Senate tees up vote on bill to aid vets exposed to burn pits
A bill enhancing health care and disability benefits for millions of veterans exposed to toxic burn pits is expected to win final approval in the Senate on Tuesday, ending a brief stalemate over the measure that had infuriated advocates and inspired some to camp outside the Capitol. President Joe Biden has pushed for the legislation, saying the measure “makes good on our sacred obligation” to care for veterans and their families. The Senate overwhelmingly approved the legislation once before, but it required a do-over for a technical fix. But the process derailed when Republicans made a late attempt to change another aspect of the bill last week and blocked it from advancing. The abrupt delay outraged veterans groups and advocates, including comedian Jon Stewart. It also placed GOP senators in the uncomfortable position of delaying the top legislative priority of service organizations this session of Congress. A group of veterans and their families have been camping out at the Capitol since that vote. Senate Majority Leader Chuck Schumer, D-N.Y., said he had good news for them, announcing a final vote for Tuesday evening. “Veterans who were exposed to the toxic fumes of burn pits will be treated by the VA like they should have been from the beginning,” Schumer said. Some Democrats have questioned whether Republicans blocked the bill for spite, after an announcement just hours earlier that key Democrats had agreed on a way forward on a health, energy, and tax bill that Republicans oppose and may be unable to stop. “Wait a minute. You’re not going to help our veterans because we want to lower the cost of prescription drugs, because we want to lower the cost of health care, because we want to protect the planet? Of course, you don’t agree with any of those things, but would you use that to vote against our veterans?” House Speaker Nancy Pelosi, D-Calif., said at a press conference last week. “It’s really immoral, almost criminal.” Republican senators rejected that charge and said the changes they seek would not affect spending for veterans in the bill. The bill contains two major components for veterans who served in Iraq and Afghanistan. Veterans who served near burn pits will get ten years — rather than five — of enhanced health care coverage through the Department of Veterans Affairs upon their separation from the military. Second, the legislation directs the VA to presume that certain respiratory illnesses and cancers were related to burn pit exposure, allowing veterans to obtain disability payments to compensate for their injury without having to prove the illness was a result of their service. Roughly 70% of disability claims related to burn pit exposure are denied by the VA due to lack of evidence, scientific data, and information from the Defense Department. The military used burn pits to dispose of such things as chemicals, cans, tires, plastics, and medical and human waste. Hundreds of thousands of Vietnam War-era veterans and survivors also stand to benefit from the legislation. The bill adds hypertension, or high blood pressure, as a presumptive disease associated with Agent Orange exposure. The Congressional Budget Office projected that about 600,000 of 1.6 million living Vietnam vets would be eligible for increased compensation, though only about half would have a severe enough diagnosis to warrant more compensation. Also, veterans who served in Thailand, Cambodia, Laos, Guam, American Samoa, and Johnston Atoll will be presumed to have been exposed to Agent Orange. That’s another 50,000 veterans and survivors of deceased veterans who would get compensation for illnesses presumed to have been caused by their exposure to the herbicide, the CBO projected. The bill is projected to increase federal deficits by about $277 billion over ten years and does not include offsetting spending cuts or tax increases to help pay for it. When the CBO scored the bill, it projected that nearly $400 billion spent on VA services would take place as mandatory spending rather than discretionary spending. The Committee for a Responsible Federal Budget, a nonpartisan fiscal watchdog, said a reclassification to mandatory would “both reduce the pressure to keep those costs under control and make it easier for appropriators to spend more elsewhere in the budget without offsets.” Sen. Pat Toomey, R-Pa., is seeking a vote for an amendment that he said would not change the spending slated for veterans programs but how the government accounts for that spending. However, the dynamics Toomey has spoken about also applied to the bill when the Senate voted on it in June. Senators then voted for the measure by a resounding vote of 84-14, raising questions about why Republicans voted against advancing the do-over effort last week. Advocacy groups for veterans, a key voting bloc in the upcoming midterm elections, were furious and ramped up the political pressure on lawmakers to act. At a Capitol Hill news conference the day after last week’s procedural vote, speakers used terms such as “villains” and “reprehensible” to describe the Republican senators who voted against advancing the measure last week but voted for almost the exact same bill in June. “Veterans are angry and confused at the sudden change from those they thought had their backs,” said Cory Titus of the group Military Officers Association of America. Sen. Kirsten Gillibrand, D-N.Y., said the veterans camped out at the Capitol are exhausted and want to go home. “But they will not. They will not go home until the job is done,” Gillibrand said. Republished with the permission of The Associated Press.
