Thursday, February 16, 2012

Stand up Maya!





President Barack Obama, don't threaten veterans. That was the message of House Veterans Affairs Committee Chair Jeff Miller this morning. What was he talking about? He was noting that other departments know whether or not sequestration would effect them but VA doesn't. In 1985, the Congress passed the Gramm-Rudman-Hollings Budget Act. If the budget triggers sequestration, then automatic cuts would take place. Chair Miller explained that they had repeatedly attempted to get a clear answer from the White House on this issue but that they still had no answer. "If the president won't lead on this issue," Chair Miller declared, "then we will."
It was a lively hearing. So much so that all overshadowed Miller's opening remarks.
The hearing was about the 2013 budget and two panels appeared before the Committee. The first panel was Secretary of Veterans Affairs Eric Shinseki (with the VA's Robert Petzel, Allison Hickey, Steve Muro, Roger Baker and Todd Grams). Paralyzed Veterans of America's Carl Blake, VFW's Ramond Kelley, Disabled American Veterans' Joseph Violante, AMVETS Diane Zumatto and the American Legion's Timothy Tetz. We'll note the second panel in tomorrow's snapshot and focus on the first panel today. The White House has put out their trial budget. The House Veterans Affairs Committee was focusing on the budget in terms of veterans issues.
Chair Jeff Miller: In the -- in the current budget submission, it has a billion dollars for Veterans Job Corps. We all are keenly aware of the high number of unemployed veterans in our country today. And not a single member of this Committee nor this Congress should be in any way satisifed with that number. And we have tried to do things in this Commitee to help bring those numbers down. My concern is there's no detail in the budget submission. Where did the number one billion dollars come from? You know, it was chosen to be provided in your entitlement accounts to be dispensed over a five year period. And so I think we all benefit from a conversation, Mr. Secretary, as to who's going to be focused on, what area of the veteran population, how's it going to work and what will happen to these jobs once the funds run out?
Secretary Eric Shinseki: Mr. Chairman, the proposal for the Veterans Job Corps, the $1 billion piece of that, is a program that we're seeking Congressional authorization on and we are putting together the details of that which we would provide to you and you would have a chance to review. I would say that the intent here is to put up to 20,000 veterans back to work over the next five years on projects that will protect and restore our public lands. Projects would be in national parks, forests, rivers and trails, wild life refuge, national monuments, other public lands. Veterans could work on park maintenance projects, patrolling public lands, rehabilitating natural and recreational areas and in administrative, technical, law enforcement-related activities. The Veterans Job Corps program is a project that's going to be coordinated with other departments and we are a -- sort of a oversight of the distribution of funds but there are others who will be participating. I'm told that uh -- and I'm confident that uh VA resources won't be diverted to fund this $1 billion that it will come from elsewhere. And I don't know exactly where at the moment. But, Mr. Chairman, I'll share that with you as soon as I have clarity.
And we'll note, from his written statement about the Veterans Job Corps, "The program will serve all Veterans, but will have a particular focus on post-9/11 Veterans." So the 20,000 jobs are not guaranteed to veterans of today's wars. I'm not saying they should be but I am saying 20,000 wasn't, to me, an impressive number, and became less so when it was going to address not only the largest unemployed veterans population (young veterans of today's wars) but all veterans. US House Rep Corrine Brown would bring up the issue of contracts and outsourcing and asking why every contract the VA outsourced didn't have a clause in it about hiring veterans? Not really an answer. "You're not answering the question," Ranking Member Bob Filner pointed out to the VA's Allison Hickey as she went on about how one contract has seen a company hire 15% veterans and how they have conversations with contractors. Filner pointed out that Brown's question was why didn't they mandate this in the contract, why have conversations when you should be writing it into the contract? Hickey attempted to reply but Shinseki took over.
Secretary Eric Shinseki: Mr. Filner, we'll take a look at this.
Ranking Member Bob Filner: Oh, come on, you can give me some kind of answer. Are you saying we can't do it legally?
Secretary Eric Shinseki: I don't know. I don't know the answer to that question.
