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Hearing Transcript on Legislative Hearing on H.R. 784, H.R. 785, H.R. 1211, and Discussion Draft on Emergency Care Reimbursement
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LEGISLATIVE HEARING ON H.R. 784, H.R. 785, H.R. 1211, AND DISCUSSION DRAFT ON EMERGENCY CARE REIMBURSEMENT
HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS FIRST SESSION MARCH 3, 2009 SERIAL No. 111-3 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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COMMITTEE ON VETERANS' AFFAIRS |
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON HEALTH
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined. |
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C O N T E N T S
March 3, 2009
Legislative Hearing on H.R. 784, H.R. 785, H.R. 1211, and Discussion Draft on Emergency Care Reimbursement
OPENING STATEMENTS
Chairman Michael Michaud
Prepared statement of Chairman Michaud
Hon. Cliff Stearns
Prepared statement of Congressman Stearns
WITNESSES
U.S. Department of Veterans Affairs, Gerald M. Cross, M.D., FAAFP, Principal Deputy Under Secretary for Health, Veterans Health Administration
Prepared statement of Dr. Cross
American Legion, Joseph L. Wilson, Deputy Director, Veterans Affairs and Rehabilitation Commission
Prepared statement of Mr. Wilson
Disabled American Veterans, Joy J. Ilem, Assistant National Legislative Director
Prepared statement of Ms. Ilem
Herseth Sandlin, Hon. Stephanie, a Representative in Congress from the State of South Dakota
Prepared statement of Congresswoman Herseth Sandlin
Iraq and Afghanistan Veterans of America, Todd Bowers, Director of Government Affairs
Prepared statement of Mr. Bowers
Tsongas, Hon. Niki, a Representative in Congress from the State of Massachusetts
Prepared statement of Congresswoman Tsongas
Veterans of Foreign Wars of the United States, Eric A. Hilleman, Deputy Director, National Legislative Service
Prepared statement of Mr. Hilleman
SUBMISSIONS FOR THE RECORD
Filner, Hon. Bob, Chairman, Committee on Veterans' Affairs, and a Representative in Congress from the State of California, statement
Paralyzed Veterans of America, statement
Vietnam Veterans of America, Thomas J. Berger, Ph.D., Senior Analyst for Veterans' Benefits and Mental Health Issues, and Marsha Four, Chair, National Women Veterans Committee, statement
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
LEGISLATIVE HEARING ON H.R. 784, H.R. 785, H.R. 1211, AND DISCUSSION DRAFT ON EMERGENCY CARE REIMBURSEMENT
Tuesday, March 3, 2009
U. S. House of Representatives,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:00 a.m., in Room 334, Cannon House Office Building, Hon. Michael Michaud [Chairman of the Subcommittee] presiding.
Present: Representatives Michaud, Teague, Rodriguez, Halvorson, Stearns, Boozman.
OPENING STATEMENT OF CHAIRMAN MICHAUD
Mr. MICHAUD. I would like to have the hearing come to order. I want to thank everyone for coming today.
Today’s legislative hearing is an opportunity for Members of Congress, veterans and the U.S. Department of Veterans Affairs (VA) and other interested parties to provide their views on and discuss recently introduced legislation within the Subcommittee’s jurisdiction in a clear and orderly process.
I do not necessarily agree or disagree with the bills before us today, but I believe that this is an important part of the legislative process and will encourage frank and open discussion of these ideas.
We have four bills under consideration today. They cover a wide range of issues, including mental health, women veterans and reimbursement for emergency care treatment in non-VA facilities.
The four bills before us today are H.R. 784, sponsored by Representative Tsongas of Massachusetts; H.R. 785, sponsored by Representative Tsongas of Massachusetts; a Draft Discussion of Emergency Care Reimbursement by Chairman Filner from California; and H.R. 1211, Women Veterans Healthcare Improvement Act by Representative Herseth Sandlin, who is also a Member of this Committee.
So I look forward to hearing the views of the witnesses on these bills before us today, and I would like to recognize Congressman Stearns for any opening statement that he may have.
[The prepared statement of Chairman Michaud appears in the Appendix.]
OPENING STATEMENT OF HON. CLIFF STEARNS
Mr. STEARNS. Mr. Chairman, thank you very much.
I am delighted to be here.
I think your opening statement appropriately said it, that we have four bills before us. You are not saying you agree or disagree, but you are saying let us listen to the arguments and hear what they are.
I think, particularly, every Member of Congress should realize that before we pass legislation, we should consider the impact of this legislation to the economy, and is it going to impact States and cause them to spend more money, is it going to somehow decrease jobs. So I try to look at these four pieces of legislation in that respect, too.
The first bill, H.R. 784, would require VA to submit quarterly reports on mental health professional vacancies.
The second bill, H.R. 785, would establish a pilot program to provide mental health outreach and training on certain college campuses for Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans.
The Department of Veterans Affairs has made great improvements in the past 2 years to reach out to more veterans and provide better, more effective mental health services.
Mr. Chairman, with a growing number of veterans in need of mental health care, we must continue to focus on how we can build on the progress VA has made thus far, and I am very interested in hearing views on these proposals.
I thank the Chairman, Mr. Filner, for reintroducing his bill to expand the benefits for veterans related to the reimbursement of expenses for emergency treatment in the local non-VA facilities. I am pleased to see that changes have been made to the bill to clarify the requirements for VA payment under the program.
