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GOVERNMENT AFFAIRS COMMITTEE
BY JOHN MITERKO, CHAIR, VVA GOVERNMENT AFFAIRS COMMITTEE,
WITH VVA GOVERNMENT AFFAIRS STAFF
After years of appearing before Congress and appealing to
members to increase funding for veterans health care, this
time around Congress did the right thing. In
the House, the Military Construction and Veterans’ Affairs
Appropriations Subcommittee, led by Rep. Chet Edwards (D-Texas),
moved to give a lot more money for veterans’ health
care and claims processing—$3.8
billion more than the administration requested and $9.9 billion
more than enacted in the current fiscal year.
As we write
this, the largesse of the House has inspired threats of veto
from the White House—and promises from
the GOP minority to go all out to obstruct efforts to pass
FY’08 spending bills. Republicans, who could not get
bipartisan agreement on the budget in 11 of the 12 years
they controlled Congress, “will use every tool at our
disposal,” promised Minority Leader John Boehner (R-Ohio)
to slow floor action on appropriations bills.
In addition
to the hefty—and much-needed—increase
for veterans’ programs, the bill’s discretionary
total is $8.2 billion, fully 15 percent more than what is
available this year. The bill also boosts military construction
projects, providing 13 percent more than the current level
and taking into account FY 2007 supplemental appropriations.
It also includes $8.4 billion to cover base-closing expenses,
44 percent more than this year and slightly more than requested
by the administration.
An analysis by Matthew Spieler in Congressional
Quarterly notes that Democrats “have long contended
that the Bush administration and Republicans in Congress
have short-changed veterans’ programs. While the Military
Construction-VA spending bill was once regarded as the least
controversial of the appropriations measures, highly publicized
accounts of soldiers’ living conditions at poorly maintained
facilities at Walter Reed Army Medical Center sparked outrage,
prompting leaders of both parties to promise swift action
and rigorous oversight. “Increases in the number of
wounded military personnel in Iraq and Afghanistan have put
greater pressure on veterans’ health
programs,” Spieler wrote.
“Improvements in military
medicine are now enabling seriously injured military personnel
to survive their wounds in greater numbers than in previous
wars, increasing demands on the military and veterans’ health
care systems…. The rising number of wounded personnel
contributed to the pressure to increase funding for veterans’ medical
care.
“The bill’s total after scorekeeping adjustments
is $18.2 billion (20 percent) more than the current level,
not counting FY 2007 emergency supplemental funds, and $4
billion (4 percent) more than the administration’s
request. When FY 2007 supplemental funds are taken into account,
the total appropriation is $11.6 billion (12 percent) more
than the current level.
“The measure provides $64.7
billion in discretionary spending, $14.8 billion (30 percent)
more than the current level, not counting FY 2007 emergency
supplemental funds, and $4 billion more than the administration’s
request. Taking FY 2007 supplemental funding into account,
the discretionary spending appropriation is $8.2 billion
(15 percent) more than the current level.
“This bill
appropriates a total of $87.7 billion for all veterans’ programs,
$8.1 billion (10 percent) more than the current level, including FY 2007 emergency
supplemental funding, and $3.8 billion (4 percent) more than the administration’s
request.
“The measure provides $37.1 billion for veterans’ health
programs, $3.1 billion (9 percent) more than the current level, and $2.5 billion
(7 percent) more than the administration’s request.
“Within this total, the measure provides $28.9 billion
for veterans’ medical
services, $3.4 billion (13.3 percent) more than the current
level, and $1.7 billion (6 percent) more than the administration’s
request.”
The total also approaches the figure VVA had
estimated is needed to fund the VA fully.
This is good news
for veterans and their families—assuming that the bill
retains its key features as it moves through the legislative
process. Once this measure is signed into law, we and the
other veterans’ service organizations
can focus our individual energies and collective efforts
on continuing to improve VA operations and on instituting
a sane, modified method of long-term funding for veterans’ needs.
ADDRESSING
THE GAPS
Rural health care is becoming a hot topic. At a hearing of
the Subcommittee on Health, chairman Rep. Michael Michaud
(D-Maine) pointed out that although 20 percent of the nation’s
populace lives in rural areas, 40 percent of veterans returning
from deployments in Afghanistan and Iraq live in rural communities.
This leads to “significant challenges maintaining ‘core
health care services,’” Michaud said.
These core
services have been defined by the Institute of Medicine as
primary care, hospital care, long-term care, mental-health
and substance-abuse treatment, and public health.
Currently,
there are some 650 community-based outpatient clinics. However,
despite improved access, only 12 of 156 new priority clinics
have opened since the VA released its CARES report almost
three years ago. An additional 18 clinics not on the list
have opened.
The creation of an office of rural health care
mandated by Congress is the first significant step into identifying
the issues and posing solutions. And several of the panelists
at the hearing did just that. Among the ideas:
Establish
a rural veterans advisory committee.
Increase the reimbursement
for beneficiary travel; eleven cents a mile just doesn’t
cut it any more and hasn’t for a
long time now.
Establish mobile Vet Centers to serve rural
populations.
Members of Congress
have heeded the needs of rural veterans. Rep. John Salazar
(D-Colo.), for one, has introduced H.R. 2005, the Rural Veterans
Health Care Improvement Act of 2007. We believe that this
legislation offers pragmatic solutions to address the problems
of access to health care experienced by too many rural veterans.
The bill would increase travel reimbursement for veterans
who travel to VHA facilities to the rates paid to federal
employees. The current reimbursement rate was established
decades ago and does not adequately compensate for the costs
of gasoline, wear and tear on vehicles, or increased insurance
in order to travel to distant medical centers. In the same
vein, the grant program for rural veterans’ service
organizations to develop transportation programs could be
an innovative way to strengthen community resources that
may already assist with veterans’ travel
needs.
The establishment of centers of excellence for rural
health research, education, and clinical activities, another
component of this bill, should fill a gap in VA health care
and lead to innovation in long-distance medical and telehealth
care. These centers have brought the synergies of clinical,
educational, and research experts to bear in one site. Such
centers have allowed VA to make significant contributions
to the fields of geriatric medicine and mental illness. It
would require demonstrations of rural treatment models. Demonstrations
on treating rural veteran populations would be extremely
useful in assessing effective ways to offer health care to
individuals who are generally poorer, more likely to be chronically
ill, and more likely to have challenges in access to regular
health care.
Establishing partnerships—with the Indian
Health Service and with the Department of Health and Human
Services—should add to greater cooperation and collaboration
in meeting the needs of rural veterans.
We would caution,
however, that we would not like to see these demonstration
projects exploring more opportunities to do widespread contracting
out of veterans’ health
care services. Demonstration models should be assessed according
to outcomes such as quality of care, cost, and patient satisfaction
and the results reported to Congress.
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2008, Vietnam Veterans of America. All Rights Reserved. 8605 Cameron
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