Ranking Member Bob Filner: She must know the answer [gesturing to Hickey]. I mean, come on. This is not rocket science here. You issue contracts 100 times a day. Why can't we have contracts that do this?
Secretary Eric Shinseki: You can. And I don't know the circumstances of this contract. And I would --
Ranking Member Bob Filner: But she apparently does. Why didn't we do it here?
Allison Hickey: So, Congressman, I will go back to our physician folks to ask --
Ranking Member Bob Filner: Oh, come on. You guys know the answer to this. Why are you so afraid to just tell us?
Secretary Eric Shinseki: I'm not sure it wasn't in the contract, Mr. Filner. That's why --
Ranking Member Bob Filner: Well she's sure --
Allison Hickey: Congressman --
Ranking Member Bob Filner: You started off your testimony, "I know the contract." So did it specify or not?
Allison Hickey: I will find out and get back to you for the record --
Ranking Member Bob Filner: I don't understand this. You know this better than you're saying here.
US House Rep Corrine Brown then noted that one of the biggest complaints she gets is that VA does billions of dollars of work and they're not doing it with veterans, they're not hiring them and this at a time when so many veterans are unemployed. Brown noted employment elsewhere in the hearing as well. US House Rep and Dr. Roe raised the issue of the large number of suicides and shared that one thing he's hearing from veterans is that they're doing well in one-on-one sessions and then they're moved on to groups and that's not working. "These needs aren't being met in large group settings," he explained. The short answer is that the VA is currently evaluating with plans to increase in the numbers hired where needed.
US House Rep Corrine Brown: Sir, I have a follow up on that, you said can we hire -- are we not -- are we trying to hire all those people or are we working with other agencies as far as subcontracting out? Because we're not going to be able to hire enough people. He talked about the group setting, some people can benefit from the group setting, everbody don't need that one-on-one but some people do. So based on the resources, how can we better utilize the dollars to meet the needs?
Dr. Robert Petzel: Thank you, Congressman Brown. We do contract in the community. We do provide on a fee basis mental health care. And as the Secretary was just pointing out to me a new modality that's becoming increasingly important is tele-mental health where we provide both evaluation and therapy in a tele-health setting -- where the patient may be remotely, a hundred miles away. They're on a television screen with an appropriate supervisor and the psychiatrist or psychologist is back at a larger medical center. It has been very successful in treating PTSD and other mental health disorders. And I think that this is going to become a more common practice as we move forward.
FYI, Petzel called every female House Rep, throughout the hearing, "Congressman." Maybe here we'll call him "Mrs. Dr. Petzel" in the future?
Last week, Senator Patty Murray, Chair of the Senate Veterans Affairs Committee, participated in a Virtual Town Hall, an online Town Hall which allowed her and veterans all over the country to interact. The Virtual Town Hall was sponsored by Disabled American Veterans and a full transcript of the exchange can be found here. Various veterans participating in the Virtual Town Hall noted the delays and backlog with regards to claims -- not surprising, over 500,000 claims are currently backlogged according to the VA's Allison Hickey testimony in today's hearing. Senator Murray observed, "I receive so many complaints from veterans and their families about long waits for claims. I visited the Seattle Regional Office a few months ago and was astounded at the mountain of paper work and had the opportunity to really see what we are facing. I am working hard to try and help the VA get a handle on this. We do have to recognize that the claims are increasingly complex and there are more of them with the number of service members coming home today. We want them to be done efficiently but correctly. This will remain a top priority for me." And in today's hearing, Ranking Member Bob Filner touched on the issues of backlog and Agent Orange.
Ranking Member Bob Filner: And I just want to ask a couple -- focus on a couple areas that I've been involved with over the years. One is the claims backlog. In your budget presentation ou title it "Eliminate The Claims Backlog." But I don't see any real estimate or projection or anything of when you think you're going to do that but I still think that -- in the short run, at least -- to get this turned around your notion of -- I think you used the word "brute force" a few years ago, if I recall that.