I would also like to commend my good friend, Stephanie Herseth Sandlin, for being a champion of women’s veterans. Her bill, the "Women Veterans Health Care Improvement Act," includes a number of provisions designed to study, improve, and expand access to care for our courageous women veterans.
The number of women serving in the active-duty Guard and Reserve, obviously, continues to increase. Today, women represent almost 8 percent of the total veteran population and nearly 5 percent of all veterans who use VA health care services.
VA estimates that the number of women veterans enrolled in VA health care will more than double over the next decade. So, obviously, it is essential for us to be making sure that the VA is providing appropriate programs and services throughout the country to meet the unique physical and mental health needs of our women veterans.
As we examine new initiatives, we must also be careful to ensure that they complement and do not overlap existing VA efforts in research and programs for women veterans.
So, I look forward to a very productive discussion on these legislative proposals and want to thank all of our witnesses for participating in this hearing on a very cold day here in Washington. Your testimony will help guide us to best serve our veterans in our Nation.
I thank you, Mr. Chairman. With that, I yield back the balance.
[The prepared statement of Congressman Stearns appears in the Appendix.]
Mr. MICHAUD. Thank you very much. I know Representative Tsongas has another meeting she has to go to, so why don’t we start with Representative Tsongas. If you could explain H.R. 784 and H.R. 785 to us and we will ask you questions if we have any.
Representative Tsongas?
STATEMENTS OF HON. NIKI TSONGAS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MASSACHUSETTS; AND HON. STEPHANIE HERSETH SANDLIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF SOUTH DAKOTA
STATEMENT OF HON. NIKI TSONGAS
Ms. TSONGAS. Thank you, Chairman Michaud and Congressman Stearns for giving me this opportunity to testify.
I have introduced two bills, H.R. 784 and H.R. 785, to improve the quality and accessibility of mental health services for our veterans.
Almost one million Operation Enduring Freedom and Operation Iraqi Freedom veterans have left active duty and become eligible for VA health care since 2002; 400,304 or 42 percent of these veterans have obtained VA care, and approximately 44 percent of that number are facing mental disorders. The three most common diagnoses are post-traumatic stress disorder (PTSD), depressive disorders and neurotic disorders. These rates are two to three times that of the general population.
My first bill, H.R. 784, simply requires that the VA report vacancies in mental health professional positions at VA facilities on a quarterly basis. With the significant influx of new war veterans facing mental health wounds, as well as the already existing veterans’ populations from earlier generations receiving care at the VA, it is incumbent upon us to make sure that we have the necessary staffing to provide care. This bill will help this Congress perform our oversight role, and it will help the VA use its limited resources to effectively care for our veterans.
The second bill, H.R. 785, will help veterans seeking to improve their lives through education. The 110th Congress passed the most sweeping modernization of the Montgomery GI Bill since the program’s creation after World War II. The purpose of the modernization is to give veterans of Afghanistan and Iraq access to the education and job training tools that they will need to achieve the American dream they risked so much to defend.
As I stated earlier, approximately 44 percent of Afghanistan and Iraq veterans who have sought treatment at the VA have demonstrated signs of mental health wounds, including PTSD. Studies have shown that PTSD can have a negative impact on an individual’s ability to focus and ability to learn.
Returning from a war, separating from service, and then beginning school can place significant strains on the mental health of a veteran. It is critical that we provide our veterans with the assistance they need to manage and recover from these wounds so that they can take advantage of the opportunities available to them.
To that end, I have introduced H.R. 785. This bill directs the Secretary of Veterans Affairs to carry out a pilot program to provide outreach and training to certain college and university mental health centers so that they can more effectively identify and respond to the mental health needs of veterans of Operation Enduring Freedom and Operation Iraqi Freedom.
My legislation would not break the continuum of care provided by the VA. The purpose of this bill is to provide college counselors and other staff, who come in close contact with student veterans at their schools, with the tools to recognize symptoms of combat-related mental health wounds, the ability to appropriately assist a student veteran in need, and an understanding of how to effectively refer that student veteran to the VA for care.
I believe my legislation will actually augment the VA’s continuum of care and bring in veterans who may be hesitant or apprehensive about seeking care from the VA. The intention of both bills is to ensure that we have adequate services to address the mental health care needs of our veterans, and that we give our veterans the opportunity to build full lives once they take off the uniform.
Thank you for the opportunity to testify before the Subcommittee. I look forward to working with you, Chairman Michaud and the other Members of this Subcommittee, to improve these bills and to improve the quality and accessibility of the care we provide our veterans. Thank you.
[The prepared statement of Congresswoman Tsongas appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Representative Tsongas.
I just have one question on H.R. 784. How would you respond to potential criticism that the data collection required by H.R. 784 would be burdensome?
Ms. TSONGAS. Well, as we know, data collection is an essential management tool for the VA and an essential tool for Congressional oversight. We hear about wait times and staffing shortages from our veterans. I think any Member of Congress, as we are out in our districts, often receives that input from those who have been seeking care. So it is difficult to imagine how the VA can truly understand what is happening at the local level without this data. And it will help to provide a baseline for the VA going forward so that it and we better understand their capacity to fill and augment the services they provide.
Mr. MICHAUD. Okay. Thank you very much.
Mr. Stearns, do you have any questions?
