Congress gavels in
Lawmakers are back from recess and have a lot to do before the end of the year. With presidential politics set to take center stage in 2020, there is precious little time to get things accomplished.
Coming up on Capitol Hill
House Committee on Veterans’ Affairs
- Sept. 10 at 10 a.m. ET: Full Committee Member Day Hearing
- Sept. 11 at 10 a.m. ET: Subcommittee on Health Legislative Hearing (there will be a big emphasis on women veterans, via ModernHealthcare)
- Sept 16 at 10 a.m. ET: Subcommittee on Economic Opportunity Field Hearing: “Combating Veteran Homelessness in the Tampa Bay Area
- Sept. 18 at 2 p.m. ET: Full Committee Oversight Hearing: Critical Impact - How Barriers to Hiring at VA Affect Patient Care and Access
- Sept. 19 at 10:30 a.m. ET: Disability Assistance & Memorial Affairs Subcommittee Oversight Hearing: Update on VA Contracted Exams, Quality Review Process, and Service to Rural Veterans
- Sept. 19 at 2 p.m. ET: Oversight & Investigations Subcommittee Oversight Hearing: Examining VA’s Over-payments and Collection Processes
Senate Veterans Affairs Committee Chair to step down
Sen. Johnny Isakson oversaw a radical new era in veterans’ health care delivery. Now, he’s retiring due to health issues and Sen. Jerry Moran (R-KS) is set to take the chairman’s seat. Here are a few insights into Sen. Moran’s positions on veterans’ health care.
In 2018, Moran argued that the VA Community Care program gave ‘too much power to the VA.’ Since its implementation, the rules governing private providers’ health care quality has been, well, lax. Some private providers said that if they were forced to meet quality criteria and performance requirements, they would not provide care to veterans.
After he was fired by tweet, Shulkin famously wrote that he was removed because he was deemed a threat to VA privatization. Moran said in a press release:
“That is why it is so concerning to me that allegations of “privatizing” VA health care are being used as a distraction from the VA’s solemn responsibility to support those the agency was created to serve. This false narrative diverts attention from the very real problems that persist at the VA and ignores the hard truth: Proposals to reform and consolidate community care were fully supported and endorsed by those who now want to call it privatization. Do not be fooled by this double talk, which unfortunately is all too familiar.
I expect the new leadership at the department will put to rest the disruption and spectacle that has stifled progress on community care reform for the VA. We need the VA to function in service to our veterans and we cannot revert back to the days when veterans were forced to wait weeks or months to access the care they earned. Our nation’s heroes deserve the best our country has to offer.”
Moran is also closely aligned with the Concerned Veterans for America. Per ProPublica: “Despite the committee’s 13-1 rejection, Moran’s proposal found a key ally in the White House: Darin Selnick, who used to work at a group backed by the billionaire brothers Charles and David Koch called Concerned Veterans for America and had signed onto an infamous proposal to dismantle the VA health system.”
Improve the Well-being of Veterans Act
Two companion pieces of legislation (S. 1906 and H.R. 3495) have been introduced. So far, there has been little coverage into what the “Improve the Well-Being for Veterans’ Act” would do. VHPI has joined with the American Psychological Association, the Association of VA Psychologist Leaders, the Association of VA Social Workers, the Nurses Organization of Veterans Affairs in an analysis. Here are the topline points:
1. Foremost, the bill is based on the false premise that non-VA mental health care entities are what’s missing to reach veterans who do not seek VA mental health care or live in areas where suicide rates are highest.
Veterans who do not seek VA mental health care were studied extensively last year in the National Academies of Sciences, Engineering and Medicine Evaluation of the Department of Veterans Affairs Mental Health Services.1 It found the main reasons that veterans do not seek VA care are that they do not know how to apply for VA benefits, are unsure whether they are eligible, are unaware that the VA offers mental health care or do not perceive a personal need for mental health services whether within or outside of the VA. The National Academies offered excellent recommendations for reaching this subset of veterans.
Regarding the 20 veterans who die by suicide daily, much is known about the 6 who used VA recently for health care. However, very little is understood about the remaining 14. It is not known whether they are already receiving mental health care in the community, lack knowledge about VA eligibility, or would refuse care in the community or VA even if offered. Community mental health entities awarded grants in this bill would not reach veterans in any of these scenarios.
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2. Relatedly, the bill ignores VA’s growing telemental health capacity to reach vulnerable veterans, especially those who reside in rural areas where veteran suicide rates are highest.
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3. For decades, the VA has used grants in special circumstances when outside entities could effectively augment services the VA could not provide itself. This bill, for the most part, duplicates and potentially supplants the critical function of the VA’s Office of Mental Health and Suicide Prevention to address veterans’ mental health needs.
