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REPUBLICAN PRESS RELEASE

June 20, 2007

Buyer: Surge of new low-priority veterans could endanger care for core constituency

For more information, contact: Jeff Phillips, (202) 225-3527

Washington, D.C. — A House Committee on Veterans’ Affairs hearing today considered the effects of lifting a 2003 Department of Veterans Affairs (VA) suspension on enrollment of priority group 8 veterans – those without service-connected disabilities and with sufficient income to presumably afford other health care options. In January 2003, responding to excessive waiting times for medical appointments, the VA secretary exercised his authority under the law to temporarily suspend the enrollment of priority group 8 veterans. The suspension remains in effect.

During testimony, Michael J. Kussman, M.D., VA’s under secretary for health, testified that it would cost VA $33 billion over ten years to enroll priority group 8 veterans. He expressed concerns about VA’s ability, faced with this influx of new patients, to maintain access and quality of care for veterans.

Committee Ranking Member Steve Buyer (R-Ind.) cited testimony of Stephanie J. Woolhandler, MD, MPH, associate professor of medicine, Harvard Medical School , as representative of the incremental universal healthcare agenda. To the disapproval of VSOs (veterans' service organizations) present at the hearing, Woolhandler, an advocate of universal health care, testified that in such a system, veterans would have an insurance card and be free to get care outside the VA system. VSOs and other veterans’ advocates fear that a significant reduction in patients would reduce the viability of the VA healthcare system. “I am very concerned that submerging VA in a national healthcare monster would drastically diminish its ability to care for veterans,” Buyer said.

The following is Ranking Member Buyer’s opening statement:

“Mr. Chairman, when I spoke on the floor last week during consideration of the VA appropriations bill, I commended the majority on your strong veterans’ funding.

You have broken ranks with your predecessors, the previous Democratic Majority and the Clinton administration, in particular the Democratic Majority of the 1970s and 1980s that gave us a VA system that was depicted in the movie, “Born on the Fourth of July,” and the Clinton administration that gave us flat-line budgets.

Republicans are no strangers to budget increases; VA funding doubled during our majority after decades of low budgets. Our experience teaches that budget increases cannot substitute for good management.

The challenge before this committee will be to ensure that VA manages its resources to produce the best possible outcomes for eligible veterans.

The values we learned in the military taught us that we care first for our wounded and only then do we consider ourselves. To do otherwise is shameful conduct contradictory to our values.

During the two years I chaired this committee, budgets reflected those values, which shaped my priorities: We must care for veterans who have service-connected disabilities, those with special needs, and the indigent veterans returning from war; ensure a seamless transition from military service to the VA; and provide veterans every opportunity to live full, healthy lives.

Veterans with service-connected disabilities, those with catastrophic disabilities, and the indigent are the “core constituency” — our highest priority for quality care.

The term “core constituency” is not new: VSOs [veterans’ service organizations] considering eligibility reform in 1995 used the term “core group.” The VFW has recently used the term “core constituency” for these veterans.

Providing core constituency veterans with quality care has been the traditional mission of the VA. The Veterans’ Health Care Eligibility Reform Act of 1996 established a system of patient enrollments based on priorities in which core veterans were assigned the highest priority.

Care for non service-connected veterans and those with higher incomes was authorized only when resources were available – meaning low-priority veterans. After care was opened to category 7 and, later, category 8 veterans, the number of VA patients increased from just under 3 million to over 5 million.

VA has not been able to keep up, even with a near-doubling of the healthcare budget. We are now learning that waiting times for appointments are longer than VA had reported. Core constituency veterans wait longer because millions of low-priority veterans are competing for appointments.

This was not the intent of Congress, which in House Report 104-690 stated, '. . . in designing an enrollment system and providing care, the VA may not enroll or otherwise attempt to treat so many patients as to result either in diminishing the quality of care to an unacceptable level or unreasonably delaying the timeliness of VA’s care delivery'.

VSOs didn’t intend this outcome either. Statements by major VSOs at the time of eligibility reform show widespread support for giving top priority to veterans with service-connected conditions.

David Gorman, then Deputy National Legislative Director for Disabled American Veterans, referred to 'the priority that must be accorded to service-connected veterans before you can go ahead and start taking care of the non service-connected veterans.'

