In the meanwhile, it continues to be the position of the
American Legion that VA should comply with the intent of
Congress to maintain the minimum long-term nursing home
capacity for those disabled veterans who are in the most
intense resource groups, clinically complex, special care,
extensive care and special rehabilitation case mix groups, at
least until a study of VA future requirements is completed.
The Nation has a special obligation to these veterans. The
American Legion opposes this provision of Section 2. This
section also exempts former prisoners of war for co-payments
for extended care services for non-service connected
disabilities. Veterans who have suffered hardships,
deprivations and the indignities of captivity by an enemy
government should receive the best care that we have to offer
at no cost. They have already bought and paid for it. The
American Legion is pleased to support this provision.
The Veterans Prescription Drugs Assistance Act of 2005, S.
614, requires VA to fill prescriptions for any condition where
a Medicare eligible veteran makes an annual, irrevocable,
renewable election to get his or her medications from VA. The
bill takes care to make sure that the new benefit is cost
neutral to VA by allowing VA to establish new schedules of
annual enrollment fees, co-payments, and allowing VA to charge
the full cost of medication to the veterans.
The American Legion believes that while well-intentioned,
this bill has serious problems. First, it requires the Medicare
eligible veteran to make a decision as to where to get his or
her medications based on information that is not yet available
and further complicates already unfathomable extant and pending
regulation for Federal prescription drug benefits. Unforeseen
and unintended consequences will be rife. For example, the new
Medicare Part D drug benefit includes penalties for late
enrollment. Therefore, should a veteran elect to use VA, and
then elect to use Medicare Part D, the veteran would end up
paying a premium for having elected to use VA first.
Secondly, despite VA's renowned buying power in the
pharmaceutical markets, manufacturers will react predictably to
hundreds of thousands of new beneficiaries receiving
medications with pricing predicated on the Federal supply
schedule for pharmaceuticals or on VA's negotiated off-schedule
pricing. If history is any indication, the pharmaceutical
industry will react negatively to siphoning off of more
profitable non-FSS-P volume by raising prices to VA.
Lastly, this bill represents yet another windfall for the
Centers for Medicare and Medicaid Services, which already
subsidizes--which VA already subsidizes for the non-service
connected care of Medicaid eligible veterans to the tune of
billions of dollars per year.
I see the light has turned red. Mr. Chairman, this
concludes my testimony. I will be happy to answer any
questions. Thank you.
[The prepared statement of Mr. Mooney follows:]
Prepared Statement of Donald Mooney, Assistant Director, Veterans
Affairs and Rehabilitation, The American Legion
Mr. Chairman and Members of the Committee:
The American Legion appreciates this opportunity to express our
views on the many important bills being considered today by the
committee. We applaud the committee for holding hearings on these vital
issues. Due to the late arrival of some of the draft legislation to our
offices, we are unable to comment on all of them at this time. We
therefore ask permission of the committee to supplement the written
record with our views as soon as we have the opportunity.
S. ----, ``THE VETERANS HEALTH CARE IMPROVEMENTS ACT OF 2005''
SEC. 2. COPAYMENT EXEMPTION FOR HOSPICE CARE
This section would exempt veterans receiving end-of-life outpatient
hospice care from co-payments for those services. The American Legion
supported legislation in the 108th Congress, which subsequently became
law, applying to inpatient care. We support the extension of this
exemption to outpatient care as well as the exemption of co-payments
for inpatient hospice care.
SEC. 3. NURSING HOME BED LEVELS AND EXEMPTION OF EXTENDED CARE SERVICES
CO-PAYMENTS FOR FORMER PRISONERS OF WAR
The President's fiscal year 2006 VA budget request contains a
legislative proposal to repeal the provision of the Millennium Act
requiring VA to maintain its Nursing Home Care Unit (NHCU) bed capacity
at the 1998 level of 13,391. The language in the budget request refers
to this mandate as ``a baseline for comparison.'' The Millennium Health
Care Act requires VA to maintain its in-house bed inventory at the 1998
level; however, this capacity has significantly eroded rather than been
maintained. In 1999 there were 12,653 VA NHCU beds, 11,812 in 2000,
11,672 in 2001 and 11,969 in 2002. VA estimated it had 12,239 beds in
2003 and 12,245 in 2004. The President's budget request projects only
9,975 in fiscal year 2006, a 27 percent decrease from the Millennium
Act mandate. VA claims that it cannot maintain both the mandated bed
capacity and implement all the non-institutional programs required by
the Millennium Act.
According to VA's fiscal year 2002 Annual Accountability Report
Statistical Appendix, in September 2002, there were 93,071 World War II
and Korean War era veterans receiving compensation for service-
connected disabilities rated 70 percent or higher. The American Legion
believes that VA should comply with the intent of Congress to maintain
a minimum LTC nursing home capacity for those disabled veterans who are
in the most resource intensive groups; clinically complex, special
care, extensive care and special rehabilitation case mix groups. The
Nation has a special obligation to these veterans. They are entitled to
the best care that VA has to offer and they should not be dumped onto
Medicaid, as is now the trend. Providing adequate inpatient LTC
capacity is good policy and good medicine. The American Legion opposes
this provision of Section 3.
This section also exempts former prisoners-of-war from co-payments
for extended care services for non-service-connected disabilities.
Veterans who have suffered the hardships, deprivations and indignities
of captivity by an enemy government or other entity should receive the
best care that we have to offer at no cost. They have already bought
and paid for it. The American Legion is pleased to support this
provision of Section 3.
SEC. 4. AUTHORIZE VA REIMBURSEMENT FOR NON-VA-PROVIDED EMERGENCY CARE
This section will authorize VA to reimburse emergency medical care
for which veterans are personally liable; either directly to the
veteran, to the facility providing the emergency care or to a third
party that paid for the care. To qualify, the veteran must be enrolled
in VA healthcare and must have received treatment from VA within 24
months prior to the emergency care. The veteran must have insurance or
other third party coverage that pays some of the costs and leaves the
veteran liable for uncovered costs such as deductibles and co-payments.
This section is separate from similar statute that provides similar
coverage to veterans who have no insurance or who needed emergency
treatment for a service-connected condition, a non-service-connected
condition aggravating a service-connected one, a totally service-
connected disability or who is enrolled in VA vocational
rehabilitation.
The American Legion supports this section; however, we note that it
does nothing to correct the problems with VA policy on non-VA emergency
treatment, generally, especially as regards local ambulance
transportation. This has become an issue of concern to many American
Legion veterans advocates around the country.
We relate a case-specific in which a veteran rated 60 percent
disabled and 100 percent individually unemployable had had bilateral
knee replacements for his service-connected condition. He ambulates
with the assistance of braces and a cane. On a visit to the local mall,
the veteran's knees gave out and he fell forward, injuring his hands,
elbows and knees. The veteran's wife called the local rescue squad
because the veteran was in extreme pain. The nearest VA Medical Center
was in Roseburg, Oregon, 150 miles to the north, so the decision was
made to transport the veteran to the local hospital for stabilization.
The VA Outpatient Clinic in White City, 15 miles away, was not staffed
for emergencies or orthopedic trauma and the veteran was not seen there
until several days after the incident. The attending at the VAOPC
confirmed that the veteran's left knee was fractured. The veteran
requested that VA pay the charges from the local hospital, but VA
denied on the basis that the injury was not emergent; that is, life-
threatening, and the injury could have been handled within the VA
system. This, despite the fact that, even if the VAMC was close enough
to use, it was on ``divert'', meaning it would not receive inbound
ambulances. The denial of the veteran's claim is currently on appeal.
The American Legion believes Congress should closely examine the
criteria under which VA is authorized to reimburse emergency non-VA
treatment versus how it actually does.
SEC. 5. AUTHORIZE VA, FOR A 14-DAY PERIOD, TO PROVIDE CARE FOR NEWBORN
INFANTS OF VETERANS WHO HAVE DELIVERED IN A VA FACILITY (OR AT VA
EXPENSE)
This section adds 2 weeks of neonatal care of a newborn infant that
has been delivered to a veteran in a VA medical facility or at VA
expense. As of March 2005, 1.7 million of the Nation's 24.7 million
veterans are women. Women now account for 15 percent of active duty
military personnel and are currently serving in Iraq and Afghanistan
under identical conditions as male servicemembers. VA now provides a
full continuum of comprehensive medical services including health
promotion and disease prevention, primary care, women's gender-specific
health care; e.g., hormone replacement therapy, breast and
gynecological care, maternity and limited infertility (excluding in-
vitro fertilization), acute medical/surgical, telephone triage,
emergency and substance abuse treatment, mental health, domiciliary,
rehabilitation and long-term care. Given the unknowns of military
environmental exposures in the current conflicts, Congress is wise to
extend this care to the newborn children of these veterans. The
American Legion supports this section.
SEC. 6. ALLOW PROVIDERS OF CARE TO VIETNAM VETERANS' SPINA BIFIDA
CHILDREN AND CHILDREN WITH COVERED BIRTH DEFECTS TO SEEK FROM THIRD
PARTY PAYERS PAYMENT FOR THE DIFFERENCE BETWEEN AMOUNT BILLED AND
AMOUNT REIMBURSED BY VA
VA will provide a Vietnam veteran's child who has been determined
to suffer from spina bifida and children with covered birth defects
with such health care as the VA determines is needed by the child for
spina bifida or covered birth defects. Under 38 C.F.R. 17.901, VA is
the ``exclusive payer'' for spina bifida services and services related
to covered birth defects regardless of any third party insurer,
Medicare, Medicaid, health plan, or any other plan or program providing
health care coverage. The rates paid by VA for the care of children of
Vietnam veterans with spina bifida and covered birth defects, in many
cases, do not cover the amounts billed by non-VA providers, exposing
the parents to ``balance billing'' for the amounts not reimbursed. This
legislation would clarify that the ``exclusive payer'' language in 38
C.F.R. 17.901 does not preclude providers from balance billing third-
party payers and relieves the parents of responsibility for VA
underpayment by holding harmless the parents of beneficiary children
from balance billing by providers.
Caring for a child with spina bifida and/or covered birth defects
imposes economic and emotional burdens on the parent that may be
compounded by medical debt incurred as a result of balance billing. The
American Legion supports this provision.
SEC. 7. AUTHORIZE ON A PERMANENT BASIS GRANTS AND PER DIEM PAYMENTS TO
PROVIDERS OF SERVICES TO THE HOMELESS, AND INCREASE FROM $99 MILLION TO
$130 MILLION PER YEAR
Homelessness in America is a travesty, and veterans' homelessness
is disgraceful. Left unattended and forgotten, these men and women, who
once proudly wore the uniforms of this Nation's armed forces and
defended her shores, are now wandering the streets in desperate need of
medical and psychiatric attention and financial support. While there
have been great strides in ending veteran homelessness there is much
more that needs to be done. We must not forget them. The American
Legion supports funding of the Homeless Veterans Grants and Per Diem
Program at $133 million.
SEC. 8. MARRIAGE AND FAMILY THERAPY
This section adds Marriage and Family Therapy to the list of
professionals authorized to practice in VA facilities. A major
criticism of VA Post-Traumatic Stress Disorder Treatment programs has
been the exclusion of spouses and children from the recovery process.
In many cases, the residuals of the veteran's traumatic experiences
impact the family members of the veteran as severely as the veteran him
or herself. Education about post-traumatic stress reactions, training
in coping skills, the use of efficacious therapies such as exposure
therapy, cognitive restructuring and family counseling are generally
accepted as methods of care for PTSD. The addition of Marriage and
Family Therapy to multi-disciplinary treatment in VA will add a needed
dimension to the holistic treatment model required to successfully help
the veteran and his loved ones recover from the trauma of war. The
American Legion supports this provision.
SEC. 9. AUTHORIZE SENIOR EXECUTIVE SERVICE COMPENSATION TO THE
DIRECTOR,
VA NURSING SERVICE
The American Legion has no position on this issue.
SEC. 10. REPEAL OF COST COMPARISON STUDIES PROHIBITION
The American Legion has no position on this issue.
SEC. 11. MENTAL HEALTH/PTSD SERVICE IMPROVEMENTS
In the 2003 report of the Special Commission on Post-Traumatic
Stress Disorder, released before the invasion of Iraq, it was noted
that demand for VA PTSD specialized services is growing. Fifty percent
of all veterans service-connected for PTSD became service-connected
within the last 5 years and the population served by VA specialized
PTSD outpatient programs grew by 86 percent between fiscal year 1995
and fiscal year 2001. The Commission noted that the intensity of
services provided to veterans service-connected for PTSD actually fell
by 9.3 percent over the 5 years preceding the report. This decline in
capacity is illustrated by the fact that of the 205,996 veterans who
had a VA clinic visit where PTSD was the focus of treatment, only 28
percent received it in a specialized PTSD program. The other 72 percent
received treatment in some other setting, including 17 percent who were
seen in a non-mental health setting. Additionally, of the 128,000
veterans seen in Vet Centers in fiscal year 2002, only 55 percent were
receiving services of any kind in a VA medical center. In its 2002
report, the Commission noted that the average waiting time to enter a
specialized PTSD inpatient program was 47 days with waits approaching 1
year in some facilities. The Commission concluded that VA's specialized
PTSD services are so fully saturated that that they cannot absorb new
patients (now, Iraq war returnees) without diluting the intensity of
service provided to each veteran.
This section directs VA to: (1) Expand the number of clinical
treatment teams dedicated to Post-Traumatic Stress Disorder (PTSD) in
VA medical facilities (funded at $5 million in each of fiscal years
2006 and 2007); (2) expand and improve diagnosis and treatment of
substance abuse ($50 million); (3) expand and improve tele-health
services where veterans are remote from VA facilities ($10 million);
(4) improve education of VA primary care professionals to diagnose and
treat mental health issues ($1 million); expand the delivery of mental
health services in VA Community Based Outpatient Clinics ($20 million)
and; (5) expand and improve Mental Health Intensive Case Management
Teams for veterans with serious and chronic mental illness ($5
million).
These improvements come at a time when VA is experiencing an
upswing in demand for mental health services by veterans of Operations
Iraqi Freedom and Enduring Freedom. The American Legion has long
advocated the reinstatement of mental health and substance abuse
capacity that was severely curtailed in the 1990's and we support this
section of this bill. However, we have concerns that by earmarking the
$95 million the bill would appropriate in fiscal years 2006 and 2007,
VA will be forced to further ration other programs and services. VA's
fiscal year 2006 appropriation already falls well short of what VA
needs to maintain currents levels of service and access. The American
Legion believes the Congress should authorize additional funding to
cover the costs of implementing this section.
