The VVA Veteran: Government Affairs: Obama Pledges Two-Year VA Budgets | Five Top Priorities For The 111th Congress

January / February 2009

the vva veteran masthead

GOVERNMENT AFFAIRS

Obama Pledges Two-Year VA Budgets

BY JOHN MITERKO, CHAIR, GOVERNMENT AFFAIRS COMMITTEE, WITH GOVERNMENT AFFAIRS STAFF

Days before the November election, Barack Obama pledged to push for an advance appropriation for the perennially short-funded Department of Veterans Affairs.

“First and foremost, the way our nation provides funding for VA health care must be reformed,” he wrote in an October 28 letter to the president of the American Federation of Government Employees. “My administration will recommend passage of advance appropriation legislation for the FY 2010 appropriations cycle, instead of yearly continuing resolutions that lead to delays in hiring and facility construction.”

“The fact that [Obama] supports this means action in the next Congress is very likely,” said a spokesman for Sen. Daniel Akaka (D-Hawaii), who introduced advanced appropriations legislation in the waning months of the 110th Congress. “If they knew their budget in advance, they could make hires and advances and improve IT.”

The Partnership for Veterans Health Care Budget Reform, a coalition of nine veterans service organizations of which VVA is a member, is calling for VA budget reforms because only twice in the last fourteen years, and only three times in the last twenty, has the VA budget been approved by the start of the October 1 fiscal year. The Partnership has proposed that Congress pass a VA budget a year ahead of time, which would mean that in 2009 lawmakers would need to pass both a fiscal 2010 budget and a fiscal 2011 budget.

Rep. Bob Filner (D-Calif.), chair of the House Veterans’ Affairs Committee, introduced a similar bill in the House late in the session. Yet even with the endorsement of the new president, passage of a bill stipulating advance appropriations for the VA cannot anticipate easy going. There likely will be opposition from other agencies that also would want advance appropriations.

Delayed budgets hurt veterans because they make it harder for VA to plan capital improvements, buy medical equipment, and hire additional workers.

VA GOES “IN HOUSE” WITH NEW GI BILL

After having taken a lot of heat for initially outsourcing development of the information technology needed to implement the new GI Bill, the VA decided—no doubt reluctantly, given the penchant of the Bush administration to outsource as many government functions as it could get away with—to rely upon its own workforce to set up the IT programs needed to implement the educational benefits of the new education bill.

The announcement came after VA officials did not receive enough proposals from qualified private-sector contractors to create an IT program that implements the new benefit. At no time did VA consider contracting out responsibility for administering this educational assistance, according to a VA press release.

“Many private contractors were apparently reluctant to offer proposals because of external misconceptions as to the scope of the work involved. While it is unfortunate that we will not have the technical expertise from the private sector available to assist us in developing the information technology solution, the VA can and will deliver the benefits program on time,” Secretary of Veterans Affairs James B. Peake said.

VVA had contended that the way the VA under the current administration was trying to contract out this work violated federal acquisition law and set procedures to determine if the work could be performed as effectively and efficiently by current VA employees. The American Federation of Government Employees had filed a complaint that the proposed VA action had violated A-76 rules and procedures.

Retired Navy Adm. Patrick W. Dunne, the VA Under Secretary for Benefits, said the VA would have been remiss if it had failed to assess the ability of the private sector to help set up the technology aspects of the program’s implementation.

Instead of asking for proposals from the private sector for a computer program that would better assist VA employees to get the job on time, VA has contracted with SPAWAR, a division of the U.S. Navy, to do the computer design program. Unfortunately, SPAWAR has a more-than-questionable record of bringing projects in on time and within budget. As of late December, there was no training of VA personnel and very few, if any, new personnel hired to be ready to meet the demand of this important new program, which was enacted six months ago.

The new GI Bill will provide educational assistance to veterans, military members, reservists, and National Guard members who have served since September 11, 2001. By law, the new benefits are scheduled to start on August 1.

