A publication of Vietnam Veterans of America, Inc. ®
An organization chartered by the U.S. Congress
October 2001/November 2001
Government Relations
Now, More Than Ever
By Phillip Litteer, Chair, Government Affairs Committee, With Rick Weidman, Director of Government Relations, and Pat Eddington, Associate Director
The veterans healthcare system of the Department of Veterans Affairs has been grossly under funded since Fiscal Year 1996. Vietnam Veterans of America estimates that due to its failure to keep pace with medical inflation, the VA, over the past five years, has lost at least 25 percent of its organizational capacity to assist veterans with needed health-care problems. All this has occurred while more veterans than ever are seeking health-care services from the VA.
Much has been written in this space over the last two years in regard to the problem of not enough money being put into the Veterans Healthcare Administration (VHA). Congress has added more money than two successive administrations have requested for the last two years, and it will add more to the 2002 appropriations that will pass Congress before November 15.
Even with the additional money added by Congress, the appropriation will fall billions short of what is needed to keep pace with medical inflation. Every hospital in the VHA will take a substantial cut. Those cuts will vary according to the number of veterans in a given area, but will range between $7 to $10 million at many VA hospitals.
Additionally, we will have veterans returning from war. VA has its "Fourth Mission," to back up military hospitals and the civilian medical system in times of national emergency. VA staff members are now deployed to help civilians in New York City and in Washington with problems stemming from the September 11 attacks. The cost estimate for this effort is well over $100 million. Had there been 5,000 wounded instead of killed at the World Trade Center, top VA officials have admitted that the civilian medical system would have collapsed, and the backup VA system would have imploded.
On October 15 and 16, 2001, the House and Senate respectively held hearings into the VA’s ability to carry out its fourth mission: backing up DoD in times of war and providing backup to the National Disaster Medical System (NDMS) in the aftermath of a domestic disaster or crisis. VVA’s Government Affairs and Healthcare committee chairs, Phil Litteer and Dr. Linda Schwartz, provided a statement for the record for the October 15 House Veterans Affairs committee hearing.
Litteer and Schwartz noted because of the loss of capacity in the VA health-care system to treat veterans with special needs (i.e., the seriously mentally ill, homeless veterans, blinded veterans, veterans suffering from spinal cord injuries, and veterans exposed to toxic substances), any large influx of Enduring Freedom veterans would swamp an already overwhelmed VA system.
"Should our country be forced into large-scale ground combat operations in Southwest Asia as part of a larger counter-terrorism campaign," Litteer and Schwartz noted, "it is inevitable that we will see an influx of casualties requiring these kind of specialized services. Just as inevitably, DoD will turn to the VA for assistance in treating and subsequently caring for and compensating these veterans, particularly given the downsizing of the services’ medical organizations in the wake of Desert Storm. Our view is that the VA is fundamentally unprepared to cope with this new crisis."
"How quickly would VA medical establishments be able to provide trauma or other emergency support to local hospitals in major cities should those hospitals be overrun with civilian casualties? We suspect the answer would not be reassuring, particularly since the total number of inpatient VA beds has declined from 53,000 in FY 95 to 22,000 in FY 2000 (the last year for which figures are available)," Schwartz and Litteer noted.
During both the House and Senate Hearings, VA Secretary Anthony Principi stated that he had identified $250 million in needed upgrades to allow the VA to meet its fourth-mission requirements. Principi conceded that "VA needs to enhance its medical preparedness to respond to casualties from chemical and biological agents by providing training to its health-care workers on decontamination procedures and on diagnosis and treatment of chemical, biological, and radiation injuries."
Principi also acknowledged that recent events had put the VA’s Capital Asset Realignment for Enhanced Services (CARES) process on hold. Principi has directed the VHA to reexamine how the CARES process may impact VA’s ability to meet is wartime support role for DoD and its ability to provide assistance during a national emergency.
VVA reiterated to both the VA and the relevant Congressional committees that any VA support for national emergencies must not come at the expense of treating and serving existing veterans.
VVA has been told that it is too late to redouble our efforts to secure the proper funding we have been advocating for--that it will just be business as usual on the VA health-care budget. In other words, the VA health-care system will be inadequately funded again.