Mr. STEARNS. Thank you, Mr. Chairman.
Let me just go along with what the Chairman just sort of alluded to, the fact that these quarterly reports on mental health vacancies, obviously, I think everybody would agree, would improve care for veterans. I guess as the Chairman alluded to, is the fact that it could be duplicative.
Last year, Congress created a grant program for institutions of higher education to establish "Center of Excellence for Veteran Student Success," and it was set up to coordinate services to address the academic, financial health, and social need of veteran students.
Just a suggestion. Is it possible that within that Center for Excellence for Veterans Success, where they are coordinating services dealing with health, rather than perhaps creating a new separate pilot program, is it possible we could achieve the same goals under that Center for Excellence that is already established where they do actually coordinate dealing with, not only academic, financial, and social needs, but also health, to improve the mental health outreach? So, in a sense, coordinating with this existing legislation and just folding it in, rather than a separate program, I guess, would be a question.
Ms. TSONGAS. Well, we would be happy to work with the VA and the Committee, Subcommittee, going forward to look at ways to integrate this. In my former life, I was an administrator in a community college, and you see how often a very unique role that counselors in institutions of higher education play with incoming students.
And so we would be happy to work, as I said, with the VA to see if there is of way of integrating a program that really takes advantage of what colleges have to offer, the fact that they are often those at first—guidance systems are often the first to really deal with incoming students, and find a way that we can leverage both.
Mr. STEARNS. So you would be receptive, perhaps, to maybe even allowing a pilot program, using this existing structure to see how it would work as maybe a possibility of solving this?
Ms. TSONGAS. Well, I would be happy to look at that as a possibility, a way of going forward. But I do think that we recognize—acknowledge and recognize that there is a need out there that many returning soldiers will be taking advantage of the modernized GI bill going on to college and, yet, still suffering from the impact of their service in war.
So we do want to take advantage of that moment of contact in these institutions of higher education. And as the bill says, it focuses on those institutions that are receiving significant numbers of young people from these wars.
But, again, as I said, I would like to work with the Committee on that, and the VA.
Mr. STEARNS. Okay. Thank you, Mr. Chairman.
Mr. MICHAUD. Thank you.
Mrs. Halvorson, do you have any questions of Ms. Tsongas?
Mr. Boozman?
Mr. Teague?
Mr. TEAGUE. No, not at this time. Thank you.
Mr. MICHAUD. Thank you.
Okay. Well, thank you very much, Ms. Tsongas. I really appreciate your willingness to come today and bring forward these two pieces of legislation. I will be looking forward to working with you as we deal with this later on in the year. Thank you very much.
Ms. TSONGAS. And thank you for this opportunity. And I apologize for—
Mr. MICHAUD. No, that is totally understandable with all of our busy schedules. Thank you very much.
I am very pleased to recognize Representative Herseth Sandlin for her many years working and fighting for veterans’ issues, especially women veterans’ health care. I also want to thank you for your willingness to let Representative Tsongas go through her testimony so she can get on to her next meeting.
So without any further adieu, Representative Herseth Sandlin.
STATEMENT OF HON. STEPHANIE HERSETH SANDLIN
Ms. HERSETH SANDLIN. Well, thank you and good morning, Mr. Chairman, Mr. Stearns, other Members of the Subcommittee. Thank you for holding today’s hearing, and I certainly appreciate having the opportunity to be here to discuss the "Women Veterans Health Care Improvement Act."
H.R. 1211, which I introduced on February 26th, 2009, enjoys original cosponsor support from a number of Health Subcommittee Members, including Chairman Michaud; the distinguished Ranking Member of the Economic Opportunity Subcommittee, Mr. Boozman; and Mr. Moran. The bill will take important steps to expand and improve Department of Veterans Affairs Healthcare Services for women veterans.
Before I talk more about the bill and the needs of women veterans, I would also like to take this opportunity to thank the Disabled American Veterans (DAV) for their continued leadership and the effort to address the needs of women veterans and their support for this important legislation.
As your Subcommittee knows, Mr. Chairman, more women are answering the call to serve and more women veterans need access to services that they are entitled to when they return. With increasing numbers of women now serving in uniform, the challenge of providing adequate health care services for women veterans is overwhelming. With more women seeking access to care and for a more diverse range of medical conditions, in the future these needs will likely be even significantly greater.
I would like to share just a few statistics with you that highlight the need for a comprehensive update of VA services for women veterans. As of October 2008, there were more than 23 million veterans in the United States. Of this total, women veterans made up 1.8 million, or as Mr. Stearns noted, 8 percent of the total veteran population.
There are increasing numbers of women veterans of childbearing age. For example, 86 percent of OEF/OIF women veterans are under the age of 40.
The VA notes that OEF/OIF female veterans are accessing health care services in large numbers. Specifically, 42.2 percent of all discharged women have utilized VA health care at least once. Of this group, 45.6 percent of them have made visits two to ten times.
Finally, according to the VA, the prevalence of potential PTSD among OEF/OIF women veterans treated at the VA from fiscal year 2002 to 2006 grew dramatically from approximately 1 percent in 2002, to nearly 19 percent in 2006. So the trend is clear, but not surprising. More women are answering the call to serve, and more women veterans need access to health services.