VA requires COVID-19 vaccination for health care workers
The Department of Veterans Affairs on Monday became the first major federal agency to require health care workers to get COVID-19 vaccines, as the aggressive delta variant spreads across the nation and some communities report troubling increases in hospitalizations among unvaccinated people. The VA’s move came on a day when nearly 60 leading medical and health care organizations issued a call for health care facilities to require their workers to get vaccinated. No federal law stands in the way of employers requiring vaccinations, but like mask mandates, the issue has been politicized in a society that’s divided on matters of public health. “With more than 300 million doses administered in the United States and nearly 4 billion doses administered worldwide, we know the vaccines are safe and highly effective at preventing severe illness and death from COVID-19,” Dr. Susan Bailey, immediate past president of the American Medical Association, said in a statement. “Increased vaccinations among health care personnel will not only reduce the spread of COVID-19 but also reduce the harmful toll this virus is taking within the health care workforce and those we are striving to serve.” Although vaccination among physicians is nearly universal — 96% according to an AMA survey — that’s not the case for many other people working at health care facilities. In nursing homes, only about 60% of staffers are vaccinated, compared with about 80% of residents, according to recent numbers from Medicare. And COVID-19 cases are rising. At the VA, vaccines will now be mandatory for certain medical personnel — including physicians, dentists, podiatrists, optometrists, registered nurses, physician assistants, and others who work in departmental facilities or provide direct care to veterans, said VA Secretary Veterans Affairs Secretary Denis McDonough. Employees will have eight weeks to be fully vaccinated. “It’s the best way to keep veterans safe, especially as the delta variant spreads across the country,” McDonough said in a statement. “Whenever a veteran or VA employee sets foot in a VA facility, they deserve to know that we have done everything in our power to protect them from COVID-19. “With this mandate, we can once again make — and keep — that fundamental promise,” he added. It was unclear what would happen to VA employees who refuse to be vaccinated. The agency said vaccination will be required “absent a medical or religious exemption.” The longstanding policy in the health care industry is for staff to stay up-to-date with vaccinations, such as annual flu shots. Exceptions for medical reasons include known allergies. In addition to the AMA, the medical and health care groups calling for mandatory vaccines for health workers included the American Academy of Nursing, the American Public Health Association, the American Pharmacists Association, and, for the first time, a nursing home industry group. LeadingAge, which represents nonprofit nursing homes and eldercare facilities, had previously advocated educating nursing home employees about the benefits of getting their shots. Also joining the call was the National Medical Association, the leading professional group representing Black physicians. “Unfortunately, many health care and long-term care personnel remain unvaccinated,” the groups said in a statement. “We stand with the growing number of experts and institutions that support the requirement for universal vaccination of health workers.” Earlier this year, the U.S. Equal Employment Opportunity Commission said current federal laws do not prevent an employer from requiring employees physically entering the workplace to be vaccinated against COVID-19. The Centers for Disease Control and Prevention has heavily promoted vaccinations as a way to slow the pandemic and save lives. However, the agency has not recommended that state or local officials or employers mandate vaccinations for their employees. “The politics is really tricky because President Biden hasn’t ordered mandatory vaccinations for federal workers,” said Lawrence Gostin, a public health law expert at Georgetown University. “And it would seem hypocritical if CDC made that recommendation” to businesses or state and local officials, he said. A CDC spokeswoman would not comment. To make matters more complicated, the COVID-19 vaccines have yet to win full approval from the Food and Drug Administration. They continue to be provided under emergency use authorization, and the lack of full approval has fed into hesitancy among some people. Still, the FDA’s emergency approval process was thorough and didn’t skip the extensive testing required of any vaccine. Of the three manufacturers of vaccines approved in the U.S., Pfizer and Moderna have applied for full approval, and a Pfizer decision is expected soon. The COVID-19 vaccines were not brewed overnight, either. They were the fruit of more than 10 years of behind-the-scenes research and huge injections of funding that laid the groundwork for them to be rolled out so quickly. Katie Smith Sloan, CEO of LeadingAge, said it’s time to go beyond the power of persuasion. “As COVID-19 variants emerge and proliferate, we can start saving more lives today by ensuring staff are fully vaccinated,” she said. Republished with the permission of the Associated Press.
Donald Trump, 2020 Democrat contenders tout efforts to boost veterans
On Veterans Day, President Donald Trump paid tribute to America’s troops at a New York City parade as top 2020 Democratic candidates outlined their plans for the Department of Veterans Affairs, such as naming a woman to run the agency for the first time. The Democratic proposals, coming two days before historic impeachment hearings, sought to highlight policy differences with the embattled president before a key bloc of voters.“The president has let veterans down,” said Democrat Pete Buttigieg, the 37-year-old mayor of South Bend, Indiana. A former Navy intelligence officer, Buttigieg said female veterans and service members in particular have been neglected, including on concerns about sexual harassment and women’s health. Women are the military’s fastest-growing subgroup. “I think leadership plays a huge role so absolutely I’d seek to name a woman to lead VA,” he said. Trump was the first sitting president to attend New York’s veterans parade, viewing veterans as standing among his biggest supporters. Past presidents have typically spent Veterans Day at Arlington National Cemetery for a ceremonial wreath laying. Trump praised the strength of the U.S. military and the death of Islamic State leader Abu Bakr al-Baghdadi, saying the nation’s veterans “risked everything for us. Now it is our duty to serve and protect them every single day of our lives.” More than 100 protesters booed, some holding black balloons that read “support our troops, impeach.” In a liberal city where Trump is deeply unpopular in spite of his roots there, a nearby building’s soaring windows were adorned with signs reading “IMPEACH” and “CONVICT.” Veterans overall have strongly backed Trump throughout his presidency, though views vary widely by party, gender and age, according to AP VoteCast, a survey of 2018 midterm voters. In particular, younger veterans and women generally were more skeptical of Trump, who received multiple draft deferments to avoid going to Vietnam. Former Vice President Joe Biden, whose late son Beau spent a year in Iraq with the Army, stressed that he would “restore trust” in VA. Taking aim at Trump’s stalled progress in reducing suicide among veterans, Biden pledged to hire more VA staff to cut down office wait times for vets at risk of suicide to zero as well as continuing the efforts of the Obama-Biden