Representative Lane Evans and Members of the panel:
Thank you for the opportunity to present the views of the Disabled American Veterans (DAV) on mandatory funding for veterans' health care. We sincerely appreciate your interest in this issue and for providing us the forum to discuss an alternate way to fund veterans' health care.
As an organization of more than 1.2 million wartime service-connected disabled veterans, DAV is concerned about the government's commitment to meet the health care needs of sick and disabled veterans. Access to timely top quality medical care is of the utmost importance to many of our nation's 2.3 million service-connected disabled veterans and other sick veterans who need and rely on the Department of Veterans (VA) health care system for treatment of their health care needs. The effectiveness of all veterans' programs, including VA health care, is dependent upon sufficient funding for the available benefits and services, and resources adequate to allow for their timely delivery.
However, today we are not meeting our promises to our veterans. As a result of perennially inadequate health care budgets, VA is no longer able to provide timely access to quality health care. Pressures on the VA health care system have escalated to a critical point that can no longer be ignored. For this reason, the following veterans' organizations formed the Partnership for Veterans Health Care Budget Reform: The American Legion, AMVETS (American Veterans), Blinded Veterans Association, Disabled American Veterans, Jewish War Veterans of the U.S.A., Military Order of the Purple Heart of the U.S.A., Paralyzed Veterans of America, Veterans of Foreign Wars of the United States, and Vietnam Veterans of America. The goal of the Partnership is to make VA health care funding mandatory. Many other organizations also support the Partnership's goal.
We have often stated that through their extraordinary sacrifices and contributions, veterans have earned the right to health care as a continuing cost of national defense. However, veterans' health care remains a discretionary program, and each year, funding levels must be determined through an annual appropriations bill. Year after year, DAV, along with the other co-authors of The Independent Budget and other veterans' service organizations, has fought for sufficient funding for VA health care and a budget that is reflective of the rising cost of health care and increasing need for medical services. Unfortunately, despite our continued efforts, the cumulative effects of insufficient health care funding have now resulted in the severe rationing of medical care. We adamantly believe that America's citizens, as beneficiaries of veterans' military service and sacrifice, want the government to fully honor its moral obligation to provide quality and timely health care services to wartime service-connected disabled veterans. In fact, a recent nationwide survey, conducted by Princeton Survey Research Associates International for DAV and Paralyzed Veterans of America, showed strong support for veterans' health care and benefits. Three out of four Americans (75 percent) believe veterans' health care should be a "top to high priority” in the federal budget. Nearly all survey respondents (95 percent) said veterans should not have to wait to receive their benefits. Most Americans (87 percent) also support making veterans' health care funding mandatory.
Likewise, concerns about the need for veterans health care budget reform were addressed by the President's Task Force to Improve Health Care Delivery for Our Nation's Veterans (Task Force or PTF), created by President Bush in May 2001 by Executive Order 13214.
The Task Force was charged to identify ways to improve health care delivery to VA and Department of Defense (DoD) beneficiaries through better coordination and improved business practices. Of most importance to DAV is the Task Force's recognition of a "growing dilemma” concerning VA health care. In May 2003, the PTF noted in its Final Report, that there is a significant mismatch in VA between demand and available funding—an imbalance they believed not only impedes collaboration efforts with DoD but, if left unresolved, will delay veterans' access to care and could threaten the quality of VA health care.
We concur, in part, with the Task Force's findings and recommendation that the Federal Government should provide "full funding” to ensure that enrolled veterans in Priority Groups 1-7 (new) are provided the current comprehensive benefits in accordance with VA's established access standards by using a mandatory funding mechanism, or some other changes in the budget and appropriations process to achieve that goal. DAV, however, would apply the "full funding” or a mandatory funding approach to all enrolled veterans, Priority Groups 1-8.
This past year, Secretary of Veterans Affairs Anthony J. Principi described the current state of veterans' health care as "the perfect storm” gathering on the horizon. The best selling book, The Perfect Storm, describes a rare meteorological phenomenon that occurred in 1991, when a cold front building off Canada, a major tempest brewing over the Great Lakes, and a hurricane developing near Bermuda collided and created one of the most devastating storms of the century, trapping a small fishing boat, the Andrea Gail, working off the Grand Banks. The "storm systems” gathering over veterans' health care are a dramatic increase in the number of veterans enrolling in the VA, skyrocketing medical costs, and decades of inadequate, inflation-eroded appropriations. Any one of these developments can be devastating in itself, but combined, they spell disaster for the VA health care system and the thousands of veterans who rely on its specialized medical services and programs.
There is widespread agreement that the funding system, not the VA health care system, is in need of fundamental reform. The DAV, as part of the Partnership for Veterans Health Care Budget Reform, fully supports a mandatory funding mechanism as a long-term solution to this problem.