Clearly, we must do everything we can from a public policy standpoint to meet this new challenge. To address some of these issues, the "Women Veterans Health Care Improvement Act" calls for a study of barriers to women veterans seeking health care, an assessment of women health care programs at the VA, enhancement of VA sexual trauma programs, enhancement of PTSD treatment for women, establishment of a pilot program for childcare services, care for newborn children of women veterans, and the addition of recently separated women veterans to serve on advisory committees.
The VA must ensure adequate attention as given to women veterans program so quality health care and specialized services are available equally for both men and women.
I believe my bill will help the VA better meet the specialized needs and develop new systems to better provide for the health care of women veterans, especially those who return from combat, who are sexually assaulted, who suffer from PTSD or who need childcare services.
Mr. Chairman, thank you, again, for inviting me to testify here today. I look forward to answering any questions you or other Members of the Subcommittee may have.
[The prepared statement of Congresswoman Herseth Sandlin appeared in the Appendix.]
Mr. MICHAUD. Thank you very much. Once again, thank you for all your work in dealing with veterans’ issues during your tenure here as a Member of Congress.
I just have one question. As you know, the Senate actually introduced a companion bill. Reading that companion bill, there is one difference and that is dealing with newborn care. I believe the Senate version allocates 7 days. Your version allocates 14 days for newborn care. Is there any rationale for the difference?
Ms. HERSETH SANDLIN. Well, importantly, the 14-day provision, in my bill, that was recommended by the Women’s Advisory Committee, but I am more than happy to further discuss with you, as we look at differences with the Senate bill, visiting with those women on the Women’s Advisory Committee, as to the purpose of their recommendation for 14 days versus 7 days. But, certainly, I think that we can find a way to negotiate the appropriate duration of the care following birth.
Mr. MICHAUD. Do you know what the Congressional Budget Office (CBO) has scored this provision?
Ms. HERSETH SANDLIN. We have requested a cost estimate from CBO. Unfortunately, we haven’t received an official cost estimate yet.
As you know, much of what is in the bill requires studies, pilot programs, updated procedures, so those provisions we anticipate the cost will be relatively small. Although I do think, as it relates to the additional provision that we have included this year in the bill that we didn’t include last year, as it relates to a duration of care for newborn children, that that would probably be the largest item as it relates to the cost estimate. And as soon as we get it from CBO, we obviously—I think the Health Subcommittee has requested the score as well.
Mr. MICHAUD. Thank you very much.
Mr. Stearns?
Mr. STEARNS. Thank you, Mr. Chairman. I thank the gentlelady for her bill and for her testimony.
Generally, I think my purpose is just to clarify so that we understand things.
I think you know that the VA is currently undergoing its own national survey of women veterans, which they expect to complete this fiscal year. I guess, their concern, and perhaps our concern would be, do you think we should give the VA, perhaps, some flexibility here and let them complete their own comprehensive assessment first, and let them analyze it and find the results, perhaps, before entering into a study that is mandated in this bill? It is just a consideration of what you feel.
Ms. HERSETH SANDLIN. Well, thank you for the question.
In the VA’s testimony during the 110th Congress when they testified on that version of this bill, the VA acknowledged the need for such a study, but indicated that they don’t have the resources, the staff or the budget needed to carry out such a study. So, while they may have undertaken that, I think it is very important that, with the authorization and, of course, with the resources that would go along with that, that we don’t in any way delay.
There are other studies going on that are a little bit more narrow. They are sort of peer-reviewed studies that would occur in just one publication.
But I think that it is important now, at the beginning of this Congress, in light of the statistics that I cited, that you as well cited, Mr. Stearns, that we acknowledge that they have, perhaps, undertaken a study, but we want it to be as comprehensive as possible. And we think the provisions authorized in this bill, particularly with the input from the Women’s Advisory Committee, we don’t want to be duplicative at the end of the day either.
And I think it is important to add to their efforts, thus far, to make sure they understand what this Committee is looking for as they do an overall assessment of the need for women veterans and their health care services.
Mr. STEARNS. When this assessment is done under your bill, is it your intent that the contract or entity that is conducting this comprehensive assessment of women’s health care programs? Would they also be required to develop the follow-up plan?
Ms. HERSETH SANDLIN. We haven’t anticipated if that same contractor would be responsible for doing the follow-up. I think that is something that I can discuss with Secretary Shinseki, working with Mr. Michaud, working with you, working with Mr. Brown on this Subcommittee.
But I think, for continuity’s sake, if that is what has been done in the past, when they have done, worked with a contractor, do a study, that it makes the most sense to utilize the same entity for follow-up, that that is something that we would likely want to pursue for continuity purposes.
Mr. STEARNS. My last question, Mr. Chairman. How would the requirements to provide graduate medical education, training certification and continuing medical education for mental health professionals under this Section 202 of the bill actually work towards helping the training that VA is already providing?
Ms. HERSETH SANDLIN. Well, I think that the VA has done a remarkable job in many instances, given some of the Medical Centers that I have had a chance to visit, not just in my own district, but in other parts of the country, including Virginia, including up in New Hampshire, of being very creative as it relates to identifying those individuals who may be suffering from PTSD and what type of follow-up is going to be most aggressive and effective, given the individuals that they are working with.
But I think that they are, while their current training efforts are excellent, they fall short because they don’t address the depth of education needed, as you state, for both the graduate medical education or continuing medical education, including clinical supervision, mentoring and skills testing to master the several commonly used evidence-based treatment protocols.
