Provisions of the Veterans Access, Choice, and Accountability Act of 2014, recently signed into law by President Obama, were the main points of discussion at The American Legion's Veterans Legislative Town Hall in Charlotte, N.C. on Aug. 22. The event was held in conjunction with the 96th American Legion National Convention.
The event, moderated by American Legion Legislative Director Louis Celli, featured a panel of three congressional staff members: Steve Robertson, majority staff director for the Senate Committee on Veterans' Affairs (SVAC); Nancy Dolan, minority staff director for the House Committee on Veterans' Affairs; and Victoria Lee, a minority staff member for SVAC.
The VA reform law addresses systemic problems identified in timely access to health care and in management accountability at the Department of Veterans Affairs. It includes provisions for the training and hiring of health-care staff, using non-VA facilities for veterans' health care, expands counseling and treatment eligibility for those suffering from military sexual trauma, expands eligibility for Fry academic scholarships, and provides the veterans community with more GI Bill education benefits.
Management accountability was a critical part of the law, Robertson said, "because there were a lot of people that weren't providing accurate information and, consequently, a lot of the decisions former (VA) Secretary Shinseki was making were based upon bad data."
On the issue of the need for more access to VA health care, Robertson told attendees "We had been working for several years trying to open up more community-based outpatient clinics (CBOCs) that are leased properties, as well as other VA medical facilities that were going to be leased." A change made by the Congressional Budget Office (CBO) in the way it scores the budgeting for leased properties put a hold on opening up 27 VA facilities, he said. Instead of budgeting leased facilities year by year, CBO budgets the entire cost of a multi-year lease in a single fiscal year.
Celli said CBO chose such a budgeting method because if VA cancels a contract, it is responsible for paying the rest of the lease up-front. "In The American Legion's investigation," he said, "we found that in the 20 years of contracting history with leasing of CBOCs, (a contract cancellation) has only happened one time -- through the bad acting of the vendor -- and VA was released from that obligation. So in the hundreds of CBOCs that have been leased, there's only been one contract disputed, and that dispute ended in favor of VA."
The new law doesn't stop with the issues of access and accountability, Dolan said. "There are other provisions that help veterans in the bill and, quite frankly, that was a big point of discussion – the scope of the bill and how much do we include." Legislators made a "very conscious decision" to address more issues in order to "get ahead of some of the potential crises that may be coming down the road."
Lee talked about how the law addresses problems with VA's "scheduling package" by creating a task force to determine the best way to improve its capabilities.VA uses VISTA for electronic health records, a system that was developed in the 1980s. "VA has tried several times to upgrade the scheduling package and it was not very successful." Lee had just viewed a demonstration of VISTA "which is very archaic."
VA is planning to purchase a new scheduling package, Lee said, but it will take several years to deploy. "Right now, VA is working on some patches' for the scheduling package," turning off some capabilities to make sure no one is gaming the system, "but it's not user-friendly. I talked to the (VA) chief of IT and basically this package has to reach out to 71 different applications in order to do a schedule."
In terms of what happens next, Dolan said, "There's a couple of important things to remember. We have the law, (but) there is a whole other process where VA has to write the regulations and the policies to be able to implement the law, and the law gives them 90 days to do that.
"I can tell you I spent many years on the executive-branch side, and typically regulations for a law this size would probably take a year or two, so VA has a huge challenge. The approach they appear to be taking is to take the first big chunks, the access piece and the accountability piece, and that's what they're really focusing on most in that 90-day period."
Dolan said she got many inquiries from veterans, asking if they could seek health care from private practitioners. She explains that there is a "lag between the law being signed and the actual execution. I think one of our jobs now is to make sure that lag is as short as possible, and then also to make sure that VA is interpreting the law the way that it was intended.
"We have some concern with public communication and the perception of what veterans may think the law does, versus what it actually does. And that's where we look to folks like the Legion to really be able to help to communicate" what the VA reform law does for veterans.
For example, veterans may go to the doctor with their Choice Cards (which will pay for private health care with VA funding), and the doctor may provide medical treatment or services that aren't covered by VA. "And then you have the problem of who's going to pay that bill. So as we move forward over the next couple of weeks and months, strong communication between Congress, VA and veterans – that should be the primary focus."
Responding to a question about VA's new leadership (Secretary Robert McDonald and Deputy Secretary Sloan Gibson), Robertson said, "Both of these gentlemen, even though they went to West Point, are coming from the business world, so I think the vision that they're going to bring to the organization is going to be a little bit different than what we've seen in the past. Their leadership style is going to be somewhat different." He noted that one of McDonalds's first directives was to have hospital directors visit regularly with front-desk staff who schedule appointments, and to make certain they understand what that staff is doing.
"The VA product is not the problem," Dolan said, but the business model behind it. She said there was a lot of concern when McDonald was nominated because of his corporate background, and that VA was "going to be too much of a business, changing the dynamic of the product. And I think what we have seen and heard so far is that there is great respect and understanding of the value of the product, but also a respect and appreciation that the business side of the house has to be fixed."