Secretary Eric Shinseki: It was probably a poor choice of words.
Ranking Member Bob Filner: No, it's okay. It was good. Gives me something to shoot at, you know? I don't think it's going to work. I just think all this stuff you have is good stuff but it's too big and, as you point out, there's all kind of factors making it bigger. I still think you have to take some, I'll say, radical step in the short run -- whether it's to grant all the Agent Orange claims that have been submitted or have been there for X number of years or, as I've suggested at other times, all claims that have the medical information in it and have been submitted with the help of a Veterans Service Officer you accept subject to audit. That is, unless you take some real radical step to eliminate a million of them or 500,000 of them, you're never going to get there. It's going to always be there. You don't want that as your legacy -- I don't think. So -- Nor do we. I think you're going to have to take some really strong steps in terms of accepting stuff that's been in the pipeline a long time, again, that has adequate -- by whatever definition -- documentation and help from professional support. Plus this incredible situation of Agent Orange where, as you know, not only have those claims increaded but we're talking about -- as you well know -- your comrades for thirty or more years that have been wrestling with this. Let's give the Vietnam vets some peace. Let's give them a real welcome home. Let's grant those Agent Orange claims. Let's get those -- whatever it is, 100,000 or 200,000 of our backlog -- just get them off the books. I don't know if you want to comment on that but I still think you're never going to get there with -- All this is good stuff. We've talked about it on many occasions. But it's not going to fundamentally -- or at least in the short run change it around so you can get to a base level of zero or whatever you want to be and move forward from there.
Secretary Eric Shinseki: Mr. Filner, I'll call on Secretary Hickey for the final details but we've pretty much worked through the Agent Orange -- the increase in Agent Orange claims. I think we're well down on the numbers. I'll rely on her statistic here.
Many other issues were touched on. We'll note the exchanges on women veterans.
Ranking Member Bob Filner: The House passed a bill that I had put forward a year or two ago called a Women's Veterans Bill of Rights. It got through the House, it got stuck in the Senate. [He's referring to HR 809 which he introduced in the 111th Congress and which the Senate didn't pass. He reintroduced HR 809 in the new Congress in February of 2010.] I would just ask that you look at that. You can do stuff administratively. You could post something in each of our centers and clinics. We have a long way to go on this but women veterans need to feel that this institution is evolving to meet their needs. And a statement at the front door of their rights, I think, would be very helpful. So I would just ask you to look at that. We didn't do it legislatively but I think you could do some stuff administratively.
Shinseki replied that women veterans' issues in the proposed budget increased by 17%. Dropping back to his written statement, he gives 8% as the number women make up in VA's total population, women are "nearly 15 percent of today's active duty military forces and 18 percent of National Guard and Reserves." 337,000 women access care through VA and, "The 2013 budget includes $403 million for the gender-specific healthcare needs of women Veterans, an increase of 17.5 percent over the 2012 level." Later in the hearing, US House Rep Linda Sanchez would raise the issue of women veterans and we'll jump to her exchange.
US House Rep Linda Sanchez: Secretary Shinseki, I recently had the opportunity to visit the Patient Alligned Care Center at the Long Beach VA facility and I want to applaud the efforts there to provide an integrated system of care. But one of the things that's been brought to my attention is the levels of staffing for the new models that will be put in place. I heard from doctors, nurses and other pracitioners to discuss how thinly they feel they are being stretched in this new system. And it's a system that they want to see succeed. They're employed there because they believe in the mission, they want to provide the service. But I'm wondering if you could maybe go into a little bit of detail as to how the $433 million that is proposed for patient-centered care -- how that will go towards staffing to make sure that we have the staff availble to meet the needs of those veterans.
Secretary Eric Shinseki: I'm going to call on Dr. Petzel for the details.
US House Rep Linda Sanchez: Sure.