So H.R. 1211 authorizes that needed training, resources and certification. And I think it is important, building on the efforts of some of the Medical Centers, but they have been doing it, I think, based on the leadership at each of the Medical Centers. And I think, again, this provides more comprehensive training and needs with the graduate medical studies and the type of clinical supervision across the system in the VA, again, building on some of the very effective and successful programs that have been built and developed piecemeal among different Medical Centers across the country.
Mr. STEARNS. I thank the gentlelady.
And thank you, Mr. Chairman.
Mr. MICHAUD. Thank you very much.
Mrs. Halvorson?
Mrs. HALVORSON. Thank you, Mr. Chairman.
I have got a couple of questions. But, first of all, thank you, thank you so much for bringing this to our attention. I know that I am very pleased that the Committee is addressing some of the issues here of the health care for women. We all know that the increase in women veterans are going to be quite a challenge, especially in the differences, culturally.
You pointed to a number of existing efforts to train mental health professionals using the evidence-based practices. However, the VA has only trained a limited number of professionals to date. What are the VA’s plans, that you know of, for ensuring that the training reaches all of the mental health professionals that are practicing in the VA?
I know when Secretary was here, he said that he believes that there is a woman’s outreach person at each one of the 156 centers. What is going on with regards to that?
Ms. HERSETH SANDLIN. Oh, that is a good question, and I don’t know specifically. Again, I think it has varied, based on the leadership of the directors at the different Medical Centers. And, certainly, there is a sharing of information and best practices.
But as we have seen the explosion of women veterans accessing care, I think some Medical Centers have been more aggressive than others. I also think that in the early years of OIF/OEF, when we were dealing with emergency budget requests, there was a difficulty in adequately resourcing and fully funding all of the programs or new developed programs that some of the Medical Centers were trying to pursue to identify and effectively treat, both women and men veterans who suffer from PTSD.
I think as it relates to the proposed budget that we have seen from the new administration and the increased resources, with a focus on breadth in comprehensive care, I don’t know specifically how much of those resources they would dedicate towards women’s programs, specifically those addressed to PTSD for women veterans, whether it is related to combat experience, whether it is related to sexual trauma, or other circumstances.
But I do think that this bill is important because it provides the type of guidance, as well as authorizes the resources necessary, to make sure that all of those who are serving veterans and their mental health care needs have the adequate training, have the adequate education and clinical supervision necessary to ensure that the evidence-based research demonstrates can be most effective in caring for these veterans.
Mrs. HALVORSON. Great. And the only other question I have is—and excuse my ignorance, I am new—what has been done in the past with regards to newborn care of babies of veterans, female veterans?
Ms. HERSETH SANDLIN. Well, I don’t believe the VA facilities have ever provided for newborn care. I remember, and I think I would need counsel to correct to me if I am wrong, I recall an early debate when I was—shortly after I was elected in 2004. I believe we were discussing the level of prenatal care for women veterans. So just as recently as 5 years ago we were discussing whether or not the VA should provide a breadth of prenatal care services.
So, in my opinion, and based on my recent experience, it seems somewhat unreasonable and an unfair financial burden for women veterans, if now that we are providing, as I think we appropriately should for prenatal care for women veterans, that we wouldn’t provide for a set, a duration, whether it is 7, 10 or 14 days, of care for that newborn, which can be quite costly and could be, again, an unfair financial burden to the woman veteran.
Mrs. HALVORSON. Thank you. Thank you, Mr. Chairman.
Mr. MICHAUD. Thank you.
Mr. Teague?
Mr. TEAGUE. Yes. Thank you. I really like the bill, but I do have a couple of concerns because I believe that there may be a lot of gender disparity occurring.
For instance, if we had a female veteran that requested a female counselor, female doctor, what are the chances of her getting that female counselor or doctor?
Ms. HERSETH SANDLIN. Well, I can’t answer that. I don’t have the numbers at my disposal that I could get from the VA in terms of the number of psychiatrists and clinical psychologists they currently employ that would be providing—that would be available to provide care. I don’t know if Counsel has those statistics.
Ms. WIBLEMO. Well, I don’t have the statistics, but the VA certainly tries to pair up, if there is a gender issue, say military sexual trauma (MST) or some type of gender issue where a female wants to see a female doctor, they try to pair up the gender-specific requests. I mean, it is not—you know, I don’t know that they have an entire program where they—
Probably a better question for the Department of Veterans Affairs when they come up, but I know they do try to do that, as far as gender disparity is concerned.
Mr. TEAGUE. Thank you. And, also, like Congresswoman Halvorson said, I am new, and a lot of these things you all probably already plowed through last year and years before. But I was concerned and curious as to how to get that information because I will follow up on it and because I do hope that we are accepting the fact that they are different and that their needs are different and we need to remove all the barriers that we can to be sure that they get all of the help that they need.
Ms. HERSETH SANDLIN. Well, thank you, Mr. Teague. And I think one of the provisions in the bill, as it relates to the assessment and the evaluation as to what those barriers are, a survey of women veterans, asking them if you aren’t currently receiving care, why is it that you aren’t. And what we can anticipate anecdotally is one of the provisions that is included in the bill, which is a lot of women veterans are the primary care givers to their children. And if they don’t have access to childcare services at the time that they are receiving their care and their counseling, that can be a barrier. And, so that is included, and we have changed the bill in this Congress so that, not just women veterans, but male veterans who also are responsible for the care of their children can access those services under that pilot program.
