Apr112013
Hearing Transcript on The U.S. Department of Veterans Affairs Budget Request for Fiscal Year 2009.
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THE U.S. DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST FOR FISCAL YEAR 2009
HEARING BEFORE THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED TENTH CONGRESS SECOND SESSION FEBRUARY 7, 2008 SERIAL No. 110-67 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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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking
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Malcom A. Shorter, Staff Director 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
February 7, 2008
The U.S. Department of Veterans Affairs Budget Request for Fiscal Year 2009
OPENING STATEMENTS
Chairman Bob Filner
Prepared statement of Chairman Filner
Hon. Steve Buyer, Ranking Republican Member
Hon. Stephanie Herseth Sandlin, prepared statement of
WITNESSES
U.S. Department of Veterans Affairs, Hon. James B. Peake, M.D., Secretary
Prepared statement of Secretary Peake
American Legion, Steve Robertson, Director, National Legislative Commission
Prepared statement of Mr. Robertson
American Veterans (AMVETS), Raymond C. Kelley, National Legislative Director
Prepared statement of Mr. Kelley
Disabled American Veterans, Kerry Baker, Associate National Legislative Director
Prepared statement of Mr. Baker
Iraq and Afghanistan Veterans of America, Paul Rieckhoff, Executive Director
Prepared statement of Mr. Rieckhoff
National Coalition for Homeless Veterans, Cheryl Beversdorf, RN, MHS, MA, President and Chief Executive Officer
Prepared statement of Ms. Beversdorf
National Association for Uniformed Services, Rick Jones, Legislative Director
Prepared statement of Mr. Jones
Paralyzed Veterans of America, Carl Blake, National Legislative Director
Prepared statement of Mr. Blake
Veterans for Common Sense, Paul Sullivan, Executive Director
Prepared statement of Mr. Sullivan
Veterans of Foreign Wars of the United States, Dennis M. Cullinan, Director, National Legislative Service
Prepared statement of Mr. Cullinan
Vietnam Veterans of America, Richard F. Weidman, Executive Director for Policy and Government Affairs
Prepared statement of Mr. Weidman
SUBMISSIONS FOR THE RECORD
Submission for the record
Friends of VA Medical Care and Health Research, statement
Miller, Hon. Jeff, a Representative in Congress from the State of Florida, statement
Mitchell, Hon. Harry E., a Representative in Congress from the State of Arizona, statement
MATERIAL SUBMITTED FOR THE RECORD
Post Hearing Questions and Responses for the Record:
Reports:
THE U.S. DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST FOR FISCAL YEAR 2009
Thursday, February 7, 2008
U. S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 1:00 p.m., in Room 334, Cannon House Office Building, Hon. Bob Filner [Chairman of the Committee] presiding.
Present: Representatives Filner, Brown of Florida, Snyder, Michaud, Herseth Sandlin, Hall, Hare, Berkley, Donnelly, McNerney, Space, Walz, Buyer, Moran, Brown of South Carolina, Miller, Brown-Waite, Lamborn, Bilirakis, Buchanan.
OPENING STATEMENT OF CHAIRMAN FILNER
The CHAIRMAN. Good afternoon. And welcome to this meeting of the House Committee on Veterans' Affairs.
Secretary Peake, we welcome you to your first meeting with us in an official capacity and I know you have met with many of us unofficially. We thank you for starting our relationship off with good, positive notes and we look forward to your year in office and your testimony today. Of course, if you do your job right, we might be able to extend that.
So we certainly welcome you all. This is obviously one of the most important hearings that we could have as we hear the budget presentation from Secretary Peake.
We have other witnesses also who have a direct stake in the U.S. Department of Veterans Affairs (VA) budget and we thank all of you who have worked hard and have been diligent to ensure the VA budget is sufficient to meet the needs of our veterans.
Obviously the benefits, the services, the healthcare that we provide for our Nation's heroes are our prime responsibility and we must make sure that we provide the resources needed by our servicemembers returning from Iraq and Afghanistan and also, of course, we cannot forget the veterans from the previous conflicts.
This will not be cheap, but the service that has been rendered has been real and our VA budget must provide real funding levels to meet the needs of all our veterans.
Part of the cost of war is the cost of treating our veterans. I wish that you would talk to the President, Mr. Secretary, that when you have a supplemental funding request for the war, we need a supplemental for the warrior, too. The President is leaving it to the regular budget process to try to take care of those costs rather than provide for them in a supplemental.
The budget you are presenting today, Mr. Secretary, increases VA medical care by $2 billion, which is a five and a half percent increase; and would just barely cover the increase in inflation for healthcare in our Nation.
We are glad you increased that budget, but you are going to have to get used to me waving this around. This is The Independent Budget. I hope you have looked at it. I hope you will look at it. The Independent Budget (IB), which we will hear more about today, also asks for an additional $1.6 billion over what you have asked for healthcare.
And although you have put in an increase for medical care in the budget, seven out of the ten major accounts in the VA budget you have decreased, including major construction projects, minor construction projects, grants for State cemeteries, grants for State homes, et cetera.
So although you have increased the healthcare budget, it is at the expense of the rest of these accounts. We are particularly concerned that in your five-year budget estimates, there is a $19 billion decrease over five years below the current services budget. We have concerns about not only this year, but how you are projecting for the future.