Dr. Robert Petzel: Thank you, Mr. Secretary. Congressman Sanchez, when we implemented the PAC [Patient Aligned Care] program, several years ago, the first thing that we did was a survey of what we call PAC readiness. One of which was to determine how many support people there were in place for each one of the providers in a PAC clinic. The desirable ratio agreed to in the entire health care community is 3 people per provider. We found that there were places that were reaching that goal and then others that weren't. One of the major things that has been involved in the PAC model financing has been to provide the medical centers with -- and the clinics with -- the number of people that they need to support the provider. I will look specifically at Long Beach and I can, in fact, get back to you. But our goal -- and we're very close to it as I understand -- is to have 3 support people per provider in each one of our clinics.
US House Rep Linda Sanchez: Okay because I hear stories about staffing being stretched and no new hires or people leave and are not replaced. And so the concern is to have the appropriate amount of people available to provide the services that are needed. And I would appreciate you following up with me about that. To the Secretary, I know that you and I have previously discussed some of my concerns -- specifically with respect to the VA employing female specialists to assist specifically female veterans with VA services. And I know that the administration's budget contains $403 million to address the needs of women veterans. I'm wondering if you can tease that out a little bit and provide more specifics on how that money will be used to address the growing needs of the female veteran population?
Secretary Eric Shinseki: Uh, thank you, Congresswoman. I'm going to call on Dr. Petzel for the details but this is confirmed that you and I have had discussions about this.
US House Rep Linda Sanchez: Yes.
Dr. Robert Petzel: I thank you, Mr. Secretary. Uh, the -- our goal is to ensure that every female veteran has a choice of providers and that, if they wish to, they will be able to be seen by a female provider. About 75% of women choose to have a female provider. And we are able to meet that need in virtually every setting except perhaps some remote community-based outpatient clinics where we just don't have those sort of uh facilities. I can, for the record, give you the details about how much staffing -- what kind of staffing is to be associated with the $403 million increase we're seeing in women's health programs. I don't have that number at the tip of my fingers but it is important to us as I'm sure it is to you that women have a choice, that if they wish to see a female provider, they are afforded that opportunity.
US House Rep Linda Sanchez: Yeah, one of the things on my tour of the Long Beach facility is that they do have a sort of separate women's clinic area where women can choose that to be their point of entry to the system.
Dr. Robert Petzel: About sixty of our largest medical centers have specific women's centers, women's health centers where all of the services are provided in that same environment. The rest of them are sort of associated with women specific primary care clinics when they're not as large. And then, in community based outpatient clinics we have trained the primary care providers in the necessities of women's health.
Homelessness was touched on by US House Reps Corrine Brown and Dr. Phil Roe. We're ignoring that for two reasons. 1) Roe brought up that once a case worker has X number of clients, the VA isn't issuing vouchers so even though there is space a veterans left sleeping on the street or somewhere else (he or she receives no voucher). Shinseki noted that homeless veterans were decreasing. Are they? Or is this program -- which tracks beds used in shelters -- not factoring in that veterans aren't receiving vouchers if their caseworker is maxed out? That's not addressed and until it is, I'm not interested in going into the figures. 2) What we do know is that one group of homeless veterans is increasing and it's not the stereotype of the homeless veteran. Earlier this week, Peggy McCarthy (The Day) reports on homeless veterans. Andy and Miriam Miranda live with their young son in a New Haven shelter. Andy's a veteran, they both have degrees and were teachers and their home was foreclosed during these economic hard times. McCarthy reports an emerging trend for homeless veterans is that it's no longer a single veteran but families. Connecticut saw 15 veterans family appealing for help via the homeless programs in 2008 but last year saw 135 families which mirrors what's happening on a national level (2010 saw "an 86 percent increase over 2009"). This increasing group -- homeless veterans with their femilies -- was not addressed in the hearing. The VA budget calls for "$1.352 billion for programs that will prevent and treat Veteran homelessness" (Shinseki's written statement) and I'm fine with noting that figure but, repeating, if VA is saying that the number of homeless veterans is decreasing and US House Rep Roe is telling us -- without any dispute from Shinseki or anyone from the VA on the panel -- that homeless people are being turned away when beds are available, that they're not being given vouchers, then I think the VA needs to clarify how they're collecting their numbers.

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