administration to stem homelessness. About 20 veterans die by suicide each day, a rate basically unchanged during the Trump administration. Trump earlier this year directed a Cabinet-level task force to develop a broader roadmap for veterans’ suicide prevention, due out next spring. “Our veterans deserve leaders who will fight for them as ardently and as forcefully as they have fought for us,” Biden wrote in a Veterans Day statement with his wife, Jill. In a jab at Trump, Vermont Sen. Bernie Sanders released a video highlighting his role in working with the late Republican Sen. John McCain, a decorated war hero, to pass legislation that included the Veterans Choice program in 2014. Trump routinely takes credit for being the first to enact the Choice program. What he actually got done was an expansion of the program achieved by McCain and Sanders, a former chairman of the Senate Veterans Affairs Committee. Speaking at an event focused on seniors and veterans in Des Moines, Iowa, Sanders pledged to combat efforts to privatize the VA and assured a questioner that he would end the “very ugly practice” of deporting military veterans who are not U.S. citizens. “How cruel is it that when people put their lives on the line to protect us,” they are deported, he said. As president, Sanders promised he would build upon his past legislative efforts by making it easier for veterans to get into the VA system. He joins Buttigieg and Massachusetts Sen. Elizabeth Warren in urging increases in doctor pay to attract top VA candidates and fill 49,000 VA positions that have sat vacant as the Trump administration promoted private health care options. During a Veterans Day speech in Rochester, New Hampshire, Buttigieg reflected on his own military path, while taking some digs at Trump. “Having seen the outrage of Americans willing to put their lives on the line for this country having their careers threatened by a president who avoided his own chance to serve, yes, we are going to end the transgender military ban right away,” Buttigieg said. He added later in the speech that the VA needs to be depoliticized. “We’re going to have five-year terms for key positions so that decisions are made based on what is best for veterans and not based on whoever last spoke to the president during a golf game or made the right campaign contribution,” Buttigieg said. During a campaign stop in southeast Iowa, Biden noted that he carries with him every day the totals of those who have died as a consequence of wars in Iraq and Afghanistan. As of Monday, he told about 200 people at a private college in Oskaloosa, the total had reached 6,900. “Every single one of those fallen angels leave a broken community behind,” he said. Tens of thousands more, however, have returned home with post-traumatic stress disorder, Biden said. “They are in trouble and they deserve every single thing we can give them,” he said. Yen reported from Washington. Associated Press writers Alexandra Jaffe in Des Moines, Iowa, Tom Beaumont in Oskaloosa, Iowa, and Zeke Miller in New York contributed to this report. By Hope Yen and Hunter Woodall Associated Press. Republished with the permission of the Associated Press.
Senate confirms Robert Wilkie for Veterans Affairs secretary
The Senate on Monday confirmed Pentagon official Robert Wilkie to be secretary of Veterans Affairs, charged with delivering on President Donald Trump’s campaign promises to fire bad VA employees and steer more patients to the private sector. Wilkie won approval on a bipartisan vote of 86-9, securing the backing of many Democrats after insisting at his confirmation hearing that he will not privatize the government’s second-largest department. It was a moment of respite from the sharp political divisions engulfing Trump’s other nominees in the final months before congressional midterm elections. Wilkie is Trump’s third pick for the job in 18 months. The longtime public official says he will “shake up complacency” at VA, which has struggled with long waits in providing medical treatment to millions of veterans. In a statement released by the White House, Trump applauded the confirmation vote and said he looked forward to Wilkie’s leadership. “I have no doubt that the Department of Veterans Affairs will continue to make strides in honoring and protecting the heroic men and women who have served our nation with distinction,” he said. Trump selected Wilkie for the post in May after firing his first VA secretary, David Shulkin, amid ethics charges and internal rebellion at the department over the role of private care for veterans. Trump’s initial replacement choice, White House doctor Ronny Jackson, withdrew after allegations of workplace misconduct surfaced. Wilkie, a former assistant secretary of defense under President George W. Bush, has received mostly positive reviews from veterans’ groups for his management experience, but the extent of his willingness to expand private care as an alternative to government-run VA care remains largely unknown. Trump last year pledged he would triple the number of veterans “seeing the doctor of their choice.” Currently more than 30 percent of VA appointments are made in the private sector. Under repeated questioning at his hearing, the Air Force and Navy veteran said he opposed privatizing the agency of 360,000 employees and would make sure VA health care is “fully funded.” When pressed by Sen. Jon Tester, the top Democrat on the panel, if he would be willing to disagree with Trump, Wilkie responded “yes.” “I have been privileged to work for some of the most high-powered people in this town,” said Wilkie, currently a Pentagon undersecretary for Defense Secretary Jim Mattis. “They pay me for their opinions, and I give those to them.” Wilkie’s main task in the coming months will be carrying out a newly signed law to ease access to private health providers. That law gives the VA secretary wide authority to decide when veterans can bypass the VA, based on whether they receive “quality” care, but the program could face escalating costs. Some Democrats have warned the VA won’t be able to handle a growing price tag, putting it at risk of budget shortfalls next year. Major veterans’ groups want full funding for core VA medical centers, which they see as best-suited to veterans’ specialized needs such as treatment for post-traumatic stress. As VA secretary, Wilkie also will have more power under a new accountability law to fire VA employees. Lawmakers from both parties have recently raised questions about the law’s implementation, including how whistleblower complaints are handled and whether the law is being disproportionately used against rank-and-file employees rather than senior managers who set policy. “The tone has been set by President Trump on the direction of VA reforms,” said Dan Caldwell, executive director of the conservative Concerned Veterans for America. “There have been a tremendous number of bills passed in the last year and half, and all will require a lot of work to make sure they are properly implemented.” Republican Sen. Johnny Isakson of Georgia, chairman of the Senate Veterans Affairs Committee, praised Wilkie as “eminently qualified,” saying he will “bring stability and leadership” to VA. Wilkie served as acting VA secretary after Shulkin’s firing in March, before returning to his role as Pentagon undersecretary. He will replace current acting VA secretary Peter O’Rourke, who clashed with the VA inspector general after refusing to release documents relating to VA whistleblower complaints and casting the independent watchdog as an underling who must “act accordingly.” Under pressure from Congress, the VA agreed last week to provide documents to the IG. Republished with the permission of the Associated Press.