We share the Task Force's vision of a veterans' health care system that is no longer impaired by the mismatch between resources and demand for care. Therefore, it is essential that some type of practicable guaranteed funding measure be enacted to ensure that all eligible veterans—including those injured in Operations Iraqi Freedom, Enduring Freedom, and the War on Terror, who will need the VA health care system into the middle of this century and beyond—have access to timely, quality health care now and in the future. We believe that guaranteed funding will close the gap identified by the Task Force between funding and demand for veterans' health care. Anything short of guaranteed funding is unlikely to fully resolve the crisis. And, like the tiny Andrea Gail caught in open waters, unable to weather the destructive forces bearing down on her, America's sick and disabled veterans may not survive the perfect storm that threatens the VA health care system.
The Task Force concluded that, "our nation's commitment to those who have served should not waiver. Improving health care delivery to our nation's veterans will require action by the President, Congress, VA and DoD.” As the Task Force pointed out, a number of commissions, advisory panels, and government study groups have convened since 1991 and looked at many of the same issues addressed in its final report. These findings are well known and well documented. They are issues that the veterans' service organizations have been trying to resolve for years. This past year, the Partnership has been pressing Congress to take action on what the PTF considered one of its major recommendations—full funding for VA health care to ensure enrolled veterans are provided comprehensive benefits, according to VA's established access standards. Our nation's sick and disabled veterans cannot wait any longer for the government to take action. Now is the perfect opportunity to move forward and resolve this untenable situation.
Unfortunately, the Administration has refused to endorse, or even to acknowledge, the recommendation of the PTF. We can only conclude that this rejection has nothing to do with the soundness of this recommendation, but rather obedience to raw political priorities focused on matters other than the best means to maintain effectiveness of the veterans' medical care system. In the same vein, we have also found it disheartening that neither the Chairman of the House or Senate Veterans' Affairs Committees have been willing to hold hearings on this issue to discuss the crisis in veterans' health care funding and the common sense solution provided by the PTF.
The VA's Veterans Health Administration (VHA) is the largest health care delivery system in the United States, providing care to more than 4 million veterans annually at over 1,300 sites. Following enactment of Public Law 104-262, the Veterans' Health Care Eligibility Reform Act of 1996, a standardized Medical Benefits Package became available to all enrolled veterans. Since that time, VA has transformed itself into a world-class health care system and proven it is a treasure worth preserving. VHA serves as the primary back-up to the Department of Defense and National Medical Systems in times of national emergency and is a leader in research and health professions education. Nearly one-half of the physicians in the United States have received all or part of their training through VA.
Most importantly, the veterans' health care system acts as a safety net for service-connected disabled and low income veterans and is a provider of a wide range of specialized services not readily available in the private sector, tailored to meet the unique needs of veterans, including: spinal cord injury medicine; blind rehabilitation; prosthetics; treatment for post traumatic stress disorder and traumatic brain injury; and extended mental health and long-term care programs. VA also provides comprehensive programs for the chronically mentally ill, the homeless, and veterans with AIDS-related disorders and hepatitis C. VA has set standards for safety, quality, and efficiency and is also the nation's leader in geriatric research, education and training. Major medical breakthroughs pioneered by VA have benefited millions of Americans.
As our nation debates how to address the overall crisis in health care—the uninsured, the underinsured, and skyrocketing health care and prescription costs—we hope that the debaters will focus on the advantages of having a strong VA health care system to address the needs of our nation's sick and disabled veterans. A fully funded VA health care system can provide the means to relieve the pressure on the private health care sector, provide a cost-effective alternative for scarce taxpayer dollars, and to honor our nation's commitment to its veterans for their sacrifices in protecting our freedoms that all Americans enjoy and cherish.
Studies have shown that VA provides more cost-effective care than comparable private sector health care. Without VA, millions of veterans would be forced to rely on Medicare and Medicaid at substantially greater federal and state expense. Additionally, private sector health care organizations would not likely want to enroll veteran patients who are typically older, poorer, more severely disabled, or chronically sicker than the average U.S. citizen. VA health care for veterans is a win-win situation. Veterans get excellent comprehensive health care services tailored to their needs, while society gets highly trained doctors and nurses, and the taxpayer pays a fraction of the market value for the expertise the academic affiliates bring to VA.