SEC. 12. DATA SHARING IMPROVEMENTS
This section authorizes the exchange of protected health
information between VA and the Department of Defense (DoD) on patients
receiving treatment from VA and any person who may receive treatment
from VA including ``current and former members'' of the Armed Services.
This language is vague and seems to propose that VA become the
repository of all medical records of ``all current and former'' members
of the Armed Services. This would place an extreme burden on VA and
require it to take over some of the functions of the National Archives'
National Personnel Records Center (NPRC) that currently manages the
service medical and personnel records of millions of former
servicemembers at its facility in Saint Louis. When VA requires the
medical records of an individual, usually for compensation and pension
claims purposes, it requests them from NPRC. For soldiers separated or
released from active duty after October 1994, their health records
already go directly to the Department of Veterans Affairs' Record
Management Center (VA RMC), also in St. Louis. Additionally, VA and DoD
currently have a number of ongoing information exchange initiatives in
development in their efforts to meet the Seamless Transition mandates
of Congress. The American Legion defers comment on this section and
requests the committee to provide clarification.
SEC. 13. EXPANSION OF NATIONAL GUARD OUTREACH AND ASSESSMENT
This section directs VA to collaborate with State National Guard
officials and expand the total number of VA employees dedicated to
outreach under the VA's Rehabilitation Counseling Service's Global War
on Terrorism Outreach Program. The American Legion supports this
section.
Many of our servicemembers returning home from duty on Operations
Iraqi Freedom and Enduring Freedom are not being properly advised of
the benefits and services available to them from the Department of
Veterans Affairs and other Federal and State agencies. This is
especially true of Reserve and National Guard units that are
demobilized at hometown Reserve Centers and National Guard armories,
rather than at active duty demobilization centers. To assist in making
sure that these servicemembers are aware of the services and benefits
they have earned through their honorable service in the Global War on
Terrorism, The American Legion has developed a Welcome Home brochure.
This brochure outlines the basic entitlements and benefits available
from VA and provides contact phone numbers and Internet web sites from
which servicemembers may obtain more information. The American Legion
intends to distribute this document to demobilization centers, Reserve
Centers, National Guard armories and Transition Assistance Programs
nationwide.
SEC. 14. EXPANSION OF TELE-HEALTH SERVICES
This section directs VA to install tele-medicine technology in a
larger number of Veterans Readjustment Counseling Services facilities
(Vet Centers) and to report to Congress its plan to do so in fiscal
years 2005 through 2007. The American Legion supports this section and
further believes that Vet Centers in highly rural and isolated areas
should receive priority for this technology.
SEC. 15. MENTAL HEALTH DATA SOURCES REPORT
This section requires VA to submit a report to the Congress on the
mental health data maintained by VA, including a list of the sources of
such data, and assessment of the advantages and disadvantages of the
current data and recommendations for improving the collection, use and
location of such data. The American Legion has no position on this
issue.
S. ----, ``THE BLINDED VETERANS CONTINUITY OF CARE ACT OF 2005''
In this bill, Congress has found that approximately 1,500 veterans
are on waiting lists for admission to VA blind rehabilitation programs
nationally and that this situation is due largely to shortages of blind
rehabilitation specialists in VA facilities. This legislation directs
VA to establish blind rehabilitation specialist positions at VA
facilities having 150 or more currently enrolled legally blinded
veterans and prioritizes implementation by fiscal year starting with VA
facilities having the highest numbers of blind veterans. The bill
further appropriates $5 million a year for each of fiscal years 2006
through 2010 for implementation. The American Legion supports this
initiative; however, we have concerns that by earmarking the $5 million
the bill would appropriate in fiscal years 2006 through 2010, VA will
be forced to further ration other programs and services. VA's fiscal
year 2006 appropriation already falls well short of what VA needs to
maintain currents levels of service and access. The American Legion
believes the Congress should authorize supplementary funding to cover
the costs of implementing this section.
S. ----, ``TO REQUIRE THE SECRETARY OF VETERANS AFFAIRS TO PUBLISH A
STRATEGIC PLAN FOR LONG-TERM CARE, AND FOR OTHER PURPOSES''
The American Legion supports this bill, however, due to restraints
of time the American Legion requests the committee to allow us to
submit our views as an addendum to the written record.
S. ----, ``TO ESTABLISH A GRANT PROGRAM TO PROVIDE INNOVATIVE
TRANSPORTATION OPTIONS TO VETERANS IN REMOTE RURAL AREAS.''
The American Legion supports this bill; however, due to restraints
of time The American Legion requests the committee to allow us to
submit our views as an addendum to the written record.
S. ----, ``THE MENTAL HEALTH CAPACITY ACT OF 2005.''
The American Legion supports this bill; however, due to restraints
of time The American Legion requests the committee to allow us to
submit our views as an addendum to the written record.
S. ----, ``THE NEIGHBORING ISLANDS VETERANS HEALTH CARE IMPROVEMENTS
ACT.''
The American Legion has consistently supported the establishment of
VA facilities to serve veterans in remote and underserved areas. The
American Legion supports this bill; however, due to restraints of time
The American Legion requests the committee to allow us to submit our
views as an addendum to the written record.
S. 481, ``TO EXTEND COMBAT VETERANS' POST-DISCHARGE 2-YEAR PERIOD OF
ELIGIBILITY FOR VA HEALTH CARE TO 5 YEARS''
The American Legion supports this bill; however, due to restraints
of time The American Legion requests the committee to allow us to
submit our views as an addendum to the written record.
S. 614, ``THE VETERANS PRESCRIPTION DRUGS ASSISTANCE ACT OF 2005''
This bill mandates VA to provide prescription medications to
Medicare-eligible veterans who are receiving disability compensation,
nonservice-connected pension, aid and attendance or are housebound. VA
must fill prescriptions written by ``a duly licensed physician'' for
any condition under this legislation. Veterans receiving nonservice-
connected pension who are also receiving aid and attendance may
continue to receive this benefit even if their incomes exceed maximum
income limitations by not more than $1,000.00. Under current law, such
veterans would lose eligibility for any VA care or services once their
incomes exceed the maximum income limitation.
This bill also requires VA to fill prescriptions written by ``duly
licensed physician[s]'' for any condition where the Medicare-eligible
veteran makes an annual, irrevocable, renewable election to get his or
her medications from VA. VA is required to provide the veteran making
the election with information about the benefits, costs and
consequences prior to permitting the election. The bill takes care to
make sure that the new benefit is cost-neutral to VA by allowing VA to
establish new schedules of annual enrollment fees, co-payments and
allowing VA to charge the full cost of medications to veterans. VA is
also authorized to provide immunizations to Medicare-eligible veterans,
provided that the vaccines required are furnished to VA by the
Department of Health and Human Services at no charge.
Mr. Chairman, The American Legion believes that while well-
intentioned, this bill has serious problems.
First, it requires the Medicare-eligible veteran to make a decision
as to where to get his or her medications based on information that is
not yet available and it further complicates already unfathomable
extant and pending regulation and criteria for Federal prescription
drug benefits. Unforeseen and unintended consequences will be rife; for
example, the new Medicare Part D drug benefit includes penalties for
late enrollment, therefore, should a veteran elect to use VA, then
later elect to use Medicare Part D, the veteran could end up paying a
premium for having elected to use VA first. If enacted, implementation
of this benefit should be delayed for several years to allow the entire
Federal drug benefit landscape to stabilize.
Second, despite VA's renowned buying-power in pharmaceutical
markets, it is unclear how manufacturers will react to hundreds of
thousands of new beneficiaries receiving medications with pricing
predicated on the Federal Supply Schedule for Pharmaceuticals (FSS-P)
or VA's negotiated off-schedule pricing. If history is any indication,
the pharmaceutical industry will react negatively to any siphoning-off
of more profitable non-FSS-P volume with predictable effects on VA's
drug costs.
Last, this bill represents yet another windfall for the Center for
Medicare and Medicaid Services (CMS), which VA already subsidizes for
the nonservice-connected care of Medicare-eligible veterans to the tune
of billions of dollars per year. The requirement that VA recover all
its costs for filling prescriptions through enrollment fees, new co-
payment schedules and direct cost billing relieves CMS of fiscal
exposure for this population of beneficiaries and places it on the
backs of veterans. VA should be authorized to recover incurred costs
not covered by existing co-payments in this new benefit from CMS.
The American Legion has consistently opposed enrollment fees for VA
eligibility, including any prescription-only benefit. We restate that
position today and express adamant opposition to the introduction of
new co-payment schedules not already in law. Additionally, The American
Legion has opposed the filling of prescriptions written by non-VA
providers. VA Consolidated Mail Outpatient Pharmacies (CMOPs) are
already running at over-capacity and would require significant
additional infrastructure to meet the demand imposed by this bill.
S. 716, ``THE VET CENTER ENHANCEMENT ACT OF 2005''
The American Legion supports this bill; however, due to restraints
of time The American Legion requests the committee to allow us to
submit our views as an addendum to the written record.
S. ----; ``THE SHELTERING ALL VETERANS EVERYWHERE ACT''
This bill authorizes funding of the VA Grants and Per Diem Program
at the full rate for domiciliary care and appropriates $200 million per
fiscal year for fiscal years 2006 through 2011, expands eligibility for
veterans at imminent risk of homelessness and appropriates an
additional $50 million for that purpose for those years expands
outreach to at-risk veterans, including those separating from active
duty. It further extends authorization for treatment and rehabilitation
for seriously mentally ill and homeless veterans and permanently
reinstates VA authority to transfer properties obtained through
foreclosure of VA home mortgages wherein VA may sell, donate, lease, or
lease with option those properties to nonprofit organizations, States
or localities for use in sheltering homeless veterans. The bill
reauthorizes $5 million per year for fiscal years 2005 through 2011,
funds the Homeless Veterans Service Provider Technical Assistance
program at $1 million for the same period, expands eligibility for
dental care for homeless veterans, requires an annual report to
Congress from VA on the status of its assistance to homeless veterans
and extends the life of the VA Advisory Committee on Homeless Veterans.
The current Administration has vowed to end the scourge of
homelessness within 10 years. The clock is running on this commitment,
yet words far exceed deeds. On any given night in this Nation, there
are as many as 300,000 homeless veterans with as many as 600,000
homeless during the year. While less than 9 percent of the Nation's
population are veterans, 34 percent of the nation's homeless are
veterans and 75 percent are wartime veterans. This bill is the first
major proposal in years to fund veterans homelessness programs at
levels that have a potential to make a real impact and The American
Legion vigorously supports it. The American Legion has concerns that by
earmarking the funding required by this bill from existing
appropriations, VA will be forced to further ration other programs and
services. VA's fiscal year 2006 appropriation already falls well short
of what VA needs to maintain currents levels of service and access. The
American Legion believes Congress should authorize additional funding
to cover the costs of implementing this forward-thinking legislation.
Mr. Chairman, this concludes my testimony. I will be happy to
answer any questions.
Chairman Craig. Don, thank you very much, and again, your
full statement will be part of the record and any additional
comments you wish to make on these individual pieces of
legislation will also become a part of the record.
Now let me go to Dennis Cullinan, Director, National
Legislative Service, Veterans of Foreign Wars.
Dennis.
STATEMENT OF DENNIS M. CULLINAN, DIRECTOR, NATIONAL LEGISLATIVE
SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES
Mr. Cullinan. Thank you very much, Mr. Chairman, and on
behalf of the men and women of Veterans of Foreign Wars, I want
to thank you for inviting us to participate in today's most
important hearing.
For the purposes of today's hearing, I am just going to
extract briefly from our written statement.
With respect to the Veterans Health Care Act of 2005,
Section 3, while we support exempting former POWs from co-pays
for extended care services, we must oppose the provision that
would eliminate the VA's statutory requirement to maintain 1998
staffing and service levels of the extended care facilities.
With respect to Section 5, this section would allow newborn
children of mothers who have been receiving maternity care to
receive 14 days of care at VA facilities. We strongly support
this provision because it closes a loophole and is fair to the
mother and to the family.
Currently, no direct health care coverage is provided to
the children's families, and they must find outside health care
insurance to help pay for the child's treatment. The 14-day
window this bill provides allows the parents of the child to
secure additional health care coverage, whether through a
private company or through Medicaid, and would ease VA's
ability to find a local hospital to accommodate the family.
Next I will address S. 481. The VFW supports Senator
Akaka's bill that would give separating service members who
have served in a combat zone an additional 3 years of access to
the VA health care system. Extending this limit to 5 years give
these men and women an important safety net, and can also give
them peace of mind as they return from the stress of combat,
safe in the knowledge that their health care safety net will be
there should they need it or should they fall ill as a result
of their service.
With respect to S. 716, the Vet Center Enhancement Act, the
VFW applauds the introduction of this legislation that would
enhance services provides to vet centers, to clarify and
improve the provision of bereavement counseling by the
Department of Veterans Affairs.
This legislation will allow VA to hire 50 more OIF and OEF
veterans to help reach out to the newly transitioning veterans
adjusting back to civilian life. And we must ask who better to
explain services and help ease their transition than someone
who has served alongside them, who can relate to their
experiences, and has already navigated VA's many benefit
programs. This legislation will also go one step further to
help surviving family members who have suffered the loss of a
loved one by clarifying who can use the benefit from vet center
bereavement counseling services.
The VFW feels that we have an obligation to help make the
transitioning period for returning service members and the
readjustment period for survivors, those killed in battle, as
smooth and as problem free as possible.
Thank you, Mr. Chairman. That concludes my statement.
[The prepared statement of Mr. Cullinan follows:]
Prepared Statement of Dennis M. Cullinan, Director, National
Legislative Service, Veterans of Foreign Wars of the United States
Mr. Chairman and Members of the Committee:
On behalf of the 2.6 million men and women of the Veterans of
Foreign Wars of the United States and our Auxiliaries, I would like to
thank you for inviting us to today's hearing on veterans' health care
legislation.
With the changes in the Appropriations committee, much of our focus
to this point has been on the proper of level of funding for the
Department of Veterans Affairs (VA), especially the amount going toward
the Veterans Health Administration (VHA).
But, it is also important to focus on the actual programs receiving
that funding, how effectively they treat veterans, and whether there
are any necessary corrections or additions.
And the bills under consideration today do just that.
draft bill, the veterans health care act of 2005
Section 2: VFW supports this provision, which would exempt hospice
care from services that require co-payments.
Section 3: While we support exempting former POWs from co-payments
for extended care services, we must oppose the provision that would
eliminate VA's statutory requirement to maintain 1998 staffing and
service levels of extended care facilities.
Although VA has failed to live up to this target, eliminating this
provision would get rid of a very important target. VA must live up to
its obligations, not shirk from them.
With the Administration's budget proposal, there was much
discussion about VA's long-term care programs. If changes, such as
this, are to be made, then VFW feels that there must be a larger
discussion about the role of VA in long-term care.
