DAV Calls on Congress to Fully Fund the VA

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Chairman Sanders, Chairman Miller, Ranking Member Burr, Ranking Member Michaud:

Last week, Acting Secretary Sloan Gibson appeared before the Senate Veterans’ Affairs Committee to discuss the progress made by the Department of Veterans Affairs (VA) over the past two months to address the health care access crisis for thousands of veterans. Secretary Gibson testified that after re-examining VA’s resource needs in light of the revelations about secret waiting lists and hidden demand, VA required supplemental resources totaling $17.6 billion for the remainder of this fiscal year through the end of FY 2017.

As the leaders of organizations representing millions of veterans, we agree with Secretary Gibson that there is a need to provide VA with additional resources now to ensure that veterans can access the health care they have earned, either from VA providers or through non-VA purchased care. We urge Congress to expeditiously approve supplemental funding that fully addresses the critical needs outlined by Secretary Gibson either prior to, or at the same time as, any compromise legislation that may be reported out of the House-Senate Conference Committee. Whether it costs $17 billion or $50 billion over the next three years, Congress has a sacred obligation to provide VA with the funds it requires to meet both immediate needs through non-VA care and future needs by expanding VA’s internal capacity.

Last month, we wrote to you to outlining the principles and priorities essential to addressing the access crisis, a copy of which is attached. The first priority “…must be to ensure that all veterans currently waiting for treatment must be provided access to timely, convenient health care as quickly as medically indicated.” Second, when VA is unable to provide that care directly, “…VA must be involved in the timely coordination of and fully responsible for prompt payment for all authorized non-VA care.” Third, Congress must provide supplemental funding for this year and additional funding for next year to pay for the temporary expansion of non-VA purchased care. Finally, whatever actions VA or Congress takes to address the current access crisis must also “…protect, preserve and strengthen the VA health care system so that it remains capable of providing a full continuum of high-quality, timely health care to all enrolled veterans.”

In his testimony to the Senate, Secretary Gibson stated that the Veterans Health Administration (VHA) has already reached out to over 160,000 veterans to get them off wait lists and into clinics. He said that VHA accomplished this by adding more clinic hours, aggressively recruiting to fill physician vacancies, deploying mobile medical units, using temporary staffing resources, and expanding the use of private sector care. Gibson also testified that VHA made over 543,000 referrals for veterans to receive non-VA care in the private sector – 91,000 more than in the comparable period a year ago. In a subsequent press release, VA stated that it had reduced the New Enrollee Appointment Report (NEAR) from its peak of 46,000 on June 1, 2014 to 2,000 as of July 1, 2014, and that there was also a reduction of over 17,000 veterans on the Electronic Waiting List since May 15, 2014. We appreciate this progress, but more must be done to ensure that every enrolled veteran has access to timely care.

The majority of the supplemental funding required by VA, approximately $8.1 billion, would be used to expand access to VA health care over the next three fiscal years by hiring up to 10,000 new clinical staff, including 1,500 new doctors, nurses and other direct care providers. That funding would also be used to cover the cost of expanded non-VA purchased care, with the focus shifting over the three years from non-VA purchased care to VA-provided care as internal capacity increased. The next biggest portion would be $6 billion for VA’s physical infrastructure, which according to Secretary Gibson would include 77 lease projects for outpatient clinics that would add about two million square feet, as well as eight major construction projects and 700 minor construction and non-recurring maintenance projects that together could add roughly four million appointment slots at VA facilities. The remainder of the funding would go to IT enhancements, including scheduling, purchased care and project coordination systems, as well as a modest increase of $400 million for additional VBA staff to address the claims and appeals backlogs.

In reviewing the additional resource requirements identified by Secretary Gibson, the undersigned find them to be commensurate with the historical funding shortfalls identified in recent years by many of our organizations, including The Independent Budget (IB), which is authored and endorsed by many of our organizations. For example, in the prior ten VA budgets, the amount of funding for medical care requested by the Administration and ultimately provided to VA by Congress was more than $7.8 billion less than what was recommended by the IB. Over just the past five years, the IB recommended $4 billion more than VA requested or Congress approved and for next year, FY 2015, the IB has recommended over $2 billion more than VA requested. Further corroboration of the shortfall in VA’s medical care funding came two weeks ago from the Congressional Budget Office (CBO), which issued a revised report on H.R. 3230 estimating that, “…under current law for 2015 and CBO’s baseline projections for 2016, VA’s appropriations for health care are not projected to keep pace with growth in the patient population or growth in per capita spending for health care – meaning that waiting times will tend to increase…