If $15 billion can be found to rescue the airlines, then $3 billion in additional operating funds to keep up with inflation and begin to restore adequate staff and organizational capacity to the VA hospitals can be found--as well as an additional $700 million to make VA hospital buildings safe. If $100 billion can be found for an economic stimulus package, then at least $ 1.5 billion can be found to be available as needed for the Fourth Mission of the VA to treat civilian casualties of enemy attacks.
If your Representative and Senators tell you there is nothing to be done, it is too late, or they are not properly situated to change the "business as usual" system in Congress, you may remind them that these are not normal times. "Business as usual" just will not do. As President Abraham Lincoln said during the Civil War, "the dogmas of the quiet past are inadequate to the stormy present." We need Senators and Representatives who can, in Lincoln’s words, "think anew."
We hope the citizens who serve in the 100 Senate seats and the 435 seats in the House of Representatives can think anew and respond by providing the funds to prepare for this huge problem.
If action is not taken to provide more funds immediately, then when the VA hospital in a Member’s district or a Senator’s state cannot provide for those veterans currently seeking services, much less for new returning veterans, it will not be the VA’s fault, but rather the fault of those in Congress and those in the Executive Branch who did nothing in the face of clear need.
VVA national leadership will write to every Senator and Representative on this subject. However, you must do your part. If each of us expresses our concern respectfully by e-mail or fax or phone calls--not to mention letters to the editor of our local weekly and daily papers--then we will have done our job. If each of us, collectively as VVA, and individually as veterans and citizens, do not act now, then shame on us. If we do our job, and there is no meaningful response in the form of real action from your Senator or Representative to provide more money now, in FY 2002, then shame on them.
Terrorist Attacks Reshape Legislative Landscape
In addition to highlighting the need for more money for the Veterans Health Administration, the most immediate effect of the September 11 terrorist attacks was the temporary cessation of legislative activity, followed by a reordering of hearing priorities. It is also very difficult to reach key staff, and letters are not being accepted, much less read.
One casualty of this process was the September 25 House Government Reform Committee’s proposed hearing on Gulf War Illnesses. The hearing has been postponed until early 2002, as has a hearing on the VA’s information-technology programs. What follows is a recap of the legislative and regulatory highlights from Labor Day through mid October 2001.
Two days after the World Trade Center and Pentagon attacks, DoD officials conducted a meeting with veterans service organization representatives at which they disclosed for the first time that Vietnam-era veterans were deliberately exposed to live biological warfare experiments.
The sailors and Marines involved in the tests--code named Shady Grove--were assigned to the U.S.S. Granville S. Hall (YAG-40) and five Army light tugs (2080, 2081, 2085, 2086, and 2087). Shady Grove was conducted between January 22 through April 9, 1965, over the open ocean in the Pacific. An A-4B aircraft sprayed Coxiella burnetii (which causes Q fever) and Pasteurella tularensis (which causes tularemia) over the target vessels. DoD officials claim that less than 100 personnel were involved in the tests, but the true number remains unknown as DoD has to date declined to declassify the records associated with Shady Grove.
Pentagon officials admitted to VVA staff that at least 20 and perhaps as many as 100 such experiments were conducted during the 1960’s as part of the Navy’s Shipboard Hazard and Defense (SHAD) nuclear, biological, and chemical (NBC) defense program. (The actual number of such tests in the SHAD series was at least 110 separate tests.)
VVA has filed a FOIA request for the declassification of all SHAD-related documents and will be seeking passage of legislation to mandate the immediate and complete declassification of SHAD records in order to assess the potential health impact and compensation implications of the tests. Veterans with knowledge of these tests are urged to contact VVA’s Government Relations staff at the National office: email govtaffairs@vva.org
GAO Criticizes VA over Medical Care Collection
The first post-attack VA-related hearings were held on September 20. The first was conducted by the House Veterans Affairs committee’s (HVAC) Oversight and Investigation subcommittee, which examined the VA’s effectiveness in collecting past due bills through its Medical Care Collection Fund (MCCF). The MCCF is the third-party payer mechanism used by the VA to bill insurance companies for care provided to veterans by the VA. VVA submitted a statement for the record in which VVA Government Affairs chairman Phil Litteer noted, "VA has an abysmal track record of collecting from private insurers."