But, for now, our membership strongly supports maintaining the
current spectrum of VA long-term care services. We cannot support this
statutory reduction in service.
Section 4: We agree with this section, which would close the
loopholes in the reimbursement process for veterans seeking emergency
care. Too frequently, because of these complex regulations that the
veteran, or non-VA hospitals, might not be aware of, veterans are
unnecessarily being charged for their emergency care.
This problem is especially evident for our rural veterans, who,
when emergencies occur, cannot take the time to make the trip to VA;
they must go to the closest hospital.
VA must ensure that all veterans are treated fairly and that they
not be unfairly punished or harmed because of their need for emergency
care.
Section 5: This section would allow newborn children of mothers who
have been receiving maternity care to receive 14 days of care at VA
facilities. We support this provision, because it closes a loophole,
and is fair to the mother and family.
Currently, no direct health care coverage is provided to the
children and families must find outside health insurance to help pay
for the child's treatment. The 14-day window this bill provides allows
the parents of the child to secure health care coverage, whether
through a private company or through Medicaid, and would ease VA's
ability to find a local hospital to accommodate the family.
This would give the families an important peace of mind allowing
them to focus on the joys of becoming parents. It makes a small change
in the law to do what is right for veterans.
Section 6: VFW also agrees with this section, which would allow
health care providers to seek reimbursement for extra expenses not
covered by VA for treatment of children with spina bifida of certain
Vietnam veterans.
This provision is important because of the complex nature of their
health care problems, and the difficult and frequent treatment these
children require. Making payment easier will encourage more facilities
to provide the kinds of treatment these children need by eliminating an
economic hurdle.
Improved access to health care is nothing but a good thing for
these veterans and their families.
Section 7: While we support the increased grants for homeless
veterans contained in this section, we feel that the funding level in
Senator Obama's draft bill, which we discuss later, to be more
appropriate.
Section 8: The VFW does not take a position on this section, so
long as the changes in qualification do not mean impaired access to
marriage and family counseling. As we are seeing, today's long and
frequent deployments are creating an increased need for these kinds of
services.
Section 9: The VFW has no position on this section.
Section 10: The VFW takes no position on this provision.
Section 11: We are pleased with this section, which improves and
expands VA's ability to provide mental health care services. It
includes $95 million in funding to improve treatment for PTSD and
substance abuse problems. It also makes access to health care more
efficient by pursuing tele-health initiatives, and expanding the number
of clinical treatment teams.
With the difficulties of the unique nature of combat our men and
women are facing, these mental health services will take on an
increasingly important role. While much of our concern has focused on
those with physical wounds, just as much effort must be focused on the
unseen psychological wounds, which can linger and manifest themselves
in many other problems for years.
Giving veterans easier access and de-stigmatizing the treatment of
these issues prevents future difficulties from arising, and helps the
veteran transition smoothly back into society.
Section 12: The VFW supports this provision, which would eliminate
any bureaucratic barriers toward VA-DoD health care sharing, by
allowing the two departments to fully share any protected health
information for their patients.
The seamless transition between these two departments has long been
a VFW goal. We hope that this provision would lead us one step closer
toward that goal.
Section 13: We are pleased to support this section which improves
outreach to National Guard members to inform them of their benefits and
rights with VA.
We have frequently heard that the information they receive upon
returning is confusing. We hope that expanding this program would
alleviate some of the confusion surrounding their benefits status, and
would enable those who need assistance to find a VA program that meets
their needs.
Section 14: The VFW would also support this provision, which
improves health care by increasing the number of Readjustment
Counseling Centers which can provide tele-health services with VHA
facilities.
We believe that expanding veterans' access to health care
facilities with this simple technology would be beneficial and help
these veterans get treatment for illnesses and disabilities. Improved
access means that more veterans can receive care, often with less of a
burden. That is undoubtedly a good thing.
Section 15: We have no position on this section.
S. 481
The VFW supports S. 481, Senator Akaka's bill that would give
separating servicemembers, who have served in a combat zone, an
additional 3 years of access to the VA health care system.
Public Law 105-627 provided Gulf War veterans, as well as those who
serve in any future combat zones, 2 years of eligibility for VA health
care. This was part of a larger package of improvements for Persian
Gulf veterans in response to the health problems many of them faced.
Given the uncertainty surrounding the health of many of them, and the
difficulties of diagnosis that many of them faced, they were granted
continued access to VA health care so that these problems could be
monitored, or any new symptoms could be treated.
Unfortunately, because of the prohibition on new category 8
veterans, many of these veterans will have their access to health care
completely curtailed. In the past, they could have continued to access
the system.
Extending these veterans' eligibility is especially important when
you factor in the difficulty VA has with disability claims processing,
and the role that VA disability now has in health care eligibility.
With disability claims taking many months to process, veterans who may
ultimately prove to be disabled will slip through the cracks and denied
their earned health care because of an overly bureaucratic process.
That is clearly not right, and it does not do what is right for
America's veterans.
Extending this limit to 5 years gives these men and women an
important safety net, and can also give them peace of mind as they
return from the stresses of combat, safe in the knowledge that their
health care safety net will be there, should they need it, or should
they fall ill as a result of that service.
S. 614 THE VETERANS PRESCRIPTION DRUG ASSISTANCE ACT
This legislation would permit Medicare-eligible veterans to receive
an out-patient medication benefit from the VA provided that they forgo
medical care and services from VA during the year they choose such
benefit.
By way of background, the Veterans' Health Care Eligibility Reform
Act of 1996 provides all veterans enrolled in Categories 1-8 full
access to all of the health services described in VA's Medical Benefits
Package, which includes prescription drugs.
The Final Report of the President's Task Force To Improve Health
Care Delivery for Our Nation's Veterans, released in May, 2003, noted
that ``According to a November 2002 [Government Accountability Office
(GAO)] report, of the $3 billion VA spent on outpatient pharmacy drugs
in fiscal year 2001, 13 percent of the total cost, or $418 million, was
for former Priority Group 7 veterans.'' Other surveys have also
suggested that former Priority Group 7 veterans are significantly
affecting VA's pharmacy workload, and anecdotal evidence suggests that
many of these veterans are coming to VA only for prescription drugs.
The GAO study reported that in fiscal year 1999, 400,000 of the former
Priority Group 7 veterans had 11 million prescriptions filled. ``In
fiscal year 2001, the number of veterans in this group seeking
prescription drugs increased to 800,000 and the number of prescriptions
filled grew to 26 million.''
These numbers are alarming when one considers that many of these
veterans come to VA with prescriptions from their private physicians
already written and in-hand only to find out that they cannot get their
prescription filled until they see a VA physician. The VA Inspector
General noted ``frequent comments in patient medical records reflecting
the frustration of veterans in having to go through VA's extended
process of scheduling exams and tests and then spending sometimes the
entire day at the medical center solely, from their perspective, to
have their prescriptions filled or refilled.''
In addition, the VA Inspector General also found once veterans
received appointments with VA physicians, these VA physicians
``routinely review and approve the orders of the private physicians--
[and] exams frequently duplicate tests and exams that have already been
performed by the patient's private physician and are conducted to allow
the VA physician to support filing a prescription that the patient
brought from his/her private physician.''
Given the current situation and the opportunity to potentially
mitigate the impact of long waiting times and produce cost savings by
streamlining an inefficient and overly bureaucratic process, the VFW
supports the creation of an out-patient prescription benefit that would
free up VA health care appointments and potentially reduce the backlog.
In addition, we support providing an outpatient medication benefit to
Medicare-eligible Category 8 veterans who are currently precluded from
enrolling in VA health care.
VFW, however, does not support the language that requires veterans
to forgo their earned VA health care in favor of Medicare. Veterans are
unique in that they have an entitlement to Medicare by way of financial
contribution and have also earned the right to VA health care through
virtue of their service to this Nation. They must not be forced to give
up their rights to either. VFW will continue to fight for adequate
appropriations to allow all veterans access to VA's full Medical
Benefits Package.
S. 716, THE VET CENTER ENHANCEMENT ACT OF 2005
VFW applauds the introduction of S. 716, The Vet Center Enhancement
Act of 2005, legislation that would amend title 38, U.S.C. to enhance
services provided by vet centers, to clarify and improve the provision
of bereavement counseling by the Department of Veterans Affairs, and
for other purposes.
In February 2004, the Department of Veterans Affairs (VA)
authorized the Vet Center program to hire 50 Operation Iraqi Freedom
(OIF) and Operation Enduring Freedom (OEF) veterans to provide outreach
to their returning comrades. As time passes and more and more veterans
of OIF and OEF as well as those serving all over the globe in the War
on Terror return home with both physical and mental battle scars, the
need for enhanced services provided by VA is critical. Community based
Vet Centers provide a safe haven and offer a wide-variety of
readjustment services designed to assist transitioning veterans.
Currently, 60 percent are staffed by veterans who have served in
combat. This legislation will allow VA to hire 50 more OIF and OEF
veterans to help reach out to those newly transitioning veterans
adjusting back to civilian life. Who better to explain services and
help ease their transition than someone who served along side them, can
relate to their experiences, and has already navigated VA's many
benefit programs?
This legislation will also go one step further to help surviving
family members who have suffered the loss of a loved one by clarifying
who can use and benefit from vet center bereavement counseling
services. The VFW feels that we have an obligation to help make the
transitioning period for returning servicemembers and the readjustment
period for survivors of those killed in battle as smooth and as
problem-free as possible.
DRAFT BILL, SAVE REAUTHORIZATION ACT
The VFW offers our support for Senator Obama's draft bill which
would expand and improve upon VA's homelessness programs.
VA estimates that there are approximately 250,000 homeless
veterans. That is a national tragedy. These men and women have served
this country, and now find themselves in an unfortunate situation. We
must not leave these men and women behind. This bill greatly helps our
homeless veterans, and is a positive step toward ending this national
problem.
The legislation includes provisions that would provide $200 million
in funding for the homeless providers grant and per diem programs
annually through fiscal year 2011, and $50 million per year for the
Homeless Veterans Reintegration Program.
The programs it would extend are of great benefit to homeless
veterans, helping them to make the sometimes-difficult transition back
into society. We applaud this legislation and thank the committee for
considering it.
We received two draft bills from Senator Akaka's office, which, we
were not able to review in time. We would be happy to offer our
comments for the record, after we've had sufficient time to review
them.
This concludes my statement, Mr. Chairman. I would be happy to
answer any questions that you, or the Members of this committee, may
have.
Chairman Craig. Thank you very much. Your full statement
will be a part of the record.
Now, Adrian Atizado, Assistant National Legislative
Director, Disabled American Veterans. Welcome before the
committee.
STATEMENT OF ADRIAN ATIZADO, ASSISTANT NATIONAL LEGISLATIVE
DIRECTOR, DISABLED AMERICAN VETERANS
Mr. Atizado. Mr. Chairman, Members of the committee, on
behalf of the members of the Disabled American Veterans and its
auxiliary, we wish to express our appreciation for this
opportunity to present our views on the bills and draft bills
on today's agenda.
For the sake of brevity, I will limit my oral remarks to
highlight notable provisions of the bills, and ask the
committee to refer to my written testimony for additional
information.
The DAV supports Section 2 of the Veterans Health Care Act
of 2005, which would prohibit collection of co-payments from
veterans receiving hospice care furnished by VA. As you may
already know, Public Law 108-422 does not exempt veterans from
co-pay for hospice care, provided in other VA settings such as
hospital inpatient as well as in the home.
Similarly, DAV supports the provisions in Section 3 that
would exempt former POWs from inpatient long-term care service
co-payments.
As part of the independent budget the DAV strongly opposes
the provision of Section 3 that would eliminate VA's
requirement to maintain nursing bed capacity. This provision
recognizes and strengthens the importance of the Veterans
Health Administration specialized services and reflects the
vulnerability of these high-cost services in an under funded
system, especially at a time when the projected workload of VA
chronic care services will continue to rise in the future.
Section 4 would allow VA to reimburse a veteran for any
remaining expenses for having received emergency treatment at a
private facility. Now, DAV does have a resolution to support
this legislation. However, we do object to the eligibility
limitations for reimbursement of emergency services on veterans
enrolled in a VA health care system.
DAV Resolution 47 calls for adequate funding and permanency
of all veterans employment and training programs, including
homeless programs. Therefore, we support Section 7 of this
bill. However, we do note that any improvements and expansions
gained would be lost in the following years due to rising costs
such as inflation which affects the reimbursement rate, which
increases annually.
DAV Resolution 175 calls for the appeal of all co-payments
for veterans' medical services and prescriptions. Accordingly,
we do oppose the co-payment provision in S. 614, the Veterans
Prescription Drug Assistance Act.
The proposed legislation which would require VA to publish
a long-term care strategic plan to address the significant
needs of sick and disabled veterans for chronic care, DAV has a
resolution calling for legislation to establish a comprehensive
program of extended care services for veterans. However, as
part of the IB, the DAV is opposed to the provision in the bill
which requires the strategic plan to include specific plans to
utilize Medicare, Medicaid and private insurance companies to
expand care. Specifically, under tight budget constraints, this
provision would allow a shift in VA's responsibility to
veterans and reduces internal capacity to care for America's
aging veterans.
I see my time has run out. I do appreciate again the
opportunity to testify and welcome any questions you may have.
[The prepared statement of Mr. Atizado follows:]
Prepared Statement of Adrian Atizado, Assistant National Legislative
Director, Disabled American Veterans
Mr. Chairman and Members of the Committee:
On behalf of the members of the Disabled American Veterans (DAV)
and its Auxiliary, I wish to express my appreciation for this
opportunity to present the views of our organization on the bills and
draft bills on today's agenda. As always, we appreciate this
committee's efforts to improve benefits and services for disabled
veterans. With a few exceptions, the provisions of these bills are
beneficial and justified.
DRAFT LEGISLATION VETERANS HEALTH CARE ACT OF 2005
Public Law 108-422, Section 204, only exempted veterans from
extended care co-payments for VA hospice care services provided in a
nursing home setting. However, hospice care is provided in other
settings such as hospital inpatient, and in the home. Section 2 of this
legislation would prohibit the collection of co-payments from veterans
receiving hospice care furnished by the Department of Veterans Affairs
(VA) in any setting. The DAV testified in support of the same provision
in S. 2486 last year, and the DAV fully supports Section 2 in this
draft bill.
Similarly, the DAV supports the provision in Section 3 that would
exempt former POWs from inpatient long-term care service co-payments.