Donald Trump’s goosey claims on trade, jobs
President Donald Trump is using some goosey numbers to rationalize his aggressive rhetoric on trade, disregarding strong points in U.S. competitiveness to paint a dark portrait of a world taking advantage of his country. Conversely, he’s glossing over aspects of the economy that don’t support his faulty contention that it’s the best it’s ever been. The complexities of health care for veterans are also set aside as he hails a new era in the Department of Veterans Affairs’ system. A look at some of his statements over the past week and the reality behind them: TRUMP: “Why isn’t the European Union and Canada informing the public that for years they have used massive Trade Tariffs and non-monetary Trade Barriers against the U.S. Totally unfair to our farmers, workers & companies. Take down your tariffs & barriers or we will more than match you!” — tweet Thursday. TRUMP: “Farmers have not been doing well for 15 years. Mexico, Canada, China and others have treated them unfairly. By the time I finish trade talks, that will change. Big trade barriers against U.S. farmers, and other businesses, will finally be broken. Massive trade deficits no longer!′ — tweet Monday. THE FACTS: Whatever his beef with farm trade with specific countries, he’s wrong in suggesting U.S. agriculture runs a trade deficit. The U.S. exports more food products than it imports, running a $17.4 billion surplus last year. It’s long been a bright spot in the trade picture and it’s why many U.S. farmers are worried about losing markets as Trump retreats from, renegotiates or disparages trade deals. U.S. farmers do brisk business with the three countries he complains about in the tweet, two of them under the umbrella of the North American Free Trade Agreement, which Trump is threatening to leave if it’s not recast to give the U.S. greater advantage. The U.S. exported $20.5 billion in agricultural products last year to Canada, the largest market for U.S. farmers. That made for a modest deficit of $1.8 billion. The U.S. exported $18.6 billion in farm goods to Mexico, running a deficit of $6 billion. The U.S. has a lopsided advantage with China on farm goods, in contrast to manufactured products. It sold $21 billion in agricultural products to China in 2016, for a surplus of $16.7 billion. The Agriculture Department says exports of food products have grown “steadily over the last two decades.” Trump’s unrelievedly negative view of the EU may be grounded in a substantial trade deficit with the continent, but his administration’s trade office takes a longer and more benevolent view of the relationship. “Two-way U.S.-EU trade has been roughly balanced over time,” says the U.S. Trade Representative’s Office, “and the very high levels of foreign investment accounted for by each in the other’s markets means that the transatlantic economy is arguably the most integrated on Earth.” ___ TRUMP: “The EU trade surplus with the U.S. is $151 Billion.” — tweet Thursday. THE FACTS: He’s wrong about the trade deficit with the EU. As he usually does, Trump ignored trade in services in his calculation. The U.S. is more competitive in services than in goods overall, and services are a big part of the trade equation. The U.S. saw a $153 billion trade deficit in goods with the EU last year, but a surplus in services brought the actual trade deficit with the union down to $101 billion. ___ TRUMP: “Best Economy & Jobs EVER, and much more.” — tweet Monday referring to achievement in his first 500 days in office. THE FACTS: May’s unemployment rate of 3.8 percent is not the best ever. And the economy has seen many periods of stronger growth. The lowest unemployment rate since World War II was reached in 1953, when it averaged 2.9 percent, almost a full point lower than today. The job market is certainly strong, with unemployment at an 18-year low, and if it drops another tenth of a point, it’ll be the lowest since 1969. Yet the jobless rate was at or below 4 percent for four straight years back then, from 1966 through 1969, and wages were rising more quickly. The cost of items such as college and health care was much lower then. Overall the economy has yet to show it can sustain growth in excess of 3 percent, as Trump has promised. In the 1990s boom, still the longest on record, the U.S. economy expanded at an average annual pace of 4.3 percent for five years, from 1996 through 2000. In the 1980s, growth averaged 4.6 percent annually from 1983 through 1987. While the economy has picked up from 2016, its best showing since Trump took office was 3.2 percent in last year’s third quarter. ___ TRUMP: “Separating families at the Border is the fault of bad legislation passed by the Democrats. Border Security laws should be changed but the Dems can’t get their act together! Started the Wall.” — tweet Tuesday. THE FACTS: No law mandates that parents must be separated from their children at the border, and it’s not a policy Democrats have pushed or can change alone as the minority in Congress. Children are probably being separated from the parents at the border at an accelerated rate because of a new “zero tolerance policy” being put in place by Trump’s own administration. Announced April 6 by Attorney General Jeff Sessions, the policy directs authorities to prosecute all instances of illegal border crossings, even against people with few or no previous offenses. Administration officials are quick to note that Sessions’ policy makes no mention of separating families. That is correct. But under U.S. protocol, if parents are jailed, their children are separated from them because the children aren’t charged with a crime. So while separating families might not be official U.S. policy, it is a direct consequence of Sessions’ zero-tolerance approach. According to U.S. Customs and Border Protection, more than 650 children were separated from parents at the border during a two-week period in May. ___
