CVO and the VA Budget for 2013 by Bruce E. Parry, CVO Chair

The Obama Administration Budget proposed for 2013 for the VA is $140.3 billion. $76.3 billion is for mandatory benefits such as disability compensation and pensions. The remaining $64 billion is for discretionary spending, primarily for medical care.*CVO and VA Budget

The discretionary spending amount represents a 4.5% increase from the current year. This is more than $4 billion less than the major veterans organizations call for in The Independent Budget. Of particular note is the “minuscule” increase in medical and prothetic research of $1.6 million and in VA facility construction, according to the VFW.*

The CVO position on this budget is that all medical costs ought to be done by formula and counted under the mandatory spending, just as benefits and pensions are. This is what we mean by Full Mandatory Funding of VA healthcare benefits. The formula should be:

(The Number of Veterans to be Treated) x (The Average Cost for Treating a Veteran) x (A Factor for Increased Cost of Medical Care from Year to Year) = (Total Medical Care Allocation in the Proposed Budget)

CVO also demands for full eligibility for VA healthcare for all veterans. This means that the number of veterans to be treated in the above formula, should take into consideration how many veterans would use the VA healthcare system if all veterans had free and unencumbered access to the VA.

If there was full eligibility for VA healthcare, the humiliating and despised Means Test—by which veterans are segregated into different “Priority Groups” based on their income and other factors—could be completely eliminated. In fact, the Priority Groups themselves could be eliminated.

The VA was established as a healthcare system to serve all veterans. This promise has been continually eroded. Thousands of veterans are still excluded from even applying for VA healthcare benefits. This is a travesty and a disgrace in a country where nearly 50 million people have no healthcare. Veterans need healthcare and further burden the public sector when it is denied by the VA. Veterans have already paid for their healthcare through their military service.

CVO calls for Full Mandatory Funding and Full Eligibility for all Veterans of VA healthcare. We ask you and your organization to join us now!

* Source: VFW Magazine, May 2012, Washington Wire.

Full federal funding of VA health care – including mental health care for all veterans without further payment.

Mandatory VA Healthcare Funding: Currently, VA healthcare is funded through a process that requires Congressional debate every year. This means that the VA healthcare budget is a political football tossed back and forth year after year. Over the last five years, a movement has grown to make VA healthcare funding what is called an “entitlement.” In Congressional jargon, an entitlement is something that is automatically funded unless Congress takes action, the exact opposite of what happens now. Instead of being an annual political football, VA healthcare would be funded by a formula.

mandatory funding

Mandatory Funding for VA Healthcare
Coalition of Veterans Organizations
March 19, 2007

VA healthcare funding by Congress is “discretionary” funding. By this, we mean that each year, the VA healthcare is funded according to the judgment of Congress and the President. As a result, VA healthcare funding is a political football, debated each year according to the political needs of the Administration and Congress.

Veterans’ call for mandatory funding means that VA healthcare funding would become an “entitlement.” In Congress, an entitlement is funded each year according to a formula. It is not subject to political debate. The formula Veterans are calling for would include three parts: the number of Veterans using the VA, the cost of actually treating a Veteran, and an annual adjustment for increases in providing medical care.

The number of Veterans using the VA is a straightforward projection the VA makes every year anyway. The cost of actually treating a veteran is already known. Current funding is insufficient to cover the actual costs of covering Veterans and is leading to the cost cuts in services provided to veterans. The mandatory funding bill needs to have a one-time increase in funding to make sure the real costs of treating Veterans is funded. Increases in the cost of healthcare each year are also well known. That is how insurance companies determine how much to raise their rates. The significant increases in recent years in the VA healthcare budget have not been enough to cover these yearly increases in healthcare costs. The GAO has pointed out that recent VA projections of healthcare costs have seriously underestimated actual costs. The mandatory funding bill must ensure that this is corrected immediately.

