Department of Veterans Affairs Fiscal 2019 Budget Submission for Medical Programs and Construction

Chairman Wenstrup, Ranking Member Brownley, and distinguished members of this subcommittee, on behalf of Denise H. Rohan, National Commander of The American Legion; the country’s largest patriotic wartime service organization for veterans and our 2 million members; we thank you for inviting The American Legion to present our position on President Trump’s proposed FY19 budget[1] for the Department of Veterans Affairs.

The American Legion is a resolution-based organization. We are directed and driven by the millions of active Legionnaires who have dedicated their money, time, and resources to the continued service of veterans and their families.  Our positions are guided by 99 years of consistent advocacy and resolutions that originate at the grassroots level of the organization – local American Legion posts and veterans in every congressional district of America.

The American Legion appreciates the president’s following through with the promises he made on the campaign trail. At a time when most federal agencies are experiencing a decrease in their respective budgets, the Department of Veterans Affairs (VA) will hopefully, with assistance from this critical committee, receive a much-needed increase.

Our members tell us they prefer to receive their medical care at VA. When an overwhelming force of veterans are all saying the same thing, it is vital that we listen to them. The president’s proposed budget is reflective of veterans’ voices, and should encourage this Congress to invest in the largest integrated medical system not only in the United States, but the world.

In 2003, The American Legion created and implemented our System Worth Saving program, designed to visit, examine, and audit Veterans Affairs Medical Centers (VAMCs). Through our program’s town hall meetings, veterans have shared with us that they appreciate the VA, the VA understands them, and that the VA system is a system worth saving. The proposed budget, and the increase in funding in particular, is reflective of a desire to ensure there is a strong and robust Department of Veterans Affairs.

In a VA Fact Sheet, they stated, “The Budget demonstrates VA’s ongoing commitment to providing Veterans more efficient, timely, and quality services by requesting an increase of $12.1 billion, more than six percent, above the FY 2018 Budget. The Budget makes every dollar count by using management efficiencies and savings, modernizing systems, and focusing resources on foundational series and key priorities.” The American Legion appreciates the requested increase and looks forward to engaging with this committee and the VA to ensure they use the funds appropriately, for the benefit of the veteran.

In reviewing the proposed budget, we will highlight and focus on three main impacted topics.

COMMUNITY CARE

“I intend to build a system that puts veterans first and allows then to get the best possible health care and services wherever they may be –in VA or in the community.”

-VA Secretary David Shulkin, February 1, 2017

The veteran community learned from the 2014 Phoenix wait time scandal that there is a need for care in the community. After the Choice Act was passed and signed into law, the number of veterans who had the desire to receive care in the community, opposed to the VA, skyrocketed. In 2018, a large percentage of veterans, many of which are proud members of The American Legion, have a preference to receive medical services closer to their homes.

When the Choice program was implemented, there were multiple other non-VA care programs such as Fee-Basis, Project Access Received Closest to Home (ARCH), Patient Centered Community Care (PC3) and others. By resolution, The American Legion has long endorsed combining and streamlining these multiple programs, creating one unified system that has the veteran and the best clinical interest of the veteran at heart.

Because of The American Legion’s efforts, advocacy, and resolution, we stand by the president’s budget request and appreciate the investment in the VA and the community care programs, with the intention to streamline and unify. President Trump’s budget states, “The Budget provides $70.7 billion, a 9.6-percent increase above the 2017 enacted level, to provide high-quality healthcare services to veterans and eligible beneficiaries. The Budget also proposes $75.6 billion in advance appropriations for VA medical care programs in 2020, a 6.9-percent increase above the 2019 request. In addition, $11.9 billion would be used to enhance and expand veterans’ access to high-quality community care, by consolidating multiple community care programs, including the Veterans Choice Program, into one unified program.”

The American Legion calls on this committee, and the 115^th Congress to ensure the Department of Veterans Affairs is properly equipped to provide state-of-the-art medical care to veterans through their facilities and community care providers. Further, The American Legion supports increasing funding levels, as this proposed budget calls for.

The American Legion applauds Secretary Shulkin for his focus on mental health issues leading to veteran suicide.  The proposed budget calls for slightly more than $8.6 billion to expand and transform VA’s focus on mental health services and is listed as VA’s number one clinical priority. This funding is absolutely critical, not only as an attempt to reduce the number of veteran suicides, but also supports President Trumps Executive Order[2] to improve mental health resources for veterans transitioning from active duty to civilian life and  the Secretary’s decision for VA to provide emergent mental healthcare treatment for veterans with other-than-honorable discharges[3]. Losing one life to suicide is one too many.

VA INFRASTRUCTURE REVITALIZATION

The ability to provide the best care anywhere is not only about the medicine or methods in which medicine is delivered. The facility in which the care is administered is absolutely critical to the safety and successful treatment of those who have selflessly raised their right hand in defense of our Nation. Taking the necessary steps to ensure each and every VA facility, a VAMC, Community Based Outpatient Clinic (CBOC), Regional Office or others, is safe, modern, and efficient will only assist the agency in providing the best care for those who have served.

