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Congressional Updates

Both chambers of Congress were in session this week.

On Thursday, December 8 members of the House and Senate Appropriations committees held a conference in the U.S. Capitol. Their objective was to agree to a single omnibus measure to fund the remaining portions of the federal government which have not yet been funded for FY 2012. Both committees have passed the majority of the spending measures, but only one – MilCon/VA funding – has passed both chambers. That measure, H.R. 2055, has not cleared a conference committee.

LEGISLATIVE FOCUS FOR THE WEEK: House Subpanel Examines Veteran Suicide. On Friday, December 3, the House Veterans’ Affairs’ Subcommittee on Health held a hearing entitled, “Understanding and Preventing Veteran Suicide.” According to a study by the Center for New American Security veterans committed suicide at a rate of one every 36 hours during the period ranging from 2005 to 2010. Figures from the Department of Veterans Affairs (VA) put that figure at an even higher rate of one every 80 minutes; a third of those veterans were already receiving VA care at the time of the decision to take their own life.

Subcommittee Chairwoman Ann Marie Buerkle (NY) and Ranking Member Mike Michaud (ME) spoke of the seriousness of these statistics, and reaffirmed their commitment to better understanding the issue. Especially important were means to improve outreach and destigmatize the associated mental health issues so veterans could seek and receive the care they need to prevent this tragedy.

Several veterans groups comprised the hearing’s first panel. Common concerns included ineffective outreach to carry the message to the veterans of America. It was generally agreed that VA has in place some effective programs to treat the complex issues that give rise to suicidal thoughts, but because of a lack of public knowledge, combined with ineffective local implementation of the programs, many vets aren’t getting the care they need in a timely enough fashion to make a difference. One of the early panelists cited a study by the Institute of Medicine (IOM) commissioned by VA in 2006. Although VA had paid for this study, they had yet to show signs of implementing any of the recommendations. The panelist noted “If VA and DoD were to use the PTSD assessment protocols and guidelines [from the IOM study] …our veteran warriors would receive the accurate mental health diagnoses needed to assess their suicide risks.”

When pressed by Chairwoman Buerkle on the question of “What one improvement could we make to better get the help to veterans?” two points became clear as common answers among the panelists. VA must do a better job of reaching out to veterans and making them aware of the services available. Furthermore, VA must move away from looking at numbers and assembly line process and move more towards looking at the actual veterans involved.

Veterans’ groups clearly play a role in outreach. It was agreed upon by multiple participants that veterans often respond far better to direct veteran-to-veteran contact than by those perceived as outsiders who don’t understand their individual struggles. Proactive treatment early in the exposure cycle to disorders such as PTSD and TBI have also been proven critical to an improved prognosis for productive reintegration both into service members’ active duty units and civilian society back home.

The second panel focused on reports by the Center for a New American Security and the Rand Corporation, as well as Jan E. Kemp, RN, PhD who is the National Mental Health Director for Suicide Prevention in the Veterans Health Administration (VHA). Dr. Kemp rather poignantly acknowledged, “The bottom line is veterans are still dying. We have to do better.” Although the Rand Corporation found the quality of care provided by VHA “as good or better than public or privately funded care” challenges still remain.

The Committee members, as well as all panelists agreed VA is working very hard to address this issue and to treat veteran suicide with the gravity it deserves. However, many agree they are still falling short in critical areas. There is incomplete data and accounting of suicide, and greater data could help better analyze ways to prevent future suicides. Veterans still struggle to get timely appointments, sometimes experiencing delays of months or more to get needed appointments. Obviously, with suicidal thoughts, timely treatment is critical. Veterans also, in many cases because of a lack of available appointments and providers, fail to receive the full amount of treatment necessary for a complete course of therapy in dealing with certain mental health problems. VA cannot cling to a “fire and forget” method of simply doling out medicine and failing to provide needed follow up appointments.

Sadly, there are no easy answers to the problems posed by veteran and active duty suicide. Several things are clear, among them the need for more robust staffing to deal with the influx of veterans seeking help with psychological issues associated with suicide, as well as better outreach on behalf of VA to reach the veterans and their loved ones in a position to intervene and provide a much needed lifeline.

What is abundantly clear is that all parties, be they public or private, Congress, VA, veterans’ groups or even the general public are deeply concerned about the problem of veteran suicide and are giving the issue the attention and gravity it deserves.

Joint Homeland Security Hearing on Homegrown Terrorism

On December 7, The American Legion legislative team attended an unclassified joint hearing held by the House and Senate Homeland Security committees entitled “Homegrown Terrorism: The Threat to Military Communities inside the United States.” After taking written testimony and opening remarks from the witnesses, the chairmen closed the joint committee hearing to the public to take classified information.