We are disappointed again that the VA has submitted a budget, which assumes the continuation of the enrollment ban on so-called Priority 8 veterans. Although you were not here, Mr. Secretary, we were promised a detailed report by January of this year listing the resources needed by the VA to lift this ban and we still have not received that report and that information.
The ability of the Secretary to deny enrollment to a group of veterans was provided to the VA in order to address unexpected and unforeseen circumstances in the short term. It was never meant by Congress to provide the VA with the ability to ban groups of veterans year after year after year.
Again, in this budget—as has been the case over all the budgets from the Bush Administration—legislative proposals are included to increase fees and co-payments for certain veterans. Enrollment fees and increases in pharmacy co-payments have been rejected year after year after year by this Congress and, yet, they are back again.
So I would like to know, and I think this Committee wants to know, why you have offered these proposals again and the policy reasons for deeming the proposed receipts from these proposals mandatory dollars.
We will seriously look at your budget proposal. We have concerns, as I have mentioned, and we have incredible needs as you well know.
We have hundreds of thousands of young men and women coming back from Iraq and Afghanistan with post traumatic stress disorder (PTSD) and traumatic brain injury (TBI). They are not adequately diagnosed. They are not adequately treated. They are like ticking time bombs in our society, and as you know, suicide rates have reached Vietnam levels.
There was an incredible report in the New York Times about PTSD veterans who have committed homicides. A third of those diagnosed with PTSD seem to have felonies. This is a national tragedy and it is up to us to deal with it. In fact, if we have sufficient resources, we can deal with most of the problems we see happening.
We hope the budget will take care of these needs. We see already, as we see with Vietnam veterans, homeless Iraqi War veterans. We cannot allow this to happen and we will be looking at the budget to try to make sure that it does not.
I will recognize the Ranking Member, Mr. Buyer, for his opening statement.
[The statement of Chairman Filner appears in the Appendix.]
OPENING STATEMENT OF HON. STEVE BUYER, RANKING REPUBLICAN MEMBER
Mr. BUYER. Thank you very much, Mr. Chairman.
I would like to welcome you, Secretary Peake, to your very first testimony, this being the second session of the 110th Congress. It is my pleasure to welcome you as our first witness.
Secretary Peake is a retired Lieutenant General of the United States Army Medical Corps. He is a combat-wounded Vietnam veteran, a Silver Star recipient, and former Surgeon General of the Army.
I know from my tenure on the Armed Services Committee that Secretary Peake is a man of principle, who adheres to Army values, and I am encouraged that our perspectives over the years are similarly aligned with regard to serving America's soldiers, sailors, airmen, Marine, Coast Guardsmen, and our veterans and their dependents.
I also recognize as you move into this position, Mr. Secretary, that you step into it with a pretty good team when I look at Admiral Cooper and General Kussman and Mr. Tuerk, and you have a champion to your right over there in Gordon Mansfield.
Gordon has been around a long time. He knows a lot about the systems and knows a lot about the personalities, the players, knows a lot about the Veterans Service Organizations (VSOs), knows who is substantive and who makes noise. I mean, he knows. And so he can be very valuable to you in his candor. He is a good man.
Mr. Secretary, when I read your written statement, I was struck by some things. Number one, your top legislative priority is to implement the recommendations of the Dole-Shalala Commission. With the influx of thousands of returning combat veterans from Iraq and Afghanistan, we must act promptly to make the fundamental changes in the way VA and the U.S. Department of Defense (DoD) compensate and assist veterans and their survivors for disabilities and deaths attributed to military service.
It is urgent that Congress, the VA, and DoD work together in a decisive manner to implement such reform while the will to do so exists. Otherwise, we will be merely passing the targeted problems off to others.
Successful reform would make great strides toward our mutually-held goal of ensuring that veterans returning from military service are able to make a smooth and easy transition back to a productive life.
Mr. Secretary, I am heartened by some other provisions in your budget proposal. I commend the legislative proposal to expand the specialized residential care and rehabilitation in VA and approve medical foster homes for TBI patients. However, I do have some concerns with one of the other provisions.
Now, I differ with the Chairman when it comes to enrollment fees and co-pays because these are very good management tools. I personally agree with cost-sharing fees for higher income, nonservice-connected veterans.
Now, in your proposal for the first time I have seen that any funds collected would go to the Treasury. I think they should stay within the VA. My gut tells me this Committee once again will not accept an increase in co-pays or enrollment fees. It is one of the massive errors that we made as a Committee when we opened it up. We should have given these tools to you and we did not. And you keep asking for them and this Committee will not do it. And I will not belabor it.
Another issue, the claims backlog continues to be a looming problem, but according to the budget proposal, you anticipate with additional employees the backlog can be reduced by 24 percent. We are very optimistic and we will get into how you can justify that.
I am also encouraged that the VA is perhaps finding a foothold. However, I question how these remarkable efficiencies can be achieved. You know, 24 is a big number, so I am pretty eager.
We learned, not long ago, from Admiral Cooper with regard to staff training as a challenge and the exams that you gave and how many did not pass those exams. So we are interested to hear how the training is going.
I also want to get into how you are making a better use of the information technology (IT) to reduce the backlog problem. I also understand you have got an initiative underway and we want to hear about that.
Also, any updates, Mr. Howard, you can give us with regard to how the IT transition is going and what needs that you may have. I see we have a bump up in our IT budget, so if you can tell us what that is going toward, software, hardware, as you implement your centralization model that is of great interest to us.