Veterans deserve a VA that is clean, modern, and safe. Providing the VA with the appropriate funding to deliver modern healthcare is the first step, but the subsequent steps include bolstering funding to guarantee that VA facilities are the best they can be.

The proposed budget would provide for $1.8 billion for 91 major and minor construction projects including new medical care facilities, national cemeteries, and projects at regional offices. The budget also provides $1.4 billion for non-recurring maintenance projects to maintain and modernize medical facilities. These investments enhance the safety and security of VA facilities and help VA programs and services keep pace with modern technologies.

• Approximately $1.1 billion will fund major construction projects, including construction of a community living center and domiciliary at Canandaigua, New York; construction of a facility that would specialize in spinal cord injuries at Dallas, Texas; and expansion of four national cemeteries that would provide slightly more than 80,000 new gravesites. This funding will also include $400 million to address critical seismic issues at VA facilities.

• In addition, $707 million will fund minor construction projects, including corrections and additions to Veterans Health Administration facilities, gravesite expansions at national cemeteries, and renovations at regional offices.

• VA would use the $1.4 billion in funding for non-recurring maintenance to address infrastructure needs in its medical facilities.

The American Legion understands the need to invest and modernize the infrastructure of VA, in order to provide quality services to veterans and their families. Considering and acknowledging that VA is the largest integrated medical system in the country, the need to update facilities and systems is never-ending. We support the increased funding and expansion of and for VA facilities. Further, we applaud and welcome the increased funding aimed at making sure the VA is not only modern and safe, but that this critical agency is physically here for future generations of veterans.

We also applaud the creation of a new facility in Dallas, Texas, that would specialize in spinal cord injuries. The Global War On Terror, and any armed conflict, returns servicemembers with catastrophic injuries, often times impacting and damaging their spinal cord. The creation of a new spinal cord facility is a clear message that the VA will continue to be on the cutting edge of battle-borne injury, all in the name of the fine men and women who wore the fabric of our military in distant lands.

LIFETIME ELECTRONIC HEALTH RECORDS

The American Legion, through resolution, has long endorsed and supported the Department of Veterans Affairs in creating a Lifetime Electronic Health Records (EHR) system. Additionally, The American Legion has encouraged both the Department of Defense (DoD) and the VA to use the same EHR system, or, at the very least, systems that were interoperable.

In 2009, The American Legion was pleased when the Obama administration announced that the DoD and the VA would finally create a path to integrate the flow of patients’ information between DoD’s AHLTA (Armed Forces Health Longitudinal Technology Application) and VA’s VistA (Veterans Information System and Technology Architecture) Electronic Health Record (EHR) platforms.[4]

In 2015, DoD announced that Cerner was awarded a $4.3 billion, 10-year contract to overhaul the Pentagon’s electronic health records for millions of active military members and retirees.  However, around the same time, VA announced it would maintain and modernize VistA.

The American Legion was disappointed in VA’s and DoD decisions to go in different directions and voiced concerns about their decision. Then, on June 6, 2017, Secretary Shulkin announced that the VA would adopt the same Cerner EHR system as the DoD during a news briefing at VA’s headquarters in Washington, D.C.

The impending contract, that the VA is in the final stages of negotiating, will set the standard for record transferability and standardization in America.  This new national standard will increase patient access, decrease wait times, and enhance good medicine for all Americans, not just veterans. 

Through the president’s proposed budget, it calls on Congress to provide $4.2 billion for the Office of Information Technology (OIT). If allocated, the budget would provide $204 million to recapitalize VA’s legacy IT systems with new enterprise and business-lines  as the data within these systems are vital, pertinent, and crucial to the success of future IT systems. Furnishing funds for legacy systems is not only necessary for the current systems, but is quite mandatory in order to ensure the data is transferred to the new EHR system.

In addition to maintaining the legacy systems that VA created and continues to utilize, $1.2 billion of the allocated funds for the OIT would be placed in a separate budget account for the acquisition of the current Cerner electronic health records system . Ensuring that VA has the necessary funding to maintain the Cerner system, and allowing the agency to obtain and utilize the same system as the DoD, is a massive step forward in interoperability with the benefit of the veteran.

The American Legion supports allocating the increased funding for the OIT and for the Cerner Electronic Health Records system, as both the DoD and VA have had disjointed systems for far too long.

VETERAN HOMELESSNESS

According to the VA, at any given point in January 2017, there were roughly 40,000 homeless veterans in the United Stated of America[5]. Of those 40,000 homeless veterans, about 15,000 were physically living on the street and had no shelter. The American Legion has long assisted homeless veterans and has encouraged both the VA and the Congress to take necessary steps to drastically reduce that number.

The American Legion was beyond pleased in 2009 when then-VA Secretary Eric Shinseki laid out a comprehensive plan to eradicate veteran homelessness by 2015. Secretary Shinseki stated, “President Obama and I are personally committed to ending homelessness among Veterans within the next five years,” said Shinseki.  “Those who have served this nation as Veterans should never find themselves on the streets, living without care and without hope.” Now in 2018, Secretary Shinseki’s plan to eradicate homelessness among veterans was not 100% successful; it did, by many people’s standards, put a massive dent in this disgraceful problem. 