The focus of the hearing centered about a 14-page report (link below) released by House Homeland Security Chairman Peter King (NY) at the hearing which found that “at least 33 threats, plots and strikes against U.S. military communities since 9/11 have been part of a surge of homegrown terrorism.” Both chairmen said the military is the number one target for radical Islamist extremist groups.

The committee report stated there are “serious gaps” in the “military’s preparedness for attacks against its personnel, dependents and facilities … such as a lack of adequate and clear training in spotting indicators of violent Islamist extremism in individuals who wear the same uniform as those they may target.” In support of that contention Chairman King pointed to the 2009 shootings in Texas at Fort Hood and at a military recruiting station in Arkansas, which killed a total of 14 people and wounded more than two dozen. Senate Chairman Joseph Lieberman noted that “the only Americans who have lost their lives in terrorist attacks in our homeland since 9/11 have been killed at U.S. military facilities.”

There were two panels of witnesses. Panel 1 was: Paul N. Stockton, Assistant Secretary of Defense for Homeland Defense and Americas' Security Affairs, accompanied by Jim Stuteville, Army Senior Advisor, Counterintelligence Operations and Liaison to the Federal Bureau of Investigation; and Lieutenant Colonel Reid L. Sawyer, Director, Combating Terrorism Center at West Point. Panel 2 was Daris Long, father of one of the Arkansas victims.

Ranking Member on the House committee, Rep. Bennie Thompson (MS), said singling out the one ideology [Islam] would ostracize members of the armed services and would ignore the possibility of other emerging terrorist groups. “Our military is open to all faiths. A congressional hearing that focuses on religion and the military is likely to harm unit cohesion and undermine morale within our military.”

Witness Stuteville said that in the wake of the Fort Hood shootings the military has chosen to focus training soldiers and officers to recognize signs of possible extremism within their ranks by identifying behavioral activity and not particular ideologies. “We adopted that approach because we want to make sure that we can account for any type of threat, both those previously and those in the future,” he said.

Rep. Dan Lungren (CA) challenged Mr. Stockton with questions and argued that al-Qaeda represented “violent Islamist extremism.” If the U.S. is at war with al-Qaeda, then it is also at war with “violent Islamist extremism,” he said. Mr. Stockton defended the administration position by saying that to confuse the two would aid al-Qaeda’s propaganda machine.

The report can be found at this link: investigative report.

Congressional Briefing Asks, “Inside Deficit Reduction: What Now?”

On December 2, Legislative staff attended a briefing on Capitol Hill sponsored by the Alliance for Health Reform concerning the recently enacted Budget Control Act of 2011 and its possible effects on the health care system. The Budget Control Act tasked six senators and six representatives, from both sides of the aisle, to find at least $1.2 trillion in deficit reduction over the next decade. After weeks of deliberation, members of the “Super Committee” did not reach an agreement by the November 23 deadline. As a result, automatic spending cuts to defense and nondefense spending are set to kick in beginning in January 2013, leaving many questions about the short-term and long-term consequences of the committee’s failed negotiations.

Panelists were: Katherine Hayes, George Washington University; Stuart Butler, The Heritage Foundation; Len Nichols, George Mason University; Sheila Burke, Harvard University; and Dan Mendelson, Avalere Health. They discussed possible directions for the future in light of the current situation, examining historical precedents and the current political and fiscal climate.

The Congressional Budget Office has shown that the main driver of projected federal deficits is rising health care costs. For example, Social Security has little to do with our long-run budget problem, and the imbalance in this program can be fixed relatively easily, but federal health care spending is projected to triple as a percentage of our economy over the next decades, barring major changes in policy. Addressing this situation is a necessary condition, therefore, for dealing with this nation’s long term debt and deficits.

Katherine Hayes, associate research professor in the Department of Health Policy at George Washington University’s School of Public Health and Health Services, discussed the fundamentals of the sequestration process as outlined in the Budget Control Act (BCA). After clarifying the difference between discretionary and direct spending, Ms. Hayes explained that the $1.2 trillion in spending reductions are to be evenly split between defense and nondefense spending. Within these two categories, the BCA provides for a proportional division between discretionary and direct spending cuts. Central to Ms. Hayes’ presentation was the observation that the sequestration procedures in FY 2013 differ greatly from their continuation between 2014 and 2021. For example, in FY 2013, sequestration will apply to both discretionary and direct spending since the reductions start after the first quarter of the fiscal year (beginning October 1, 2012). Between 2014 and 2021, discretionary spending will be regulated by adjusting statutory caps and direct spending through sequestration of non-exempt programs. She also noted that cuts will be much harsher in 2013 because of the short time frame in which they must occur.