And, Mr. Secretary, you mentioned in your written statement that one of your highest legislative priorities is the establishment of a new position to serve as the VA's Chief Acquisition Officer. I have long been interested in procurement reform at the VA and I look forward to discussing this and other procurement reform initiatives. And I am not the only one. The Chairman and others are very concerned about procurement issues.
Also, in your budget, you are asking for $64 million for seismic corrections to the main hospital building in San Juan, Puerto Rico. Two years ago, we passed the law and we asked for you, the VA, to explore options for construction of a new VA medical facility in San Juan, so I am interested in the results of that study.
With that, Mr. Secretary, we welcome you and we look forward to your testimony.
And I yield back to the Chairman.
The CHAIRMAN. Thank you, Mr. Buyer.
Mr. Secretary, the floor is yours and we look forward to hearing from you. We will have questions from Members after your testimony.
Secretary PEAKE. With your permission, Mr. Chairman, I have a written statement that I would like to submit for the record.
The CHAIRMAN. Without objection, so ordered. Thank you.
Secretary PEAKE. Thank you.
STATEMENT OF HON. JAMES B. PEAKE, M.D., SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY HON. MICHAEL J. KUSSMAN, M.D., MS, MACP, UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION; HON. DANIEL L. COOPER, VADM (RET.), UNDER SECRETARY FOR BENEFITS, VETERANS BENEFITS ADMINISTRATION; HON. WILLIAM F. TUERK, UNDER SECRETARY FOR MEMORIAL AFFAIRS, NATIONAL CEMETERY ADMINISTRATION; HON. ROBERT T. HOWARD, ASSISTANT SECRETARY FOR INFORMATION AND TECHNOLOGY AND CHIEF INFORMATION OFFICER, OFFICE OF INFORMATION AND TECHNOLOGY; HON. ROBERT J. HENKE, ASSISTANT SECRETARY FOR MANAGEMENT; AND HON. PAUL J. HUTTER, GENERAL COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS
Secretary PEAKE. Mr. Chairman, Congressman Buyer, ladies and gentlemen of the Committee, I am honored to be here as the sixth Secretary of Veterans Affairs now responsible for the care of veterans. I appreciate the opportunity that the President has given to me to make a difference.
With me today, Congressman Buyer has already introduced my leadership team, and he is right about the quality, from my far left, our General Counsel, Paul Hutter; Mr. Bill Tuerk, our Under Secretary for Memorial Affairs; Mr. Bob Henke, our Assistant Secretary for Management. From my far right is Bob Howard, our Assistant Secretary for Information Technology; Admiral Dan Cooper, our Under Secretary for Benefits; Dr. General Mike Kussman, our Under Secretary for Health.
In my almost two months at the VA, I have seen both the compassion and the professionalism of our employees. It is frankly just exactly what I expected. The culture is one of deep respect for the men and women that we serve. The group at this table, and the VA at large, understands that America is at war and it is not business as usual.
I appreciate the importance of and I look forward to working with this Committee to build on VA's past successes, but more importantly, to look to the future to ensure veterans continue to receive timely, accessible delivery of high-quality benefits and services earned through their sacrifices and services and that we meet the needs of each segment of our veterans' population.
The President's request totals nearly $93.7 billion, $46.4 billion for entitlement programs and $47.2 billion for discretionary programs. The total request is $3.4 billion above the funding level for 2008 and the funding level that I am talking about is the funding level that includes the $3.7 billion plus-up from the emergency funding.
This budget will allow VA to address the areas critical to our mission, that is providing timely, accessible, high-quality healthcare to our highest-priority patients. We will advance our collaborative efforts with the Department of Defense, including progress towards secure, interoperable electronic medical records system.
We will improve the timeliness and accuracy of claims processing and ensure burial needs of veterans and their eligible family members are met and maintain the veterans cemeteries as national shrines.
Young men and women in uniform who are returning from Iraq and Afghanistan and their families represent a new generation of veterans. Their transition and reintegration into our civilian society when they take that uniform off is a prime focus. Those seriously injured must be able to transition between the DoD and VA system as they move on their journey to recovery.
This budget funds our polytrauma centers and sustains the network of polytrauma care that Dr. Kussman and his team have put in place. It funds the Federal recovery coordinators envisioned by the report of the Dole-Shalala Commission and it sustains the ongoing case management of all levels of our system.
We know that prosthetic support must keep pace with the newest generation of prostheses as our wounded warriors transition into the VA system. In this budget, you will see a ten percent increase in our budget for this.
In 2009, we expect to treat about 333,000 Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans. That's a 14 percent increase. We are seeing already a little bit of increase in the cost per capita of caring for these and we have increased our budget projection 21 percent to cover this. That is nearly $1.3 billion to meet the needs of OIF and OEF veterans that we expect will come to the VA for medical care.
This budget will sustain our outreach activities that range from 799,000 letters that we have sent out to more than 205,000 engagements with our Vet Centers reaching out to National Guard and Reserve units as part of the PDHRA, post deployment health reassessment process. It does not mention the 8,154 military briefings to about 300,000 veterans, service men and women that the Veterans Benefits Administration (VBA) has conducted.
This is also part of seamless transition. With the authority to provide care for five years for service-related issues, we can, without bureaucracy, offer the counseling and the support and care that might be needed to avert or mitigate future problems. And we want these young men and women to get those services.
