MY SAN ANTONIO
Military 
VA PLAN WORRIES SOME VETS
 
By Scott Huddleston 
San Antonio Express-News 

Web Posted : 10/02/2003 12:00 AM 
Texas veterans are voicing concerns about a plan aimed at streamlining health care that would cut services in parts of the state, including Kerrville.

Vietnam veteran and Air Force retiree Placido Salazar, who believes he was seriously affected by the defoliant Agent Orange, listens to a VA panel hearing on benefits. The meeting was Wednesday at the Convention Center.
Billy Calzada/Express-News 

The plan, intended to help the Department of Veterans Affairs evolve from an outdated hospital-based system to a fluid, user-friendly network focusing more on outpatient services and partnerships with the military and private sectors, already is being criticized as out of touch with the needs of veterans.

"I do not believe we were really involved inside the loop," William Morin, a national service officer with Disabled American Veterans, told a five-member panel Wednesday at the Convention Center.

The panel next will hold a hearing in Waco — where a 72-year-old hospital has been targeted for closure — that is expected to draw one of the largest crowds on a tour of about 40 cities. Friday's meeting — set for 9 a.m. at the Waco Convention Center, which seats up to 1,500 people — will include comments from registered speakers with the VA and veterans' groups.

VA officials have said the plan, called the Capital Asset Realignment for Enhanced Services (CARES), sets forth a vision for the next 20 years. But critics say it fails to correct long-running inadequacies.

Walter Schellhase, chairman of the Hill Country Veterans Council, criticized proposals to move 25 inpatient beds from the Kerrville VA Hospital to Audie Murphy VA Hospital and to open new clinics in San Antonio. The Kerrville facility has been downsized in recent years from 300 beds to 25. 

"It makes no sense whatsoever," he said.

The Kerrville facility would continue to provide outpatient services, primary care and some specialty care, as well as nursing home care for up to 154 patients.

A few veterans asked the commission to commit to restoring the Waco VA Hospital, which has about 800 employees and 250 beds, mostly for psychiatric care. The hospital provided outpatient services to about 17,000 veterans last year. If it closes, most patients would transfer to a VA facility in Temple.

CARES also proposes closing VA facilities in Marlin and Big Spring; Brecksville, Ohio; Canandaigua, N.Y.; Gulfport, Miss.; Lexington, Ky.; Livermore, Calif.; and Pittsburgh. The commission plans to forward the plan by the end of the year to VA Secretary Anthony J. Principi, who has said he hoped to forward a final plan to Congress early next year. 

Even though the plan calls for expansion of health services in Corpus Christi and Harlingen, access to care is a continuing concern, since veterans in the Rio Grande Valley often must travel up to 300 miles for care. 

"The Valley has been screaming for services for many years," said Carlos Martinez, the national outreach president with the American GI Forum.

The CARES Commission projects that the number of U.S. veterans eligible for benefits will drop from about 23 million to 14 million by 2020. But VA enrollment is projected to rise from 59,000 to 66,000 in South Texas. That includes a jump from 20,000 to 24,000 in the Valley, which gets about 3,000 Winter Texans each year, and visits from veterans living in Mexico.


Jim Mance, a U.S. Army veteran who was a communications specialist in Korea from 1971 to 1974, is fitted for crutches by Robert Managbanag at Audie Murphy VA Hospital. A VA panel is holding public hearings on its plans for streamlining veterans' health services. 
Billy Calzada/Express-News 

U.S. Sen. Kay Bailey Hutchison, R-Texas, challenged the panel Wednesday to expand veterans' services in Kerrville and across South Texas, since nearly one in 10 active-duty service personnel returns to Texas to live.

"Texas, therefore, has a rapidly growing veterans population, and I believe this will require expanded veterans' medical services" across the region, she said in a letter to the panel.

Jose Coronado, director of the South Texas Veterans Health Care System, said he was concerned that the plan does not account for veterans returning from Iraq. Local authorities have said Brooke Army Medical Center lately has taken in at least one veteran per day from Iraq who needed hospitalization.

Wednesday's hearing generated an audience of about 40 people, including 20 who had not preregistered to speak. Natalie Sutto, a regional VA spokeswoman, said Friday's hearing is expected to draw several hundred people because of concerns over the Waco facility.

