Mr. Chairman and members of the Subcommittee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to submit a statement for the record on H.R. 784; H.R. 785; the “Women Veterans Health Care Improvement Act;” and draft legislation concerning emergency treatment furnished in a non-Department of Veterans Affairs (VA) facility.  PVA appreciates the emphasis this Subcommittee continues to place on addressing mental health needs of veterans.  We are also pleased to see that the Subcommittee intends to address the needs of a rapidly growing population—women veterans. 

H.R. 784

PVA fully supports H.R. 784, a bill that requires the VA to provide quarterly reports on vacancies in mental health professional positions.  As explained in the FY 2010 edition of The Independent Budget, there is a national shortage of behavioral health professionals.  Despite this fact, the VA still must improved its succession planning in mental health services in order to address the professional field shortages, recruitment, and retention challenges. 

Ultimately, the key to ensuring that the VA is able to provide adequate mental health services to the current generation of veterans and veterans of previous eras is strong oversight.  As such, this legislation establishes an additional tool that can be used for that oversight.  As explained in The Independent Budget:

The development of the MHSP [Mental Health Strategic Plan] and the new Uniform Mental Health Services package provide an excellent road map for the VHA’s transformation of its mental health services to veterans.  However . . . the IBVSOs have expressed continued concern about the pace of implementation of the mental health clinical, education, and research programs.  There are also significant gaps that need to be closed, especially in oversight of mental health programs and in the case management programs for OEF/OIF combat veterans.

Given the incredible amount of resources that have been invested in VA mental health programs in recent years this oversight will be critical.  For additional recommendations and discussion about VA mental health programs, please refer to the FY 2010 edition of The Independent Budget.

H.R. 785

PVA supports H.R. 785, a bill that requires the VA to conduct a pilot program to provide outreach and training to certain college and university mental health centers.  Much like the issues addressed with regards to H.R. 784, the VA is at a critical period in its provision of mental health services.  This pilot program will allow the VA to expand its efforts to meet the needs of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans.  This legislation is particularly timely in light of the possibility for substantial new enrollments of this generation of veterans into colleges and universities as a result of the benefits provided under the Post-9/11 GI Bill.  As with the broader mental health programs administered by the VA, the success of this program will also depend on serious oversight.  However, if successful, this pilot program could provide an effective blueprint for the expansion of VA mental health services in the future.  

The “Women Veterans Health Care Improvement Act”

PVA supports the draft legislation—the “Women Veterans Health Care Improvement Act.”  Women have played a vital part in the military service throughout our history.  In the last 50 years their roles, responsibilities, and numbers have significantly increased.  Current estimates indicate that there are 1.8 million women veterans comprising nearly 8 percent of the United States veteran population.  According to Department of Defense (DoD) statistics, women service members represent 15 percent of active duty forces, 10 percent of deployed forces, 20 percent of new recruits, and are a rapidly expanding segment of the veteran population. 

Historically, women have represented a small numerical minority of veterans who receive health care at Department of Veterans Affairs (VA) facilities.  However, if women veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) continue to enroll at the current enrollment rate of 42.5 percent, it is estimated that the women using VA health care services will double in two to four years. 

As the population of women veterans undergoes exponential growth in the next decade, VA must act now to prepare to meet the specialized needs of the women who served.  Overall the culture of VA needs to be transformed to be more inclusive of women veterans and must adapt to the changing demographics of its women veteran users—taking into account their unique characteristics as young working women with childcare and eldercare responsibilities.  VA needs to ensure that women veterans’ health programs are enhanced so that access, quality, safety, and satisfaction with care are equal for women and men. 

This legislation is meant to expand and improve health care services available in the VA to women veterans, particularly those who have served in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF).  More women are currently serving in combat theaters than at any other time in history.  As such, it is important that the VA be properly prepared to address the needs of what is otherwise a unique segment of the veterans population. 

Title I of the bill would authorize a number of studies and assessments that would evaluate the health care needs of women veterans.  Furthermore, these studies would also identify barriers and challenges that women veterans face when seeking health care from the VA.  Finally, the VA would be required to assess the programs that currently exist for women veterans and report this status to Congress.  We believe each of these studies and assessments can only lead to higher quality care for women veterans in the VA.  They will allow the VA to dedicate resources in areas that it must improve upon.

Title II of the bill would target special care needs that women veterans might have.  Specifically, it would ensure that VA health care professionals are adequately trained to deal with the complex needs of women veterans who have experienced sexual trauma.  Furthermore, it would require the VA to disseminate information on effective treatment, including evidence-based treatment, for women veterans dealing with Post-Traumatic Stress Disorder (PTSD).  While many veterans returning from OEF/OIF are experiencing symptoms consistent with PTSD, women veterans are experiencing unique symptoms also consistent with PTSD.  It is important that the VA understand these potential differences and be prepared to provide care. 

PVA views this proposed legislation as necessary and critical.  The degree to which women are now involved in combat theaters must be matched by the increased commitment of the VA, as well as the Department of Defense, to provide for their needs when they leave the service.  We cannot allow women veterans to fall through the cracks simply because programs in the VA are not tailored to the specific needs that they might have.  Finally, we would encourage the Subcommittee to review the extensive policy section in the FY 2010 edition of The Independent Budget—“Women Veterans’ Health and Health Care Programs.” 

Emergency Treatment in a Non-VA Facility

The draft legislation will expand eligibility for emergency medical care at the VA for some veterans.  Currently, veterans who have a third-party insurance provider that pays a portion of medical expenses in the event of an emergency do not have the balance of their medical expenses covered by the VA.  This proposed legislation should eliminate that situation.  It will prevent the VA from denying payment for emergency service at non-VA hospitals when a veteran is partially covered by their third-party insurance. 

We do have one question about the legislation.  PVA is unclear about why a seemingly arbitrary date—October 8, 2007—was chosen as the effective date?  Otherwise, PVA supports this legislation. 

Mr. Chairman and members of the Subcommittee, PVA would once again like to thank you for the opportunity to provide our views on this important legislation.  We look forward to working with you to continue to improve the health care services available to veterans. 

Thank you again.  We would be happy to answer any questions that you might have.