Mental health from PTSD to depression to substance abuse are issues that I know are of great concern to you and they are of great concern to us. This budget proposes $3.9 billion for mental health across the board. That is a nine percent increase from 2008. It will allow us to sustain an access standard that says if you show up for mental health, you will be screened in 24 hours and within 14 days have a full mental health evaluation if needed.
It will keep expanding the mental health access according to a uniform mental health package, trained mental health professionals and our community-based outpatient clinics, and there are 51 new Community-Based Outpatient Clinics (CBOCs) planned for 2009. And that is in addition to the 64 that are coming in 2008.
Our Vet Centers will bring on yet an additional 100 OIF and OEF counselors. And Dr. Kussman is prepared, as the need is identified, to add additional Vet Centers.
We appreciate the issues of rural access in this arena and our Vet Centers are budgeted for 50 new vans to support remote access as well as expanding telemedicine into 25 locations.
But this budget and our mission is more than just about these most recently returning men and women. We should remember that 20 percent of VA patients who in general are older and with more comorbid conditions than the general population have a mental health diagnosis. In fiscal year (FY) 2007, we saw 400,000 veterans of all eras with PTSD.
This budget will sustain VA's internationally recognized network of more than 200 specialized programs for the treatment of post traumatic stress disorder to our medical centers and clinics that serve all of our veterans.
We have a unique responsibility to those that have served before and, you know, we still have one World War I veteran. One died earlier this week actually. The World War II and Korea veterans are recipients of our geriatric care and our efforts at improving long-term, noninstitutional care where in this budget we have increased funding 28 percent will make a huge difference in their quality of life.
We currently have 32,000 people served by home telehealth programs. This budget continues our work in this area and in the expansion of home-based primary care.
Overall, the President's 2009 budget request has $41.2 billion for VA medical care, an increase of $2.3 billion over the 2008 level, but that is more than twice the funding level available at the beginning of the Bush Administration. With it, we will provide quality care, improve access, expand special services to the 5,771,000 patients we expect to treat in 2009, 1.6 percent above our current 2008 estimate.
In April of 2006, there were over 250,000 unique patients waiting more than 30 days for their desired appointment date. And you are right. That is not acceptable. As of January 1st, we had reduced the waiting list to just over 69,000. With this budget request, we believe we have the resources to virtually eliminate the waiting list by the end of next year.
Information technology cross-cuts the entire department and this budget provides more than $2.4 billion for this vital function, 19 percent above our 2008, and reflects the realignment of all IT operations and functions under the management control of our Chief Information Officer, Robert Howard.
A majority, $261 million of that increase in IT funds will support VA's medical care program, particularly VA's electronic records system. I emphasize this here because it is so central to what we do and to the care we provide and the care that is touted in such publications as the book, Best Care Anywhere, as the key to our quality that is lauded worldwide.
This IT budget also includes all the infrastructure support such as hardware and software and communication systems for those 51 CBOCs that I mentioned as an example. And there is $93 million for cyber security continuing us on that road to being the gold standard.
IT will also be key as we move our claims model down the road to paperless processes. It is an investment that we must make. This budget sustains the work of VETSNET that is giving us management data already to really get after our claims processing and virtual VA, our electronic data repository.
In addition to IT, this budget does sustain a two-year effort to hire and train 3,100 new staff to achieve our 145-day goal for processing compensation and pension claims in 2009. This is a 38-day improvement, 21 percent in processing time than it was from 2007 and that 24 day or 14 percent reduction from this year.
This is important because the volume of claims received is projected to reach 872,000 in 2009. That is a 51 percent increase since 2000.
Can we show that slide, that graph up here? The active Reserve and National Guard returning from OEF and OIF have contributed to an increase in new claims and bring with them really an increasing number of issues with each claim which you can see the difference between the claims growth on the bottom curve and the issues curve growth on the top curve. It is out of proportion.
[The graph referred to is attached to Secretary Peake's testimony, which appears in the Appendix.]
Secretary PEAKE. And what you see also is that Dan Cooper has been able to keep that time to complete, that average days to complete relatively flat even with that growth. Each one of those issues has to be separately adjudicated and judged and can really be separately rated, if you will.
The President's budget includes seven legislative proposals as has been mentioned totaling $42 million. One of those proposals expands the authority to cover payment for specialized residential care and rehab in VA approved medical foster homes for OIF and OEF suffering from TBI.
We again do bring you a request for enrollment fees for those who can afford to pay and for a raise in the co-pays. Again, this does not affect our VA budget and I believe that is the same as it was last year. The money would return to the Treasury. That is $5.2 billion over a period of ten years, not in the short term, but it does reflect the matter of equity for those veterans who have spent a full career in the military and under TRICARE who do pay an annual enrollment fee for that care.
The $442 million to support VA's medical and prosthetic research program, though less than what we have had from the augmented 2008 budget, is actually about 7.3 percent more than what we received in 2007 or what we asked for in 2007 and 2008.
It does contain, however, $252 million devoted to research projects focused specifically on veterans returning from service in Afghanistan and Iraq, projects in TBI and polytrauma and spinal cord injury and prosthetics and burn injury. In fact, we anticipate with this Federal grants and other grants, we will have a full research portfolio of about $1.85 billion.
This budget request includes just over $1 billion in capital funding for the VA, with resources to continue to five medical facility projects already underway in Denver, Orlando, Lee County, Florida, San Juan, and St. Louis and to begin three new medical facility projects at Bay Pines, Tampa, Florida, and Palo Alto, two of which relate to our polytrauma rehab centers and continue our priority in this specialized area of excellence.