Commission member Michael K. Wyrick, a retired Air Force major general, said the panel generally sees the plan as a beacon of hope for veterans.

"We're vets, too," he said. "We want it done right."
 

ARMED FORCES NEWS
MEDICAL CARE BILL FOR SHAD/112 VETS
October 10, 2003


The "Health Care for Veterans of Project 112/Project SHAD Act of 2003" has cleared the House and gone to the Senate Committee on Veterans' Affairs. The bill would authorize VA medical care to veterans of Projects SHAD/112 for illnesses presumed to be attributable to the projects. The projects, including Project Shipboard Hazard and Defense and related land-based tests, were conducted by the DoD Deseret Test Center as part of a program for chemical and biological warfare testing from 1962 through 1973. If the bill becomes law, veterans would be eligible to apply through December 31, 2005.

 

ARMED FORCES NEWS
LATEST ON CONCURRENT RECEIPT TRADEOFF
October 10, 2003


A House plan for concurrent receipt of military retired pay and VA compensation in exchange for severe cutbacks in the VA compensation system got the ax after opposition from veterans" organizations, and concurrent receipt itself may no longer be on the table this year, according to sources. Instead, lawmakers are looking at a way to satisfy disabled veterans and their champions in the face of an upcoming election year. An option would be to expand Combat-Related Special Compensation, currently available to only about 18 percent of disabled military retirees, Expansions could include expanding eligibility for retirees with disabilities caused by combat or combat-related training from the current 60 percent, or perhaps even modifying the combat-related restrictions to include any veteran who was injured on the job. The deciding factor, according to administration and House officials, is how to fund increases. 
 

House Leaders Near New Deal For Disabled Retirees 

by Tom Philpott 
10/10/2003 

Rep. Tom Cole (R.-Okla.) 

With fewer strings attached this time to avoid the ire of veterans' groups, House leaders are nearing a new deal with the Bush administration to end for many military retirees the offset in retired pay that occurs when they draw disability pay from the Department of Veterans Affairs. The deal would cost an estimated $30 billion over 10 years, says Rep. Tom Cole (R-Okla.), a freshman lawmaker who serves on the House Armed Services Committee and was briefed on the plan. At issue is the century-old ban on "concurrent receipt" of both military retirement and VA disability compensation. Retirees now forfeit a dollar of retired pay for each dollar they draw in VA disability compensation.

Here are some highlights of how that law would be changed under the tentative deal that Cole was briefed on by House leaders in early October:

COMBAT-RELATED CONCURRENT RECEIPT -- Effective Jan. 1, 2004, military retirees with 20 or more years of service and disabilities tied to combat or combat-related training would see offsets in retired pay from those disabilities restored as they continue to draw VA compensation. 

CR PHASE-IN FOR SERIOUSLY DISABLED-- Also Jan. 1, retirees with disabilities of any kind rated 50 percent or higher would begin to see lost retired pay restored in phases over a set period of perhaps 10 years. Cole cautioned that the length of phase-in was still being negotiated as the Office of Management and Budget work cost estimates for various options.

CR FOR RESERVISTS -- Unlike under the new Combat-Related Special Compensation program, which took effect June 1, Reserve and National Guard retirees would be eligible for concurrent receipt too, as described above. There would be no hurdle of 7200 retirement points as under CRSC.

CRSC, SPECIAL DISABILITY COMPENSATION -- Persons eligible for CRSC likely would get the new concurrent receipt deal or CRSC, whichever is greater. But the special disability compensation program, which pays up to $325 a month to retirees given VA disability ratings of 60 percent or higher within four years of retirement, likely would end because the new deal would provide better benefits.

PRESIDENTIAL COMMISSION -- In 2004, a special commission would be established to study VA and military disability programs and to recommend reforms, which could include tightening disability rules for future generations of veterans. Current retirees would be grandfathered from any changes to criteria and benefits, Cole said. Veterans groups likely would be represented on the commission. 

Cole, whose district includes Fort Sill and thousands of retirees, described the deal as "real serious." He added, "I'm going to be surprised if we don't get a major step forward" on concurrent receipt.

He credited Rep. Duncan Hunter (R-Calif.), chairman of the House Armed Services Committee, and Rep. Roy Blunt (R-Mo.), majority whip, for a "phenomenal job" negotiating with the Senate and White House.

