STATEMENT OF RICHARD F. WEIDMAN DIRECTOR OF GOVERNMENT RELATIONS VIETNAM VETERANS OF AMERICA BEFORE THE HOUSE VETERANS AFFAIRS SUBCOMMITTEE ON HEALTH REGARDING VETERANS MILLENNIUM HEALTH CARE ACT MAY 19, 1999 Mr. Chairman, Vietnam Veterans of America (VVA) thanks you for the opportunity to appear here today to present our views on the draft of the proposal for the "Veterans Millennium Health Care Act" and on the draft for the proposed "Pilot Program of medical Care for Certain dependents of Enrolled Veterans." We thank you and the Chairman of the full Committee, the Honorable Bob Stump, for your leadership in advancing these proposals to try and collectively find mechanisms to better cope with what can only be called a looming crisis in the delivery of health care to veterans.
Vietnam Veterans of America (VVA) is also grateful to you and to your distinguished colleagues on both sides of the aisle for your continued efforts toward securing a reasonable amount of funding for the Veterans Health Administration for FY 2000. While VVA believes that perhaps some of the changes that continue to be wrought by Executive action and administrative changes as well as legislation may ultimately prove to be useful in improving the quality and quantity of health care delivered to our Nation's veterans, the precipitating factor has been that there is simply not enough money being put into the system to keep it from faltering.The acute shortage of resources is really having a widespread and profound impact this Fiscal year, after all of the "management efficiencies" wrung out of the system in the past four years. Next year will be even more grim. The situation will only worsen in the years to come, unless there is a dramatic change to stop diminishment of resources, and hence the destruction of the system. One veteran commented that observing the unfolding sequence of events is like "watching a train wreck in slow motion." VVA applauds your efforts to make some of those dramatic changes, by seeking additional ways to secure vitally needed resources for the Veterans Health Administration (VHA).
Vietnam Veterans of America (VVA) generally favors the "Veterans Millennium Health Care Act" (Millennium Act). The current state of resources simply dictate that there must be changes if we are to have enough resources to preserve even the minimum of organizational capacity in VHA. Elements of the Millennium Act make hard choices, but this may well be necessary at this time.
In regard to the proposed modifications to Section 8110 of Title 38 that would prohibit the closure of 50 percent of the beds within a bed section, VVA believes that this is a step in the right direction. The problem is that this only slows the diminishment of needed organizational capacity, and does nothing to reverse the diminishment of inpatient bed capacity that VVA maintains has already been inappropriately eliminated at many stations. Neuro-psychiatric bed capacity (particularly for PTSD inpatient and residential treatment programs and substance abuse services programs) have been decimated on a virtual system wide basis. While this is a welcome step, there must still be some sort of remedial effort to rebuild capacity in many areas of the country, particularly in the "specialized services" medical areas, such as Spinal Cord Injury, Seriously Mentally Ill, and Post Traumatic Stress Disorder bed capacity.
The quarterly reports required will be welcome, as obtaining timely information in this newly decentralized system is problematic at best. While there are many salutary effects of allowing decisions to be made as to how best to accomplish the mission at the lowest possible level of an organization, the mission and goals must be set at the highest level, based on the direction of Congress. The management reporting systems and accountability mechanisms of VHA need to be greatly enhanced and regularly and rigorously employed. This requirement will help VHA to move in this needed direction. Of particular interest to VVA is the requirement that VHA provide justification and plans for providing another means of providing quality medical services to the veterans affected, and to do so in writing in a public way.
The defining of nursing home care for at least those veterans most in need is a move that VVA applauds. While we do not object to co-payments for veterans with the means or resources to pay (i.e., other than low-income veterans), VVA is concerned that the amount for the non- institutionalized spouse be sufficient as to not cause hardship. Frankly, people with high incomes are much less likely to enter into VHA nursing care, so great restraint is called for in order to ensure that the spouse is not made destitute, and her (his) life shortened by having an undue diminishment in loss of quality of life due to income reductions.
The formation of the revolving fund known as the "Veterans Affairs Extended Care Fund" is welcome. VVA also agrees with the requirement that mandates implementation of "Federal Advisory Committee on the Future of Long Term Care," with the resultant increase in current capacity (to greater than the organizational capacity as of September 30, 1997) for long term care, more adequate reporting requirements, and other needed changes. VVA also endorses strengthening the Adult Day Care and Respite Care programs. The requirement that the Secretary provide extended care as an entitlement to veterans is long overdue..
