STATEMENT OF BLAKE C. ORTNER SENIOR ASSOCIATE LEGISLATIVE DIRECTOR PARALYZED VETERANS OF AMERICA BEFORE THE HOUSE COMMITTEE ON VETERANS AFFAIRS, SUBCOMMITTEE ON HEALTH CONCERNING PENDING LEGISLATION AND THREE DRAFT BILLS ADDRESSING HEALTH CARE FOR VETERANS MARCH 25, 2010 Chairman Michaud and members of the Subcommittee, on behalf of Paralyzed Veterans of America (PVA), I would like to thank you for the opportunity to present PVA s position on the legislation pending before the Subcommittee, as well as the three draft bills you are preparing.
H.R. 84, the Veterans Timely Access to Health Care Act H.R. 84, the Veterans Timely Access to Health Care Act, would establish standards of access to care within the VA health system. PVA has testified on similar legislation in the past and is unable to support H.R. 84. Under the provisions of this legislation, the Department of Veterans Affairs (VA) will be required to provide a primary care appointment to veterans seeking health care within 30 days of a request for an appointment. If a VA facility is unable to meet the 30-day standard for a veteran, then the VA must make an appointment for that veteran with a non-va provider, thereby contracting out the health care service. The legislation also requires the Secretary of the VA to report to Congress each quarter of a fiscal year on the efforts of the VA health system to meet this 30-day access standard. Access is indeed a critical concern of PVA. The number of veterans enrolled in the VA is continuing to increase. This is particularly true as more and more Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans continue to take advantage of the services in VA. Likewise, the effort of the Administration to expand Priority Group 8 enrollments is increasing the workload. Unfortunately, funding for VA health care in the past has had difficulty keeping pace with the growing demand. Even with the passage of Advance Appropriations and record budgets in recent years, funding is not guaranteed to be sustained at those levels and PVA is concerned that contracting health care services to private facilities when access standards are not met is not an appropriate enforcement mechanism for ensuring access to care. In fact, it may actually serve as a disincentive to achieve timely access for veterans seeking care. Contracting out to private providers will leave the VA with the difficult task of ensuring that veterans seeking treatment at non-va facilities are receiving quality health care. PVA is also concerned about the continuity of care. If veterans are shifted between the VA and non-va facilities each time the imposed standard is not met, how will this affect 2
the quality of the health care these veterans receive? This is neither an effective nor efficient way to supply health care and in the long run may be detrimental to the veteran. We do think that access standards are important, but we believe that the answer to providing timely care is in providing sufficient funding in the first place in order to negate the impetus driving health care rationing. For these reasons, PVA cannot support H.R. 84. H.R. 949 to improve collective bargaining rights and procedures PVA supports H.R. 949 introduced by Chairman Filner that will more quickly resolve adverse actions and set deadlines for final decisions. H.R. 1075, the RECOVER Act (Restoring Essential Care for Our Veterans for Effective Recovery) PVA strongly supports H.R. 1075, the RECOVER Act (Restoring Essential Care for Our Veterans for Effective Recovery). During periods of major disasters, medical care is as critical as food or water to protecting the lives and health of those in the affected disaster area. Ensuring veterans have uninterrupted access to health care during these periods is critical to their well-being. The ability of the Secretary of VA to enter into contracts for in-patient care with non-department facilities for those veterans who otherwise would normally be provided care by Department medical facilities only makes sense. PVA would only caution that this arrangement should not inadvertently lead to delays in repairing or replacing VA facilities that may have been damaged during the disaster. VA facilities still provide a unique form and quality of care that is seldom replicated in non-va facilities, particularly for those veterans with special health needs such as spinal cord injury, blindness and other catastrophically disabled veterans. Likewise, this contracting authority should not become the default health care policy for meeting the needs of veterans in a disaster area. H.R. 2698, the Veterans and Survivors Behavioral Health Awareness Act and H.R. 2699, the Armed Forces Behavioral Health Awareness Act PVA supports H.R. 2698, the Veterans and Survivors Behavioral Health Awareness Act and H.R. 2699, the Armed Forces Behavioral Health Awareness Act. The 3