The doctor is in: White House physician nominated to lead VA
President Donald Trump fired Veterans Affairs Secretary David Shulkin and nominated White House doctor Ronny Jackson to replace him following a bruising ethics scandal and a mounting rebellion within the agency. A Navy rear admiral, Jackson is a surprise choice to succeed Shulkin, a former Obama administration official and the first nonveteran to head the VA. Trump had been considering replacing Shulkin for weeks but had not been known to be considering Jackson for the role. In a statement, Trump praised Jackson as “highly trained and qualified.” It was a decision that signaled Trump chose to go with someone he knows and trusts, rather than choosing a candidate with a longer resume, to run a massive agency facing huge bureaucratic challenges. Shulkin said he was undone by advocates of privatization within the administration. He wrote in a New York Times opinion piece that they “saw me as an obstacle to privatization who had to be removed.” He added: “That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.” Jackson has served since 2013 as the physician to the president, one of the people in closest proximity to Trump day in and day out. His profile rose after he conducted a sweeping press conference about the president’s medical exam in January in which he impressed Trump with his camera-ready demeanor and deft navigation of reporters’ questions as he delivered a rosy depiction of the president’s health, according to a person familiar with the president’s thinking but not authorized to discuss private conversations. Jackson eagerly embraced the idea of moving to the VA, according to a White House official who spoke on condition of anonymity to discuss personnel matters. Ironically, it was Shulkin who had recommended Jackson for an undersecretary position at the agency in fall. Jackson was vetted during that time on his policy positions and other issues, the official said. The promotion of Jackson marks the latest Trump hire to be driven at least as much by personal familiarity with the president as by his vision for the role at government’s second-largest department, responsible for 9 million military veterans in more than 1,700 government-run health facilities. Brig. Gen. Dr. Richard Tubb, who trained Jackson, said in a letter read at Jackson’s briefing that the doctor had been attached like “Velcro” to Trump since Inauguration Day. “On any given day,” he wrote, “the ‘physician’s office,’ as it is known, is generally the first and last to see the President.” A White House official said Shulkin was informed of his dismissal by chief of staff John Kelly before the president announced the move on Twitter on Wednesday. A major veterans’ organization expressed concern over Shulkin’s dismissal and Trump’s intention to nominate Jackson, whom they worried lacked experience to run the huge department. “We are disappointed and already quite concerned about this nominee,” said Joe Chenelly, the national executive director of AMVETS. “The administration needs to be ready to prove that he’s qualified to run such a massive agency, a $200 billion bureaucracy.” Rep. Phil Roe, chairman of the House Veterans Affairs Committee, said he believed Shulkin did a “fantastic job” and didn’t think he should have been dismissed, but “at the end of the day, Cabinet secretaries serve at the pleasure of the president.” “I respect President Trump’s decision, support the president’s agenda and remain willing to work with anyone committed to doing the right thing on behalf of our nation’s veterans,” said Roe, a Republican from Tennessee. Shulkin is the second Cabinet secretary to depart over controversies involving expensive travel, following Health and Human Services Secretary Tom Price’s resignation last September. Trump said in a statement he is “grateful” for Shulkin’s service. Shulkin had agreed to reimburse the government more than $4,000 after the VA’s internal watchdog concluded last month that he had improperly accepted Wimbledon tennis tickets and that his then-chief of staff had doctored emails to justify his wife traveling to Europe with him at taxpayer expense. Shulkin also blamed internal drama at the agency on a half-dozen or so rebellious political appointees, insisting he had White House backing to fire them. But the continuing VA infighting and a fresh raft of watchdog reports documenting leadership failures and spending waste — as well as fresh allegations that Shulkin had used a member of his security detail to run personal errands — proved too much of a distraction. It was the latest in a series of departures of top administration officials, including Secretary of State Rex Tillerson and national security adviser H.R. McMaster. The VA change comes as Trump is trying to expand the Veterans Choice program, fulfilling a campaign promise that major veterans’ groups worry could be an unwanted step toward privatizing VA health care. His plan remains in limbo in Congress. Having pushed through legislation in Trump’s first year making it easier to fire bad VA employees and speed disability appeals, Shulkin leaves behind a department in disarray. Several projects remain unfinished, including a multibillion-dollar overhaul of electronic medical records aimed at speeding up wait times for veterans seeking medical care as well as expanded mental health treatment for veterans at higher risk of suicide. Trump selected Robert Wilkie, undersecretary of defense for personnel and readiness, to serve as the acting head of the VA. Republished with the permission of the Associated Press.