The DAV has a resolution calling for the repeal of all co-payments for
veterans' medical services and prescriptions. We commend this committee
for recognizing the tremendous undue burden placed on veterans in need
of end-of-life care that provides dying patients and their loved ones
with comfort, compassion, and dignity. Furthermore, veterans in no
other group as a whole have borne a greater burden on behalf of our
Nation and deserve more in return than our former POWs. Many suffered
unimaginable horrors from torture, humiliation, other physical and
psychological trauma and abuse, deprivation, isolation, and
malnutrition. In addition to the effects of physical and mental trauma,
many suffered from diseases caused by unsanitary conditions and
inadequate diets. Many, perhaps, never fully recover from a life
experience that is far more traumatic than most in society ever have to
endure. To the extent we can provide former POWs benefits that address
their special needs or afford some general recompense in proportion to
their suffering and sacrifices, we should never hesitate to do so.
Section 3 has another provision that, if passed, would eliminate
the required nursing bed capacity to be no less than the level during
fiscal year 1998. As part of The Independent Budget (IB), the DAV
strongly opposes the provision in Section 3 that would eliminate VA's
requirement to maintain nursing bed capacity. This provision recognizes
and strengthens the importance of the Veterans Health Administration's
(VHA's) specialized services and reflects the vulnerability of these
high-cost services in an under funded system. The projected workload
for VA chronic care services will continue to rise in the future. To
address this burgeoning demand VA has testified that it will increase
capacity in its non-institutional long-term care program. However, the
Government Accountability Office's (GAO) review of this program found
high variations in the availability of six VA non-institutional long-
term care programs. Until it can be verified that these non-
institutional programs are increased and functioning at a level of
satisfaction to veterans who would need these services, it seems an
unwise decision to relieve VA from the requirement that it protect the
vulnerability of its institutional long-term care capacity.
Section 4 would allow the VA to reimburse a veteran for any
remaining expenses from having received emergency treatment at a
private facility. The DAV has a resolution to support legislation to
authorize enrolled veterans to receive emergency medical care in
private medical facilities at VA's expense when VA facilities are not
reasonably available. However, we object to the eligibility limitations
for reimbursement of emergency services on veterans enrolled in the VA
health care system. Due to the existing eligibility criteria for VA
reimbursement of emergency treatment, many veterans do not seek
emergency treatment in non-VA facilities. When they do, they are
charged for emergency care as a result of denial of payment by VA for
such care based on the existing eligibility criteria. For example, the
eligibility criteria indicate veterans must not only be enrolled in the
VA health-care system, but they also must have been seen by a VA
health-care professional within the previous 24 months. As part of the
ill, the DAV believes all enrolled veterans should be eligible for
emergency medical services at any medical facility. It is outrageous to
penalize a veteran for seeking emergency care when he or she is
experiencing symptoms that manifest a life-threatening condition.
Section 5 of this bill would authorize care for newborn children of
enrolled women veterans following delivery. Women Veteran Coordinators
have complained that it is very difficult to secure a contract for care
for a woman veteran for the delivery of a baby without securing a
contract for initial post-delivery newborn care. Private hospitals are
reluctant to accept a sole contract for care for the mother and risk
financial responsibility for the care of the newborn infant following
delivery. The promise of comprehensive health care services includes
prenatal care and delivery. Health care professionals consider the
initial newborn care immediately following delivery as part and parcel
of the delivery itself this legislation would authorize VA to pay for
the initial care of the newborn infant for 14 days after the date of
birth or until the mother is discharged from the hospital, which ever
is the shorter period. DAV has no resolution from our membership on
this issue; however, its purpose is beneficial. We have no objection to
the committee's favorable consideration of this section of the measure.
Because of an apparent correlation between veterans' service in
Vietnam and spina bifida and other birth defects in the children of
veterans, Congress authorized special programs including medical
treatment to these children. Section 6 of this bill addresses the
disparity between billed charges for medical services rendered and
payments received by non-VA health care providers for treating children
of Vietnam veterans who are suffering from the effects of exposure to
Agent Orange. While protecting the veteran and family against the
difference between the amount billed and the amount paid by VA, this
provision would allow non-VA health care providers to seek third party
payments to compensate for the difference. Having no mandate from our
membership on this issue, we do not have a position on this section.
Section 7 would authorize increased appropriations for homeless
providers' grants to $130 million beginning in fiscal year 2006. DAV
Resolution No. 047 calls for adequate funding and permanency for all
veterans' employment and training programs, including homeless
programs. We thank the committee for recognizing the value and
importance of this program, which serves a vulnerable portion of the
veteran population; however, we note that any improvements and
expansions gained would be lost in the following years due to rising
costs such as inflation and the annual increase of reimbursement rates.
Section 8 would allow VA to employ marriage and family therapists
and require VA to submit a report to both the House and Senate
Veterans' Affairs committees. The report would include the actual and
projected workloads for providing marriage and family counseling
related to posttraumatic stress disorder (PTSD) treatment, an
assessment of the effectiveness of this treatment, and any
recommendations for improvement. DAV has no position on these
provisions since our membership has not provided us with a mandate on
this issue.
Section 9 of this bill would authorize Senior Executive Service
compensation to VA's Nursing Service Director. The DAV supports this
provision of the bill in keeping with DAV Resolution No. 199, which
seeks the enactment of legislation providing for competitive salary and
pay levels for VA physicians, pharmacists, dentists, and nurses.
Section 10 would eliminate the prohibition to utilize funds
appropriated for veterans medical care toward any cost comparison study
between VA services and similar commercial services. The DAV does not
have a resolution on this issue; however, due to the perennially
inadequate level of medical care funding, we are concerned this
provision would have a deleterious affect on VA's ability to deliver
needed medical care to sick and disabled veterans in a timely manner.
VA supplies one-third of all care provided for this Nation's
chronically mentally ill and have developed broad-reaching programs to
meet the psycho-social needs of homeless veterans. Without these
specialized services many veterans who are homeless or suffer severe
mental illness or substance use problems would return to the street,
end up in jail, or rely on more expensive and less comprehensive State-
sponsored programs. The private sector is ill-equipped to provide these
kinds of specialized services VA patients frequently need. Section 11
of this bill would expand VA's mental health services. To increase the
number of PTSD Clinical Teams (PCTs), Mental Health Intensive Case
Management teams (MBICMs), substance abuse treatment, improve mental
health education and training programs for providers, increase access
to VA's mental health services through tele-health initiatives, and
increase the availability of mental health services in Community-Based
Outpatient Clinics (CBOCs), $95 million would be authorized. With the
authorization of additional funds for these programs, the DAV supports
these provisions that would enhance VA's ability to provide mental
health services.
On May 19, 2005, a hearing was conducted by the House Veterans'
Affairs committee on seamless transition. GAO provided testimony, which
indicates the Department of Defense (DoD) and VA have been working on a
data sharing agreement for over 2 years, but have not reached an
agreement. GAO cited differences between the two agencies in their
interpretation of the Health Insurance Portability and Accountability
Act of 1996 (HIP AA) and the HIP AA privacy rule, which governs the
sharing of individually identifiable health data. Section 12 seeks to
address this impasse by allowing both agencies to exchange protected
health information despite any other provision of law. This would
enable VA to locate, identify, and follow up with servicemembers who
are injured while on active duty and may be eligible for VA benefits
and services.
VA has indicated, of the nearly 86,000 veterans from Operation
Enduring Freedom (OEF) and Iraqi Freedom (OIF) that have sought medical
care from VA, over half are from the National Guard and Reserve.
Moreover, over 9,000 veterans from Operation Enduring Freedom and Iraqi
Freedom suffer from PTSD, and over 2,000 have sought care in Vet
Centers. Outreach to National Guard and Reserves is now considered a
form of psychosocial intervention and provides direct access to Vet
Centers by providing information to individuals about the availability
of specialized services they may require and may be entitled. Section
13 would expand VA's outreach to the National Guard and Reserve
component of the military by increasing the number of employees in the
Readjustment Counseling Service's Global War on Terrorism Outreach
Program, requiring that information on VA benefits and services be made
available to returning Guardsmen, and an appropriate needs assessment
be conducted on all VA benefits and services. In addition, this section
would allow for collaboration between VA and appropriate State National
Guard officials to facilitate this outreach program. Section 14 would
require VA to submit a plan to both the House and Senate Veterans'
Affairs committees to increase the number of Vet Centers capable of
providing tele-mental health for fiscal years 2005 through 2007.
According to VA, the Veterans Readjustment Counseling Service maintains
206 Vet Centers, of which there are currently 20 Vet Centers across 14
Veterans Integrated Service Networks (VISNs) that have linkages to
provide tele-mental health services. The DAV does not have a resolution
on these issues; however, the purpose of this provision appears
beneficial and we look forward to favorable consideration by this
committee.
Section 15 would require the Secretary of Veterans Affairs to
submit a report to both the House and Senate Veterans' Affairs
Committees with data regarding the source of VA's mental health data,
such as the locations of facilities maintaining such data.
Additionally, the report is to include an assessment of the information
and recommendations for improving data collection, use, and repository
locations. The DAV does not have a resolution on this issue; however,
the provisions appear beneficial.
S. 481
This bill would extend the eligibility period for veterans who
served in combat during or after the Persian Gulf War, from 2 years
following discharge or release from active military service to 5 years,
to receive VA medical care. The DAV has no resolution pertaining to the
bill. However, because it would benefit recently discharged veterans
and their family members, the DAV has no objection to its favorable
consideration.
S. 614
In addition to allowing Medicare-eligible veterans to elect to
receive from VA outpatient prescription medication prescribed by a
physician, the Veterans Prescription Drugs Assistance Act, would direct
VA to collect co-payments and/or an enrollment fee to furnish
prescription medications for veterans in receipt of compensation and
increased pension. Furthermore, the bill would require VA to inform
each veteran considering an election to receive VA medication under
these provisions of the terms of the election.
As this committee may be aware, veterans service organizations
acquiesced to the use of co-payments which were only imposed upon
veterans under urgent circumstances and as a temporary necessity to
contribute to reduction of the Federal budget deficit. Accordingly, the
Omnibus Budget Reconciliation Act of 1990 established VA's authority to
charge co-payments to veterans for prescription medication and medical
services with a sunset date of September 30, 1991. However, since 1997,
Congress and the Administration have used the amount estimated that VA
might collect from veterans to offset appropriations for VA. Most
recently, on September 20, 2003, Public Law 108-7 eliminated the sunset
provision making co-payments permanent without debate through hearings
and other authorizing committee processes.
DAV Resolution No. 175 calls for the repeal of all co-payments for
veterans' medical services and prescriptions. Accordingly, we oppose
the co-payment provisions of this bill, which would require a veteran
to pay an annual enrollment fee and the full cost of prescription
medication VA would otherwise pay. Such provisions move VA farther down
the road of shifting the costs of care onto the backs of sick and
disabled veterans. Moreover, this provision is fundamentally contrary
to the spirit and principles underlying the provision of benefits to
veterans by a grateful Nation. We believe that providing our Nation's
veterans with high quality health care is a continuing cost of national
defense and should be our first priority, without cost to veterans.
S. 716
The Vet Center Enhancement Act of 2005 requires that VA employ, in
career conditional status, up to an additional 50 veterans of
Operations Enduring Freedom or Iraqi Freedom to provide outreach to
veterans on the availability of readjustment counseling and related
mental health services at Vet Centers. The bill also eliminates any
limitation on duration of employment of veterans for the aforementioned
program. Moreover, VA's authority to provide bereavement counseling at
Vet Centers would be revised to include parents of military
servicemembers who die while serving on active military duty. For
fiscal year 2006, $180 million would be authorized to be appropriated
for the Readjustment Counseling Service Program. The DAV has no
official mandate from our membership on this measure. However, its
purpose is beneficial, and we do not object to its favorable
consideration.
Draft Bill to be entitled the, ``Sheltering All Veterans Everywhere
Act'' or the ``SAVE Reauthorization Act of 2005''.--This bill would
improve or reauthorize the following programs servicing the needs of
homeless veterans.
Homeless Providers Grant and Per Diem Program.--The Homeless
Providers Grant and Per Diem (GPD) Program provides competitive grants
to community-based, faith-based, and public organizations to offer
transitional housing or service centers for homeless veterans. This
provision would reauthorize the GPD program through fiscal year 2011 at
$200 million annually. GPD is set to expire September 30, 2006. The
current annual authorization level for the program is $99 million.
Homeless Veterans' Reintegration Program.--The Homeless Veterans'
Reintegration Program (HVRP) is an employment services program
established to help homeless veterans reintegrate into the labor force
and attain financial independence. HVRP assists homeless veterans via
grants to State and local Workforce Investment Boards, commercial
agencies, and non-profit organizations, including faith-based and
community-based organizations. Qualified agencies directly assist
homeless veterans with job placement, training, counseling, and resume
preparation. This provision would reauthorize the HVRP through fiscal
year 2011 at $50 million annually.
VA Outreach Services.--The VA would be required to provide
information concerning homelessness, including risk factors, awareness,
and contact information for preventative assistance, to members of the
Armed Forces separating from active duty.
Grant Program for Homeless Veterans With Special Needs.--The grant
program authorizes VA to make grants to assistance providers to assist
homeless veterans with special needs, including women (with and without
children), frail elderly, terminally ill, or chronically mentally ill.
The special needs program has enabled VA and GPD providers to devote
attention to underserved subpopulation within the homeless veteran
population. It is currently authorized through fiscal year 2005 at $5
million annually. This bill would continue the program at current
levels through 2011.
Dental Care.--This provision would expand eligibility for dental
care by eliminating the criteria that veterans must be receiving
treatment in an approved homeless program for a period of 60
consecutive days prior to becoming eligible for dental treatment.
Authorization of appropriations for the Homeless Veterans Service
Provider Technical Assistance Program.--This program authorizes VA to
make competitive grants to qualified organizations that provide
technical assistance to nonprofit groups that provide assistance to
homeless veterans. It is necessary because community-based and faith-
based organizations serving homeless veterans lack the technical
expertise to acquire grants via the complex set of funding and service
delivery streams associated with housing and supportive services. This
bill would reauthorize the program through 2011 at $1 million annually.
Annual Report.--This provision would require VA to report on
homeless veteran coordination efforts with other Federal departments
and agencies, including the Department of Defense, Department of Health
and Human Services, Department of Housing and Urban Development,
Department of Justice, Department of Labor, Interagency Council on
Homelessness, and the Social Security Administration.
Advisory Committee.--This provision would add the Executive
Director of the Interagency Council on Homelessness (ICH) to the
Advisory Committee on Homeless Veterans.
Study on Military Sexual Trauma and Homelessness.--This provision
would authorize a study on the relationship between military sexual
trauma and homelessness. The VA Secretary's Advisory Committee on Women
Veterans recommended in 2004 that a study be conducted on the possible
correlation between military sexual trauma and homelessness among
veterans and effective service models for assembling various treatment
modalities and environments.