This year, the Democrats have proposed a VA healthcare budget of $37.1 billion for fiscal year 2008. That is an increase of $4.8 billion (a 14.8 percent increase over fiscal year 2007). The President has proposed a budget of $34.2 billion (an increase of 5.5 percent over 2007). The contrast between these offers gives some idea of how the political process makes VA healthcare funding a political football.
Veterans and the major Veterans organizations have called for mandatory VA healthcare funding. “The DAV and other groups have long urged Congress to enact legislation that will provide a reliable, predictable funding stream for veterans’ health care. Assured funding will enable the VA to efficiently and effectively plan for and meet the growing needs of our nation’s sick and disabled veterans, both now and in the future,” said the DAV National Commander Bradley S. Barton recently.
The Mandatory VA Healthcare Funding bill before this Congress (the 100th) is HR 1382 Sponsored by Rep. Randy Kuhl (R-NY). There are no co-sponsors for this bill. It uses the formula outlined above. While it does not call explicitly for a one-time increase in funding, that is built in to the formula it uses. Mandatory funding bills have been put forward in each Congress since 2002.

Another bill before the House Veterans Affairs Committee was submitted by Rep. Christopher Smith (R-NJ). This could be called the “Not-quite Mandatory Funding Bill” HR 1041. It sets up a board to determine VA healthcare budget needs and requires the President to submit that as his VA healthcare budget. Additionally, it also calls for Vets to face no more than 30-day wait to get into a VA.
One politically connected person has suggested that in order to make VA funding truly “mandatory,” a Trust Fund would have to be set up with an independent funding source. This has, to our knowledge, never been proposed in legislation. The idea is similar to the Social Security, Medicare and Federal Highway Trust Funds. It would be funded by a tax and the funds could not be used for any other purpose than VA healthcare. A tax on military hardware procurement has been suggested as a possible source of funds. The idea behind this is that without a Trust Fund, any Congress can undo what another Congress has done, so VA healthcare would still be, in fact, a political football. Congress has been much less willing to tamper with Trust Funds, so this would better ensure consistent VA healthcare funding.

The key idea here is that the VA should not be the one to determine who they treat. Congress should tell the VA who to treat and then the VA should do it. Thus, Congress should set the eligibility requirements for VA healthcare.
Eligibility for VA healthcare should be extended to all veterans who have been honorably discharged from the military service, including the regular, reserve and National Guard components. There should be no income provisions or “means test” and there should be no exclusions or divisions among veterans as to who shall be treated.
This specifically means that the 2-year limitation on VA healthcare that has been imposed on veterans that served in Iraq and Afghanistan will be eliminated and they, like veterans of other wars, will have lifetime access to the VA.
It also means that the “freeze” or exclusion of so-called “Priority 8” veterans would be eliminated. There would be no longer a need to have any income-related criteria for receiving VA healthcare.
Modern warfare has meant a drastic change in the needs of Veterans. Many more Veterans are living after devastating wounds received in combat. In World War II there were two casualties for every fatality. In Vietnam, it was 3 to 1. Currently, it is running 16 to 1! This means that men and women are returning to civilian life with devastating and lifetime wounds—both physical and mental. Veterans with shattered bodies need the VA specifically to deal with the kinds of conditions that one rarely sees outside the military. The VA has always excelled at this.
But modern warfare is also devastating to the mental state of those serving and we are seeing more men and women returning from war with extreme and severe mental and emotional disorders than ever before. Many of these conditions take years to develop and to manifest themselves with sufficient severity for the veteran to seek help. Setting time limitations is a lesson unlearned from previous conflicts and absolutely demonstrates the VA’s inability to care for the wounded. In addition limitations cut off the veterans possibility for recovery and rehabilitation. Recent legislation has ensured that mental health and physical health are seen as equivalent. This law must be applied to VA healthcare.
There are many more women in combat than ever before. The VA must recognize the expanded needs of women and their particular forms of trauma. In addition to combat-induced suffering of combat wounds and mental and emotional illness, women are subjected to sexual abuse and even assault.
No legislation has yet been proposed that covers everything said above. Two bills, HR 612 (Rep. Filner, D-CA, Chair of the House Veterans Affairs Committee) and S 383 (Akaka, D-HI, Chair of the Senate Veterans Affairs Committee) calls for extending the 2-year limitation for veterans that served in Afghanistan and Iraq from 2 to 5 years. We consider this totally insufficient, inadequate and uncaring. Another bill, HR 463 (Rep. Rothman, D-NJ), calls for the elimination of the freeze on Priority 8 veterans.