Cole first discussed the new concurrent receipt deal in early October with another news organization. In our interview on Oct. 6, Cole repeated his belief that Senate Republican leaders had agreed to the deal and that final negotiations were with the White House. Yet he cautioned that there still are "lots of cooks in the kitchen," including the appropriations committees, which control funding, Defense officials, who strongly have opposed concurrent receipt, and OMB officials, studying final details. 

Other congressional sources I spoke with said Cole could be wrong about Senate leaders already being on board.

"I'm fairly confident this deal is going to proceed," said a House source close to the negotiations. "But the hurdle we have to overcome yet is different than what I think Mr. Cole believes it is.... Given the state of negotiations, we're not comfortable talking about it. This isn't a done deal and we're not going to do anything to jeopardize our discussions."

"I've got to think," said another House source, "that this thing is very close to being unveiled. It's just a question of how soon they can pull all the actors together. The long pole in the tent now may be the Senate."

Sen. John Warner, chairman of the Senate Armed Services Committee, could not be reached for comment. Warner, sources said, was not pleased with the way House leaders worked an initial deal with the White House last month, and created a firestorm of criticism from veterans groups. That deal linked approval of full concurrent receipt for all 700,000 retirees with disabilities to the tightening disability rules for future veterans, including active and reserve forces fighting terrorism in Iraq and Afghanistan.

Warner, architect of CRSC, has favored allowing that program to run at least a year before taking further action. CRSC would raise the pay of roughly 35,000 disabled retirees who earned Purple Hearts for war wounds or have combat-related or training-related disabilities rated 60 percent or more.

Sen. Harry Reid (Nev.), Democratic whip, said in a statement that he opposes the new deal negotiated by House Republicans. "I've been working on this issue for years, and I'd love for Congress and the White House to finally reach an agreement -- but it has to be an agreement that is fair to all our veterans," Reid said. "We need full concurrent receipt. That's what the Senate has passed for three years now, and it's what the House and White House should approve as well. Anything less would short-change the people who fought to keep us safe." 

If Senate Republicans come to support the House deal, sources said, Reid can expect great pressure from service associations not to stand in the way this year of a significant though partial victory on concurrent receipt.

Want to comment on this article? Send Tom an e-mail at milupdate@aol.com. Want to see reader responses to previous Military Update columns? Click here to go to the latest Military Forum. 

Syndicated columnist TOM PHILPOTThas covered military affairs for more than 25 years, including six as senior editor of Navy Times. He writes free-lance magazine articles, primarily on defense issues. His work has appeared in Washingtonian, Reader's Digest, and Kiplinger's Personal Finance magazines. His book, Glory Denied, is now available in paperback. To send feedback on MILITARY UPDATE columns, e-mail Tom at milupdate@aol.com.

UPDATE ON CONCURRENT RECEIPT LEGISLATION
TAKE ACTION! 
October 20, 2003 


For nearly two decades, legislation that would allow career retirees of the Armed Forces to collect full military retirement and Department of Veterans Affairs (VA) disability compensation has been pending before Congress. Currently, if they receive VA disability compensation, their retirement pay is reduced by a commensurate amount.

The House leadership has announced a plan that has purportedly been agreed to by leaders in the Senate and the Administration. The legislation will be included in this year's Department of Defense (DOD) authorization bill, which is currently in conference. According to House officials, the DOD authorization bill should be finalized by November.

If enacted, Combat-Related Special Compensation (CRSC) would be expanded to include all combat or hazardous duty disabilities from 10% to 100%, effective January 1, 2004. Currently, only those with qualifying disabilities rated 60% or higher or who have a compensable disability associated with the Purple Heart Medal are eligible. Retirees must apply to their parent service for CRSC payments, but there is no phase-in period for CRSC. DOD is discouraging retirees from applying until this provision is signed into law. The DAV website has a link to the CRSC application.

Also, the DOD provision would authorize all career military retirees with VA disability ratings of 50% or higher to have full concurrent receipt phased in over a 10-year period. No application is expected to be required. If enacted, the phase in would begin January 1, 2004, in the following amounts:

100% disability, $750 per month; 
90% disability, $500 per month; 
80% disability, $350 per month; 
70% disability, $250 per month; 
60% disability, $125 per month; and 
50% disability, $100 per month. 