But I think that we will be able to find—and, again, I know that the Department of Veterans Affairs will be testifying on these bills here today as well—is it a barrier, for example—and that is what we tried to find out in this survey—for women who may be suffering from PTSD, if they feel that their chances of getting, and let us say they are suffering PTSD from military sexual trauma, is it a barrier to them accessing services from the VA because they believe that they are quite unlikely to get a female counselor, versus who they may be aware are already providing counseling services to some of their male counterparts.
So, again, I think the bill is trying to get to some of the concerns that you have as it relates to the first provision, being one that seeks to address what are the barriers to care, so that arms the VA with information they need in developing new programs that can do a more effective outreach.
Mr. TEAGUE. Good. As I thought, you all have already checked on most of the things that I had questions about. I appreciate, not only having done that, but of both of you for giving me time today. Thank you.
Mr. MICHAUD. Thank you very much, Mr. Teague.
Once again, I want to thank you very much, Congresswoman, for coming today and bringing forward this very important piece of legislation. I look forward to working with you as we move forward in dealing with the legislation. Thank you.
I would like to call up the second panel to come testify. On the second panel we have Joy Ilem from the Disabled American Veterans; Joseph Wilson, the American Legion; Eric Hilleman from the Veterans of Foreign Wars of the United States (VFW); and Todd Bowers from Iraq and Afghanistan Veterans of America (IAVA). I want to thank each of you for coming this morning. I look forward to hearing your testimony, and we will start with Ms. Ilem.
STATEMENTS OF JOY J. ILEM, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; JOSEPH L. WILSON, DEPUTY DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; ERIC A. HILLEMAN, DEPUTY DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES; AND TODD BOWERS, DIRECTOR OF GOVERNMENT AFFAIRS, IRAQ AND AFGHANISTAN VETERANS OF AMERICA
Ms. ILEM. Thank you, Mr. Chairman and Members of the Subcommittee. I appreciate the opportunity to offer our views on the bills under consideration today.
H.R. 784 would require quarterly reports to Congress regarding clinical mental health vacancies in VA networks by a medical facility.
We appreciate the intended purposes of the bill, but as written, we are concerned that enactment would not elicit the kind of information Congress needs to properly evaluate VA status and results in achieving its mental health reforms. Therefore, we ask this Subcommittee to consider expanding the scope of the bill.
Over the past several years, VA has developed an aggressive plan for reform through its mental health strategic plan and uniform mental health services package. Likewise, Congress has provided significant increases in funding to improve VA mental health programs and services.
We believe the intended purpose of this bill is to ensure there is real progress in increasing the number of mental health staff and programs, specifically to improve access to these specialized services. To achieve this result, we believe detailed oversight and monitoring are necessary now and imperative if ongoing progress in filling critical gaps in mental health services across the Nation is to be assured and the goal of recovery fully embraced.
The oversight process we envision in mental health is one that is data driven and transparent and includes local evaluations and site visits to factor in local circumstances and needs. An empowered VA organizational structure is needed to carry out this task.
Such a structure would require the Veterans Health Administration (VHA) to collect and report detailed data at the national, network and Medical Center levels, on the scope of programs available and on the net increase over time in the actual capacity to provide comprehensive, evidence-based, mental health services.
We believe the recommendations further outlined in our statement would provide the architecture for a truly effective oversight of VA mental health programs. Again, while DAV supports the basic intent behind H.R. 784, we ask this Subcommittee to consider this broader scope of oversight of VA’s mental health programs.
H.R. 785 would establish a 4-year pilot program aimed at improving outreach to OEF/OIF veterans on the campuses of colleges and universities.
DAV Resolution 166 supports program improvement and enhanced resources for VA mental health programs to achieve readjustment of new combat veterans and continued effective mental health care for all enrolled veterans needing such services. Therefore, DAV is pleased to support H.R. 785.
H.R. 1211, the "Women Veterans Health Care Improvement Act," would expand and improve VA health care services available to women veterans with a focus on women veterans returning from Operations Iraqi and Enduring Freedom.
The current number of women serving in active military service in its Guard and Reserve components has never been larger, and this trend predicts that the percentage of future women veterans who will enroll in VA health care and use other VA benefits will continue to grow proportionately.
Also, women are serving today in military occupational specialties that take them into combat theaters and expose them to some of the harshest environments imaginable. As a result, women, too, bear the cost of war.
VA must prepare to receive a significant new population of women veterans in future years who will present with needs that VA has likely not seen before in this population.
Mr. Chairman, this comprehensive legislative proposal is fully consistent with the series of recommendations that have been made in recent years by VA researchers, experts in women’s health, VA’s Advisory Committee on Women Veterans, the Independent Budget and the DAV.
DAV Resolution 238 seeks to ensure high quality comprehensive health care services for all women veterans, with a special focus on the unique post-deployment needs of women veterans returning from the wars in Iraq and Afghanistan. Therefore, we fully support H.R. 1211 and urge the Subcommittee to recommend its enactment.
The final bill under consideration is a draft proposal aimed at expanding eligibility for reimbursement by VA for emergency treatment in non-department facilities. This bill’s purposes are in full accord with the mandate from our membership expressed in DAV Resolution 178. Its intent is also consistent with the recommendations of the Independent Budget to improve reimbursement policies for non-VA emergency health care services for enrolled veterans. For these reasons, Mr. Chairman, we urge introduction of the bill and we endorse its enactment into law.