The DAV supports this draft legislation and encourages the
committee to consider it favorably. The DAV is very supportive of HVRP
and other homeless veterans' initiatives. It is an unfortunate and sad
fact that many veterans, for various reasons, have been unable to make
their way in the society they swore to defend. Such veterans exist
without decent shelter, adequate nutrition, or medical care. Services
provided by homeless veterans can mean the difference between a veteran
living on the streets or living in transitional housing until they are
capable of providing for themselves. As a member of the National
Coalition for Homeless Veterans (NCHV), the DAV supports the testimony
and recommendations submitted by the Coalition, which include all of
the provisions of this bill.
In addition to legislative advocacy on behalf of homeless veterans,
it is important to note that the DAV takes an active role in seeking to
prevent and end homelessness among our Nation's veterans. The DAV
Homeless Veterans Initiative, which is supported by our Charitable
Service Trust and Colorado Trust, promotes the development of
supportive housing and services to help homeless veterans become
productive, self-sufficient members of society. Since 1989, DAV
allocations for homeless projects have exceeded $2 million.
DRAFT BILL TO BE ENTITLED, THE ``BLINDED VETERANS CONTINUUM OF CARE ACT
OF 2005''
According to VA, of the 160,000 veterans eligible for Blind
Rehabilitation Services, over 38,000 are currently enrolled to receive
services. The impact of blindness is individualized and includes both
the older veteran whose vision gradually worsens due to macular
degeneration or diabetes and the serviceperson who is rendered totally
blind by traumatic injury. Each of these veterans requires
individualized, specialized care and treatment suited to the cause of
blindness, physical and medical condition, age, ability to cope with
frustrating situations, learning ability, and the overall needs and
lifestyle of the veteran. The Blinded Veterans Continuum of Care Act of
2005 would require VA to establish Blind Rehabilitation Outpatient
Specialists (BROS) at designated VA medical facilities with Visual
Impairment Service Teams (VIST) or with more than 150 enrolled veterans
who are legally blind.
The IB places special emphasis on VA's specialized programs such as
the Blind Rehabilitation Service (BRS), which is known worldwide for
its excellence in delivering comprehensive blind rehabilitation to our
Nation's blinded and severely visually impaired veterans. Favorable
consideration of this bill by this committee would preserve VA's
mission and role as a provider of blind rehabilitation services, as
well as benefit the approximately 120 servicemembers from Operations
Enduring Freedom and Iraqi Freedom who suffer from visual impairments.
DRAFT BILL TO REQUIRE VA TO PUBLISH A LONG-TERM CARE STRATEGIC PLAN
The proposed legislation would require VA to publish a long-term
care strategic plan to address the significant need of sick and
disabled veterans for chronic care in both institutional and non-
institutional settings. According to VA, the veteran population is
projected to decline to 20 million by 2010, but over the same time
period those age 75 and older will increase from 4.5 to 4.7 million and
those 85 and older will nearly triple from 510,000 to over 1.3 million.
Older veterans, particularly those over 85, are especially likely to
have multiple, complex chronic diseases requiring comprehensive health
care including long-term care services. Of equal importance is the fact
that current VA patients are not only older in comparison to the
general population, but they are much more likely to be disabled and
unable to work, generally have lower incomes, and lack health
insurance.
With a constrained budget, an increasing and aging veteran
population, and the high cost of providing inpatient long-term care, VA
is struggling with the issue of long-term care. An attempt was made to
address long-term care through the Capital Asset Realignment for
Enhanced Services (CARES) initiative. GAO's May 2003 report, ``VA LONG-
TERM CARE: Service Gaps and Facility Restrictions Limit Veterans'
Access to Non-Institutional Care'' (GAO03-487), confirmed veterans'
access to non-institutional long-term care services is limited and
highly variable across the Nation.
Extensive gaps in service exist due in part to restrictions based
on veterans' levels of service-connected disability that are
inconsistent with existing eligibility standards. GAO cites VA
headquarters as the source of such disparity as a result of not
providing clear and adequate guidance on making non-institutional long-
term care services available. Furthermore, VA headquarters has failed
to emphasize non-institutional long-term care as a priority, and has
failed to develop a performance measure to ensure the provision of
these services consistently across VA facilities.
The DAV has a resolution calling for legislation to establish a
comprehensive program of extended care service for veterans in need of
such care for a service-connected disability. However, as part of the
IB, the DAV is opposed to the provision in the bill, which requires the
strategic plan to include specific plans to utilize Medicare, Medicaid,
and private insurance companies to expand care. Under tight budget
constraints, this provision would allow a shift in VA's responsibility
to veterans and reduce its internal capacity to care for America's
aging veterans. Care for aging veterans should not be shifted to
private providers because it is more convenient or more cost-effective
to do so. VA nursing home care is an integral part of VA's health care
benefit package and is an entitlement to certain eligible veterans, and
these individuals should not be forced to accept other forms of nursing
home care because VA has reduced its capacity.
DRAFT BILL TO ESTABLISH A GRANT PROGRAM TO PROVIDE TRANSPORTATION
TO MEDICAL CARE FOR RURAL VETERANS
VA currently operates 100 outpatient clinics in 27 States that are
located in areas considered as rural or highly rural. Veterans residing
in such areas experience difficulty in accessing adequate health care
in a timely manner, which in turn reduces the continuity and quality of
care provided to existing enrollees in the VA health care system.
Because so many sick and disabled veterans lack transportation to and
from VA medical facilities for needed treatment, the DAV operates a
nationwide Transportation Network. This program continues to show
tremendous growth as an indispensable resource for veterans. Across the
Nation, DAV Hospital Service Coordinators operate 183 active programs.
They have recruited 9,657 volunteer drivers who logged 26,429,512 miles
last year, taking over 725,084 veterans to and from VA medical
facilities. Since 1987, our volunteer drivers have driven 8,958,755
veterans more than 338 million miles to and from their VA medical
appointments.
This proposed legislation would establish a grant program
administered by VA to provide innovative transportation options to
veterans in remote rural areas. DAV's mission of service reflected in
the commitment of men and women in our Transportation Network to assist
veterans who have no other means of getting to their VA medical
appointment, coupled with a mandate from our membership calling for
timely access to quality health care and medical services; we support
this bill and urge favorable consideration by the committee.
Due to the timeliness in receiving the remaining three draft bills
scheduled for today's agenda, the DAV is unable to provide position on
these measures at this time. However, we request the opportunity to
submit our written testimony for the record at a later time.
On behalf of the DAV, I want to thank the committee for its
consideration of these important legislative matters and for the
opportunity to present our views. We sincerely appreciate your
continuing support of veterans.
Chairman Craig. Adrian, thank you very much and your full
statement will be a part of the record.
Next Carl Blake, Associate National Legislative Director,
Paralyzed Veterans of America. Thank you.
STATEMENT OF CARL BLAKE, ASSOCIATE NATIONAL LEGISLATIVE
DIRECTOR, PARALYZED VETERANS OF AMERICA
Mr. Blake. Thank you, Chairman Craig. PVA would like to
thank you for the opportunity to testify today on the proposed
legislation. I will limit my remarks to just a select few of
the legislative proposals.
PVA strongly opposes the provision of the Veterans Health
Care Improvements Act that would repeal section 1710(b),
subsection B of title 38. This section ensures that the VA
maintains bed and staffing levels at the same level established
by Public Law 106-117 of the Veterans Millennium Health Care
and Benefits Act. Despite an aging veteran population and
passage of Public Law 106-117, the VA's average daily census
has continued to decline since 1998 and is projected to reach a
new low of 9,795 for fiscal year 2006. We feel that the VA is
ignoring the law by providing services to fewer and fewer
veterans in the nursing home care program.
PVA opposes section 10, which would allow the VA to use
money appropriated for health care to be used to conduct cost
comparison studies between the provision of care by the VA and
private and other types of contractors. Now is not the time to
allow the VA to draw much-needed health care dollars when the
medical system is already struggling to meet the demands being
placed on the system. Furthermore, we do not believe that the
contracted care is more cost effective and cost efficient than
that provided by the VA, and we certainly do not believe that
that care will be as high quality as that provided by the VA.
S. 614 would allow a Medicare eligible veteran to receive
medications from the VA on an outpatient basis. These veterans
will not otherwise be eligible for Medicare services from the
VA. PVA has expressed concerns in the past about similar
expansions of prescription drug benefits. We believe that
opening up the VA pharmacy system in the way that this
legislation does could ultimately change the basic primary
mission of the VA, which is to provide health care to sick and
disabled veterans. The VA does not need to become the veterans'
drug store at this time.
As a participating member of the National Coalition of
Homeless Veterans, PVA also supports the provisions of the
Sheltering All Veterans Everywhere Act.
PVA supports the proposed legislation introduced by Senator
Salazar that would require the VA to publish a strategic plan
for long-term care. PVA is astounded by the fact that the VA
has a proposal on the table such as the legislation being
considered today to repeal the Millennium Health Care
requirements, the horrific budget proposal, even though aging
veterans are a significant part of the population the VA will
have to care for in the future.
Congress must make every effort to ensure that the VA
develops a reasonable and effective strategic plan to provide
long-term care and to ensure that the VA immediately implements
that plan.
Mr. Chairman, I would like to thank you again for the
opportunity to testify, and I would be happy to answer any
questions that you might have.
[The prepared statement of Mr. Blake follows:]
Prepared Statement of Carl Blake, Associate National Legislative
Director, Paralyzed Veterans of America
Chairman Craig, Ranking Member Akaka, members of the committee,
Paralyzed Veterans of America (PVA) would like to thank you for the
opportunity to testify today on the ``Veterans Health Care Improvements
Act of 2005,'' the ``Mental Health Capacity Enhancement Act of 2005,''
the ``Neighbor Islands Veterans Health Care Improvements Act,'' S. 481,
S. 614, the ``Veterans Prescription Drugs Assistance Act,'' S. 716, the
``Vet Center Enhancement Act of 2005,'' and the ``Sheltering All
Veterans Everywhere Act.'' As more and more veterans are entering the
Department of Veterans Affairs (VA) health care system, it is important
that we continue to upgrade the health care options available to them.
THE ``VETERANS HEALTH CARE IMPROVEMENTS ACT OF 2005''
PVA appreciates the efforts of the committee to address the many
health care issues facing veterans with this proposed legislation. PVA
supports the provision of Section 3 of the bill that would exempt
former prisoners of war from paying co-payments for extended care
services. It is only right that we recognize the extreme hardships that
these men and women faced in defense of this country.
However, we strongly oppose the provision that would repeal Section
1710B(b). This section ensures that the VA maintains bed and staffing
levels at the same level established by the P.L. 106-117, the
``Veterans Millennium Health Care and Benefits Act.'' Despite an aging
veteran population and passage of P.L. 106-117, the VA has continuously
failed to maintain its 1998 VA nursing home required average daily
census (ADC) mandate of 13,391. VA's average daily census (ADC) for VA
nursing homes has continued to decline since 1998 and is projected to
decrease to a new low of 9,795 in fiscal year 2006. The VA is ignoring
the law by serving fewer and fewer veterans in its nursing home care
program.
PVA is deeply troubled by this move to eliminate the mandatory ADC
requirement contained in the Millennium Health Care bill. This proposed
change is not driven by current or future veteran nursing home care
demand. In fact, the General Accounting Office (GAO) reported ``the
numbers of aging veterans is increasing rapidly, and those who are 85
years old and older, who have increased need for nursing home care, are
expected to increase from approximately 870,000 to 1.3 million over the
next decade.''
PVA strongly feels that the repeal of the capacity mandate will
adversely affect veterans and is a step toward allowing VA to reduce
its current nursing home capacity. This is not the time for reducing VA
nursing home capacity with increased veteran demand looming on the near
horizon.
PVA does not oppose the provisions of Section 3 which would allow
the VA to reimburse a veteran for expenses incurred while receiving
emergency treatment at a non-VA medical facility. However, we have
concerns about some of the eligibility criteria that determine what
veterans are eligible for this reimbursement. In accordance with The
Independent Budget for fiscal year 2006, we believe that the
requirement that a veteran must have received care within the past 24
months should be eliminated. Furthermore, we believe that the VA should
establish a policy allowing all veterans enrolled in the health care
system to be eligible for emergency services at any medical facility,
whether at a VA or private facility. PVA supports Section 4 of the
legislation that would authorize the VA to provide care to newborn
children of women veterans who are receiving maternity care. The woman
veteran may be receiving care at a VA medical center or at a non-VA
facility that the woman's care was contracted to.
PVA supports the authorization of the Homeless Providers Grant and
Per Diem Program at a level of $130 million. This reflects a
significant increase over the current authorized level of $99 million.
However, as a participating member in the National Coalition of
Homeless Veterans (NCHV) we would like to recommend that the
authorization level be increased to $200 million. This provision is
necessary because as the per diem rate to cover the daily cost of care
rises annually, there could be an actual reduction in the number of
beds if the authorization level is not increased.
PVA has no position on Section 7 which established qualifications
for marriage and family therapy and calls for a report on marriage and
family therapy workload. PVA supports Section 8 of the bill which would
authorize the VA Chief Nursing Officer to receive a salary at the
Senior Executive Service level. PVA has no position on Section 9.
PVA opposes Section 10 which would allow the VA to use money
appropriated for health care to be used to conduct cost-comparison
studies between the provision of care by the VA and private and
commercial contractors. Now is not the time to allow the VA to draw
away critical health care dollars when the medical system is already
struggling to meet the demand being placed on the system. Furthermore,
we do not believe that contracted care is more cost-effective than the
care provided by the VA, and we certainly do not believe that the VA
will find the same level of high-quality care in the private sector.
PVA supports the provisions of Section 11 which would improve and
expand the mental health services provided by the VA. We believe that
mental health disorders and Post-Traumatic Stress Disorder (PTSD) will
prove to be common problems that the men and women returning from Iraq
and Afghanistan will have to face. The additional authorization for
funds for these programs is also critical to ensure that the VA has the
resources it needs to meet what we believe will be significant demand.
PVA supports the remaining sections of the proposed legislation. We
are particularly pleased with Section 13 which would expand the number
of personnel serving as readjustment counselors so that they can
conduct additional outreach to National Guard members. It is important
that National Guard members and Reservists not be left out as we expand
the services available to those men and women who have served and are
serving in the military.
S. 481
PVA fully supports this legislation which would extend the
eligibility for hospital care, medical services, and nursing home care
from 2 years to 5 years for a veteran who served on active duty in a
theater of combat operations during a period of war after the Persian
Gulf War or in combat against a hostile force after November 11, 1998.