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4. The National Strategy for Preventing Veteran Suicide 2018-20282 promotes expanded community partnerships, with VA as the hub of its efforts. VA is capable of coordinating, training and monitoring outside entities, and this organizing role is key to the appropriate and necessary organizing structure. However, the bill empowers outside entities to be the coordinator of suicide prevention services to veterans in many communities. VA is simply to be identified as “the payor” of such services. Fracturing VA efforts into multiple, disjointed programs dilutes the overall endeavor, splinters resources, and impedes care coordination – the very opposite of effective veteran suicide prevention and something at which the VA demonstrably excels.
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5. There is no expectation that outside entities would be held to the high standards (or actually any standards) of training, provider qualification and documented best practices for mental health care to which VA holds itself.
Click here to get the full analysis and the authors' recommendations.
Tracking 2020 and Veterans’ Health Care:
- Sen. Kamala Harris releases plan that provides health care to “Other than Honorable” veterans (via CNN)
- Mayor Pete Buttigieg vowed not to privatize the VA (via The Washington Post)
The politics of Veterans’ Health Care...
...and the effort to save the Veterans Health Administration from privatization. From Suzanne Gordon and Steve Early at Jacobin Magazine:
In 2018, Democrats on the Hill helped conservative Republicans and the Trump administration pass the VA MISSION Act. As currently being implemented, this legislation will siphon billions of dollars away from the VHA’s budget and direct that money toward private doctors and for-profit hospitals often ill-prepared to treat veterans.
As the VHA is starved of needed funding, its staffing levels will further decline and then its nationwide network of public hospitals and clinics will be dismantled. (According to union estimates, there are already 49,000 existing vacancies.)
Rather than expanding veterans’ access to high-quality care, Republicans — backed by the Koch Brothers–funded Concerned Veterans for America — and their Democratic Party enablers are laying the groundwork for the complete privatization of veterans’ health care.
Under the guise of saving taxpayers money and giving veterans more “choice,” these bipartisan opponents of Medicare for All want our best working model of single-payer health care to become a poster child for its “failure.”
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Rick Weidman, Executive Director for Government and Policy Affairs at the Vietnam Veterans of America, is a leading defender of the VHA who notes, with wry understatement, that “the military is a collection of very dangerous occupations.”
The best-known hazards of military service are encountered in combat, of course.
Enlisted men and women assigned to frontline duty in Iraq, Afghanistan, or elsewhere have returned with gunshot wounds, lost limbs, traumatic brain injuries, PTSD or MST (military sexual trauma), and respiratory problems from burn-pit exposure.
During noncombat duty, even more military personnel suffer job-related injuries or illnesses similar to those experienced by millions of blue-collar workers in civilian life.
Most American workers who get hurt on the job or develop an occupational disease soon become familiar with the shortcomings of our fifty-state system of workers’ compensation. Benefit levels are too low. Private employers fight their claims.
Rehabilitation services are fragmented and managed by private insurers. Workers who get approved treatment for specific work-related conditions may not be able to return to work. At some point, this deprives them of job-based medical coverage for themselves and their families. So even successful workers’ comp claimants can end up in personal bankruptcy due to unpaid bills for other care.
In contrast, veterans who qualify for VHA medical benefits, due to their low income or service-related condition, land on an island of socialized medicine within our larger system of private insurance and for-profit health care providers.
After getting a disability rating based on a particular service-related illness or injury, a veteran enters the VHA system and becomes eligible for unrelated treatment, then or later — from hip replacements to cancer surgery and hospice care.
Like residents of the UK covered by the National Health Service, VHA patients get the benefit of an integrated national network of public hospitals and clinics. All VHA doctors, nurses, and therapists are salaried, not paid on a “fee for service” basis. About a third of the VHA’s 300,000 staff members are veterans themselves. This helps create a unique culture of empathy and solidarity between patients and providers that has no counterpart in American medicine.
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But most constructive critics of the VHA know that further underfunding and expanded outsourcing of care is not the answer. That’s why union-represented VHA staff and their labor and veteran organization allies are blowing the whistle on Trump’s privatization push. On June 5, hundreds of activists around the country participated in protest rallies, press conferences, or informational picketing as part of a “National Day to Save the VA.”
As Vietnam veteran Skip Delano points out, our “private-sector health care system does not have the capability or the capacity to meet the needs of veterans. They will be sent to providers who may know little or nothing about their special problems and may fail to diagnose critical conditions like PTSD, Agent Orange, or burn-pit exposure, or military sexual trauma, to name only a few.”
A former postal worker, coal miner, and New York city teacher, Delano has decades of experience with good, union-negotiated medical coverage.