TAKE IT SLOWLY

A key lawmaker is urging President-elect Barack Obama to move slowly and cautiously on his pledge to grant all veterans medical attention at VA facilities, or risk clogging the system and harming quality.

Obama said repeatedly during the campaign that one of his first acts as president would be to sign an executive order permitting veterans with non-service-related disabilities to seek medical care within the VA system, according to an article in CQ Today.

These so-called Priority 8 veterans make up the lion’s share of living American veterans. Veterans are designated as Priority 8 when their incomes exceed a certain threshold, which varies from county to county based on the level of affluence in a given location. They are the most affluent category of veterans, even though some earn as little as $28,430 a year.

Until January 2003, these veterans were permitted to seek treatment at VA health facilities, but the VA announced a freeze on new Priority 8 enrollments that year to alleviate a 300,000-plus patient backlog and quell a funding crisis.

The chair of the House Appropriations Military Construction, Veterans Affairs, and Related Agencies Subcommittee, Rep. Chet Edwards (D-Texas), says that he will fight to fund VA health care for Priority 8 veterans, the article noted, but that he wants to do so at a gradual pace. VVA agrees with this approach.

“Even if we had unlimited dollars, it would take time to hire all the doctors and nurses,” Edwards said. “We don’t want to double, triple, quadruple the wait times. I would urge the administration to maintain the goal but spread it out equally.”

This approach would involve continuing to raise the Priority 8 income threshold over several years to include more and more veterans. It is an approach VVA endorses. As VVA National President John Rowan stated: “Perhaps the best way to achieve the objective of including all Priority 8 veterans and still be able to deliver quality medical care while avoiding delays is to raise the income limit by $5,000 every six months. That would include most veterans in four years, and virtually all within eight years.”

Congress authorized $375 million in the fiscal 2009 Military Construction and Veterans Affairs spending measure to raise the Priority 8 income threshold and bring more of these veterans into health care-eligible categories. But it is unlikely that the amount appropriated will do much to move the threshold to a significantly higher income level, according to a Senate Veterans’ Affairs Committee aide.

If Obama orders a plan to raise the threshold gradually to cover all veterans, it would require Congress to continue to increase funding for the VA year after year. Aides note that if the President-elect wants to make all Priority 8’s eligible at the same time, it would likely require an emergency supplemental spending bill that would total billions of dollars.

Obama will have plenty of backers on Capitol Hill for his VA medical coverage plans. Sen. Patty Murray (D-Wash.), one of the Senate’s great champions of veterans, is one of those proponents.

“While the VA health care system certainly has its share of problems, closing its doors to thousands of veterans who have served us is not the answer to fixing them,” Murray told CQ Today. “That means expanding access, but it also means providing the funding and resources to hire doctors and staff, invest in VA infrastructure, do research, and decrease the wait on benefit claims. We make a promise to all veterans when they sign up to serve that, regardless of their future income or health needs, they will receive VA medical care.”

TBI LINKED TO LONG-TERM HEALTH ISSUES

On December 4, the Institute of Medicine’s Committee on Gulf War and Health released a 376-page report on the long-term consequences of traumatic brain injury. The committee reviewed nearly two thousand TBI studies, but pointed out the lack of scientific data on such injuries.

Among the committee’s findings were evidence of a causal relationship between penetrating TBI and unprovoked seizures as well as death, and between severe or moderate TBI with unprovoked seizures.

There was “sufficient” evidence, the report said, of an association between TBI and decline in neurocognitive function, long-term unemployment and problems with social relationships; Alzheimer’s-like dementia, endocrine dysfunction, depression, aggressive behavior, memory problems, and early death. There was “limited/suggestive” evidence of an association between moderate or severe TBI and diabetes or psychosis; and between mild TBI and visual problems, dementia, post-traumatic stress disorder, and suicide.

“Inadequate/insufficient” evidence existed on the relationship between moderate or severe TBI and brain tumors; mild TBI and employment and social functioning problems, bipolar disorder, or attempted suicide; TBI and multiple sclerosis or amyotrophic lateral sclerosis (Lou Gehrig’s disease). This does not mean that there is no link, only that the government has not funded research projects of sufficient size to discover if there is a link. VVA believes that this is willful ignorance.