As GAO reported in 1999, VA collections from insurers declined in every fiscal year from 1995 through 1999 (the last date for which VVA has figures). From a peak of $532 million in 1995, VA third-party collections declined to roughly $400 million by the end of fiscal year 1999. Although it appears collections were up in FY 2001, this may be due to an accounting methodology change. Litteer noted in his testimony, "VA has even had to retain a private contractor to help it collect on delinquent bills. This is clearly a case of mismanagement at the VA, and we sincerely hope that today’s hearing will serve as a wake-up call for senior VA leaders where this aspect of the MCCF problem is concerned."
Litteer recommended in his testimony that Congress should mandate the Secretary of Veterans Affairs provide an annual report on the status of overdue bills, and the Congress should pass legislation that levies a $10,000/day fine on any insurer who is more than 90 days in arrears to the VA. He further urged the Congress to pass legislation to ban insurers from using exclusionary clauses denying payment for care given at VA facilities, and rounded out VVA’s recommendations with a call for the Congress to work with the VA to devise a way to develop and expedite claims where there is an MCCF payment problem that may well cause the veteran to drop out of needed treatment. VVA offered similar views in a statement for the record before the House Government Reform Subcommittee on Government Efficiency, Financial Management, and Intergovernmental Relations on October 10.
Homeless Bill Moves Forward
On October 15, the full House approved H.R. 2716, the Stuart Collick-Heather French Henry Homeless Veterans Assistance Act. As approved by the House, H.R. 2716 will: authorize 2,000 additional HUD Section 8 low-income housing vouchers over four years for homeless veterans in need of permanent housing; authorize $10 million over two years for ten new Domiciliary for Homeless Veterans programs; consolidate and improve provisions of existing law relating to homeless veterans, including authorizing $285 million over four years for the Homeless Grant and Per Diem Program; authorize $250 million over five years to strengthen the Department of Labor's (DoL) Homeless Veterans Reintegration Program (HVRP); and establish a VA-DoL demonstration program to provide information, including referral and counseling services, to incarcerated veterans and veterans in long-term institutional confinement to assist in their reintegration into their communities.
This legislation would also earmark $10 million over three years for medical care for homeless veterans with special needs, including older veterans, women, substance abusers, and those with PTSD; require VA to provide technical assistance grants to nonprofit, community-based groups to assist other groups in applying for federal grants to address homelessness among veterans; authorize VA to provide outpatient dental services to veterans enrolled for care in VHA and receiving care (directly or by contract) in VA or contract programs that traditionally serve the homeless; and require VA to have a mental-health capability wherever it delivers primary care.
The Collick-French proposal would, when enacted, eliminate the cap on Homeless Veterans Comprehensive Service Programs and require centers to be available in not fewer than the 20 largest U.S. cities. It would also authorize homeless veterans receiving care through vocational rehabilitation programs to participate in the VA's work-therapy program. VVA testified earlier this year in favor of the provisions contained in the final House version of the bill.
VVA is grateful to former Miss America Heather French Henry for her tireless efforts to help America’s homeless regain their dignity. For many veterans, especially Vietnam veterans, Heather will always be the only and true Miss America. The most extraordinary part of Heather’s beauty comes from the commitment that shines from the heart of this daughter of a Vietnam veteran. Beauty that comes from the inside lasts a lifetime.
VVA will work closely with the Senate and House conferees to ensure this legislation becomes law this year.
There is much occurring in Washington that affects the lives of Vietnam veterans and their families. You are encouraged to check the "Legislative Issues" section of the VVA web page, which is www.vva.org for more information and briefings. Sample letters and key points on funding for health-care and other issues may also be found in this section of the VVA web site.
You are also encouraged to get on the VVA Legislative Alert e-mail list by sending your request to govtrelations@vva.org to receive regular information on what is happening with the Executive Branch or the Congress. Your thoughts, suggestions, or opinions as an individual member of VVA on any part of the VVA 2001 Legislative and Policy Priorities, or in regard to other issues affecting veterans can be sent to govtrelations@vva.org or plitteer@vva.org
E-mail us at TheVeteran@vva.org