UA study to take ‘deep dive’ into risk factors for veterans, suicides
University of Alabama researchers, America’s Warrior Partnership and The Bristol-Myers Squibb Foundation have partnered on a $2.9 million study to explore risk factors that contribute to suicides, early mortality and self-harm among military veterans. “Operation Deep Dive,” funded by the Bristol-Myers Squibb Foundation, aims to create better understanding of the risk factors, particularly at the organizational and community level. Drs. Karl Hamner, director of the Office of Evaluation for the College of Education, and David L. Albright, Hill Crest Foundation Endowed Chair in Mental Health and associate professor in the School of Social Work, are the principal investigators for UA on the study. Innovative new approach Recent research has shown that neither PTSD nor combat exposure is a good predictor of veterans and suicide, so researchers must cast a wider net, Hamner said. “Previous research has focused primarily on individual-level risk factors, like prior suicide attempts, mood disorders, substance abuse and access to lethal means, but suicide is a complex phenomenon, and those factors don’t paint the whole picture,” Albright said. The study is innovative in that it focuses on veterans across the spectrum of service, gender and lifespan, using data from America’s Warrior Partnership and the U.S. Department of Veterans Affairs, new data collected during the study, and data from the Department of Defense. For instance, female veterans, who are 2.5 times more likely to commit suicide than civilian women, will be spotlighted in the study. Both the DOD and the VA will be vital in identifying veterans with varying medical histories, combat experiences and discharges from military services. America’s Warrior Partnership will also help fill the gaps in identifying veterans who don’t fit criteria for VA benefits, like National Guard or Reserve personnel who aren’t activated, or anyone who has a dishonorable discharge, which could be for a variety of reasons. “The scope of this study is timely and so needed that we really believe we can move the needle,” Hamner said. A better understanding The first phase of the study is a five-year retrospective investigation of the DOD service use and pattern of VA care utilization to examine the impact of less-than-honorable discharges on suicides and suspected suicides, and the differences in suicides between those who receive and do not receive VA services. “Helping to identify the trends or predictors of veterans’ suicide could help immensely in reducing suicide rates and provide much-needed interventions for this community,” says John Damonti, president of the Bristol-Myers Squibb Foundation. “This project will take a deep dive to better understand what was happening at the community level to design better, more targeted intervention programs.” The second phase will incorporate these findings into a three-year study that will include input from medical examiners, mental health experts, veterans, family members and the community to conduct a “sociocultural autopsy” of all new or suspected suicides in America’s Warrior Partnership’s seven partnership communities, as well as in comparison communities. The results will explore how community context and engagement affect prevention of suicides in veterans and why some former service members commit suicide, while others do not. “The overarching goal of the study is to understand triggers of suicide in order to prevent potential suicides before they occur,” said Jim Lorraine, president and CEO of America’s Warrior Partnership. “With each organization bringing its own areas of expertise and data, we can make a difference in the lives of our nation’s warriors, particularly the most vulnerable veterans.” Both Hamner and Albright are committee chairs for the Alabama Veterans Network, or AlaVetNet, which connects Alabama veterans to resources and services. Alabama Gov. Kay Ivey recently signed Executive Order 712, which tasks the group in helping reduce and eliminate the opioid crisis as well as reducing the high veteran suicide rate. This story originally appeared on the University of Alabama’s website. Republished with permission from the Alabama NewsCenter.
John McCain demands accounting from VA on money for private care
Sen. John McCain is demanding a full accounting from the Department of Veterans Affairs on the financial status of its private-sector health care program after the agency said it could face another budget shortfall as soon as December. The Associated Press reported this week that the VA had acknowledged its Veterans Choice program could run out of money by year’s end despite receiving $2.1 billion in emergency funding just last month. Another shortfall could force the VA to limit referrals to outside doctors, causing delays in medical care for hundreds of thousands of veterans. In a letter to VA Secretary David Shulkin, McCain, who chairs the Senate Armed Services Committee, said he wants to know specifically when the VA expects Choice to run out of money. McCain cites AP’s report, which included a statement from VA that Choice funds could be depleted as early as December or as late as March. The letter, sent late Wednesday, calls for a VA response by the end of the week. The Arizona Republican noted that Congress was led astray earlier this year after VA provided false assurances that Choice funds would last until early 2018. After Shulkin admitted to a budget shortfall in June, McCain joined other senators to express concern to VA about possible financial mismanagement. Congress ultimately approved $2.1 billion in emergency spending for Choice that was intended to last until February. “We said at the time that it was essential, given the growing demand for care under the Choice program, that the VA immediately correct the failures that created such a serious shortfall,” McCain wrote. “It appears as if you have not done so.” In its statement earlier this week to AP, the VA said it hoped to move quickly on a proposed long-term legislative fix that would give veterans even wider access to private doctors. The proposal, under review by the White House budget office, would seek money to keep Choice running for much of next year as VA implements wider changes. Earlier this year, the VA began limiting referrals to outside doctors as money started running low. The Choice program was passed by Congress in 2014 in response to a wait-time scandal at the Phoenix VA medical center that spread nationwide. Some veterans died while waiting months for appointments as VA employees manipulated records to hide delays. The controversy spurred Congress to establish Choice as a pilot program to relieve pressure at VA hospitals. Republished with permission from the Associated Press.