Each following year, until 2014, the payment amount will increase by approximately 10 percent. In 2005, entitled veterans would get back another 10% of any remaining offset; in 2006, they would get back 20% of the remaining offset; in 2007, 30% of the remaining offset; and so on. By January 2014, disabled retirees with 50% and higher ratings will be entitled to full concurrent receipt of military retired pay and VA disability compensation.

National Guard and Reservist career retirees will be treated the same as active duty retirees, and will be included in both the CRSC program and the phase-in of concurrent receipt for veterans rated 50 percent or higher.

Disabled retirees who qualify for both programs would have to choose one or the other. Because the CRSC program provides payment immediately, rather than the 10-year phase-in for concurrent receipt, legislators plan to allow an annual election option for CRSC-eligibles. This recognizes that a retiree who is 100% disabled, but only 60% of that is due to combat-related conditions, may find it advantageous to elect CRSC payments for a few years until the concurrent receipt payment rises to a level that exceeds the CRSC payment. Because CRSC payments are tax-free and non-disability retired pay is not, this could also figure into qualifying retirees’ election decisions.

Designing specific procedures for retirees to make such elections is but one of the many administrative challenges the Defense Department will have to address in implementing the new authority.

The new agreement also calls for the formation of a special commission to review the VA disability system and recommend any needed changes. Of its 13 commissioners, at least seven will have to be highly decorated combat veterans. Four will be appointed by the House, four by the Senate, and five by the President. The DAV has strong concerns regarding changes to title 38, and we will certainly scrutinize any suggestions to modify or reduce benefits available to disabled veterans.

The proposed legislation is a move forward; however, military retirees with non-combat disabilities rated less than 50 percent will still be treated unfairly. The DAV will continue to fight for those veterans that have not been included.

The DAV greatly appreciates the efforts of legislators who have fought so hard on this issue. Long-time concurrent receipt champions Representative Mike Bilirakis (R-FL) and Senator Harry Reid (D-NV) have kept the issue on the front burner for the past 3 years. The DAV especially thanks Representative Jim Marshall (D-GA), a freshman member of Congress and a combat disabled veteran, who came to Washington and immediately took strong steps to correct what he perceived as a gross injustice. Congressman Marshall’s discharge petition played a crucial role in attaining benefits for thousands of disabled veterans. The DAV also expresses thanks to Representatives Thomas Tancredo (R-CO) and Walter Jones (R-NC), who, despite tremendous pressure from House leadership, courageously signed the discharge petition.

Finally, the greatest praise and recognition belongs to members of our great organization for their steadfast efforts in achieving this victory. Although only a portion of our membership is affected by concurrent receipt, thousands upon thousands of e-mails, letters, and phone calls from DAV members have flooded Capitol Hill and the White House demanding that the unjust ban on concurrent receipt be lifted. As it has always been, the DAV was in the forefront to fight for disabled veterans and their families.
 

ARMED FORCES NEWS
MAJOR BREAKTHROUGH ON CONCURRENT RECEIPT
October 24, 2003


On Oct. 16, House Majority Whip Roy Blunt, R-Mo., Armed Services Committee Chairman Duncan Hunter, R-Calif., and Veterans Affairs Committee Chairman Chris Smith, R-N.J., announced a final agreement on concurrent receipt with Senate leaders and the White House. Retired Navy Vice Adm. Norbert R. Ryan, Jr., president of the Military Officers Association of America, one of several organizations represented at the press announcement, said: "This is an extremely gratifying victory for disabled retirees. MOAA is extremely pleased that years of lobbying efforts by MOAA and others have paid such great dividends for thousands upon thousands of disabled servicemen and women. This new legislation won't solve the whole concurrent receipt problem, but it's a giant step forward that will mean as much as $25,000 a year or more for 100 percent disabled retirees. We deeply appreciate the efforts of legislators who have fought so hard on this issue." Details: 

Full concurrent receipt for military retirees who are rated 50 percent or more disabled by the VA will be phased-in over a period of 10 years beginning Jan. 1, 2004. 

Combat Related Special Compensation will be expanded, effective Jan. 1, 2004, to include all retirees with combat and combat-related disabilities regardless of percentage of disability. 

