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Opening Statement of Honorable Jeff Miller, Chairman

THE COMMITTEE WILL COME TO ORDER.

GOOD MORNING, AND WELCOME TO TODAY’S FULL COMMITTEE HEARING, “EXAMINING THE IMPLICATIONS OF THE AFFORDABLE CARE ACT ON THE DEPARTMENT OF VETERANS AFFAIRS (VA) HEALTH CARE.”  
AS WE ALL KNOW, ABOUT THREE YEARS AGO, THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (A-C-A) – OR, OBAMACARE AS IT IS COMMONLY KNOWN – WAS SIGNED INTO LAW.

TODAY’S HEARING WILL FOCUS ON JUST ONE ASPECT OF THE LAW THAT I BELIEVE HAS RECEIVED DISTRESSINGLY LITTLE ATTENTION FROM THE ADMINISTRATION AND THE MEDIA TO-DATE – ITS POTENTIAL IMPLICATIONS FOR THE VA HEALTH CARE SYSTEM AND THE MANY VETERANS IT SERVES.

DESPITE INFORMING THIS COMMITTEE LAST SUMMER THAT THE DEPARTMENT WAS DEVELOPING A PROACTIVE COMMUNICATIONS STRATEGY TO INFORM VETERAN STAKEHOLDERS ABOUT THE POTENTIAL IMPACTS OF THE A-C-A, VA’S WEBSITE DEVOTES JUST TWO SENTENCES TO THE LAW, STATING THAT IT, “…WILL NOT AFFECT THE CURRENT ROLE [VA] HAS IN THE LIVES OF AMERICA’S VETERANS...”

BUT, AS WE ALL KNOW, STATING THAT THE SO-CALLED “AFFORDABLE CARE ACT” WILL NOT AFFECT THE DEPARTMENT, IS NOT THE SAME AS SAYING IT WON’T AFFECT VETERANS.

SECRETARY SHINSEKI TESTIFIED BEFORE THIS COMMITTEE EARLIER THIS MONTH THAT, “THE [AFFORDABLE CARE ACT] HAS IMPORTANT IMPLICATIONS FOR VA.”
    
VA’S FISCAL YEAR (F-Y) 2014 BUDGET SUBMISSION INCLUDES A REQUEST OF EIGHTY-EIGHT POINT FOUR MILLION DOLLARS TO IMPLEMENT THE PROVISIONS OF THE A-C-A AND MEET THE DEPARTMENT’S RESPONSIBILITIES AS A PROVIDER OF MINIMUM ESSENTIAL COVERAGE.

BURIED IN VOLUME TWO OF VA’S BUDGET SUBMISSION – LACKING CONTEXT, JUSTIFICATION, OR SUPPORTING DATA – IS A SINGLE STATEMENT ALLEGING THAT VA ASSUMES THAT IT WILL EXPERIENCE A NET ENROLLMENT INCREASE AS A RESULT OF THE LAW.

WHAT THAT “NET INCREASE” MAY BE, WHY VA BELIEVES IT WILL OCCUR, AND WHAT ACTIONS THE DEPARTMENT HAS TAKEN TO PREPARE FOR IT ARE UNKNOWN.

UNFORTUNATELY, THESE ARE FAR FROM THE ONLY THINGS WE DON’T KNOW.  LESS THAN A YEAR FROM FULL IMPLEMENTATION, WE ALSO DON’T KNOW:

-HOW VETERANS MAY RESPOND TO THE NEW CARE OPTIONS AVAILABLE TO THEM AND HOW ENROLLMENT AND UTILIZATION OF VA HEALTH CARE BENEFITS MAY BE AFFECTED IN TURN;

- HOW INCREASING DEMAND FOR HEALTH CARE SERVICES WILL AFFECT COMPETITION FOR HEALTH CARE PROVIDERS AND, IN TURN, VA’S HEALTH CARE WORKFORCE AND  RECRUITMENT AND RETENTION EFFORTS, PARTICULARLY FOR HARD-TO-FILL POSITIONS LIKE PSYCHIATRISTS;

- WHETHER VA’S CURRENT INFORMATION TECHNOLOGY SYSTEMS ARE CAPABLE OF FULFILLING THE LAW’S DATA REQUIREMENTS, WHICH INCLUDE IDENTIFYING INDIVIDUALS WHO ARE ENROLLED IN THE VA HEALTH CARE SYSTEM AND REPORTING THEIR COVERAGE STATUS TO THE  DEPARTMENT OF THE TREASURY; OR,

- IF OR WHETHER THE CRITICAL ROLE OF THE VA HEALTH CARE SYSTEM WILL CHANGE IN THE POST-A-C-A NATIONAL HEALTH CARE LANDSCAPE.
        
SADLY, I COULD CONTINUE.

A REPORT ON UNINSURED VETERANS ISSUED LAST MONTH BY THE ROBERT WOOD JOHNSON FOUNDATION AND THE URBAN INSTITUTE STATES THAT, “IT REMAINS TO BE SEEN THE EXTENT TO WHICH UNINSURED VETERANS WOULD SEEK COVERAGE THROUGH MEDICAID, THE VA, OR OTHER OPTIONS UNDER A-C-A AND WHETHER AND HOW THIS WILL VARY ACROSS STATES.”

FORMER VA UNDER SECRETARY FOR HEALTH, DR. KENNETH KIZER [KY-Z-ER], PUBLISHED AN ARTICLE LAST YEAR, IN WHICH HE STATED, “THE OVERALL NET EFFECT OF THE A-C-A ON HEALTH CARE FOR VETERANS IS UNCERTAIN AT THIS TIME, ALTHOUGH IT WILL LIKELY HAVE A NUMBER OF INTENDED POSITIVE AND UNINTENDED NEGATIVE EFFECTS.”

WHERE THE HEALTH CARE OF MILLIONS OF VETERANS IS CONCERNED, UNKNOWNS OF THIS MAGNITUDE THIS LATE IN THE GAME ARE UNCONSCIONABLE.  
NANCY PELOSI FAMOUSLY REMARKED THAT WE HAD TO PASS THE A-C-A BEFORE WE COULD FIND OUT WHAT IS IN IT.

AND NOW, ACCORDING TO VA, WE HAVE TO IMPLEMENT IT BEFORE WE CAN FIND OUT WHAT EFFECT IT MAY HAVE ON OUR VETERANS.
    
THIS HOUSE HAS VOTED MORE THAN THIRTY TIMES TO REPEAL AND REPLACE VARIOUS ELEMENTS OF THE A-C-A AND I HAVE BEEN PROUD TO SUPPORT THAT EFFORT EVERY TIME.  

IT IS NO SECRET THAT I AND MANY OF MY COLLEAGUES HAVE BEEN CRITICAL OF THE LAW FROM THE START AND REMAIN EVEN MORE CRITICAL OF – AND CONCERNED BY – IT TODAY.

INCREASINGLY, WE ARE NOT ALONE.

JUST LAST WEEK, SENATOR MAX BAUCUS - ONE OF THE CHIEF AUTHORS AND PRIMARY ADVOCATES OF THE A-C-A - CALLED IMPLEMENTATION OF THE LAW A “TRAIN WRECK.”

THE AMERICAN PUBLIC CANNOT AFFORD A TRAIN WRECK.

AND, WHAT’S MORE, OUR VETERANS DO NOT DESERVE ONE.

THANK YOU ALL FOR BEING HERE TODAY.