In addition, the committee made several key recommendations, including pre- and post- deployment neurocognitive testing for all military personnel. You can read the full report at the U.S. National Academies of Science website www.iom.edu/CMS/3726.aspx under “Gulf War and Health Volume 7.”

Five Top Priorities For The 111th Congress

Too often, it seems that the government puts off dealing with the health care problems of entire generations of veterans. For instance, the Gulf War has been over almost twenty years now, and the government is finally confronted with evidence that there are real maladies associated with military service in the Gulf, illnesses that do not form a “syndrome,” but nevertheless are real and debilitating.

Even in the face of the report about these illnesses on November 17, 2008, the VA has sent it off to the Institute of Medicine for further study to see if they should do more meaningful original research. The government’s actions are unacceptable.

Essentially, you can make a decent case that the government is treating Gulf War veterans as they have treated Vietnam veterans suffering the adverse health effects of exposure to Agent Orange and the many other toxins used in Vietnam: They are waiting for an army to die. Hence, there is a pressing need for legislative remedies.

What follows are priorities that, if enacted and enforced, will make the VA more efficient, and, more importantly, more effective in caring for our nation’s veterans.

• Enact legislation to provide advance appropriations to fund veterans’ health care. Legislation should also insure the restoration of eligibility by 2012 for all Priority 8 veterans who choose to use the VA health care system. To insure that the system can accommodate them, the VA either should increase the income ceiling by $5,000 every six months, or Congress should mandate that they do so, and provide the dollars needed for additional staffing.

• Legislation is needed to transform the Veterans Health Administration into an open, evidence-based system. This should include taking a complete military history for each veteran enrollee as part of the automated patient treatment record, and using that military history in the diagnosis and treatment modalities. It also would include verifying that all VA physicians and other clinicians complete all Veterans Health Initiative curricula in the wounds, maladies, illnesses, and other conditions that derive from military service: branch of service; when one served; his or her M.O.S.; where one served; and what one actually experienced. A verification process in veterans’ health care is needed and should be rewarded with at least a modest stipend for those who complete the series of exams (instead of giving outrageous bonuses to managers who do not deserve them). This should help start the transformation of the VHA into a wellness system that focuses on prevention, early and effective interventions, and innovative methods of motivating enrollees toward leading healthy lives, as well as innovation that evolves into better and more effective treatments.

• Additional legislation will be needed to revamp the VA’s compensation and pension system, stipulating the integration of state-of-the-art IT to include artificial intelligence, competency-based testing of all service representatives and adjudicators, and other necessary reforms. Legislation should also be enacted to give veterans who file claims for benefits at least 30 percent if their initial claim is not adjudicated within 90 days, or if their appeal is not decided within 180 days from the time of filing. Additionally, legislation should provide for an across-the-board 25 percent increase in payments for all veterans receiving benefits, including Disability and Indemnity Compensation and non-service pensions, to help them negotiate the economic realities in these hard times.

• Legislation is needed that would mandate the creation within the VA of an office of an Undersecretary for Economic Independence. Such an office would take responsibility for an enhanced and augmented Center for Veterans Enterprise, vocational rehabilitation services, the veterans’ education service, and enforcement of veterans’ preference. It would be given functional control over the Veterans Employment and Training Service and newly federalized DVOPs and LVERs, which currently reside in the Department of Labor.

• Legislation that would insure that the special needs of underserved populations are met. This would include mandating the establishment of free-standing women’s clinics in all VA Medical Centers to meet the health needs of the increasing number of women veterans using the system. It would include insuring that VA eliminates disparities in care based on gender and ethnicity. It also would insure that the resources are appropriated to make steady progress toward the goal shared by the President-elect, the House leadership, and advocates to eliminate homelessness among veterans by 2012. Part of the need is for additional authorizing legislation, and part of what is needed is full funding for programs that have been shown to work, such as the Homeless Veterans Reintegration Program, which is currently authorized at $50 million