VVA strongly agrees with Section 3 of the draft bill that extends priority care to former prisoners of war and recipients of a purple heart, regardless of service connected disabled status or income. The core of the mission of the Veterans Health Administration is about "Caring for he (or she) Who hath Borne the Battle," and this long overdue extension of eligibility only reinforces this central concept.
VVA endorses eligibility of military retirees to utilize the VHA system, as these men and women are obviously veterans. VVA does urge you, however, to pay very close attention to the required Memorandum of Understanding between VHA and the Department of Defense (DOD) to ensure that VHA is in fact receiving the resources neccesary to defray the cost of this treatment at the full rate that would otherwise have been disbursed to the private sector. VVA does, however, believe that the freedom of choice on the part of all veterans will help make the medical care and other services better. This is a first step.
Vietnam Veterans of America does not have objection to the requirement for reasonable co-payments for prescriptions and medical devices from those who truly have the resources to pay for same, and if the medical condition is truly unrelated to military service. However, VVA can cite many examples of veterans who are being billed for co-payments for medications and devices for which we believe there is a strong case that the condition is derivative from experiences in the military. Given the state of the Veteran Benefits System, timely redress is all too often not available from that quarter. An example would be veterans who often have to wait for years for a decsion on PTSD, and in the meantime are billed for medications and other treatment that their insurance will not pay. Another example would be a veterans who has diabetes that is exacerbated by hyper-tension and PTSD, thus leading to a need for prosthetic devices. Should that veteran have to pay a high co- payment? VVA thinks not. The sensitivity with which this requirement is applied will be crucial.
VVA strongly favors the creation of the Department of Veterans Affairs "Health Services Fund" as outlined in the legislation, and further suggests that such co-payments be kept locally. It is crucial that such funds be available without Fiscal Year limitations.
Vietnam Veterans of America applauds the proposed creation of the "Veterans Tobacco Trust Fund." While we strongly disagreed with the actions of the Congress and the President last year in regard to the smoking issue, the establishment of this fund will at least provide some redress and restoration in this regard. VVA would also point out that the Veterans Health Administration can and should move forward on existing authority to design and implement much more effective and "user friendly" smoking cessation programs for veterans. This, and a like effort directed toward alcohol, would do much to reduce costs in both the short run and the long run. It would also be a significant step toward a "wellness" model of care.
VVA favors the extension of authority to accept funds for education and training into not for profit corporations to be established at the local or Veterans Integrated Service Network (VISN) level by VHA. Private resources can and should be usefully garnered in this manner, that would otherwise not be available for useful purposes. VVA does, however, urge that it be an explicit requirement that each and every such entity publish an annual report and publicize that their Form 990 filings available in a very assertive public way to the veterans service organizations in that area, as well as other interested parties.
While VVA believes that there may well be some closures of primary medical centers that may make sense, we are chary of the open ended process proposed in the "Enhanced Services" program. The very term "enhanced services" may seem to many to a euphemism that is reminiscent of "Punishment with extreme prejudice." The safeguards in terms of the process may be enough to allay this concern, but we would suggest some additional limitations. First, that the program be limited to ten sites in the first two years. Secondly, that at least one primary medical facility continue to be located in each of the fifty states and Puerto Rico.Given that the President's proposed budget was the equivalent of closing 26 hospitals, some drastic actions must be taken in order to not simply have 172 "empty shells" devoid of the resources needed for the efficient delivery of quality medical care. In some cities where there is arguably a duplication of effort, and a significant overlap of catchment areas, this may be part of the "hard medicine" we referred to earlier in this statement. It is, however, an important symbol of the Veterans Health Administration being a national system that at least one such facility be kept operational in each state, with a long term planning process as to how to utilize these facilities more efficiently and effectively as the locus of care in that state.
VVA also has concerns that some hospitals are the object of "deliberate draw downs" in patient admissions as a prelude to closing. This is not a case of the need for inpatient care not being present in the catchment area, but rather a case of a less than open decision being made to target that facility.