Ending homelessness among veterans has been a substantial priority of The American Legion for many years. Supporting and making permanent the Supportive Services for Veteran Families (SSVF) program has been an  American Legion legislative priority for nearly a decade.

The SSVP program[6] is a critical program and has been described as the center of the spoked-wheel in terms of corralling efforts to end veteran homelessness. The SSVF  is a program within the Department of Veterans Affairs that provides grants and other resources to non-profits and organizations that assist homeless veterans and their families. The American Legion understands that simply providing a veteran a home is not the final solution to ending this national embarrassment of allowing the men and women who have served their Nation to be homeless. We have long endorsed and called for supportive services to assist homeless veterans, such as medical and mental healthcare, assistance in employment opportunities, aid in deciphering how to access and utilize the G.I. Bill, and other life changing services that help veterans. The programs, non-profits, and organizations that the SSVF program funds are proving veterans with more than just a home, they are providing them with much-needed services and most importantly, hope.

In context of eradicating homelessness within the veteran community, the president’s proposed budget states, “The Budget supports VA’s commitment to ending veteran homelessness by sustaining funding levels and providing opportunities to improve the targeting of intervention for veterans impacted by homelessness. Specifically, the Budget requests $1.8 billion for veteran homelessness programs including Supportive Services for Veteran Families and VA’s component of the Department of Housing and Urban Development—VA Supportive Housing Program. These programs provide critical wrap-around care to help address and prevent veteran homelessness”.

The American Legion applauds and supports President Trump’s continued support of the SSVF program and  the veterans it assists. By resolution[7], The American Legion calls upon this committee and the entire Congress to make the SSVF program permanent, and not simply sustain funding, but increase the funding to accomplish both Secretary Shinseki’s and The American Legion’s goal to completely end the plague of veteran homelessness.

The Supportive Service for Veteran Families program is the only national, veteran-specific program to help at-risk veterans avoid becoming homeless, and rapidly re-house those veteran families who lose their housing. It is critical, and this committee has the ability to truly put an end to an issue that is a dark stain on the veteran community.

CONCERNS

Lack of Research Funding: In reviewing the president’s proposed budget, The American Legion was thankful to see a section focusing on the national epidemic of opioids. In fact, the budget states that “fighting the opioid epidemic is a top priority for this administration, and VA is at the forefront of combatting this public health emergency.”

The American Legion is excited that the Nation is awakening to a concern we have been speaking of for years on the prescription of opioids, particular to those who have the invisible wounds of war.

During our review, we identified that addressing and combatting the opioid epidemic falls within the responsibility and scope of the Veterans Health Administration (VHA). Our concern is the lack of funding to research alternative therapies for this crisis. For example, the budget states the funding would be used for “multidisciplinary approaches in opioid prevention and treatment, including investments in: provider training to assess risk and manage treatment; mental health outpatient and residential treatment programs; opioid overdose, recognition, rescue and response training programs; medication assisted therapy for opioid use disorders; patient advocacy; and distribution of naloxone kits.”

At a time when over-prescription seems to be an important issue, not only within the walls of the Department of Veterans Affairs, but the nation at large, The American Legion encourages the Trump administration, and through them the VA, to allocate funding for research into complementary and alternative medicines. The members of The American Legion, and veterans across this nation share stories everyday of remedies that assist them. Medical cannabis, service animals, hyperbaric oxygen therapy, equine therapy, and other therapies should receive a heightened amount of research.

If our goal, as a Nation, is to address the opioid epidemic, then we must properly fund the clinical research that may be an alternative solution to help those who have proudly served in the  U.S. Armed Forces.

Cost of Living Adjustment: As previously stated, The American Legion supports many sections of President Trump’s proposed FY19 Budget. By resolution, The American Legion staunchly opposes the Cost of Living Adjustment (COLA) round-down.

Asking veterans to reduce their benefits to pay for the benefits of other veterans is a textbook definition of robbing Peter to pay Paul, and is unethical. Men and women served their country, often in harm’s way, with the knowledge that if they were physically damaged from their military service, the United States would either aide them to recovery or would supplement them appropriately. If we, as a Nation, decide to deploy troops to conflict, then we have a moral obligation to care for them when they return.

The motto of the Department of Veterans Affairs is “To care for him who shall have borne the battle, and for his widow, and his orphan,” and it is always incumbent to follow through with this obligation, not only when it suits the budget.

The American Legion urges this critical committee, along with the entire 115^th Congress to oppose any form of benefit reduction of veterans in the name of providing benefits to others. 

CLOSING

Chairman Wenstrup, Ranking Member Brownley, and other members of this critical committee, The American Legion thanks you for the opportunity to elucidate the position of the 2 million veteran members of this organization on President Trump’s proposed FY19 budget as it relates to the Department of Veterans Affairs. For additional information regarding this testimony, please contact Mr. Matthew Shuman, Director of The American Legion Legislative Division at mshuman@legion.org, or (202) 861-2700.