This provision has proven especially important to the men and women who
have recently served in Iraq and Afghanistan and have exited military
service.
However, PVA believes that the ability of the VA to provide this
essential care is threatened by the strain being placed on the
veterans' health care budget. We know that the VA will continue to meet
this important requirement for the young men and women who have
sacrificed so much; however, at what cost will the VA meet this demand?
The VA must receive adequate funding to ensure that it can provide the
care to veterans who are eligible under this provision of Title 38 as
well as all other veterans eligible for health care. The VA should not
be placed in a position to determine which veterans will be denied care
so that it might treat other veterans.
S. 614, THE ``VETERANS PRESCRIPTION DRUGS ASSISTANCE ACT''
The proposed legislation would allow a Medicare-eligible veteran to
receive medications from the VA on an outpatient basis. These veterans
will not otherwise be eligible for medical care services from the VA.
PVA has expressed concerns in the past about similar expansions of
prescription drug benefits. We believe that opening up the VA pharmacy
system in the way that this legislation does could ultimately change
the basic primary mission of the entire VA which is to provide health
care to sick and disabled veterans. The VA does not need to take on the
role of the veterans' drug store.
PVA fears that if we embark upon this path of only providing
certain limited health benefits to certain categories of veterans, we
could very well see the erosion of the VA's mission. The VA would
essentially revert back to the way it determined who received care and
services prior to eligibility reform, when health care was not governed
by medical needs but rather by arbitrary budget-driven classifications
stratifying veterans' health care eligibility into ``have'' and ``have
not'' categories.
With the VA having taken steps to drastically reduce access by
denying enrollment to Category 8 veterans 2 years ago and a budget
situation that could lead to even further restrictions on enrollment,
now is not the time to take chances with the lives and health of
veterans by dramatically, and fundamentally, changing the nature of the
VA health care system. The VA would then take on the new role of
managing a prescription drug plan for a whole new category of eligible
veterans.
PVA opposes the provision of this legislation that would shift the
cost burden of administering this program onto the backs of veterans.
This is yet one more attempt to shift the responsibility for providing
quality care and services away from the Federal Government. This
measure would be unnecessary if Congress provided adequate funding to
meet the needs of these veterans.
S. 716, THE ``VET CENTER ENHANCEMENT ACT OF 2005''
PVA supports S. 716, the ``Vet Center Enhancement.'' The Vet
Centers managed by the VA provide vital readjustment services to the
men and women who have placed themselves in harm's way and to their
families. Vet Centers offer various types of readjustment counseling,
including bereavement counseling, as well as related mental health
services. The mental health services are especially important as the
men and women returning from Iraq and Afghanistan seek to cope with the
stress and related difficulties they faced while in combat.
This legislation would authorize the VA Secretary to hire 50
additional Operation Enduring Freedom and Operation Iraqi Freedom
veterans to serve as outreach coordinators for the Vet Centers. These
men and women are a valuable resource because they can closely relate
to the new veterans and their families who they will be helping
readjust. We also appreciate the provision that clarifies the
availability of bereavement counseling to the parents of those
servicemembers who have made the ultimate sacrifice. In many cases, the
parents are the next of kin to the men and women who have been killed
because there is no surviving spouse.
THE ``SHELTERING ALL VETERANS EVERYWHERE ACT''
The VA estimates that more than 200,000 veterans are homeless on
any given night, and that more than 500,000 veterans experience
homelessness in a year. PVA believes that the key to overcoming
homelessness among the veterans population is employment. A veteran is
unable to provide for himself or herself, much less a family, without
the benefit of gainful employment.
As a participating member of the NCHV, PVA supports Section 3 of
this legislation. As we previously testified, increasing the
authorization level for the Grant and Per Diem Program from $99 million
to $200 million will ensure that the number of beds and the services
provided are not reduced as the daily cost of care continues to
increase.
PVA supports Section 4 of the bill that would expand the Homeless
Veterans Reintegration Program to include veterans who are deemed to be
at imminent risk of homelessness. PVA also supports the reauthorization
of the HVRP through fiscal year 2011. The change reflects one of the
goals of the NCHV. Moreover, PVA, as a member of the National Coalition
for Homeless Veterans (NCHV), also supports the reauthorization of the
program at a $50 million funding level. The HVRP is perhaps the most
cost-effective and cost-efficient program in the Federal Government. In
spite of the success of HVRP, it remains severely under-funded. Even
more tragically, DOL does not request a full appropriation in its
budget submission. For fiscal year 2006, the Administration only
requested $22 million to support this program. Enactment of this
legislation would ensure that homeless veterans who need a high level
of support get it.
PVA supports Section 5 which would clarify the outreach efforts of
the VA toward veterans and members of the Armed Forces to help them
avoid homelessness. We also support the continuation of treatment and
rehabilitation for the seriously mentally ill and homeless through
2011. PVA supports the remaining sections of the proposed legislation.
THE ``VETERANS MENTAL HEALTH CARE CAPACITY ENHANCEMENT ACT OF 2005''
PVA supports the proposed legislation introduced by Senator Akaka
that would improve mental health care services within the VA. We
believe that quality mental health services will become vital as the
rigors of combat in Iraq and Afghanistan begin to take their toll on
the men and women serving there. PVA is pleased to see the
strengthening of the performance measures for mental health programs
outlined in Section 3. We appreciate the indexing requirement for
funding specialized treatment and rehabilitation services in Section 4.
PVA also understands the need to create a joint workgroup between
the VA and Department of Defense (DoD) to address the mental health
problems that servicemen and women returning from overseas face. It is
important that the agencies work to educate servicemembers that there
is no stigma associated with treatment for a potential mental health
disorder. This is particularly true of the DOD who we believe has
helped perpetuate this belief in servicemembers through adverse
personnel actions in the past. It is important that the DOD and VA
identify the men and women who have potential mental health problems
early so that they can get the treatment that they need.
THE ``NEIGHBOR ISLANDS VETERANS HEALTH CARE IMPROVEMENTS ACT OF 2005''
PVA supports the proposed legislation introduced by Senator Akaka
that would improve the provision of health care and services to
veterans who live in Hawaii. We recognize the unique challenges faced
by veterans who live there. They do not have easy access to all of the
same services available to veterans who live on the mainland. We
support the requirements to build health care clinics on selected
islands of Hawaii. This will ease the travel burden for those veterans
seeking to get health care from the VA.
PVA supports Section 6 which authorizes the VA to conduct a study
on the demand and access to specialized care and fee-basis care from
the VA on the Hawaiian Islands. It is important that the VA maintains
the capability to provide whatever care is needed to veterans living
there.
THE ``BLINDED VETERANS CONTINUUM OF CARE ACT OF 2005''
PVA shares a unique relationship with Blinded Veterans of America
(BVA) and the veterans that they represent. Much like PVA members, BVA
members live with a catastrophic disability every day. Blinded veterans
also rely on the specialized services provided by the VA just as spinal
cord injured veterans rely on the same services. PVA fully supports the
``Blinded Veterans Continuum of Care Act of 2005.'' The establishment
of specialists at designated VA medical centers to improve the ability
of the VA to meet the needs of blinded veterans is essential. The
nature of the fighting in Iraq and Afghanistan has led to increasing
numbers of men and women with visual impairments.
LONG-TERM CARE STRATEGIC PLAN
PVA supports the proposed legislation introduced by Senator Salazar
that would require the VA to publish a strategic plan for long-term
care. The VA has recognized the massive needs that the Nation's oldest
veterans, veterans of World War II and the Korean War, will present as
they near the end of their lives. The VA has done incomparable work
when it comes to studies of aging as well as the establishment of
clinical approaches, research, education and new treatment models to
deal with diseases of old age. VA has established 130 VA nursing home
care units, and has aided the States in establishing and sustaining 128
State homes for the long-term care of elderly veterans. Despite these
efforts, the VA continues to struggle to meet the long-term care needs
of America's aging veterans. Furthermore, the Capital Asset Realignment
for Enhanced Services (CARES) Commission originally avoided the issue
all together. And now the VA is proposing to shift the burden of
providing long-term care and move into a type of niche market where it
provides care to only that subset physically amenable to
rehabilitation.
It is imperative that the VA develop and implement a viable
strategy to meet the ever-growing long-term care needs of the aging
veterans' population. PVA is astounded by the fact that the VA has
proposals on the table, such as the legislation considered today to
repeal the Millennium Health Care bill capacity requirements and a
horrific budget proposal, even though aging veterans are a significant
part of the population that the VA will have to care for in the future.
Congress must make every effort to ensure that the VA develops a
reasonable and effective strategic plan to provide long-term care, and
that the VA immediately implements that plan.
TRANSPORTATION FOR RURAL VETERANS
Although PVA recognizes the difficulties some veterans have in
accessing health care within the VA, PVA believes that it is a viable
system. With over 800 community-based outpatient clinics, the VA has
established a good network for meeting the needs of a vastly spread
veterans population.
PVA supports the legislation proposed by Senator Salazar that would
establish a grant program to provide innovative transportation options
to veterans who live in remote areas. This program would allow veterans
to continue to access the high quality care provided at VA medical
facilities without placing a financial burden for travel costs on the
veteran. It will also keep veterans from venturing into the private
sector to receive care that in many cases is substandard as compared to
the VA.
PVA appreciates the efforts the committee is making to address the
many issues facing veterans today. We would be happy to address any
additional legislative proposals for the record. Thank you.
Chairman Craig. Carl, thank you very much. Your full
statement will be a part of the record.
Now let me turn to Richard Jones, National Legislative
Director for AMVETS. Richard, good to see you. Welcome.
STATEMENT OF RICHARD JONES, NATIONAL LEGISLATIVE DIRECTOR,
AMVETS
Mr. Jones. Thank you, Mr. Chairman. Thank you for the
opportunity to present out testimony.
Throughout AMVETS' 61-year history in serving American
veterans, the members of AMVETS have held to the belief that
America's promises to veterans for the military service needs
to be recognized and honored as our forbears intended.
Mr. Chairman, in reading our submitted testimony you will
see that AMVETS agrees mostly with our colleagues in nearly
every case, so let me address one point that is a bit
different, and that is Senator Specter's bill, Senate Bill 614,
the Veterans Prescription Drug Assistance Act.
As introduced, the legislation would allow Medicare
eligible veterans to obtain prescription drugs from VA. It
would provide a partial remedy to the situation faced by older
Priority 8 banned veterans from the VA health care system, who
were banned under the 2003 decree that halted their access to
medical care. Under this legislation, a veteran who has been
diagnosed and prescribed medication by a non-VA health care
provider, could have a prescription filled at VA at a steeply
reduced price.
As the committee knows, the Department of Veterans Affairs
Secretary has banned health care access to approximately
495,000 veterans who would otherwise have been able to enroll
except for the January 17, 2003, decision which closed off
their health care benefits and denied them their earned
benefits.
These so-called high-income veterans are outside looking
in, as some have described them. They remain eligible for VA
care, but neither Congress nor the administration has supported
the funding necessary to ensure adequate resources for their
care. It is important, we believe at AMVETS, to never forget
who these so-called Priority 8 veterans are, and they are the
brave Americans who answered our Nation's call, and with
fortune and God's grace, they returned to this country
following their service whole and able to continue their lives
without disabling injury.
In today's war on terrorism it may be the priority 8
veteran who takes a post or a stand on a day following a day
where another has been killed or injured. He puts his life on
the line knowing he may return injured. But we do not win
without these priority 8 veterans who stand the ground that we
hope to liberate. These patriots serve voluntarily, and the
members of AMVETS believe each of them earns access to the
health care system through military service. These men and
women did not fail us in our Nation's time of need, and we
should not fail them.
They held in their hands for a brief period in history the
determination on whether or not we would win or lose the fight
for freedom. It is the least our Nation can do for those on
whom America depends to defend her liberty. Senate Bill 614
offers veterans an opportunity to access earned benefits that
might otherwise be denied them. To that extent we support the
bill.
Thank you, sir, for the opportunity to present testimony
today on these 10 bills.
[The prepared statement of Mr. Jones follows:]
Prepared Statement of Richard Jones, National Legislative
Director, AMVETS
Chairman Craig, Ranking Member Akaka, and Members of the committee:
Thank you for the opportunity to present testimony to the Veterans'
Affairs Committee on legislation subject to this hearing devoted to
healthcare related matters. My name is Richard Jones, AMVETS national
legislative director.
AMVETS is pleased to present our views on the ten bills before the
committee: The Chairman's proposed legislation called the ``Veterans
Health Care Improvements Act of 2005''; Ranking Member Akaka's four
proposals, the ``Mental Health Capacity Enhancement Act of 2005'', the
``Neighbor Islands Veterans Health Care Improvements Act'', and S. 481,
a bill to extend combat veterans' post-discharge 2-year period of
eligibility for VA health care to 5 years, and S. 716, the ``Vet Center
Enhancement Act of 2005''; Senator Specter's bill, S. 614, the
``Veterans Prescription Drugs Assistance Act''; Senator Obama's bill
the ``Sheltering All Veterans Everywhere Act''; and Senator Salazar's
bills to require VA to publish a strategic plan for long-term care; to
establish a grant program to provide transportation for rural veterans;
and the ``Blinded Veterans Continuum of Care Act of 2005''.
Mr. Chairman, AMVETS has been a leader since 1944 in helping to
preserve the freedoms secured by America's Armed Forces. Today, our
organization continues its proud tradition, providing not only support
for veterans and the active military in procuring their earned
entitlements but also an array of community services that enhance the
quality of life for this Nation's citizens.
Throughout our sixty-one year history, our focus and indeed our
passion have been to represent the interests of veterans as their
advocates. In this regard, this committee and our organization share a
common purpose--we support veterans in their efforts to receive the
benefits that a grateful Nation intended them to have in recognition of
their dedicated service to our country.
As a Nation, we owe veterans an enormous debt of gratitude--for
their service, their patriotism, and their sacrifices. The benefits to
which they are legally entitled are not the product of some social
welfare program, as some might argue. Rather they are yet another cost
of freedom that unfortunately is too often forgotten.
As a national veterans service organization, chartered by Congress,
AMVETS is committed to assisting veterans in their times of need. For
example, during the past 18 years, we, together with DAV, PVA, and VFW,
have co-authored a document titled, ``The Independent Budget'' in which
we identify the funding requirements necessary to support the
Department of Veterans Affairs.
We believe that America's promises made to veterans for their
military service need to be recognized and honored as our forebears
intended. We believe that veteran's benefits should be provided in a
timely and compassionate manner. We believe that to do less dishonors
those whose service in defense of this Nation provides a central
underpinning for the prosperity and freedoms we all enjoy.
We appreciate the opportunity you provide to testify on pending
legislation to enhance, update, and strengthen veterans legislation.