This concludes my testimony on behalf of the Disabled American Veterans on these important bills, and I would be pleased to respond to any questions from you or other Members of the Subcommittee. Thank you.
[The prepared statement of Ms. Ilem appears in the Appendix.]
Mr. WILSON. Mr. Chairman, thank you for the opportunity to present the American Legion’s views on these pieces of legislation.
H.R. 784, which seeks to improve the recruitment of mental health care professionals by having the Secretary of Veterans Affairs submit quarterly reports on mental health employment vacancies at VA Medical Centers nationwide, now Section (a) requires the Secretary of Veterans Affairs to submit to Congress a report describing any vacancy in a mental health professional position at any medical facility of the Department no later than 30 days after the last day of a fiscal quarter. Within these reports, the Secretary is to indicate, for each vacancy, the Veterans Integrated Service Network, or VISN, to which the facility with the vacancy is assigned.
Now, the American Legion’s System Worth Saving Task Force visits medical facilities throughout the VA medical system—reports a constant need for additional mental health providers in almost every medical facility.
As VA continues to screen, identify, and treat veterans suffering from mental health disorders through VA outreach coordinators and Vet Center’s Global War on Terror, or GWOT, counselors having the staffing capabilities to treat veterans after initial intervention is paramount.
The American Legion believes that—also, this is supported by our Resolution 150 as well. The American Legion believes that with a quarterly report, mental health care services for veterans will be more widely available because less time for recruitment will be needed.
Currently, following the interview process, the hiring process takes approximately six months. During that time, the competitive private sector at times hired the prospective mental health provider away from the VA.
The American Legion supports any standard that improves the mental health capability of VA and its medical facilities, and, in turn, would like to see the passage of H.R. 784.
To provide our veterans with the most adequate mental health care, there should be—the proper amount of mental health providers in the VA Medical Centers, there should be. The inadequacy of mental health providers gives way to substandard care and the possibility that veteran mental health care needs will fall through the cracks.
H.R. 785, this bill establishes a pilot program to provide outreach and training to certain college and university mental health centers relating to the mental health of veterans of OEF/OIF or Operation Iraqi Freedom/ Operation Enduring Freedom, and for other purposes.
Section 1(a) seeks to establish a 4-year program under which the Secretary shall provide a counseling center, a student health or wellness center at a college or university with a large veteran population to increase outreach efforts.
Resolution 150, "The American Legion Policy on Department of Veterans Affairs Mental Health Services," states that veterans continue to need increased access to mental health care.
A RAND Study on the "Invisible Wounds of War: Addressing the Mental Health Needs of Returning Soldiers," in 2008, estimated that 300,000 veterans, or 18.5 percent of those deployed, were diagnosed by VA with PTSD or major depression. This number continues to rise and efforts to increase access and quality of care at the universities and colleges are imperative to ensure assistance is available to these veterans during a time of crisis. The American Legion supports the increased outreach efforts at universities or colleges where many veteran students are not familiar with VA benefits and services.
H.R. 1211, this bill seeks to expand and improve health care services available to women veterans, especially those serving in Operation Enduring Freedom and Operation Iraqi Freedom, from the Department of Veterans Affairs and for other purposes.
Approximately 1.7 million women veterans make up approximately 7 percent of the veteran population, while 240,000 utilize VA health care services. There are currently approximately a quarter of a million women serving in the U.S. armed forces. By 2010, the percentage is projected to rise to 14 percent of the total population and 15 percent by 2020.
A National Institutes of Health study suggested several areas of improving the provision of health care to this Nation’s women veterans to include the availability of needed services, particularly women-specific services and the logistics of receiving care, the VA, such as the waiting time to obtain care and the issues relating to continuity of care. The study also revealed problems with the ease of access in VA health care as the most significant barrier to VA Medical Center use.
We hereby urge Congress to pass this bill to add to the closing of gaps, as well as building on a more firm relationship between VA and this Nation’s women veterans.
And on the Draft Emergency Treatment at Non-VA Facilities, this draft seeks to expand eligibility for reimbursement by the Secretary of VA for emergency treatment furnished in a non-department facility and for other purposes.
The American Legion believes it is essential for veterans to receive emergency medical care from non-VA facilities in the absence of available VA health care or when traveling presents a hazard or hardship for the veteran in accessing care.
In addition, VA must devise better methods of communicating and submitting payment to third-party facilities on behalf of the veteran. Making this so will decrease the stress added to veterans who have to answer to agencies collecting on behalf of non-VA facilities.
The American Legion supports the reimbursement of costs incurred by veterans who must receive emergency care at non-VA facilities.
Mr. Chairman and Members of the Subcommittee, the American Legion sincerely appreciates the opportunity to submit testimony. Thank you.
[The prepared statement of Mr. Wilson appears in the Appendix.]
Mr. MICHAUD. Thank you.
Mr. Hilleman?
Mr. HILLEMAN. Chairman Michaud, Members of the Subcommittee, thank you for this opportunity to present the Veterans of Foreign Wars views before the Subcommittee.
On behalf of the 2.2 million men and women of the VFW and our auxiliaries, it is my honor to urge quick passage of the four bills presented before this Subcommittee today.