Similarly, over the past decade the amount of funding requested by VA for major and minor construction, and the final amount appropriated by Congress, has been more than $9 billion less than what the IB estimated was needed to allow VA sufficient space to deliver timely, high-quality care. Over the past five years alone, that shortfall is more than $6.6 billion and for next year the VA budget request is more than $2.5 billion less than the IB recommendation. Funding for non-recurring maintenance (NRM) has also been woefully inadequate. Importantly, the IB recommendations closely mirror VA’s Strategic Capital Investment Plan (SCIP), which VA uses to determine infrastructure needs. According to SCIP, VA should invest between $56 to $69 billion in facility improvements over the next ten years, which would require somewhere between $5 to $7 billion annually. However, the Administration’s budget requests over the past four years have averaged less than $2 billion annually for major and minor construction and for NRM, and Congress has not significantly increased those funding requests in the final appropriations.

Taking into account the progress achieved by VA over the past two months, and considering the funding shortfalls our organizations have identified over the past decade and in next year’s budget, the undersigned believe that Congress must quickly approve supplemental funding that fully meets the critical needs identified by Secretary Gibson, and which fulfills the principles and priorities we laid out a month ago. Such an approach would be a reasonable and practical way to expand access now, while building internal capacity to avoid future access crises in the future. In contrast to the legislative proposals in the Conference Committee which would require months to promulgate new regulations, establish new procedures and set up new offices, the VA proposal could have an immediate impact on increasing access to care for veterans today by building upon VA’s ongoing expanded access initiatives and sustaining them over the next three years. Furthermore, by investing in new staff and treatment space, VA would be able to continue providing this expanded level of care, even while increasing its use of purchased care when and where it is needed.

In our jointly signed letter last month, we applauded both the House and Senate for working expeditiously and in a bipartisan manner to move legislation designed to address the access crisis, and we understand you are continuing to work towards a compromise bill. As leaders of the nation’s major veterans organization, we now ask that you work in the same bipartisan spirit to provide VA supplemental funding addressing the needs outlined by Secretary Gibson to the floor as quickly as feasible, approve it and send it to the President so that he can enact it to help ensure that no veteran waits too long to get the care they earned through their service. We look forward to your response.


Garry Augustine Executive Director, Washington Headquarters DAV (Disabled American Veterans
Robert E. Wallace Executive Director Veterans of Foreign Wars of the United States
Homer S. Townsend, Jr. Executive Director Paralyzed Veterans of America
Rick Weidman Executive Director for Policy and Government Affairs Vietnam Veterans of America
Tom Tarantino Chief Policy Officer Iraq and Afghanistan Veterans of America
VADM Norbert R. Ryan, Jr., USN (Ret.) President Military Officers Association of America
Randy Reid Executive Director U.S. Coast Guard Chief Petty Officers Association
Heather L. Ansley, Esq., MSW Vice President VetsFirst, a program of United Spinal Association
James T. Currie, Ph.D., Colonel, USA (Ret.) Executive Director, Commissioned Officers Association of the U.S. Public Health Service
CW4 (Ret.) Jack Du Teil Executive Director United States Army Warrant Officers Association
Robert L. Frank Chief Executive Officer Air Force Sergeants Association
John R. Davis Director, Legislative Programs Fleet Reserve Association
VADM John Totushek, USN (Ret) Executive Director Association of the U.S. Navy (AUSN)
Robert Certain Executive Director Military Chaplain Association of the United States
Herb Rosenbleeth National Executive Director Jewish War Veterans of the USA
Michael A. Blum National Executive Director Marine Corps League



  • a veteran myself

    I wanted to share the perspective coming from the Medical Director at a community based outpatient clinic. He recently sent out a letter announcing his resignation from the Department of Veteran Affairs with an explanation as to why. Please read, it truly details the problems front-line physicians, nurses, and ancillary staff employed by the Dept of Veteran Affairs face daily. Ultimately the veteran suffers.

    From: Hibbs,
    Jonathan R. (Walla Walla)
    Friday, June 27, 2014 3:30 PM

    Subject: Con
    onor muore chi non può serbar vita con onore

    All things in this world must come to an end, but I am sad to realize that the time for my VA career to do so has arrived earlier than I would have expected when I came here eight years ago. I have advised the Director, the Chief of Staff and the Department of Human Resources of my resignation effective 7/26/2014.

    “One who cannot serve life with honor should die with honor” paraphrases a theme from Madame Butterfly. The title character’s father has a knife with this sentiment inscribed upon the blade. In the overwrought convention of operas, both Madame Butterfly and her father use that same knife to end their physical lives, quoting this inscription at different points in the libretto, bookends to their story. I am no apologist for physical suicide, having spent a significant percentage of my professional life trying to prevent it. The inscription, however, seems very apt in reference to one’s professional life, particularly in this career.