Nevertheless, he believes that, for many patients pushed out of the VHA, “private sector care will be less veteran-centric, of lower quality, require longer wait times, and end up with many veterans getting lost in the system because of poor care coordination and lack of accountability.”
Veteran suicide rate in Colorado grows
A study finds that stigma, not mental health care availability, is to blame for the growing rates of veteran suicide. Read more at KDVR.com:
To reduce veteran suicide, especially in rural Colorado, it is important to understand and address social, economic, and cultural factors unique to their communities. Veterans have different life experiences than people who have never served in the military, and data show they often are reluctant to seek mental health care.
The 2013 Colorado Health Access Survey (CHAS) — the most extensive survey in Colorado of health care coverage, access and utilization — offers some insight into mental health status and barriers to accessing mental health care for veterans.
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Only 7.3 percent of veterans in Colorado report poor mental health, which the survey defines as experiencing eight or more days of poor mental health in the past month, compared with 12.3 percent of nonveterans in 2013.
These percentages may seem low, and they might reflect the difficulty of talking frankly about mental health. For some, it is an uncomfortable subject. People’s attitudes and beliefs about mental illness can lead them to deny symptoms, delay treatment, and suffer hardships. A national survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) found that many people feel ashamed of their challenges or worry that others will not be sympathetic to their conditions
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While the rate of veteran suicide remains high in Colorado, the good news is suicide is preventable.
Many resources, programs, and organizations are addressing the problem. In fact, the U.S. Department of Veterans Affairs (VA) identified veteran suicide prevention as its top priority and has developed a National Strategy for Preventing Veteran Suicide, which emphasizes the need for more community-level initiatives and strategies.
[RELATED: Read more about the National Strategy for Preventing Veteran Suicide]
Together With Veterans (TWV) is one such community-focused example in Colorado. It provides tailored suicide prevention training and equips rural communities with strategies to reduce stigma and promote help-seeking, with the ultimate goal of preventing suicide. Rural veterans are at higher risk of suicide than urban veterans, and are less likely to use mental health care than urban veterans.
The Together With Veterans model enlists rural veterans and their local partners, such as behavioral health providers, clinicians, and local leaders, to reduce suicide.
TWV uses five suicide prevention strategies to support local efforts.
These strategies are implemented using a five-phase process to guide communities in crafting a locally tailored plan. The process takes approximately a year and is continuously refined by the Together With Veterans team.
This model has been implemented in several rural veteran communities across the United States, including Colorado’s San Luis Valley.
The VA’s radical idea: Treat the whole person
In America’s siloed health care system, the VA’s longtime care integration gets another look. From KMOX Radio:
A new program now being offered through the nation's V-A Healthcare system attempts to change the way healthcare has been traditionally offered.
"We have really seen a shift in how we want to deliver healthcare," said Dr. Kavitha Reddy, the clinical director of the St. Louis V-A's Whole Health System. "And that comes from a place of knowing healthcare in the United States is being delivered currently often in a very fragmented way -- meaning patients often see multiple specialists and get multiple prescriptions. Often when they come to the doctor, they are seen for their illness or problem and not necessarily seen as the whole person."
The key here is taking that whole health approach.
"And what that means is that it's not just about the clinical care or the illnesses or the diseases that a person has, but it's about their lifelong health and well-being," Reddy tells KMOX. "If we did more to help people with empowerment, setting their healthcare goals, being activated and motivated to take care of themselves, and provide them with skills to actually make them be able to meet their goals, we would actually see a shift in how people are managing a lot of their chronic illnesses and diseases."
Two years ago, the VA invested in 18 flagship sites for this Whole Health approach. "And the St. Louis VA has really led the charge in this transformation," said Reddy.
Reddy calls this approach groundbreaking.
"We are trying to really shift from a population where the patient sits in the doctor's office and is told what you need to do -- you need to quit smoking, you need to move more, you need to eat better, see me in six months -- to asking what's important to you, what drives you, what motivates you and how do we create shared goals that you are actually motivated around. And once you create that goal, how do we give you the skill- building to be able to accomplish it."
Study: Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access
Health Affairs has published a study that found that the VA’s integration of mental health care into primary care settings delivered big results...but that non-VA settings had trouble replicating the VA’s success. Read it at HealthAffairs.
Quick Clicks
- Federal News Network: “Despite inter-agency best efforts, VA can’t eliminate veterans homelessness without expanding its reach”
- VAntage Point Blog: The DoD has released its 2019 Caregiver Resource Directory
- American Military News: Truman VA receives high ratings for LGBTQ health care equality
- VT Digger: White River Junction VT Expands Mental Health care for senior veterans
- CureToday.com: Veterans Health Administration plays key role in blood clot study
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