Finally, we will perform 111,000 interments in 2009. That is 11 percent more than 2007. The $181 million in this budget for the National Cemetery Administration (NCA) is 71 percent above the resources available to the Department's burial program when the President took office.
These resources will operationalize the six new national cemeteries that will open this year, providing a VA burial option to nearly a million previously unserved veteran families, and will maintain our cemeteries as national shrines that will again earn the highest marks in government and private sector for customer satisfaction.
This budget of $93.7 billion, nearly double from seven years ago, and with a healthcare component more than twice what it was seven years ago, will allow us to make great progress in the care of all of our veterans and will keep us on this quality journey in health and the management of an extraordinary benefit and ensuring the excellence of our final tribute to those who shall have borne the battle.
It is an honor to be with you, and I look forward to your questions.
[The statement of Secretary Peake appears in the Appendix.]
The CHAIRMAN. Thank you, Mr. Secretary.
We will begin the questions with the Chairman of our Health Subcommittee, Mr. Michaud.
Mr. MICHAUD. Thank you very much, Mr. Chairman.
And I want to thank you, Mr. Secretary, and your staff for coming here today to present the President's budget.
The 2009 budget submission for medical services is based primarily on actuarial analysis founded on current and projected veterans' population statistics, enrollment projections of demand, and case mix associated with current veteran patients.
Did that analysis include an increase in manpower deployment to support the surge and the subsequent redeployment back to the United States?
Secretary PEAKE. It did, sir. I understand that in a previous year, we may have been a little bit low on that projection and we, I think, made the appropriate adjustments with that, working with DoD, understanding the Congressional Budget Office (CBO) model and so forth. So that has been taken into account with this projection of 333,000.
Mr. MICHAUD. Good. And did that analysis also include the recent downturn in the economy and increased unemployment?
A lot of times, if you have a veteran who might be working, they might be provided healthcare benefits at their job of employment. But if they lose that job, then they are left in a lot of cases without any healthcare provided, so they look towards the VA. Did that include the downturn in the economy?
Secretary PEAKE. We did, I think, project the fact that we have open access for the first five years now to be able to bring them into our system and it does not matter whether they are employed or not employed. If they have something that can be related possibly to their involvement overseas, we can take care of them.
Mr. MICHAUD. So did your projection include that consideration of the downturn though? I know you can take care of them. But if you have an influx because of the downturn and you are not accounting for them, then that is going to be a—
Secretary PEAKE. Right. I cannot tell you specifically, sir, if we looked at a rise in unemployment. I do not know if that was in our model.
Mr. MICHAUD. If you can check and get back with the Committee.
Secretary PEAKE. I will, yes.
Mr. MICHAUD. My next question deals with the enrollment fee. With the enrollment fee that you are proposing, I believe in 2007, it was estimated that that would result in approximately 200,000 veterans leaving the system if they had to pay an enrollment fee.
Under this, is there an estimate of how many veterans might leave if the enrollment fee is introduced?
Secretary PEAKE. Again, it is an estimate. This does affect just the Priority 8s really because so few of the Priority 7s would fit into that. It would be on the order of folks that use us of perhaps 140,000, which is really a relatively small number, and that we also know that many of those also have insurance and do not necessarily use VA as much anyway.
It gets to some of the management issues that Congressman Buyer was talking about. You think about it. You put a little skin in the game with an enrollment fee, they are perhaps more likely to come to us and get the full benefit of what we can offer them and we would be happy to do that.
Mr. MICHAUD. And could you provide the Committee, I asked this the last time, the Department had proposed an enrollment fee, and I never received the information if you submitted it, but could you provide a breakdown on that enrollment fee, so, say if someone makes $100,000, how many people are affected, how much revenue that would produce? I would like to have a further breakdown on that, how you came up with your numbers on that enrollment fee, if you could provide that for the Committee.
Secretary PEAKE. I will provide that for the record.
[The information was provided in the response to Question 5(a) in the Post Hearing Questions posed by Mr. Filner and Responses from VA for the Record, which appear in the Appendix.]
Mr. MICHAUD. Okay. Thank you.
My last question deals with not only VA but also the Army. There was a report in the news on January 29th, and I received confirmation from VSOs from my area, where the Army actually blocked VA staff from assisting transitioning soldiers because the soldiers had been receiving higher rating in their medical evaluation board.
What is the VA doing in regards to that?
And another area actually just brought to my attention earlier this morning from the Ranking Member also deals with the Army dealing with dental work. The Army more or less is shifting that cost on to the VA and not taking care of the soldiers.
Could you respond to both those?
Secretary PEAKE. Sure. Let me address those. First, we are still trying to sort out who said what to whom on the issue of the counseling at Fort Drum. I can tell you the first report to me is that some of our people were actually helping write the requirements that were within the military system.
Our folks are not really necessarily trained to do that, but we clearly have a role of being there, advising servicemembers on what their VA benefits might be and what their ratings might be from the VA.
This actually talks to the issue of why we need to get ahead and streamline this disability system so it is not so confusing and it is not, oh, well, they are the VA and there is the DoD. So, again, the Dole-Shalala recommendations give us a road ahead on that and we need to sort out the details so we get it right.