    By vocation, by training and by licensed obligation, we are dedicated to providing health care to patients. This does not mean giving every patient everything they want, but it does mean that those patients depend on us to care for them in a manner equaling or exceeding community health care standards in our professions. The relationship of patient to health care worker always implies some vulnerability, but at the
    VA, our patients tend to be particularly vulnerable. Many have multiple health care needs, but are from the economic margins of society and have few other realistic options for care. At the same time a majority of our licensed health care professionals could probably earn higher salaries taking care of other
    patients. There is great honor to be had in caring for these particular patients, and this is often a compelling compensation of its own. When our
    professional responsibilities to these highly vulnerable patients can no longer be fulfilled with honor, however, it is time to move on. For my part, at least,
    I find myself believing that I have reached that point.

    The Veterans Health Administration has never been an easy place to work. Its systems designs seem to be relentlessly and exclusively propagated from the top down, and usually to work against its employees and clients. The documentation requirements are tortuous and toxic, and grow without limits. The bureaucracy is top-heavy and cumbersome and larded with vertical silos which explode on contact. Micromanagement seems oppressive and the resource allocation decisions often bizarre. In about ninety-three of the past ninety-six months, however, I thought these barriers to care were surmountable — simply the price one paid for the privilege of providing care to veterans who needed it. I believed that workarounds could be found and used, that authority figures of good will could be convinced to do good things, and that despite the extra work involved we would in the end get the right things for our patients. At this point, however, I find myself losing my belief that these things are true. I am not only responsible for my own panel of patients, but also for other providers and the overall quality of care delivered by my clinic, for which reason my doubts may compromise more than my own behavior. I also find myself in the morally dubious position of needing to recruit good health care workers into a work environment I believe to be hostile to those workers and contrary to the best interest of our patients.

    I have seen good providers, nurses, mental health workers and other employees burnt out, discouraged and treated with contempt. I have seen rural patients denied appropriate, accessible arrangements for care, particularly for specialty care in their own communities. I am still seeing good employees set up for failure, unable to complete their patient care tasks within the hours for which they are paid if they can be completed at all. At the same time they are unable to receive compensation for additional hours worked nor to get adequate help. I experience what Senatorial commentators referred to as “a culture where managers give more importance to meeting meaningless performance goals than helping veterans”. I find a possibly deliberate, certainly officially mandated confusion between access to actual care, on the one hand, and optimization of billable events and defensive documentation, on the other. I see delay or failure to enhance local services at rural sites of care, even when such enhancements are specifically mandated by Congress, by agency regulation or by grants to which our facilities are signatories. I see taxpayer resources thrown at command, control and administrative priorities to the exclusion and apparent harm of direct patient care. I find an increasing abyss between the locus of decision making and the place where care is provided.

    None of these perceptions arelikely to surprise any of you. They are not secrets, and I have not been shy about sharing them publicly, including and especially with facility leadership, because I believed that together we would make things better. What has changed, however, are notions that by sharing observations about problems, we would work together to solve them, that the barriers to care would fall or at least dwindle, and that with effort things would in fact improve. By and large, I find myself forced to face the reality that most of these problems actually continue to get worse.

    I often make mistakes, and it is possible my vision is not clear on this. For those of you committed to staying in the VA and serving these patients within these constraints, my heart goes out to you; I wish you well. For my own part, however, I have reached the painful conclusion that the role I play here has become increasingly dishonest, acting primarily to enable a system whose fundamental purposes seem more aligned with serving the institution itself than the patients to whom our licenses oblige us.

    I have learned a great deal from you as well as from those patients, and I cherish the many friendships I have come to rely on while I served here. Thank you, friends! Many of you have helped me to become a better physician and a better person. I hope that in the end your efforts here prove more fruitful than mine have been. May your work be filled with honor, and your days with grace.

  • wxc101049

    As a result of last weeks lack of action by the U. S. Congress with regards to passing legislation that would make life better for America’s Veterans and their families. I have wrote th the following politicians; John McCain, Jeff Flake and David Schweikert to urge them to stop the delay and do all within their ability to immediately pass all legislation that will enable America’s Veterans and their families to have improved lives. I now write to urge all DAV members to write to their elected officials and urge them to suppor;t VA Benefits, VA Medical Care, New VA Hospital Construction and VA Claims Processing improvement legislation. It is time to stop attacking the President of the United States, the Veterans Administration, the Disabled American Veterans Organization and each other. It is time to start addressing the root of the problem … and that “root problem” is the Do Nothing, Lackadaisical, Congress, of the United States of America!