Agreement reached on stalled VA accountability bill
Congressional Republicans and Democrats have reached agreement on a bill to make it easier for the Department of Veterans Affairs to fire its employees, part of an accountability effort touted by President Donald Trump. The deal being announced early Thursday could smooth the way for final passage on an issue that had been largely stalled since the 2014 wait-time scandal at the Phoenix VA medical center. As many as 40 veterans died while waiting months for appointments as VA employees created secret waiting lists and other falsehoods to cover up delays. The Hill deal followed a fresh warning from the VA inspector general’s office of continuing patient safety problems at another facility, the VA medical center in Washington D.C. After warning of serious problems there last month, the IG’s “rapid response” team visited the facility again on Wednesday and found a patient prepped for vascular surgery in an operating room, under anesthesia, whose surgery was postponed because “the surgeon did not have a particular sterile instrument necessary to perform the surgery.” The team also found “surgical instruments that had color stains of unknown origin in sterile packs,” according to the IG’s letter sent Wednesday to the VA. The IG again urged the department to take immediate action to ensure patients “are not placed at unnecessary risk.” The new accountability measure, led by Sen. Marco Rubio, R-Fla., softens portions of a bill that had passed the House in March, which Democrats criticized as unfairly harsh on workers. Sens. Jon Tester of Montana and Johnny Isakson of Georgia, the top Democrat and the Republican chair on the Senate Veterans’ Affairs Committee, agreed to back the new bill after modifications that would give VA employees added time to appeal disciplinary actions. House Veterans Affairs’ Committee Chairman Phil Roe, sponsor of the House measure, said he would support the revisions. “To fully reform the VA and provide our nation’s veterans with the quality care they were promised and deserve, we must ensure the department can efficiently dismiss employees who are not able or willing to do their jobs,” Rubio told The Associated Press. It comes after Trump last month signed an executive order to create a VA Office of Accountability and Whistleblower Protection, with an aim of identifying “barriers” that make it difficult for the VA to fire or reassign bad managers or employees. VA Secretary David Shulkin had urged the Senate to act quickly to pass legislation. The GOP-controlled House previously approved an accountability bill mostly along party lines. Rep. Tim Walz, D-Minn., argued the House should embrace language instead from a bipartisan bill by Isakson from last year with added due process protections for workers. The Senate bill to be introduced Thursday adopts several portions of that previous Isakson bill, including a longer appeal process than provided in the House bill — 180 days vs. 45 days, though workers would not be paid during that appeal. VA executives would be held to a tougher standard than rank-and-file employees for discipline. The Senate bill also codifies into law the VA accountability office created under Trump’s order, but with changes to give the head of the office more independent authority and require the office to submit regular updates to Congress. Conservative groups praised the bill. “These new measures will disincentivize bad behavior within the VA and further protect those who bravely expose wrongdoing,” said Dan Caldwell, policy director of Concerned Veterans for America, pointing to a “toxic culture” at VA. The agreement comes in a week in which Senate Democrats are standing apart from Trump on a separate issue affecting veterans, the GOP bill passed by the House to repeal and replace the nation’s health care law. Sen. Tammy Duckworth, D-Ill., warned the House measure would strip away explicit protections to ensure that as many as 8 million veterans who are eligible for VA care but opt to use private insurance would still receive tax credits. Many veterans use a private insurer if they feel a VA facility is too far away, or if they don’t qualify for fuller VA coverage because they have higher incomes or ailments unrelated to their time in service, said Duckworth, a combat veteran who lost her legs and partial use of her right arm during the Iraq war. A group of GOP senators is working to craft their own health bill. “Trumpcare threatens to rip health care out of their hands,” Duckworth said at a news briefing this week. “The question left is what will Senate Republicans do?” Congress has had difficulty coming to agreement on an accountability bill after the Phoenix VA scandal. A 2014 law gave the VA greater power to discipline executives, but the department stopped using that authority after the Obama Justice Department deemed it likely unconstitutional. Critics have since complained that few employees were fired for various VA malfeasance, including rising cases of opioid drug theft, first reported by the AP. Republished with permission of The Associated Press.