While VVA understands the need for immediate cash, we urge the VHA to make provisions for seeking uses of facilities that are no longer to be used by VHA to be made available to veterans organizations, veterans community based organizations, and other appropriate public and private entities for providing care to veterans, such as transitional housing. The need for transitional housing, and for other housing and respite care arrangements for veterans of every generation, while those veterans are in treatment, has been well documented. Before these existing facilities are divested it seems to VVA that the veterans most in need should be first in line for properties available under the enhanced use authority.VVA is concerned as well about the details of the "ongoing oversight and management, by the Department of Veterans Affairs, for the hospital care or medical service furnished" to veterans affected by the envisioned downsizing. VVA continues to strongly assert that "Veterans Health Care" is significantly different in some ways from general medicine, or that it should be. The problems that veterans have as veterans need to be systematically addressed in a ‘holistic' manner. The mechanism for doing this in the community based network of services is unclear to us. (VVA would point out that VA has yet to successfully do this while delivering care in their own primary care facilities, although we remain hopeful that adequate military histories, and other measures such as primary care teams is leading in this direction.). VVA has particular concerns in this regard as to the provision of Specialized Services such as Spinal Cord Injury units, PTSD, and other areas that are directly related prima facie to the core mission of VHA.
VVA strongly favors the extension of the eligibility for the Readjustment Counseling Services to all Vietnam Era veterans until at least the end of the year 2003. We have never quite understood this discrimination against non-combat "in-country" Vietnam-era Veteran. This will significantly aid in the outreach efforts to homeless veterans and others who have never utilized the system until now. VVA also strongly endorses the enhancement of the Committee on Mentally Ill, and the re- establishment of the "Committee on Post Traumatic Stress Disorder, " although we urge you extend the authority for said committee through at least 2004, or for five years.
In regard to the draft of the proposed "Pilot Program of Medical Care for Certain Dependents," Vietnam Veterans of America would reserve judgement at this time. While VVA strongly believes that involving the "whole family" in a "wellness" program for veterans is essential, this proposal needs some work before consideration of enactment.
Perhaps most importantly, this proposal is not the same as the "GI Bill of Health" as proposed several years ago in that there are no resources that inure to the system at the beginning of coverage. Rather, this system depends on collection of third party payments. By their own admission, VHA has done a poor job of billing and collecting third party payments for veterans. Until VHA can get the current job done in regard to funding collections, it would seem unwise to expand the scope of the task.
VVA would also note that if the purpose is at least in part one of bringing more resources into the system, then this may not be the time to try to take on families of veterans who might be eager to use the VHA system.VVA would also point out that it is widely anticipated that the Office of Management and Budget is expected to eliminate or greatly curtail the ability of "Priority 7" veterans to use Veterans Health Care facilities and services sometime in FY 2000. It may be useful to ensure that we have the organizational capacity to take care of veterans before expanding the system at this point.
Not Enough
While the enactment of the "Millennium Act" and other possible measures, such as moving aggressively toward a ‘holistic' health care model based on "wellness" (and beginning with a complete military and medical history of the veterans, to be used in the diagnosis and treatment plans) may well be neccesary, and in some cases even desirable, this will not be enough. The plain fact is that the there simply have to be more resources put into this system if we are even to come close to honoring our obligation to America's veterans.
The time to move toward modifying the gross inequity of the so-called "Balanced Budget Agreement" rank discrimination against veterans, is now. If the FY 2001 Budget request and ultimate appropriation is as unfair and inadequate as this year, then this already overtaxed and increasingly brittle system will just simply start to implode. Said simply, veterans will literally die from neglect. The Veterans Health Administration needs a Cost of Living Adjustment or "COLA" in the vicinity of three to four Billion more in the near future.
Mr. Chairman, Vietnam Veterans of America thanks you for this opportunity to share our views with you here today.
VIETNAM VETERANS OF AMERICA Funding Statement May 19, 1999 The national organization Vietnam Veterans of America (VVA) is a non-profit veterans membership organization registered as a 501(c)(19) with the Internal Revenue Service. VVA is also appropriately registered with the Secretary of the Senate and the Clerk of the House of Representatives in compliance with the Lobbying Disclosure Act of 1995.
VVA is not currently in receipt of any federal grant or contract, other than the routine allocation of office space and associated resources in VA Regional Offices for outreach and direct services through its Veterans Benefits Program (Service Representatives). This is also true of the previous two fiscal years.
For Further Information, Contact: Director of Government Relations Vietnam Veterans of America. (202) 628-2700, extension 127
E-mail us at govtrelations@vva.org