VA's success has led to unprecedented growth in the system. The number of veterans enrolled for VA medical care grew from 2.9 million in 1996 to over 7 million in 2003. Despite this far more than doubling of workload, appropriations increased by only 44 percent during those years, from $16.6 billion in 1996 to $23.9 billion in 2003. On average, appropriations for veterans' medical care increased 5 percent annually over the last eight years, while VA's Under Secretary for Health stated in congressional testimony last year that VA requires a minimum 14 percent increase each year just to maintain current services. Adding to the problem is the necessity for VA to continue well into the new fiscal year under the rate for operations for the previous year when, as is becoming commonplace, Congress fails to enact regular and permanent appropriations by the start of the current fiscal year.
Year after year, veterans must compete with pork barrel projects and other spending for funding to operate veterans' medical care programs. Year after year, the outcome is uncertain. Year after year, VA is consequently unable to use its resources most efficiently through strategic planning for the long term. Year after year, the appropriation falls short of what is needed to meet demand. In addition, it is becoming commonplace for VA to be forced to operate under temporary continuing appropriations because of Congress' inability to enact an annual appropriation by the beginning of the fiscal year. For the period of time VA is operating under such temporary funding—sometimes for several months—it cannot hire the new medical care personnel it needs, cannot purchase new equipment, and must hold in abeyance new initiatives and projects to improve services.
Even more disturbing are reports from the White House of proposed spending cuts for virtually all agencies in charge of domestic programs in the fiscal 2006 budget, including the VA.
The estimated cut for VA in fiscal year (FY) 2006 is over $900 million or 3.1 percent, bringing it below the FY 2004 level. It is ironic, as our brave men and women continue to fight the War on Terror, and as the Nation marked Memorial Day by paying tribute to World War II veterans with the dedication of a memorial in Washington, D.C., honoring their service, that Administration officials are proposing further cuts to veterans' programs.
We find it outrageous and utterly incomprehensible that while men and women serving in the military in Iraq and Afghanistan are being severely injured and killed on a daily basis, and, while many veterans are either denied timely access to health care or denied enrollment in the VA health care system, that further budget cuts in veterans' programs are even being considered. Such cuts would be absolutely devastating to an already under funded veterans' health care system and add to our sense of urgency to make VA health care funding mandatory.
That is why one of the DAV's most important legislative goals is changing the funding mechanism for veterans' medical care from the capriciousness and uncertainties of the annual discretionary appropriations process to funding mandated at adequate levels through a formula in permanent authorizing legislation. Under such mandatory funding, resources for veterans' medical care would be determined by real need rather than by the vagaries of politics. The current situation is simply unacceptable.
As you are aware, there are currently two mandatory funding bills pending in Congress. In the House: the Assured Funding for Veterans Health Care Act of 2003 (H.R. 2318), sponsored by Representative Lane Evans (D-IL), and in the Senate: the Veterans Health Care Funding Guarantee Act of 2003 (S. 50), sponsored by Senator Tim Johnson (D-SD). These measures are designed to ensure that the veterans' health care system has adequate resources to meet existing statutory obligations and are strongly supported by all the major veterans' service organizations. We extend our personal thanks to you, Representative Evans, for your unwavering support of mandatory funding.
Each year, VA is provided an annual discretionary appropriation for medical care which includes funds for direct medical care, construction and renovation of hospitals, nursing homes and clinics, as well as operating expenses. Under H.R. 2318, beginning in fiscal year 2005, the funding for all of VHA would be provided through a permanent appropriation provided by the Treasury, except for construction projects and a program that provides grants to states to build long-term care facilities. The Congressional Budget Office (CBO) estimates that enacting H.R. 2318 would result in a net increase in direct spending totaling about $30 billion in 2005, $165 billion over the 2005-2008 period, and $473 billion over the 2005-2013 period. During 2004-2013, saving in discretionary funding would be about $262 billion. We should note that VA's projection for enrollment for VA health care was increased 20 percent by CBO—we believe this estimate is overly inflated. The shift from discretionary funding to mandatory funding would also result in savings in direct spending for other government programs, primarily Medicare and Medicaid. Lower Medicaid spending for veterans who would now receive health services through VA would result in savings to states totaling about $640 million over the 2006-2008 period and $2.2 billion over the 2006-2013 period, according to CBO.
We recognize that shifting from discretionary to mandatory funding for veterans' medical care is going to be a challenge. We have regularly faced serious challenges in providing for veterans, but the logic and lessons of history reveal there are always solutions. Otherwise, all progress we have made would never have been realized and each challenge would have been defeated by one serious obstruction. Disabled veterans have faced adversity in war, in civilian life following, and in confronting those in government who do not understand or appreciate the merits and importance of veterans' programs. Through perseverance and determination, we have overcome strong opposition in the past.