On the issue of dental care, that has been an issue for the military and particularly for the Reservists for a long time. I had to come up here and testify why we took out so many teeth when we mobilized people in my previous life. So perhaps it would be nice if the military were able to have that all taken care of for the Reservists. But when they come rolling back in and come back to their home station, at least when they come to the VA, and I will give great credit to Dr. Kussman, we have gone and we have purchased the care because we are authorized to provide that dental care within what, 60 days or—
Dr. KUSSMAN. Ninety days and we're going to 180.
Secretary PEAKE. —90 days and we are going to 180 if the legislation is passed. And it will help the soldier and it, I think, will improve medical readiness because some of these people are still in the Reserves.
Mr. MICHAUD. Thank you very much.
And thank you, Mr. Chairman.
The CHAIRMAN. Thank you.
Mr. Lamborn, you are recognized for five minutes.
Mr. LAMBORN. Thank you, Mr. Chairman.
And, Mr. Secretary, feel free to answer this question or pass it on to one of your Under Secretaries.
But first I would like to say thank you, Chairman Filner and Ranking Member Buyer, for your leadership and dedication to the calls of our Nation's veterans.
I would also like to thank Chairman Hall for working with me in a bipartisan manner on the Disability Assistance and Memorial Affairs Subcommittee of which I am now the Ranking Member.
Secretary Peake, I am pleased to see that the fiscal year 2009 VA budget request addresses the concerns of our veterans. Ensuring that our national cemeteries are maintained as shrines is emblematic of the VA's core beliefs. And I look forward to working with you and Under Secretary Tuerk on this important issue.
While I remain concerned about the disability compensation claims backlog, I am encouraged that VBA plans to utilize proven information technologies to decrease processing times.
As you know, I introduced two bills last year that would authorize a pilot program to test the capabilities of an automated claims processing system that helps VA employees process claims faster and more accurately.
And, Mr. Peake, also, I would like to ask you that, this is possibly something under the purview of Under Secretary Tuerk, the budget mentions a request for $5 million for a new land acquisition line item. I understand that this money is to be allocated for those regions with the highest projected need in the future for new cemetery space for existing cemeteries.
Based on the criteria used to assess this need, is it true that Fort Logan National Cemetery in Denver, Colorado, will be the next cemetery to reach capacity?
Secretary PEAKE. Perhaps Bill can offer the specifics. The money is designed to allow us to get moving on acquisition when the opportunity arises and so that we can ensure we do not have to close cemeteries.
Mr. TUERK. To answer your question specifically, Congressman, as I look across the universe of our larger cemeteries that are going to meet capacity, there is one cemetery, Jefferson Barracks National Cemetery in St. Louis, which would reach capacity before Fort Logan. But we already have a plan in place to acquire land contiguous to the cemetery from the medical center next door.
Based on the numbers that I have seen as recently as this morning, it would appear that Fort Logan is the next large cemetery that will reach capacity on the acreage that it currently owns.
Mr. LAMBORN. Thank you.
And as a follow-up, is it true that this land acquisition needs to be completed prior to Fort Logan or another such example reaching capacity because the process for acquiring land to build a cemetery is time-consuming and sometimes unpredictable?
Mr. TUERK. Shall I?
Secretary PEAKE. Please.
Mr. TUERK. Certainly the market, the catchment area if you will, of Denver and Colorado Springs is currently served by Fort Logan. We would not want to see that that area, which has a significant number of veterans, certainly well beyond our 170,000 criterion—possibly twice as many veterans than that criterion live within the catchment area of those two cities—cease to be served. We would certainly want to begin planning for a successor cemetery to Fort Logan before that cemetery closes so there will not be a lapse in service for the veterans on the eastern slope of the Rockies in Colorado. So in response to your question, the answer is yes, we most definitely plan to, intend to, and are beginning now to plan for, a successor cemetery lest there be an interruption of service.
Mr. LAMBORN. Okay. Thank you very much.
And I have a separate topic I would like to address briefly if my five minutes are still going. Mr. Secretary, over the past year, Members from both sides of the aisle have continued our push to require VBA to move towards a paperless claims processing system that uses rules-based technology.
This was something that was added to the Republican fiscal year 2008 views and estimates and was included in my legislation, H.R. 1884 and H.R. 3047.
I am happy to read about VBA's new paperless claims processing initiative. What is the funding level for this project and how much funding will be required over the next several years to complete this project?
Secretary PEAKE. A request for information (RFI) was put out for rules-based engines. That information is coming back. And then we are planning on getting a systems integrator to come in and look at all of the process that is put together. And so we will have to find what that future cost is based on the estimates that come out of these processes.
But I will assure you it is a high priority for me to get us moving in that direction. All you have to do is walk through the VBA mail room to make you believe that this is time to change.
Mr. LAMBORN. Thank you.
And I yield back.
The CHAIRMAN. Thank you, Mr. Lamborn.
The Chair of our Economic Opportunity Subcommittee, Ms. Herseth Sandlin, is recognized for five minutes.
Ms. HERSETH SANDLIN. Thank you, Mr. Chairman.
Again, Mr. Secretary, welcome to the Committee. We look forward to working with you on a whole host of issues. And certainly Mr. Boozman and I look forward to working with you on the range of issues in the jurisdiction of our Subcommittee. And I do have a few questions for you about some of those issues, but I also want to talk with you a little bit about rural health and long-term care.
