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july/august 2007

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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.

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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