Providing quality, timely health care services for veterans disabled as a result of military service should be a top priority for this Congress, this Administration, and the American people. In a time when more veterans are turning to VA for care, it is unconscionable that VA must reduce services, close enrollment and ration care due to insufficient funding. But the discretionary appropriations process continues to unfairly subject disabled and sick veterans to the annual funding competition for limited discretionary resources. We have urged Congress to do the right thing and change the current funding mechanism for VA health care. As we stated earlier, we have been stonewalled in Washington on this issue. We are appalled at the tactics the Congressional leadership has used to stall open discussion on this issue. As a prime example, during the 107th Congress, Representative Chris Smith (R-NJ), Chairman of the House Veterans' Affairs Committee, introduced legislation (H.R. 5250), along with you, Mr. Evans, and many members of the House Veterans' Affairs Committee, which would make veterans health care funding mandatory. All of the major veterans' service organizations applauded this bipartisan effort to take action and fully supported this important initiative. However, under extreme pressure from House leadership, including having his Chairmanship threatened, Chairman Smith was unable to move this measure through his Committee, and did not introduce a mandatory funding bill during the 108th Congress.
Guaranteed veterans' health care funding would eliminate the year-to-year uncertainty about funding levels that have prevented the VA from being able to adequately plan for and meet the constantly growing number of veterans seeking treatment. We believe it is disingenuous for our government to promise health care to veterans, especially service-connected disabled veterans, and then to make it unattainable because of inadequate funding. Rationed health care is no way to honor America's obligation to the brave men and women who have so honorably served our nation and continue to carry the physical and mental scars of that service.
The shift to mandatory funding would not create an individual entitlement to health care, nor would it change the VA's current mission. Only the way the funds are provided for VA health care would change under a guaranteed funding source.
The deficiencies in medical care services to veterans from the shortfall in resources for VA hit veterans hard. The need for medical care often cannot wait, but veterans' health is put in jeopardy by unprecedented waiting times for routine and specialized services. The rationing of medical care means that some veterans will not merely suffer from delays, but will suffer from the denial of needed treatment altogether. These are the more immediate and visible effects. With these budget constraints, VA has been unable to make needed upgrades to its facilities and medical equipment. Even the most dedicated health care professionals cannot provide the best quality of care under these circumstances. Eventually, the increasing weight of these strains upon personnel and infrastructure can only lead to greater fraying of the fabric and systemic breakdown of services. After years of laboring to build this system into a model of efficiency and a world leader in medical care, this is such a foolish squandering of a valuable national resource.
It is hard to believe that our federal government "cannot afford” the funds required to rectify the problems we see today in the VA health care system. What could be more important than ensuring that those who have been disabled in service to this nation have timely access to medical treatment for their life-long disabilities?
It is only fair that Congress support America's veterans, especially at a time when we are asking new generations of men and women serving in our Armed Forces to protect the United States interests at home and abroad, maintain our security and freedoms, and fight the global war on terrorism. These men and women risk their lives daily and are clearly dedicated to fulfilling their commitment to this nation; likewise, our Congress must demonstrate its full support and commitment to them. Think of this: A young American wounded in Central Asia today will still need the VA health care system in the year 2060. He or she will still need VA disability compensation and medical benefits. Although disability compensation payments are guaranteed under a mandatory program, access to needed VA health care services are not guaranteed. We have an obligation to ensure that these veterans have access to a stable, thriving health care system, dedicated to their needs, now and in the future.
Equally important is Congress' support for those who have previously served this nation. So many veterans sacrificed their health, their limbs, and mental well-being on our nation's behalf. We believe most Americans would agree they deserve a health care system dedicated to their needs: a comprehensive, world class health care system that delivers quality, timely medical care services. None of us should forget the sacrifices made by these veterans. That is why something must be done now to ensure VA is guaranteed sufficient resources so that it can deliver the specialized high quality health care to those who need it most.
Today, we are not meeting our promises to our veterans. VA has consistently received inadequate resources to meet the rising costs for health care and increased demand for health care services. We hope that Congress is willing to make VA health care funding guaranteed and break the budget cycle that has decimated the veterans' health care system. Our nation's sick and disabled veterans cannot wait any longer to receive the health care services they need and deserve.
Once again we need strong leadership to address the current workload and resource imbalance that exists in the veterans' health care system and to guide the Department out of its existing crisis. There must be a bipartisan effort to fix veterans' health care funding in this Congress. Guaranteed funding provides the most comprehensive solution to the current VA medical care funding problem. It would ensure the viability of the veterans' health care system and meet the needs of current and future service-connected disabled veterans. Therefore, it is imperative that funding for the veterans' health care system is guaranteed so that all service-connected disabled veterans, and all other enrolled veterans, have access to high quality health services in a timely manner.
Representative Evans, in closing, we again thank you for arranging this forum to discuss mandatory funding for VA health care and for providing us the opportunity to present DAV's views on this extremely important issue.
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