In both cases, Guard and Reserve retirees, including those with less than 7,200 retirement points, will be eligible.

A 13-member commission to study possible changes to the VA disability system will be established, with four commissioners to be appointed by the House, four by the Senate, and five by the President. At least seven must have earned a Silver Star or higher decoration. 

All provisions of the agreement will be part of the fiscal 2004 Defense authorization bill. 

Legion: Concurrent Receipt Deal Not "Just"The dollar-for-dollar "disabled veterans" tax" is set for repeal for some 50 percent of military retirees who have been awarded disability compensation from the VA. But what about the other 50 percent, asks American Legion commander John Brieden. "It's a matter of priorities. Just compensation for service-disabled military retirees should be no less a priority than rebuilding Baghdad." Brieden continues: "I'm sure a lot of hard work went into this, and we appreciate it. But creating a two-tiered benefits system,that favors one group of service-disabled military retirees over another, is not the answer. Creating a commission to study VA's disability-compensation system -- a system which requires medical evidence to prove a claim and is scrutinized by congressional Veterans’ Affairs committees, an appeals process, and a federal court -- is not the answer. The answer is to repeal the tax for all service-disabled military retirees."
 

M E M O R A N D U M

TO: Action E-List
FROM: Joseph A. Violante, National Legislative Director

ADDING MONEY FOR VETERAN PUTS HOUSE IN A POLITICAL BIND
October 29, 2003


This year, veterans’ issues are attracting more press coverage than usual nationwide. I am sharing with you this article from Congressional Quarterly because it reflects very accurately the impact grassroots lobbying is having on current important issues such as funding for veterans’ medical care and concurrent receipt legislation.

Thank you for your continuing good work.


JOSEPH A. VIOLANTE
National Legislative Director

JAV:lmb Attachment

__________________________________________________________

CQ WEEKLY - VETERANS' AFFAIRS

October 25, 2003

Page 2654

Adding Money for Veterans Puts House in a Political Bind

By Niels C. Sorrells, CQ Staff

More than once this year, House Republican leaders have found themselves navigating a particularly tricky political minefield, trying to explain why they do not want to add extra funding for veterans' health costs to the fiscal 2004 budget.

Despite political sniping from their Democratic opponents, rebellions in their own ranks and a Senate that has more than once boosted proposed veterans' spending over House objections, House GOP leaders have insisted on sticking to the president's $27.2 billion proposal for veterans' health care. That total - which is reflected in the House-passed fiscal 2004 spending bill (HR 2861) for the departments of Veterans Affairs (VA) and Housing and Urban Development (HUD) - is $1.8 billion less than veterans' groups have sought.

The Senate version, which may come to the floor the week of Oct. 27, calls for $28.3 billion, but $1.3 billion of that is emergency spending, an approach that House leaders strongly oppose. (Appropriations, p. 2627)

Now, as the appropriations process enters its endgame and more soldiers are wounded in Iraq, it is becoming more and more difficult politically to stick to President Bush's budget and rebuff the entreaties of veterans. Many who are watching the process say the Senate finally may have overpowered House resistance, when it voted Oct. 17 to provide an additional $1.3 billion for veterans in a second bill: the fiscal 2004 supplemental appropriations bill (HR 3289) for the military and reconstruction efforts in Iraq and Afghanistan. That bill is now in conference.

"It's hard to get it out" in conference, one House GOP leadership aide conceded in discussing the additional spending. Politically, he said, "it's a very complicated process."

Further complicating that process are the veterans' groups, which have been clamoring publicly for the extra money. Their disagreement has left veterans and House leaders trading biting news statements for several months. At the same time, Democrats have made political hay of what they call Republican indifference to veterans' needs. (CQ Weekly, p. 1518)

In a sign that the pressure may be having an effect, House GOP leaders did an about-face on years of resistance to a benefit known as concurrent receipt, which allows disabled military retirees to claim both retirement and disability benefits; currently, their pension benefits are reduced, dollar for dollar, by the amount of their disability payments. (CQ Weekly, p. 2579)

"Some would argue that if you fund one, it takes away from the other," said Rob Simmons, R-Conn., a member of the House Veterans' Affairs Committee. "It can't help but encourage members to support them. The good will that has been generated on concurrent receipt should lead to good will on veterans' health care."