There was a handout that you had provided for the Veterans' Affairs Committee staff on February 4th. And in that handout, there was a chart as it relates to mandatory spending. And for housing, it shows an appropriation fiscal year 2007 of $50 million, fiscal year 2008 of $815 million, and fiscal year 2009, $2 million for a percentage change of 100 percent based on the fact that we are going, you know, less $813 million.
And I was just wondering if someone could explain that to me a little bit further as to why there would be such a drastic percentage change in the mandatory funding for the housing programs administered by VA.
Secretary PEAKE. If I may, I will ask Mr. Henke to answer.
Mr. HENKE. Yes, ma'am. There is a good reason for that. It is no change from our previous practice. It relates to the practice of credit reform legislation that we have had in place since 1992, now for 15 years.
There is no change in the number of loans, 180,000 loans that we are going to guarantee with the 2009 budget. It simply reflects the way we account for the risk for those loans and it is no different than we have done in the past.
Ms. HERSETH SANDLIN. So can you explain why then there was the jump from $50 to $815 million from last year?
Mr. HENKE. Because it is a projection for what is expected in that year for loan costs related to all of the cohorts that go back to 1992. What we projected in 2009 is the cohort from 2009.
Ms. HERSETH SANDLIN. Okay. Well, I think I will explore this a little bit further with you in a different setting because I want to get to some of the others.
On vocational rehabilitation loans, in the budget submission, the VA claims that fewer vocational rehabilitation loans will be provided in fiscal year 2009 than in fiscal year 2008. It is a difference of about $210 million or so.
And so I am just wondering what leads you to believe that there will be fewer loans established given the increasing numbers we are seeing, especially of OIF and OEF veterans returning home. I anticipate that there might actually be a greater need for these vocational rehabilitation loans.
Secretary PEAKE. Admiral Cooper.
Admiral COOPER. Those loans are used primarily to help people while their claims are being processed. In other words, if a person comes in and we can immediately qualify him or her for vocational rehabilitation, we go ahead and do that. And, if they need money immediately, we provide them loans. We felt as we looked at the estimate that we were higher than we needed to be right now. So we feel that the current estimate is a correct estimate.
Ms. HERSETH SANDLIN. Is that based on actual numbers then for fiscal year 2008?
Admiral COOPER. It is based on trends that we have seen over the last few years and the number we expect to come in. We feel that we do have a sufficient amount there.
Ms. HERSETH SANDLIN. Okay. Well, I will look forward to working with you—
Admiral COOPER. Yes, ma'am.
Ms. HERSETH SANDLIN. —Admiral Cooper, because we know there have been problems with the methodology in the past. I know we have tried to make some improvements to that, but we will look forward to pursuing that in a little bit more detail as well.
Secretary PEAKE. If I may just add—
Ms. HERSETH SANDLIN. Yes.
Secretary PEAKE. —we are increasing the number of vocational rehabilitation people in the field. We think this is a great program. We think it is underused. We think that we would like to see more people actually graduate from it. And so that is one of the first briefings I asked to get because I think it is a program that we really want to get behind.
Ms. HERSETH SANDLIN. Thank you, Mr. Secretary.
I do think that especially with, and this will relate to my next question on rural health and rural veterans, when we have so many folks coming home and because of the National Guard and Reserve, many of them coming from rural areas, I think these loans not just for veterans in rural areas but anywhere, but in particular rural areas and the costs associated with maintaining the training programs if they are living a further distance and how much they are paying for other expenses just to continue participating in the program. And, like you said, increasing those rates of completion of the program is very important.
The VA Office of Rural Health, I notice that the budget submission is $1 million for one full-time employee. Given that studies indicate that over 40 percent of the veterans returning home from OEF and OIF come from rural communities, I am a little concerned about whether or not this is enough given the scope of the office in terms of conducting studies, developing policies. I know that we have made tremendous progress with the community-based outreach clinics. We have a number of them in South Dakota.
But as it relates to again the rural veteran population and the challenges that they face in getting care and the additional challenges with a new generation of veterans, many of whom are in rural areas, I am a little concerned about the budget request.
Secretary PEAKE. Actually, we have two people and you say, boy, is that enough? I am not sure it is if you just say, well, that is the only two people interested in rural health in the VA. I have asked the same question.
In fact, we have contract support that is the several million dollars level. I do not recall that number off the top of my head. And we have really an integrated effort.
When I sat down with this Office of Rural Health, the one person, the second person, just joined, she was surrounded by a lot of people from Dr. Kussman's team that are working collaboratively. And so it is an area that I think is really important.
You start looking at our numbers, about 38 percent of veterans live in rural areas. About 1.7 percent live in highly rural areas. When you look at where our CBOCs are, about 41 percent of our CBOCs are in rural areas. About five percent of our CBOCs are in highly rural areas.
That is why I was excited to see the 50 vans focused with our Vet Centers, so they can do that outreach and be the first face of the VA there, and why I am excited about this issue of telehealth and telemedicine and being able to reach out into their homes even out there.
As a matter of fact, one of my first trips is going to be to Montana because Senator Tester and I have had discussions about rural health. And so I appreciate your concern about it and I will assure you that we are paying some attention to it.
Ms. HERSETH SANDLIN. I appreciate that.
And, Mr. Chairman, I know I am over my time, but I know we just mandated the creation of that office fairly recently, within the last year or so. But I do hope that through the course of the year—
Secretary PEAKE. A year is a year. I appreciate that.