Reform of funding and full accounting for all VA mental health services for veterans. Scores of veterans—many returning from Iraq and Afghanistan—do not receive the mental heath care they need, despite front-page stories detailing the horrors these veterans face.

Ending veteran homelessness

Amend the Per Diem Grant to allocate funding to each state annually to care for their homeless     Veterans: Currently each year grant proposals from all over the nation are  submitted for approval. Only a small number of states are awarded  funds. This process fails to meet the needs of more than half the  nation’s homeless Veterans.
Homelessness Coalition of Veterans Organizations March 16, 2007
According to statistics there will be between 200k and 300k homeless veterans on the streets of America. In the state of Ill there are over _____ homeless veterans, with close to 20k in the Chicagoland area. In the state of Ill there are less than 150 beds for the homeless  supported by the per diem grant issued by the VA to help the homeless. The vast majority of homeless veterans suffer from some form of metal  illness accompanied by substance abuse problems. This dual diagnosis  often started in the service but because of the severity of the  problems the veteran cannot make the claim for services from the VA by  him or her self. Programs serving homeless veterans are consistently under funded. For  example, according to the Dept of Veterans’ Affairs only 100k veterans  are served by homeless services and community-based programs, leaving  80% of the homeless veterans population without services. Again with  only 158 beds for 20,000 homeless veterans one can easily see that the  need for additional resources is urgent. (source: Chi. Continuum of  Care) Many veterans completing treatment programs at VISN 12 facilities, no  matter how well intentioned, are doomed to rehospitalization/relapse,  for there is nowhere for them to go in the community except to the  circumstances and conditions that are part of their destabilization. We  need to double the number of per diem beds immediately. One way to do  this is to encourage non-VA service providers to apply for them and  have an open application process so that those service providers with  veterans on their caseloads can continue to receive their services in a  stable, secure and sober environment and not be overwhelmed.
Homelessness/Mental Illness and Substance Abuse
With over 76% of the homeless not being treated for their mental  illness and substance abuse problems and with a cut back in the  services available at the VA, the need to utilize the monies allocated  for mental health services is critical and obvious. The fact that $42  million was returned to the general fund that was earmarked for these  programs is a death sentence for many vets and worse a living  prison/hell for others and their families. Community based services by  non-VA service providers such as Thresholds, Haymarket, and Bobby  Wright Mental Health services could bring immediate relief to  Chicago/Illinois Veterans.
The Disparity
With the not-so-new news that Illinois is next to last in the granting  of service connection for PTSD and other ailments, many veterans are  deprived of those services and resources needed to overcome their  service-incurred ailments. This delay in treatment and means of support  devastate the veteran and their family and is a major factor in  homelessness, incarnation and—in the long term—more costly to treat  once service connection is finally granted. I don t think that there is  another place where doctors findings are routinely negated by  adjudicators without medical training. Claims that are remanded by the  BVA, 3 or more times over a time span of 10, 15 or twenty years are  still waiting resolution. This situation often becomes the biggest  stressor in the veteran’s life. This situation demands that the resources needed to finalize claims  remanded more than 3 times or that have been in adjudication for more  than five years be brought on line immediately. For unless it is the  unspoken goal to see deserving veterans and their families die off or  to continue to live in the darkness and agony known only to those that  suffer from this shortcoming on the part of the VA, corrective measures  must be taken immediately. There are several reports that state that the VA is unprepared to deal  with the demands for services from Americas veterans and that the  projected budget is flawed and based on false assumptions. This—coming  from the inspector general and the Kennedy school of Government at  Harvard University—should tell our elected officials that we have  serious problems now. If nothing is done we are going to have a  disaster in the near future. We must plan for the treatment of veterans using real numbers and  guarantees, whether thru a trust fund or other means. We must roll back  some of these new policies such as 2 years of health care for our new  vets, the means test and categories for veterans. A grateful nation and compassionate knowledgeable elected officials  will settle for nothing less. Nor will we, the veterans of America,  their families and their sincere supporters, settle for less.
David J. Rogers C.V.O.