Now that the House has given veterans one long-sought benefit, their congressional allies say it will be hard for the chamber to refuse a second, especially in light of the political strength of veterans.

And the House gave veterans reason to hope Oct. 21, when it voted, 277-139, to instruct its conferees on the supplemental to support making half of the reconstruction aid for Iraq a loan, not a grant. GOP leaders argued that many of the 84 Republicans who supported the non-binding motion did so out of support for veterans - not for the loan idea, over which Bush has threatened a veto. (House Vote 567, p. 2666)

A History of Struggle

The fight for the extra veterans' health care dollars first surfaced this spring in debate over the fiscal 2004 budget resolution (H Con Res 95). The Senate included $29 billion for VA discretionary programs - which are virtually synonymous with health care - in its version, while the House included $27.2 billion.

Christopher H. Smith of New Jersey, chairman of the House Veterans' Affairs Committee, led a small group of House Republicans into open rebellion at that point, saying they would vote against the budget unless the leadership agreed to $29 billion. House leaders relented. (CQ Weekly, p. 687)

But when the fiscal 2004 VA-HUD appropriations bill came to the House floor this summer, VA health care spending was back down to $27.2 billion. This time Smith led a bipartisan group that sought to amend the bill to raise it to $29 billion. However, the Rules Committee wrote ground rules for floor debate that effectively prevented a vote on Smith's amendment.

Democrats insisted that the best approach was to defeat the rule, but that attempt failed, 229-196, with only six Republicans voting against the leadership. When it came to passing the measure, Smith and 58 other Republicans voted no. But 150 Democrats voted yes, and the bill passed overwhelmingly. (CQ Weekly, p. 1910)

The Senate Appropriations Committee came close to the $29 billion target set by veterans' advocates by adding the $1.3 billion in emergency funding for veterans' health care to the bill's total.

Thus, while the House has not included the money anywhere, the Senate now has two separate pots of $1.3 billion moving in two separate bills - VA-HUD and the supplemental. Almost no one in Congress expects that both provisions will become law, only that the dual tracking of the increase enhances the chances that one of them will be enacted.

At times, it almost seems as though senators have been daring their House counterparts to strike the veterans' money this time.

"We think we are going to prevail, because that is what the public wants us to do with taxpayer dollars," said Barbara A. Mikulski of Maryland, the ranking Democrat on the Senate Appropriations VA-HUD Subcommittee.

Christopher S. Bond, R-Mo., chairman of that panel, included the $1.3 billion emergency package in his bill and cosponsored the money in the supplemental along with Mikulski. He also predicts a win.

"I'm hoping my friends in the House will understand how necessary this is," he said. "We think this is a bare- bones number."

Stirring the Pot

House Democrats, for their part, are urging veterans' groups to declare themselves not satisfied with a number that is a half-billion dollars short of their original goal.

Bob Filner of California, the No. 2 Democrat on House Veterans' Affairs, argues that veterans' groups have grown used to being mistreated by Congress and are not exerting their power to its fullest potential. If they insisted on the full $1.8 billion, instead of acting content with $1.3 billion, he said, they could probably get what they want.

"The veterans, instead of using the power they have, accept it," he said. "I think we should hold out for more. This is what they have done to buy off protests," he said of the GOP.

Conditioned by past disappointments, veterans' groups view the political landscape more cautiously.

"Should we have turned it down? Absolutely not," Dennis Cullinan, legislative affairs director with the Veterans of Foreign Wars (VFW), said of the increase. "We have to be realistic as far as that goes. The Democrats, unfortunately, are not in a position to deliver."

Filner also calls for realism in the fight for more dollars.

"It's not a question of 'take no prisoners,' " he said, noting budget shortfalls at the VA that have left many veterans unable to access health care in a timely manner. "We're falling behind."

Bob Graham of Florida, ranking Democrat on the Senate Veterans' Affairs Committee, says he sees no reason to let up on the criticisms. "There is nothing in their past actions that would give us hope," he said of the House.

Taking No Chances

Cullinan and his cohorts are not taking any chances. The VFW, along with the Paralyzed Veterans of America, the Disabled American Veterans and AMVETS, sent an Oct. 21 letter to all House members encouraging them to support the additional $1.3 billion inserted by the Senate into the supplemental and also to support the emergency spending that the Senate inserted into the VA-HUD bill.