scholarships and other provisions of H.R. 2698 should increase the number of behavioral health care specialists. Additionally, we applaud provisions requiring those receiving the scholarship to serve in Vet Centers. As the increasing numbers of OEF/OIF veterans continues to grow, the need for behavioral specialists on Vet Center s staff will also grow. H.R. 2698 may help generate those additional individuals to meet this need. While the scholarships are not targeted or reserved for veterans, PVA would encourage VA to market the scholarship to veterans who will be best able to relate to veterans visiting the Vet Centers. PVA also welcomes provisions of both H.R. 2698 and H.R. 2699 which award grants to non-profit organizations to provide emotional support to survivors of members of the armed forces and veterans in the case of H.R. 2698 and to members of the Reserves and all family members in the case of H.R. 2699. This is in keeping with the best traditions of VA in providing for the widow and orphans of our veterans and all family members and members of the Reserves who are facing the significant challenges of multiple OEF/OIF deployments. Regarding Sec. 3 of H.R. 2698 and Sec. 2 of H.R. 2699, PVA supports these provisions of the legislation, but both sections are reflected in Senate bill S. 1963, the Caregivers and Veterans Omnibus Health Services Act of 2010 and will address the specified referral and readjustment counseling issues making these portions of the legislation no longer necessary should the legislation pass the House. H.R. 2879, the Rural Veterans Health Care Improvement Act of 2009 and H.R. 4006, the Rural, American Indian Veterans Health Care Improvement Act of 2009 PVA supports H.R. 2879, the Rural Veterans Health Care Improvement Act of 2009 and H.R. 4006, the Rural, American Indian Veterans Health Care Improvement Act of 2009. PVA recognizes that there is no easy solution to meeting the needs of veterans who live in rural areas and that Native Americans often face even tougher challenges. These rural veterans were not originally the target population of men and women that the VA expected to treat. However, the VA decision to expand to an outpatient network 4
through community-based outpatient clinics reflected the growing demand on the VA system from veterans outside of typical urban or suburban settings. The need to determine methods to provide for these more dispersed rural veterans is a challenge. Establishing Centers of Excellence for rural health research, education and clinical activities may be a way to develop better ideas for rural veteran care and help shed light on how best to provide services in rural areas. Together with the demonstration projects outlined in Section 5, a path may be identified to provide a greater level of health care for rural veterans. However, while these paths may show promise, they should still all fit within policies that promote the use of VA facilities and should not be used as a method or course to eliminate VA facilities in rural areas. While all these ideas are welcome, the greatest need still is for qualified health care providers to be located in rural settings. Only significant incentives and opportunities for these professionals will bring them to these often remote areas. In fact, the expansion of VA facilities may be the best way to care for special needs veterans that seldom have the types of critical care services that they need in rural areas. We must be sure that veterans most in need of specialized care, provided best by VA, are not sacrificed to efficiencies discovered through these programs. PVA also applauds the provisions of H.R. 2879 on travel reimbursement and transportation grants. Mobility, in particular for those with disabilities, is often the greatest challenge to care in a rural environment. Providing greater transportation benefits will allow veterans a better chance of receiving health care without a disproportionate cost often associated with the long distances traveled in rural areas. Both reimbursement and transportation grants are also included in S. 1963. We believe this portion of the legislation would no longer be necessary should S. 1963 be enacted. PVA also supports the provisions of H.R. 2879 for helping our Native American veterans through provisions for a program of readjustment and mental health care services to veterans who have served in OEF/OIF. PVA also supports the provisions of H.R. 4006 5
and H.R. 2879 which helps our Native American veterans by establishing Indian Veterans Health Care Coordinators. Improving outreach to this underserved population as well as expanding access and participation by VA, the Indian Health Service and tribal members in the Department of Veterans Affairs Tribal Veterans Representative program may help to bring a larger number of Native American veterans into the health care system. Together with the integration of electronic health records in the Indian Health Service and the authority to transfer surplus VA medical and information technology equipment, Native American veterans will have better access and a higher quality of health care. H.R. 3926, the Armed Forces Breast Cancer Research Act PVA strongly supports H.R. 3926, the Armed Forces Breast Cancer Research Act. Recent U.S. military conflicts, as happened with Operations Desert Storm/Desert Shield, have demonstrated that members of the military deployed to foreign areas often are exposed to agents, chemicals and environments detrimental to their health. In many cases, these exposures may have long-term health effects not identified during a post deployment medical examine. With the growing number of women that comprise members of the Armed Forces, and their increasing involvement in forward operating areas and combat activities, it only makes sense to examine the potential increased risk of breast cancer among this population. Draft Legislation to improve continuing professional education, waive certain requirements relating to mental health counselors, and make improvement to performance pay and collective bargaining rights PVA supports the draft legislation to raise the reimbursement rate for health professionals from $1,000 to $1,600. In addition, PVA cautiously supports the legislation to waive certain requirements relating to mental health counselors, but want to ensure that this is done only in the circumstances that will benefit VA health care and in no way be detrimental to veterans served by a counselor whose license or certification requirement has been waived. 6