Dan Mendelson, CEO and founder of Avalere Health, noted that overall, the health industry wanted the Super Committee to fail because of the relatively minor cuts encompassed in the Budget Control Act. He predicted, however, that Congress will not allow the sequestration to take effect and that in 2013 the country will have a discussion similar to the one preceding Balanced Budget Amendment of 1997, which made several changes to Medicare to control spending, provide incentives for agencies to deliver care more efficiently, and rein in use of the home health benefit to deliver long term personal care. In reforming health care, Mr. Mendelson argued that austerity measures will have to apply not only providers, but to patients as well.

Stuart Butler, director of the Center for Policy Innovation at The Heritage Foundation, agreed that sequestration measures will not be allowed to take effect, and we therefore are facing the original problems of how to address uncontrolled spending and restructure programs. Dr. Butler outlined two basic options, the first of which would entail imposing various controls and regulations to minutely alter programs, or “squeezing the balloon” that is the health care system. The second option, which he found to be more promising, is to set a real budget for direct spending defined benefit programs. He advocated allocating certain resources through block grants, converting Medicare into a premium support system, and imposing a fixed budget on institutions that deliver health care. Dr. Butler emphasized his belief that innovative and cost-saving reform will not come from the federal government, and therefore money should simply be allocated with minimal restrictions to entities, such as the states, that are more likely to produce such reform.

Len Nichols, professor of health policy and director of the Center for Health Policy Research and Ethics at George Mason University, discussed cost control from both the state and stakeholder perspectives. First, he cited four events that have had a large impact on where we are in the health care debate: the rise of the tea party, the passage of the Patient Protection and Affordable Care Act (PPACA), the budget proposed by Rep. Paul Ryan, and the realization by the general public that some people were willing to throw the federal government into default. States, he noted, want to cut Medicaid spending, but are prevented from doing so by the maintenance of effort requirements in the PPACA. Private sector stakeholders, Dr. Nichols said, recognize that in order to control overall health system spending, both Medicare and Medicaid spending need to be addressed. Cuts and constraints cannot, however, come from the public sector alone, a fact that private sector stakeholders are well aware of. Also emphasized in Dr. Nichols presentation was the importance of separating long-run and short-run spending, something that the states do not currently do. Because of the current situation, he argued, we should be expanding short-run spending and then extract savings from the health care system in the future.

Sheila Burke, faculty member at the John F. Kennedy School of Government at Harvard University, discussed the politics implicit in the current debate. She noted that the Super Committee members were given extraordinary power and authority, yet they failed to reach an agreement because of fundamental differences of opinion regarding policy – specifically the balance between spending and taxation. An agreement on these issues, noted Ms. Burke, is extremely unlikely in the pre-election period. However, she argued, as the health care debate continues, momentum will continue to grow, pushing the public to acknowledge the importance of addressing these issues. Such momentum will help to foster progress towards containing health system spending and increase the likelihood of compromise post-election.

Update on American Legion Charter Amendment Legislation

On Tuesday, December 6 the House of Representatives passed by a voice vote S. 1639, the Senate companion to H. R. 2369, the bill to amend the charter of The American Legion. The bill amends our organization’s charter to clarify statutorily the autonomous, independent nature of our posts and departments. It was a result of Resolution #1 passed at the 2010 National Convention.

As you may recall, the Senate passed S. 1639 by unanimous consent on October 6. Considering that it was three days from the bill’s introduction to its passage by the full Senate, this is an incredible success story. In his floor speech before the House vote, Rep. Altmire (PA) noted the 432 co-sponsors of the House legislation was the largest number of co-sponsors ever on a bill. The measure now goes to the White House for President Obama’s signature.

Letters of Support

On December 5, The American Legion sent letters to the leadership of the House and Senate, to include House Speaker John Boehner (OH), House Minority Leader Nancy Pelosi (CA), Senate Majority Leader Harry Reid (NV), and House Minority Leader Mitch McConnell (KY). These letters outlined The American Legion’s support for the preservation of a provision in the VA’s Home Loan Guarantee Program which ensures veterans and service members have access to affordable housing in high-cost counties.

Also on December 5, our organization sent letters to the entire membership of the Senate Armed Services Committee and select members of the House, asking them to agree to a provision in the House version of the National Defense Authorization Act for 2012 regarding the repatriation of the remains of American naval personnel buried in Tripoli, Libya in 1804. In part, the letter stated, “The Libyan government does not maintain their graves nor does the American flag fly to honor their sacrifice for our country…It is now incumbent upon you to direct the recovery of these remains of Americans.”