"There has been a general acknowledgment that veterans' health care must receive an increase of this magnitude in appropriated dollars in order to meet its responsibilities," the letter said.

James T. Walsh, R-N.Y., chairman of the House Appropriations VA-HUD Subcommittee, agrees that the pressure is on for House members to try to find some way to come up with the extra money. But he notes that such fights are not easily won.

"These are not unexpected costs," he said. "In the past, the House has balked at declaring emergencies to work around a budget."

Still, he said, it is becoming difficult to ignore veterans and their complaints. The criticism "has been more than normal because we didn't meet their expectations," he said.

But veterans' groups remain wary of overstepping their bounds. Cullinan noted that many House leaders have been irked this year by harsh letters from veterans' groups slamming members of the GOP leadership for allegedly turning their backs.

"One would expect it to get a little negative," Cullinan said.

Richard Fuller, legislative director with the Paralyzed Veterans, agrees.

"They're not happy with us right now," he said. But he noted there was no way to avoid the fight. His group was unwilling to be satisfied with what he called the GOP leadership's strategy "to give us a drip and a drab every year and then to say they were addressing the issue."

In general, Cullinan said he is not concerned that the spat will affect long-term relations. "We've had fallings out with Congress before," he said. "In general, we've been able to rebuild our relationship."

That said, however, he expects this year's fight to be one more round in a continuing battle to add more money to the annual VA budget.

Predicted Cullinan: "I expect it will be just as bad next year."

Source: CQ Weekly

The definitive source for news about Congress.

© 2003 Congressional Quarterly Inc. All Rights Reserved
 

ARMED FORCES NEWS
MOAA: CONCURRENT RECEIPT GLASS HALF FULL
October 31, 2003


Asked, "Why did you settle for a partial (concurrent receipt) deal?" the Military Officers Association of America says there was less "settling" than there was taking the partial deal or nothing. MOAA adds that "all or nothing" negotiations in the past have usually ended up with nothing, which they found unacceptable this year. In addition, "If we want these legislators to help us make further progress in the future, we need to thank them for their efforts, not spurn them," stated MOAA officials. They also say that, although they had hoped for a five-year phase-in, the package offered was 10 years or no deal. However, the 10-year spread is front-loaded, so that qualified military retirees will get back at least 95 percent of their retired pay in six years. For phase-in charts, visit http://www.moaa.org/Legislative/Retirement/CRCharts/Default.asp. For a "Frequently Asked Questions" guide, see http://www.moaa.org/Legislative/Retirement/CRQA.asp.

ARMED FORCES NEWS
MEDICAL JOURNAL SUPPORTS VA REORGINIZATION
October 31, 2003


A recent study in the New England Journal of Medicine reports that the Department of Veterans Affairs' shift from inpatient to outpatient care during the past decade has been efficient and safe. Survival rates among chronically ill veterans remained constant despite a sharp reduction in hospital-based care, according to the journal's Oct. 23 edition. Over the past eight years, VA has reorganized its health care system, closed hospital beds, expanded outpatient care and improved primary care. The journal article was based on a study by researchers at VA's Houston Center for Quality Care and Utilization Studies and Baylor College of Medicine who studied the records of 342,000 chronically ill veterans to track theirhealth care and survival between 1994 and 1998. Hospital stays fell by 50 percent and outpatient care increased moderately, while survival rates remained constant.

PRINCIPI OPTIMISTIC ON RESTRUCTURING 
OF VA HEALTH CARE
October 31, 2003 
by Tom Philpott
 

Secretary of Veterans Affairs Anthony Principi 


Despite stiff criticism from some veterans and lawmakers who would see their local VA hospital close, Secretary of Veterans Affairs Anthony Principi says he is "optimistic" that a major restructuring of the $26 billion VA health care system can begin next year. The goal, said Principi, is to make VA health care more efficient, and accessible to more veterans, by closing outdated and under-used facilities and opening modern hospitals and clinics where they are needed most. Last August, VA completed what Principi describes as the most comprehensive review ever of department health facilities. Called CARES (Capital Assets Realignment for Enhanced Services), the draft report recommended major changes at 13 locations. New hospitals would be built in Las Vegas and Orlando, Fla., new centers for the blind in Biloxi, Miss., and Long Beach, Calif., and new spinal injury centers in Denver; Little Rock, Ark.; Minneapolis and either Albany or Syracuse, N.Y. Seven old hospitals would be closed: in Brecksville, Ohio; Canandaigua, N.Y.; Gulfport, Miss.; Lexington, Ky.; Livermore, Calif.; Pittsburgh and Waco, Tex. VA would open 48 new clinics and close or realign other small facilities throughout the country. 