Ms. HERSETH SANDLIN. —we can lay the groundwork so that depending on the changes that are made to the budget as we undertake that work and what that leads to for the request for the next year, we hope we have more information going forward.
And then, finally, Mr. Chairman, one of the things I want to, because I have pursued this with previous secretaries, is the issue of long-term care. And I know that there is a statutory requirement relating to the average daily census and that the budget submission does not meet that.
And I am not going to beat anybody up about that. I would rather engage in a longer conversation at some point about the rebalancing that is needed across States, across regions, across health systems to better address how long-term care has evolved because that statutory obligation was put in in 1999. And we have seen a lot of changes in long-term care since then.
So I just wanted to make mention of that, Mr. Chairman, for a topic that I know others of us have been interested, and we look forward to working with the Secretary on.
The CHAIRMAN. Thank you very much.
Mr. Brown, you are recognized for five minutes.
Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chairman.
Thank you, Mr. Secretary, for being here today and thank you for your commitment to our veterans. And I enjoyed our conversation the other day and I was going to ask some continuing questions along those same lines.
Number one, there is a cemetery, a veterans' cemetery that has been proposed for Columbia, South Carolina. I know there has been some negotiation, I guess, with the Fort Jackson system there.
But could you tell me where we are in that process? Has there been some land exchanged between, you know, the Fort Jackson and the cemetery?
Secretary PEAKE. Can I ask Under Secretary Tuerk to answer that, please.
Mr. TUERK. Yes, sir, Mr. Brown. We have reached an agreement with the Department of the Army to transfer land from Fort Jackson to us. That transfer has not yet been effected. It is authorized by statute. We have reached an agreement with the Army on the transfer, but lawyers are working out the details, the title transfer, et cetera. And we expect actual title to pass probably in September of this year. But, we are not waiting for title to pass before we start designing the cemetery. Indeed, we have already let contracts for the design of that cemetery. I have already seen a master plan of that cemetery in sketch form. And right now we are scheduled to break ground in July even in advance of taking title with the goal of opening that cemetery for burials before the end of this year.
Mr. BROWN OF SOUTH CAROLINA. The next question is about the VA Medical University Association in Charleston. I know in 2006 in the authorization bill, we actually put $38.6 million there to start the design phase. The Medical University is already in a construction mode now.
They have already built their first tower. And we were hoping that by use of this $38.6 million or some portion thereof to start some design for replacing the old VA hospital with a new bed tower adjacent to the Medical University.
Could you give me an update on that, please.
Secretary PEAKE. Sir, as we discussed the other day, our engineer and facilities folks suggest to me that there is a longer life expectancy for that building than perhaps has been considered, the current VA hospital there down on the grounds.
We are also looking at what the requirements might be to support the veterans in that area and what kind of collaboration we might be able to build with the university.
We have this week had an engineering team down with the Navy looking at the old Charleston Naval Hospital to understand whether that might well become a better site for us to invest in to be able to provide really what we are looking at, almost a new model of care where we have a really robust ambulatory center that is capable of doing day surgery and those kinds of things, ambulatory surgery, so that people do not have to travel all the way down the peninsula.
And so I look forward to working with you, sir. And, actually, just talking to the Ranking Member about going down perhaps to visit and see you there and look on the ground. But we are looking at how to best serve the needs.
I know we have the work up at Goose Creek going on as well. So I think if we look really at the whole population area and trying to make the decision as we move forward is what we would like to be able to do.
Mr. BROWN OF SOUTH CAROLINA. Okay. I really do appreciate the opportunity to show you physically on the ground the close proximity of the VA and the Medical University and hoping that, you know, maybe by giving you an oversight of where, you know, the facilities are located, it might give you a little bit closer view.
I know we have been working on, you know, consolidating some services between the VA and some other hospital, not just for the Charleston region but across the whole system. I think it would be a whole lot of savings incurred there. And I know we appreciate Dr. Kussman for his, you know, continuing dialogue along those lines too.
So look forward to having you down in Charleston, and thank you for coming today.
Secretary PEAKE. Thank you, sir.
The CHAIRMAN. Thank you, Mr. Brown.
The Chairman of our Disability Assistance and Memorial Affairs Subcommittee, Mr. Hall, is recognized for five minutes.
Mr. HALL. Thank you, Mr. Chairman and the Ranking Member.
And, Secretary, thank you so much for you and your associates for being here today and thank you for your service to our country both in uniform and with the Veterans Administration.
I wanted to start by asking in light of questions before your tenure, the VA's budget submission in fiscal year 2007 estimated that we would see 109,000 OEF/OIF veterans and current records now show that the VA instead saw 206,000.
In fiscal year 2008, the estimate was that VA would see 263,000, but now that number has risen to 293,000. So, in other words, it is an 87,000 person increase over fiscal year 2007. This year, you estimate that you will see 333,000 OEF/OIF veterans in 2009, an increase of 40,000.
In light of the previous underestimating of that number, what should this Committee honestly expect? Do you think that 40,000 is a realistic number when the previous numbers were off by as much as 87,000?
Secretary PEAKE. Sir, I believe it is a legitimate number. I will tell you we do not want to underestimate that number. My understanding is that we have cranked in the right considerations and the Kentucky windage to try to make sure that we are coming in with a very legitimate number.
Mr. HALL. That is good. I am praying for that to be accurate.
And I wanted to know what the impact on the b
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