VFW’s National Legislative Service Director, James Magill, warned against VA being 'relieved of its primary mission of caring for those who have sustained injuries while in the service to their nation.'

Passage of reform was partly based on VA studies indicating that, with third-party collections, it would likely be budget-neutral. Reform would encourage veterans to seek preventative care in new VA outpatient clinics, reducing the need for expensive inpatient treatment later on.

The Congressional Budget Office, however, believed reform would attract so many new enrollees that it would dramatically drive up costs. CBO was right.

My great regret from this time is that I did not insist on a requirement to use accepted healthcare management tools such as enrollment fees and co-pays that reflected the true cost of healthcare. At best, we did the job half right.

Congress also gave the Secretary of Veterans Affairs the authority to limit enrollment based on funding. The law required the secretary to ensure that high-priority veterans get the care they need and deserve.

In 2003, Secretary Principi suspended new enrollments in priority group 8, so that VA could fulfill its obligation to core constituency veterans as agreed to by the VSOs in 1996.

Some say the government is obliged to provide essentially free healthcare for life to anyone who served even a year or two. I intend to protect the core constituency first.

The government has, on the other hand, long agreed to provide care to military retirees who give the better part of their adult lives to the service of the nation.

Yet, even for retirees, military healthcare is not free; they must pay enrollment fees and make co-pays for their TRICARE plans. [Buyer said he was amazed to hear an American Legion national officer once argue against any such comparison. The Legion officer had stated that TRICARE, unlike VA, guarantees care and is thus justified in charging fees. Buyer disputed the assertion’s accuracy, calling it 'bothersome.']

The latest Independent Budget cites VA data that indicates one million priority group 8 veterans are waiting for admission. I think that once we open the gates, the surge will come.

Those who think mandatory funding will increase access and maintain quality ignore the challenges entailed in expanding the system.

Does VA have the capacity to accept millions of new non service-connected veterans? Even with this year’s funding increase, can VA absorb millions of new patients?

How fast can we build new clinics? Can VA hire the doctors, nurses and other caregivers when the nation is experiencing a shortage in clinicians? How will communities cope with the siphoning of scarce clinicians when a new VA clinic opens?

If we cannot satisfactorily answer these questions, we have merely raised expectations, and that is wrong.

The VSOs advocate opening the doors to priority 8 veterans and simultaneously complain about waiting times for appointments. But “more money” isn’t the entire solution: As I said on the floor, VA carries over hundreds of millions in health care dollars. For example, in 2005 and 2006 alone, it did not spend $60 million allocated for mental health care.

This is not to say that VA hasn’t tried. Over the past several years, the department has worked hard to manage waiting times.

*  VA has opened over 800 outpatient clinics;
*  Improved collections, which have been reinvested into veterans’ healthcare;
*  Centralized information technology, management and security, which is bringing VA practices in line with those of leading technology companies;
*  Implemented an advanced clinic access program that improves the scheduling of outpatient care. This program provides priority non-emergency care for service-connected veterans rated 50 percent or higher, or for a veteran’s service-connected disability. Advanced Clinic Access has been commended by the Independent Budget;
*  VA has provided priority access to care to veterans of the Global War on Terror;
*  The department has developed a system of bar coding that reduces medication errors;
*  Instituted a patient safety program and a system of electronic health records that still has a ways to go;
*  And to top all this, VA Secretary Nicholson has told his medical center directors to stay open longer to ensure their facilities “are available when veterans need them.”

Despite these improvements, core constituency veterans are waiting too long.

The only conclusion is that the system is running at capacity with little or no ability to expand in time for an influx of priority 8 veterans. And now some want to add millions of non-service connected veterans, most of whom have other health insurance options. Categories 1 through 6 will wait even longer for appointments.

In the absence of congressional will to provide VA with accepted management tools, it is irresponsible to overwhelm VA’s ability to care for veterans who need us and for whom we truly do have an obligation to provide the very best medical care.

Before more non service-connected veterans enter the VA system, VA must be able to give veterans and Congress assurance that the current high standards of care will be maintained.”

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Larry Scott

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