S. 614, THE VETERANS PRESCRIPTION DRUGS ASSISTANCE ACT
Mr. Chairman, AMVETS supports the goal of this legislation. As
introduced, the legislation would allow Medicare-eligible veterans to
obtain prescription drugs from the Department of Veterans Affairs at
the significantly discounted cost that VA, as a high-volume purchaser
of prescriptions medications, is able to secure in the marketplace.
S. 614 would provide a partial remedy to the situation faced by
older Priority 8s ``banned'' from the VA healthcare system under the
2003 decree that halted their access to medical care. Under this
legislation, a veteran who has been diagnosed and prescribed medication
by a non-VA healthcare provider could have a prescription filled by VA
at a steeply reduced price.
As the committee knows, the Department of Veterans Affairs
Secretary has banned healthcare access to an estimated 495,000 veterans
who could have enrolled for care prior to January 17, 2003, when former
Veterans Affairs Secretary Anthony Principi closed off their healthcare
benefits and denied them access to VA medical care.
These so-called high-income veterans or ``Priority 8s'' remain
eligible for VA care, but neither Congress nor the administration has
supported the funding necessary to ensure adequate resources for their
care.
Currently, veterans are eligible to receive prescription
medications from the VA only if a VA physician prescribes the
medication. While insisting that a VA doctor see the patient may not
seem like too great an imposition, many veterans waiting for a doctor's
appointment are waiting solely to have a prescription written at VA, so
it can be filled.
It is commonly noted that the majority of the Priority 8s have
entered the system to gain access to the VA prescription drug program.
For these veterans, once they are under the care of a VA physician,
they can see dramatically reduced prescription drug costs versus the
private sector. The current VA prescription cost for enrolled patients
is $7.00 per prescription for a 30-day supply.
VA dispenses over 100 million prescriptions yearly to its nearly 5
million patients, and with this volume, VA can negotiate very favorable
drug prices. Figures from the National Association of Chain Drug Stores
claim that for 2001, VA cost per prescription was almost half the cost
found in the private sector. With the ever increasing cost of
prescriptions, it is little wonder Priority 8 veterans have availed
themselves of this benefit after Congress allowed them access to the VA
system.
It is important to understand that AMVETS remains deeply
disappointed in the continuing ban of Priority 8 veterans, which began
on January 17, 2003. In past years, this committee and its members have
fought for adequate funding for VA, yet VA has not been adequately
resourced.
It is also important to never forget who these so-called Priority 8
veterans are. These are brave Americans who answered our Nation's
military call, and with fortune and God's grace they have returned from
service whole and able to continue their lives without disabling injury
or illness.
In today's war on terrorism, the Priority 8 veteran may be one of
the soldiers, sailors, airmen or marines who stand a post or walk a
patrol in Iraq or elsewhere across the globe, replacing a fellow
soldier who was injured or who gave his life in defense of freedom and
our way of life.
These patriots serve, voluntarily, and the members of AMVETS
believe each of them has earned access to the VA healthcare system
following their military service, as statute provides. For a moment in
our history they held in their hands the defense of our Nation and its
cherished freedoms. These men and women did not fail us in our Nation's
time of need, and we should not fail them. It is the least our Nation
can do for those on whom America depends to defend her liberty.
S. 716, THE ``VET CENTER ENHANCEMENT ACT OF 2005''
Introduced by Ranking Member Akaka, S. 716 would enhance care and
services provided through Vet Centers. The bill recognizes the need to
augment these centers especially at a time when there are an increasing
number of troops returning from Operation Enduring Freedom and
Operation Iraqi Freedom. The legislation would also increase authorized
funding for Vet Centers to $180 million from $93 million to help
returning service members and surviving family members through a
smoother readjustment period. AMVETS supports this legislation.
S. 481, A BILL TO EXTEND COMBAT VETERANS POST-DISCHARGE 2-YEAR PERIOD
OF ELIGIBILITY FOR VA HEALTH CARE TO 5 YEARS
Introduced by Ranking Member Akaka, S. 481 would extend policies
and procedures for providing free health care services and nursing home
care to combat veterans for a period of 5 years beginning on the date
of separation from active military service. Under current coverage,
recently separated service members, including National Guard and
reserve personnel, are eligible for health care for 2 years. The
benefit covers all illnesses and injuries except those clearly
unrelated to military service such as the common cold and injuries from
accidents that occurred after discharge. Dental services are also not
included. Unlike other veterans there is no burden to prove they have
low-income to qualify for VA health care. This is an important change.
In past conflict, veterans have reported medical problems that have
been hard to explain or difficult to diagnose. Providing an extended
period of eligibility, common medical problems may be better diagnosed
and care more properly applied in a timely manner. AMVETS supports this
legislation.
S. ----, A BILL TO REQUIRE VA TO PUBLISH A STRATEGIC PLAN FOR LONG-TERM
CARE
Senator Salazar proposes legislation to direct VA to develop and
publish a strategic plan for long-term care. The bill recognizes that
long-term care was not included in VA's Capital Asset Realignment for
Enhanced Service (CARES) process and is therefore lacking in
appropriate consideration. AMVETS supports restructuring the VA system
through the CARES process, but it must be done with a sharp eye for the
future and with sound facilities and operations planning. With the
number of veterans over the age of 85-years old and older expected to
nearly double over the next decade to 1.3 million from 870,000, AMVETS
supports this legislation.
S. ----, A BILL TO ESTABLISH A GRANT PROGRAM TO PROVIDE TRANSPORTATION
FOR RURAL VETERANS
Senator Salazar proposes legislation to establish a grant program
managed through VA to provide critically needed transportation services
to veterans in rural remote areas. But there probably are hardly any
States in the Union with the exception of maybe Rhode Island or
Connecticut or someplace like that where we do not have at least some
veterans who are somewhat isolated from VA hospitals and are having to
go great lengths to get their medical care. Provision of a grant
program would offer a degree of opportunity to veterans who live in
these areas to access the health care benefits to which they are
entitled through honorable military service. AMVETS supports this
legislation.
S. ----, THE ``BLINDED VETERANS CONTINUUM OF CARE ACT OF 2005''
Senator Salazar's proposed legislation would provide critical
enhancements to the care provided blinded veterans. The bill would
establish Blind Rehabilitation Outpatient Specialists positions at
medical centers with Visual Impairment Service Teams (VISTs) with a
full-time coordinator or with more than 150 currently enrolled legally
blind veterans. Blind Rehabilitation Outpatient Specialists play an
important role in helping blinded veterans with a number of living
skills. In many cases, these blinded individuals achieve successful
careers despite their blindness. Clearly however, many sensory disabled
veterans have not had the same opportunities afforded them or the same
veterans assistance programs. Accordingly, this legislation would
pursue its goals of enhancing these types of services which combined
with research, rehabilitation and re-employment can make a critical
difference in the lives of blinded veterans. AMVETS supports this
legislation.
S. ----, THE ``NEIGHBOR ISLANDS VETERANS HEALTH CARE IMPROVEMENTS ACT
OF 2005''
Senator Akaka's legislation would establish vet centers and clinics
on certain islands of Hawaii. The bill would also provide staffing
enhancements to assist in adjustment counseling and related mental
health services for veterans. It also would establish a mental health
center in Hilo for the provision of mental health care and treatment.
In addition, it authorizes construction of a mental health center at
Tripler Army medical center. The facilities in Hawaii are superb and
AMVETS supports this legislation.
S. ----, THE ``MENTAL HEALTH CARE CAPACITY ENHANCEMENT ACT OF 2005''
The proposed legislation of Senator Akaka would take a number of
steps to strengthen and improve VA capacity to provide mental health
care and treatment. The bill would establish patient-staff ratios and
foster collaborative approaches for primary and mental health care
providers. The bill would also require VA to have onsite, contract, or
tele-mental health services available at not less than 90 percent of
Community-Based Outpatient Clinics. In addition the bill would
establish a joint VA-DoD workgroup on mental health tasked to study how
to recognize signs of and to deal with mental health disorders. Under
the bill, the workgroup would also consider collaborative approaches to
improve the transition of servicemembers to veterans status, care, and
treatment. AMVETS supports the goal of improving mental health
treatments and ensuring the availability of care at outpatient clinics
and throughout the VA healthcare system.
S. 1180, ``SHELTERING ALL VETERANS EVERYWHERE ACT''
Senator Obama has introduced S. 1180, the Sheltering All Veterans
Everywhere Act, to reauthorize the Homeless Providers Grant and Per
Diem (GPD) program, the Homeless Veterans Reintegration Program (HVRP),
and the Grant Program for Homeless Veterans With Special Needs. The GPD
and HVRP programs sunset in 2006 and VA homeless programs expire later
this year. The bill also calls for VA to study the interrelationship
between military sexual trauma and homelessness and effective service
models for addressing trauma among homeless veterans. AMVETS goal is to
bring a continuity of commitment to getting homeless veterans back on
their feet and into the mainstream of our communities. AMVETS clearly
recognizes that progress is being made, and our members support this
legislation, to defeat homelessness and help veterans.
S. ----, THE ``VETERANS HEALTH CARE IMPROVEMENTS ACT OF 2005''
It is critical that service men and women who have sacrificed for
their country in the Armed Services be taken care of upon their return
to home and community. To abandon our responsibilities would bring
dishonor and send a message that the contributions of our
servicemembers are not fully appreciated.
Our First President George Washington warned us to be careful about
honoring our veterans, ``The willingness with which our young people
are likely to serve in any war, no matter how justified, shall be
directly proportional to how they perceive the Veterans of earlier wars
were treated and appreciated by their Nation.''
The ``Veterans Health Care Improvements Act of 2005,'' introduced
by Chairman Craig, would undertake a number of changes in veterans
healthcare. Section 2 of this legislation completes the exemption from
hospice co-payments as enacted last year. It eliminates co-payment for
veterans using outpatient hospice care as well as previously enacted
co-payment for institutional hospice care. AMVETS supports this section
of the bill. AMVETS also supports the elimination of co-payments for
former POWs. However, we oppose the elimination of VA requirement for
maintaining a certain nursing home bed level, also contained in this
section. AMVETS supports improvements in the reimbursement of expenses
for veterans using emergency room facilities, and we support as well
Section 5 designed to care for newborn children of women veterans. It
is also appropriate to enhance payer provisions for health care
furnished to certain children of Vietnam veterans for Spina Bifida and
associated disabilities. Section 7 authorizes appropriations for the
homeless providers grant and per diem program. This is an important and
competitive program. And AMVETS is pleased to support this
authorization. AMVETS also supports the sections dealing with
improvements in tele-health, marriage therapists, and mental health
services. AMVETS also supports the bill's authorization of additional
VA personal to expand National Guard outreach programs. The upward
spiral of Guard deployment over the recent past dictates action to
improve understanding of benefits available to those who serve in our
National Guard.
This concludes AMVETS testimony. Again, thank you for the
opportunity to testify on these important bills, and thank you as well
for your continued support of America's veterans.
Chairman Craig. Gentlemen, thank all of you for being here
and providing testimony and working with us as we move some of
this legislation through. Each of your organizations opposes
the provision in S. 1182 that would repeal the bed-level
capacity requirement, but each of you has some differing reason
as to why you are against the legislation, and I frankly
appreciate the concerns that all have expressed.
Would each of you agree that having some defined package of
long-term care options is better than a bed-level requirement?
Would that be a more welcome alternative? Response?
Mr. Cullinan. Mr. Chairman.
Chairman Craig. Dennis, please.
Mr. Cullinan. If a policy were put in place that would
provide access to veterans requiring long-term care, that would
certainly be an improvement over the current situation. But the
fact is that through the years this idea of eliminating that
census has come up over and over again. It has always been
primarily budget driven, and our concern is that right now in
absence of some sort of defining policy providing proper access
to veterans to long-term care, it would simply allow VA to
divest itself of its long-term care resources, and we strongly
suspect that any resources that would be freed up through this
action would not go to VA and help pay for veterans health
care. It would be lost in the general treasury fund.
Chairman Craig. Further comment?
Mr. Mooney. Senator, I would like to note that VA is only
required statutorily to provide long-term care to veterans who
are 70 percent and greater service connected disabled. Even
that does not automatically mean that a veteran will be placed
in a nursing home. They are assessed by a geriatric assessment
team, and they are given the services that the veteran wants in
the least restrictive, least costly environment.
As I said in my testimony, VA has not conducted a
comprehensive long-term care needs assessment. There have been
two reports in the last 20 years that predicted this problem,
and no action has been really taken on any of them, on either
of them. We think before VA starts dismantling its long-term
care infrastructure, especially as regards these frail elderly
veterans who tend to have more problems than the average
nursing home resident, we need to--the VA needs to know what
their requirements will be before they start taking apart the
system that exists. I think Congress in 1997, when they
mandated this, had a sense of that, that they knew this wave of
elderly was coming, and they told VA, you need to maintain this
capacity. VA still does not know what they are going to need,
and we think until they do, they should comply with the Mill
Bill.
Chairman Craig. Carl.
Mr. Blake. Mr. Chairman, I want to refer to something that
Mr. Mooney said about 70 percent requirement for institutional
long-term care. That points out the fact that those individuals
who would be getting institutional long-term care are the most
severely disabled, and in most, maybe not all, but in most
cases, the best care that they will get is in the institutional
setting. That is not to say that we do not support the idea of
non-institutional care as well. That kind of parallels a common
held belief of PVA that we should do everything to help a
veteran become independent or seek the best independent living
possibilities for him or her.
However, I would say that it will be better if you had a
combination of the two, and not to just close off what their
current infrastructure is by eliminating the bed and staffing
requirements. The unfortunate thing about this is we deal with
the same type of issue with regards to spinal cord injury
centers, and we have an agreement with the VA that the VA will
maintain a certain bed and staffing level for SCI centers, and
that is yet another area where they fail to meet their
requirements. And every month we go out and evaluate SCI
centers, and yet it is a continuing process. But I do not think
we should push off the responsibility from the VA so that they
can just focus solely on what appears to be a move toward non-
institutional care.
Mr. Jones. Sir, thank you for the question. We look at the
most recent proposal on the 2006 budget from the administration
which suggests cutting per diem payments to State nursing
homes, and we just wonder where are they headed?
Chairman Craig. Well, they are not headed there.
Mr. Jones. Well, they are not headed there because Congress
has wisely seen----
Chairman Craig. They thought they were. Congress told them
no.
Mr. Jones. Absolutely, and we are so pleased with that
because it was headed in the wrong direction. We think this is
wrong also. Regarding 1998 bed status for a nursing home, we
face a period now where we expect to double the population of
those over the age of 85 over the next period of 8 years. As we
look to doubling the population over the next few years, as we
look to reduced per diem payments, we need to have wisdom again
and retain what Congress had put in place before. It is simply
wrongheaded and wrong directional.