The aim is not to cut VA costs, said Principi in a phone interview, but to realign resources over the next 20 years to reflect veteran population shifts and to embrace advances in medical treatment and technology. "We'll either be on the cutting edge of medicine in the 21st century" through restructuring, he said, or stay "on the trailing edge of the past century. We have a responsibility to make changes¦much like the private sector has to its systems, and to make sure the extraordinary amount of dollars the American people send us are being spent wisely." Health care, he said, "is not defined by bricks and mortar any more [but] by technology, and doctors and nurses operating in clinics [rather than hospitals] and delivering medicine thousands of miles away via telemedicine and digital radiology. So that's what we're trying to do." 

The final phase of the CARES process began in August when a 15-member commission, appointed by Principi, began reviewing the realignment recommendations. To help in that review, the commission held a series of 40 public hearings in affected communities. The CARES process began in the Clinton administration. Principi added the commission so that final decisions are viewed as more fair and credible. Chaired by Everett Alvarez, a former VA deputy administrator and prisoner of war in Vietnam, the commission likely will propose some changes to the VA recommendations when it delivers its report in early December. "I will review it carefully," said Principi. "If I find there are¦problems I will send it back [saying] 'I really disagree with these points here. I would like you to reassess them and come back to me.' But once that process is completed, I'll accept it as a national plan or I will reject it." Principi said in the end he will accept or reject all the commission recommendations. To pick on some of them, he said, would "politicize" the process and "that leads to cynicism and distrust." 

He hopes to announce a final plan to restructure VA health care within a month of accepting the commission report. "I have the authority now " to execute such a plan, Principi said. "I don't perceive Congress blocking me. I may be wrong." Restructuring VA facilities will mean "more health care, not less," Principi said, hoping to assure veterans. The VA health care system has 163 hospitals but a total of 5000 buildings on almost 20,000 acres of land. "Some facilities we inherited from the Army at the turn of the 20th Century," Principi said. "At their peak these facilities may have had 2000 patients. Today there may be fewer than 200 patients and we're maintaining 200 or even 350 acres of land." 

Principi noted a recent General Accounting Office report estimated that found the VA spends almost $400 million a year on underused facilities. Redirected, he said, that money "can buy a lot of health care and state-of-the-art ambulatory clinics and sophisticated bed towers and surgical suites and more digital technology so a doctor on the west coast can be diagnosing a patient on the east coast. That's what we're tying to accomplish." Realignment means "making difficult decisions," Principi said. "I appreciate the sensitivity at the local community [level]." 

Veterans and lawmakers from impacted areas have attacked the draft recommendations. One of the last public hearings, in Canandaigua, N.Y., attracted 1500 protesters who opposed replacing the 70-year-old VA hospital, and 700 employees, with an outpatient clinic. The 23-building campus has its own fire department, bowling alley and laundry -- but only 200 inpatients, down from a peak 1700. Still, Sen. Charles Schumer (D-N.Y.) called the closure plan "a monumental mistake." But reaction overall to CARES, said Principi, has "gone as well as one could hope for, given the gravity and comprehensive nature of this report." Veterans' groups, he said, "are keeping an open mind and have not tried to sabotage this effort in any way. They recognize that health care has changed and the demographics of the veterans population have changed.

Want to comment on this article? Send Tom an e-mail at milupdate@aol.com. Want to see reader responses to previous Military Update columns? Click here to go to the latest Military Forum. 

Syndicated columnist TOM PHILPOTThas covered military affairs for more than 25 years, including six as senior editor of Navy Times. He writes free-lance magazine articles, primarily on defense issues. His work has appeared in Washingtonian, Reader's Digest, and Kiplinger's Personal Finance magazines. His book, Glory Denied, is now available in paperback. To send feedback on MILITARY UPDATE columns, e-mail Tom at milupdate@aol.com. 
 
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