Regarding collective bargaining, PVA generally supports the provisions of the draft legislation that would improve the collective bargaining rights and procedures for certain health care professionals in the VA. These changes may be a positive step in addressing the recruitment and retention challenges the VA faces to hire key health care professionals, particularly registered nurses (RN), physicians, physician assistants, and other selected specialists. As we understand current practice, certain specific positions (including those mentioned previously) do not have particular rights to grieve or arbitrate over basic workplace disputes. This includes weekend pay, floating nurse assignments, mandatory nurse overtime, mandatory physician weekend and evening duty, access to survey data for setting nurse locality pay and physicians' market pay, exclusion from groups setting physicians' market pay, and similar concerns. This would seem to allow VA managers to undermine Congressional intent from law passed in recent years to ensure that nurse and physician pay are competitive with the private sector and to ensure nurse work schedules are competitive with local markets. Interestingly, given the VA's interpretation of current laws, these specific health care professionals are not afforded the same rights as employees who they work side-byside with everyday. For instance, Licensed Practicing Nurses (LPN) and Nursing Assistants (NA) can challenge pay and scheduling policies, while RN's cannot. This simply makes no sense to us. VA must work with their employees to achieve a less hostile work relationship, but any changes or modifications on either side of the issue must first address the care of veterans. Furthermore, this care should not be used as a rallying cry on either side as an argument for their position. Veterans deserve better. PVA appreciates the opportunity to comment on the bills being considered by the Subcommittee. I would be happy to answer any questions that you might have. Thank you. 7
Information Required by Rule XI 2(g)(4) of the House of Representatives Pursuant to Rule XI 2(g)(4) of the House of Representatives, the following information is provided regarding federal grants and contracts. Fiscal Year 2009 Court of Appeals for Veterans Claims, administered by the Legal Services Corporation National Veterans Legal Services Program $300,000 (estimated). Fiscal Year 2008 Court of Appeals for Veterans Claims, administered by the Legal Services Corporation National Veterans Legal Services Program $302,556. Fiscal Year 2007 Court of Appeals for Veterans Claims, administered by the Legal Services Corporation National Veterans Legal Services Program $301,729. 8
Blake C. Ortner Senior Associate Legislative Director Paralyzed Veterans of America 801 18 th Street NW Washington, D.C. 20006 (202) 416-7684 Blake Ortner is the Senior Associate Legislative Director with Paralyzed Veterans of America (PVA) at PVA s National Office in Washington, D.C. He is responsible for federal legislation and government relations, as well as budget analysis and appropriations. He has represented PVA to federal agencies including the Department of Labor, Office of Personnel Management, Department of Defense, HUD and the VA. In addition, he is PVA s representative on issues such as Gulf War Illness and homeless veterans, and he coordinates issues with other Veteran Service Organizations. He also served as the disability advisor for the dedication ceremonies of the Korean War Veterans Memorial. He has served as the Chair for the Subcommittee on Disabled Veterans (SODV) of the President s Committee on the Employment of People with Disabilities (PCEPD) and was a member of the Department of Labor s Advisory Committee on Veterans Employment and Training (VETS) and the Veterans Organizations Homeless Council (VOHC). A native of Moorhead, Minnesota, he attended the University of Minnesota in Minneapolis on an Army Reserve Officer Training Corps (ROTC) scholarship. He graduated in 1983 with an International Relations degree and was commissioned as a Regular Army Infantry Second Lieutenant. He was stationed at Ft. Lewis, WA, where he served with the 9 th Infantry Division and the Army s elite 2 nd Ranger Battalion. He left active duty in September 1987. He continues his military service as an Infantry Colonel in the Virginia Army National Guard. From 2001-2002, he served as Chief of Operation for Multi-National Division North for the SFOR 10 peacekeeping mission to Bosnia-Herzegovina, from 2004-2005 he commanded an Infantry Battalion Task Force in Afghanistan earning 2 Bronze Star Medals and from June 2007 to June 2008 he served in Iraq as the Chief of Operations for Multi-National Force Iraq earning a Bronze Star Medal and a Joint Commendation Medal. Additional awards include the Combat Infantryman s Badge, Combat Action Badge, Ranger Tab, Military Free Fall Parachutist Badge and the Parachutist Badge. He currently serves as commander of the 116 th Infantry Brigade Combat Team The Stonewall Brigade. Mr. Ortner resides in Stafford, VA with his wife Kristen, daughter Erika and son Alexander. 9