Chairman Craig. Thank you. My time is up, and I think
Senator Thune is moving to depart. He has been quiet all
through this, in and out, and I did want to recognize his
presence.
Senator, do you have any questions of this panel?
OPENING STATEMENT OF HON. JOHN THUNE, U.S. SENATOR FROM SOUTH
DAKOTA
Senator Thune. Mr. Chairman, thank you to you for holding
this hearing, and to the panel members for the good work that
you do representing our Nation's veterans, and this is an
important subject, the various pieces of pending legislation I
look forward to having a vigorous debate about that, about
things that we can do to improve the overall quality of health
care to America's veterans.
I think it is really important, as we do that, that we do
it in a very open manner. I have got a bill as well, which I
would at some point like to have considered. Right now it is
over at the Finance Committee because it deals with Medicare
and they have jurisdiction, and the Finance Committee is very
particular about their jurisdiction on these issues, but it has
got a number of other provisions that I also believe would fall
under this committee's jurisdiction, and some things that
hopefully we will get a chance to have all of you--I know some
of you have already reviewed some of those things, and get a
chance to comment on as we try to put together a package, a
proposal that will do a better job of addressing the health
care needs of our Nation's veterans.
But my view is it is important that we get that consensus,
that we put together something that will address the needs,
especially as we have more veterans coming home from Operation
Enduring Freedom and Operation Iraqi Freedom. We obviously owe
them a great debt of gratitude and need to make sure that we
are giving them access to the very best care possible.
So thank you for holding the hearing.
Thank you to your organizations, and again for the good
work that you do on behalf of America's veterans, and we look
forward to working with you on a consultive basis as
legislation moves forward so that we can get the very best
possible product put in place for our Nation's veterans.
I will look forward to discussing these issues further.
I have to go to a meeting now to talk about BRAC, which is
another issue of great importance. So thank you all very much.
Prepared Statement of Hon. John Thune, U.S. Senator from South Dakota
Good morning Chairman Craig and Ranking Member Akaka, Thank you for
holding today's hearing on pending veterans' healthcare legislation. I
look forward to a productive hearing. Before I begin I would like to
welcome Secretary Nicholson and Undersecretary Perlin back to the
committee. I know your schedules are busy and I thank you for taking
the time to work with us in providing the best possible healthcare for
America's Veterans. I would also like to welcome the representatives of
the Veterans Service Organizations, who often serve as the voice of
America's veterans before the committee. Thank you for your service.
Veterans' healthcare is one of the most important issues facing our
country. I am glad to see this committee addressing the matter in an
open bipartisan manner. My concern regarding veterans' healthcare is
the reason I introduced S. 963, The Veterans' Health Care and Equitable
Access Act of 2005. I believe there is a growing need to address
veterans' healthcare issues and it must be done without the affects of
politics as usual. All too often, the issue of veterans' healthcare is
exploited for its emotional value and used for partisan purposes.
Neither veterans nor this committee are served by such baseless
actions.
America's men and women are returning home from Operation Enduring
Freedom and Operation Iraqi Freedom and we owe them a debt of gratitude
and access to the best care possible. Many of our returning veterans
will have mental and physical wounds that need to be healed. I applaud
Chairman Craig and Ranking Member Akaka for holding this hearing and I
look forward to reviewing the pending legislation, both Democratic and
Republican, whose sole aim is to fulfill America's promise to our
veterans.
Thank you Mr. Chairman, I yield back.
Chairman Craig. Senator, thank you very much. And knowing
the situation in your State with BRAC, I suspect that is a
higher priority.
Senator Thune. This is a high priority as well.
Chairman Craig. Yes, it is.
A couple more question of this panel. Let me tell you where
I am coming from when it relates to static numbers of beds and
locations and facilities. In another life, just a year ago, I
chaired the Special Committee on Aging, spent a good deal of
time and consistently heard from a non-vet population though,
that they wanted to receive their services at home, near home,
around home, not at some distant location that the compensation
and/or the provider might take them. And because we have these
expanding and then declining populations, and we also have
mobility today in our population like we have never had it
before, I thought it was reasonable and appropriate that we
ought to be looking a little bit differently than we have.
And possibly to reassure your concern, we ought to get the
horse in front of the cart. We ought to see what we could do
and/or look at what the administration is proposing as it
relates to long-term care before we propose to tear down that
which we have.
But I do believe there is some sensibility to looking at
ways to deliver service that our not static and locational and
cannot be moved, but are tied to the veteran wherever he or she
may be. And I appreciate, Carl, some of the unique care
characteristics that are out there with certain veterans, that
is not to say that they could not be cared for in a specialized
institutional setting that is non-veteran or non-VA in its
character. That does not mean that we would not provide some of
that also.
Anyway, those are some of my concerns, and why I felt it
was appropriate to bring this to the forefront and have a
healthy debate with all of us about it.
I think one of the great frustrations we have today--and it
is part of what we are examining, what the past administration
of the Veterans Administration did and is still ongoing--is to
look at some of these large institutional facilities today that
cost hundreds if not millions of dollars a year to maintain,
that are located over here and the veteran is over here, and
how we do not get ourselves locked into that again. If we were
to meet the true needs of long-term care veterans today in this
bubble that we are in, we would be pouring an awful lot of
concrete to probably have it emptied 10 years down the road or
at least maybe not as necessary.
So it is my concern that we look at a variety of options of
service--and I do not blame you for buying off on something you
cannot see, feel or touch in your advocacy for our veterans. So
I think that is where I am coming from and where I will
continue to come from as we pursue this issue. I think it is an
important one, because I think long-term health care is
extremely important. That is why I placed the priority on it in
this legislation.
Any of you wish to comment further on that general area?
Carl.
Mr. Blake. Senator, I would like to thank you very much.
I think some of this goes to the heart of what Senator
Salazar's bill is about. I think we can make assumptions of
what the VA plans to do based on budget recommendations and
other things that we see going on, but until we have a clear
strategic plan that has been outlined by the VA, a lot of this
is just rhetoric and us voicing our concern and you doing the
same, and trying to address an issue that we do not really know
what the clear facts are yet.
So I think we cannot emphasize enough the need to know what
the VA's strategic plan for long-term care is going to be. Once
we have that in our hands, then we can proceed from there. That
will not probably change the concerns that I have expressed,
but at least it gives us a framework for something to work
from.
Chairman Craig. Thank you.
Don.
Mr. Mooney. Senator Craig, I would like to submit that the
elderly health care crisis is already affecting VA in other
ways. It was mentioned by Secretary Nicholson or one of the
other--it might have been Dr. Perlin--that it takes a year to
schedule an elective surgery in some places in VA, and part of
that reason is because so many elderly veterans are using VA in
the intensive care units.
Dr. Kussman once related to me that there is a bottleneck
of aging veterans in VA's intensive care units, and that VA, it
is well-known that veterans die in VA intensive care units at
about 4 times the rate they do in a standard private sector
hospital. That is how the population is affecting VA's capacity
right now. So it is already here.
Chairman Craig. Adrian, comment?
Mr. Atizado. Yes, sir. Thank you. Looking back at the
testimony that DAV provided on the capacity provision in the
Millennium Health Care Act, I get a sense that not only--
without reading our testimony but the testimony of the other
organizations as well as VA, I believe that a major concern
that had driven the capacity law to be passed, was a certain
amount of protection, a certain amount of responsibility that
must be kept by VA. DAV is certainly sensitive to the veterans'
desires as far as where they want to receive care. We do know
VA has made many strides in non-institutional settings, and
they continue to do so both in the lab as well as practical
work.
I would say that the capacity law represents more than just
the number of beds, it represents exactly that the protection
of a service, a needed service that veterans will require in
the near future, which has its vulnerabilities based on the
environment the VA operates in, under funded system, different
populations moving all over the place and the kind of care that
VA can provide, both institutional and non-institutional. And I
think that a certain amount of reassurance has to be had to the
veteran community before we do away with this law.
Chairman Craig. Well, gentlemen, I appreciate that obvious
concern and heartfelt comment as it relates to this type of
care and the importance of it, and we will continue to pursue
that and work with you and the Veterans Administration to see
if we might not clarify that vision a bit.
And I think, Adrian, what you are talking about, at least
it came to my mind as you were relating, if beds are a target
and a symbol, and not a structure, but a level of care required
to be provided, that may be a definitional term or that may in
itself be a way of an indicator. My great frustration today is
still getting into the business of pouring a lot of concrete
and large capital expenditures, only to have them obsolete a
very few years down the road in a very dynamic environment. And
therefore focusing on service and delivery of service under
certain criteria, and how do veterans become assured that
Congress and the VA are going to provide that? How do we tag
that provision in a way that is ongoing based on a certain
level of requirement?
I think we have all learned some lessons, and that is that
you can build a facility and you can turn the lights on, but
depending on budget requirements, it might not mean you allow
access through the front door. And so you sometimes have large
capital expenditures setting out there, but by criteria of
Congress and VA, depending on certain availabilities of
resources, the door may be limited, and those who can access
it, and so I am wrestling through some of these issues as we
work on them with the administration and certainly with all of
you to see where we get.
I want to thank you all sincerely for being here today. I
appreciate it. I am going to probably submit some additional
questions to you as it relates to Senate Bill 614. I can
understand your frustration about it, what it may or may not
mean as it relates to pharmaceutical drugs and gaining access
to them, or the reaction to them. We thought it was going to be
unanimous opposition. It was not quite. But I think there are
some legitimate underlying concerns. The question is how do you
address it and what is the impact of it on the existing service
because we know that one has been relatively successful.
Thank you all very much. As I said, the record will remain
open as we finalize this testimony, and the committee will
stand adjourned. Thank you.
[Whereupon, at 12:05 p.m., the committee was adjourned.]
A P P E N D I X
----------
Response to Written Questions Submitted by Hon. Senator Daniel K. Akaka
to Secretary James R. Nicholson
Question 1. In your statement before the committee, you stated that
the increased services required by the Vet Center Enhancement Act will
require only an additional $8 million and that ``there is no necessity
or justification'' for authorizing the amount of funding included in
the bill. Can you please elaborate on why you feel such a small
increase is needed when in 2004, Vet Centers cared for 9,597 OEF/OIF
veterans, and projections for 2005 are that Vet Centers will see 12,656
OEF/OIF veterans?
Answer. The $8 million referenced above in Department of Veterans
Affairs' (VA) statement to the committee was an estimate based on
projections of the cost of the additional services this bill would
direct.
The Vet Center program's mission is central to VA and its operation
is extremely cost effective. Approximately 80 percent of the annual Vet
Center program budget of $89 million for fiscal year (FY) 2005 goes
directly into the care of veteran and family members. This covers the
cost of 206 community-based Vet Centers and 943 staff.
In February 2004, Veterans Health Administration (VHA) authorized a
staff augmentation program for the centers to enhance its ability to
outreach to the veterans returning from combat operations in Operation
Enduring Freedom (OEF) and Operations Iraqi Freedom (OIF).
Specifically, the Vet Centers have hired and trained a cadre of up to
50 new outreach workers from among the ranks of recently separated OEF
and OIF veterans at targeted Vets Centers. These 50 new staff members
were hired on 3-year term appointments. Including the add-on for this
initiative, the actual program operating budget for fiscal year 2005 is
$94 million.
In March 2005, based upon the demonstrated success of the Global
War on Terrorism (GWOT) veteran outreach initiative to locate and
inform new returning veterans, VHA authorized the Vet Centers to hire
an additional 50 GWOT veterans to further enhance the program's
outreach capacity. Additionally, VA is in the process of converting the
initial 50 GWOT veteran outreach counselors to career status. The
latter action will increase the Vet Center program's annual budget by
$2.5 million starting in fiscal year 2006. Including the 3-year term
cost for the salaries of the second 50 GWOT new hires, this initiative
will cost $5 million a year for fiscal year 2006 through fiscal year
2008. Also, in November 2004, VHA approved of a plan to establish a new
four-person Vet Center in Nashville, TN. This will increase the number
of Vet Centers to 207, and increase the program's recurring base by
$393,000 annually. The first full year funding for the new Vet Center
will be realized in fiscal year 2006.
In fiscal year 2004, the Vet Centers system-wide served 125,737
veterans and provided slightly more than one million visits to veterans
and family members. For the first two quarters of fiscal year 2005, the
Vet Centers system-wide served 76,567 veterans and provided more than
half a million visits to veterans and family members. A continuation of
this rate of service delivery for the remainder of the year will
produce 153,134 veterans served and more than one million visits
provided. This represents an increase in veterans seen of 21.7 percent
while maintaining the same number of visits.
Following Secretarial authorization in the wake of hostilities in
Afghanistan and Iraq, the Vet Centers commenced in 2003 to actively
outreach and provide readjustment counseling to the new cohort of war
veterans returning from OEF and OIF and their family. To date the Vet
Centers have provided substantive services to over 19,500 veteran
returnees from OEF and OIF. Given a continuation of the current rate of
service delivery, the Vet Centers collectively will have served over
25,000 OEF/OIF veterans cumulative by the close of fiscal year 2005.
For fiscal year 2005, this amounts to over 14,000 OEF/OIF veterans
served. This represents approximately 9 percent of the projected Vet
Center workload for 2005.
Following Secretarial authorization in August 2003, the Vet Centers
initiated a program to provide bereavement counseling to military
family members whose loved ones were killed while on active duty in
Afghanistan and Iraq. Since inception of the program, over 400 cases of
active duty, military-related deaths have been referred to the Vet
Centers for bereavement counseling, resulting in services to over 600
family members. This is a new component of the Vet Center mission.
Question 2. S. 1182, the Veterans Health Care Improvement Act of
2005, would eliminate the prohibition in Title 38, Section 8110(a)(5)
against using VHA appropriated funds for cost-comparison studies in
public-private competitions without specific authorization from
Congress. Please explain your views on this provision.
Answer. Title 38 U.S.C. Sec. 8110(a)(5) prohibits the Department of
Veterans Affairs (VA) from using health-care appropriations to fund ``.
. . any activity in connection with, the conduct of any study comparing
the cost of the provision by private contractors with the cost of the
provision by the Department of commercial or industrial products and
services for the Veterans Health Administration unless such funds have
been specifically appropriated for that purpose.'' The provision in
question has had the effect of prohibiting VA from conducting cost-
comparison studies to determine whether it would be more cost-effective
for VA to directly furnish services, or obtain them by contract. The
President's Management Agenda stipulates that agencies increase their
focus on competitive sourcing and expand the number of activities
subjected to cost comparisons with commercial sources. This cannot be
accomplished with the prohibition in place.