First, H.R. 784, a bill to report quarterly on the vacancies in mental health professional positions in the Department of Veterans Affairs.
The VFW supports this bill, which would require the Secretary of the VA to report to Congress for vacancies of psychiatrists, psychologists, social workers, marriage and family therapists, and licensed professional mental health counselors. Reporting vacancies to Congress will elevate the issue and encourage mental health professionals to seek employment within the VA. Much needed attention has to be drawn to this issue. It is an important shortage that impacts all the lives of our veterans.
Second, H.R. 785, a bill to establish a pilot program from FY 2010 to 2013 to educate, engage—excuse me—to educate and engage in outreach to college and university mental health centers.
The VFW enthusiastically supports this legislation, which would require—excuse me—which would give the Secretary $3 million in funding to train college and university clinicians, administrators, and counselors for serving OIF and OEF veterans. We believe this bill will help combat veteran stereotypes and destigmatize mental health issues related to military service.
Through educating the education community, this information can hopefully be broadly disseminated into the counseling and social work industry. Not only is this a benefit to schools and to the community, it directly affects the lives of veterans on campuses across the Nation.
In a time where more veterans will be seeking use of their new GI bill, this benefit is crucial to their success for transition and reintegration.
Third, H.R. 1211, the "Women Veterans Health Care Improvement Act." The VFW is proud to support H.R. 1211, legislation that will improve benefits and services to female veterans, especially those who have served or are serving in OIF/OEF operations.
As the number of females in uniform grow, so too will the percentage of females seeking services at VA. VFW is encouraged by the improvements in this bill, and we remain hopeful this legislation will ease access to services at VA by female veterans.
The VFW recognizes the work VA has already done toward implementing quality health care for all female veterans. Yet, we have many challenges to overcome. I would like to highlight three areas of this bill for special focus.
First, extended health care coverage for 14 days to female veterans’ newborns. This is essential to the health care of the child and the mother, allowing continuity in obstetrics and gynecological care.
Second, the provision of this bill authorizing VA to provide graduate level training, certification and continuing medical education care for military sexual trauma and PTSD.
MST and PTSD are all too common among returning OIF and OEF female veterans.
Lastly, and most importantly, assessing the impediments to care were the focus on VA’s common practices. The VFW strongly believes that VA’s culture contributes to the barriers faced by women. With more conscious effort, we can make a fundamental difference in the lives of female veterans and improve their quality of care.
Finally, a draft bill to close existing loopholes and law allow VA to cover unmet emergency room treatment for veterans in certain cases. The VFW is pleased to offer our support for this bill, which will allow VA to pay for the emergency care for veterans enrolled in VHA under certain cases. It closes a loophole that sticks many veterans unfairly with a large hospital bill.
Current law unfairly penalizes veterans who receive a portion of their costs of their care covered from another source, such as an insurance settlement or judgment. They may not be eligible for reimbursement, even if the amount is a fraction of the cost of their care. This bill allows the VA to be a second payor in those situations, so every veteran will be covered.
Mr. Chairman, Members of the Subcommittee, I thank you for this opportunity and I look forward to your questions.
[The prepared statement of Mr. Hilleman appears in the Appendix.]
Mr. MICHAUD. Thank you very much.
Mr. Bowers?
Mr. BOWERS. Mr. Chairman and Members of the Subcommittee, thank you for inviting IAVA to testify today regarding this pertaining legislation. On behalf of IAVA and our 125,000 members and supporters, I thank you for this opportunity and your unwavering commitment to veterans.
I also need to point out that my testimony today does not reflect the views or opinions of the United States Marine Corps, in which I still currently serve as a staff sergeant in the Reserves. It is my gunny disclaimer so I don’t get choked this weekend, so.
H.R. 784, IAVA is very concerned with the national shortage of mental health professionals and, in particular, how the shortage affects access to adequate mental health care for troops and veterans.
The VA has already been flooded by new veterans seeking care for psychological injuries. More than 178,000 Iraq and Afghanistan veterans have been seen at the VA, have been given a preliminary diagnosis of a mental health problem. That is approximately 45 percent of new veterans who have visited the VA.
Although the VA was initially caught unprepared with a serious shortage, it is important to point out that the Department has made significant progress in responding to the needs of new veterans. Thanks to a mental health budget that has doubled since 2001, the VA has been able to devote $37.7 million to placing psychiatrist, psychologists and social workers within primary care clinics.
While psychological staff levels were below 1995 levels until 2006, the VA has recruited more than 3,900 new mental health employees, including 800 new psychologists, bringing the VA’s total mental health staff to about 17,000 people. The VA is now the single largest employer of psychologists in the country.
That being said, access to mental health care, particularly for rural and female veterans is still an issue, in part because of the continued shortage of mental health professionals. As an example, Montana ranks fourth in sending troops to war, but the State’s VA facilities provide the lowest frequency of mental health visits.
H.R. 784 will establish Congressional oversight over vacancies in the VA’s mental health professional positions, and the increased transparency will help improve staffing at VA hospitals and clinics. IAVA fully supports this legislation and looks forward to seeing its rapid implementation.
H.R. 785, with the passage of the historic Post-9/11 GI Bill last year, there will be a flood of Iraq and Afghanistan veterans taking advantage of their new education benefits and attending universities across the Nation. It is to be expected that many of these veterans will return to their student health centers while attending school for their medical care. This is an opportune tim
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