VA limiting new hiring as it aims to widen private care
Despite the lifting of a federal hiring freeze, the Department of Veterans Affairs is leaving thousands of positions unfilled, citing the need for a leaner VA as it develops a longer-term plan to allow more veterans to seek medical care in the private sector. The order by VA Secretary David Shulkin is described in an internal April 14 memorandum obtained by The Associated Press. The VA indicated it would proceed with filling open positions previously exempted under the hiring freeze. Noting that the White House had ordered all departments to be leaner and “more accountable,” the VA indicated that more than 4,000 jobs would still be left vacant unless they were specially approved “position by position” by top VA leadership as addressing an “absolute critical need.” These positions include roughly 4,000 in the VA’s health arm and 200 in benefits, plus more than 400 information technology positions and over a 100 human resource positions, according to VA data provided to the Senate Veterans Affairs Committee earlier this month. Government auditors have previously faulted the department for recent shortages in IT and HR, which it said had hurt its ability to recruit and hire key staff department-wide. Major veterans organizations also worry this could be a sign of future tightening at the VA, coming after the department had previously warned it would need “hiring surges” to address a rapidly growing disability backlog. The groups have cautioned against any “privatization” efforts at the VA that could expand private care for veterans while reducing investment in the VA itself. “It seems to be a reversal of what they have been saying, and it’s disappointing,” said Garry Augustine, executive director of Disabled American Veterans’ Washington headquarters. Carlos Fuentes, legislative director of Veterans of Foreign Wars, said his group was concerned the VA would overlook positions that didn’t directly affect health care, such as staffing of its suicide prevention hotline. The VA said in a statement Wednesday that the hiring restrictions were needed to “streamline VA’s corporate structure and administrative positions.” While President Donald Trump‘s budget blueprint calls for a 6 percent increase in VA funding, the memo indicated that the government’s second-largest agency with nearly 370,000 employees was no different from other departments that needed to improve “efficiency, effectiveness and accountability.” It left open the possibility of “near-term” and “long-term workforce reductions.” Shulkin is also putting together a broader proposal by fall to expand the VA’s Choice program of private-sector care. “This memo lifts the federal hiring freeze. However, this does not mean business as usual for hiring,” stated VA chief of staff Vivieca Wright Simpson. She said VA leadership aimed to proceed in the coming months with “deliberative hiring strategies” as it seeks to build “a future VA of Choice.” The memo comes as the Trump administration seeks to highlight accomplishment and accountability at the VA. During the 2016 campaign, Trump repeatedly criticized the VA as “the most corrupt” and pledged to expand private care. Trump planned to sign an executive order Thursday at the VA to create a new Office of Accountability and Whistleblower Protection. The head of the office will report directly to the secretary to help VA officials identify “barriers” that impede the reassignment of employees who are no longer deemed fit to work at the department in the service of veterans, Shulkin said at a White House briefing. Existing employees will staff the office. Shulkin said he didn’t have an exact figure on what the office would cost. Shulkin also has signaled, without naming specific locations, that underutilized VA facilities will have to close. “There are some parts of the country where facilities are sitting empty, and there is no sense in keeping them empty,” he has said. The Republican-led House last month approved legislation to make it easier for the VA to fire, suspend or demote employees for poor performance or bad conduct. But the measure has been slow to move in the Senate after Democrats and unions cast it as an attack on workers’ rights. Republished with permission of the Associated Press.
Senate agrees to extend VA’s program of private-sector care
The Senate on Monday approved legislation that would extend a troubled program aimed at widening veterans’ access to private-sector health care, the first step in an overhaul of programs at the Department of Veterans Affairs. The bill passed by voice vote. It would allow the VA to continue operating its Choice program until its money runs out, expected to occur early next year. Without legislation, the program will expire on Aug. 7 with nearly $1 billion left over in its account. The VA says that money can provide stopgap care until a broader revamp is designed. The Choice program was put in place after a 2014 wait-time scandal at the Phoenix VA medical center in which some veterans died. Intended to provide veterans more timely care, the Choice program allows veterans to go outside the VA network in cases where they had to wait more than 30 days for an appointment or drive more than 40 miles to a facility. Yet it often encountered long wait times of its own due to bureaucratic glitches and other problems. The Senate bill calls for fixes in the program to address some of those concerns, by helping speed up VA payments and promote greater sharing of medical records. It now goes to the House, which was expected to easily pass the measure Wednesday. “This bipartisan legislation cuts some of the red tape that slows down veterans’ access to care in their communities,” said Montana Sen. Jon Tester, the top Democrat on the Senate Veterans’ Affairs Committee. “I’m proud that Republicans and Democrats in Congress worked together to provide these solutions for veterans.” Tester sponsored the bill along with Republican Sens. John McCain of Arizona and Johnny Isakson of Georgia. Major veterans’ organizations and Democrats were not opposed to continuing the Choice program as a stopgap. But they are closely watching the VA’s subsequent overhaul, after President Donald Trump‘s transition team signaled last year that it would consider a “public-private” option in which veterans could get all their medical care in the private sector, with the government paying the bill. Veterans groups generally oppose that as a threat to the viability of VA medical centers. While VA Secretary David Shulkin has promised not to privatize the department, he says he wants to build stronger partnerships with the private sector to improve VA care. A newly formed White House Office of American Innovation led by Trump’s son-in-law, Jared Kushner, is also now examining ways to improve the VA. Republished with permission of The Associated Press.
Martha Roby introduces legislation to offer veterans better resources
Veterans receiving mental health care and substance abuse treatment through the Department of Veterans Affairs stand to gain a powerful new ally under legislation introduced by Alabama 2nd District U.S. Rep. Martha Roby. H.R. 1712, the Protection and Advocacy for Veterans Act, would empower state and local Protection and Advocacy agencies to directly investigate the quality of mental health care and substance abuse treatment provided to veterans at the VA and allow these agencies to advocate for patients found to be receiving inadequate care. Protection and Advocacy agencies monitor the quality of state-operated hospitals, clinics, psychiatric wards, prisons, and other facilities. Their agents have the authority to inspect medical records and take legal action on behalf of patients when necessary. Roby’s bill would authorize funding for a pilot program testing the feasibility of utilizing Protection and Advocacy agencies to provide this service at the VA. “For 40 years, Protection and Advocacy agencies in Alabama and around the country have provided a critical service by monitoring the quality of care in state-operated hospitals, clinics, and other facilities,” said Roby in a news release. “I believe bringing this degree of expertise in patient advocacy to the VA would greatly benefit veterans, particularly those in need of mental health care or substance abuse treatment.” Roby continued, “In recent years, Congress has boosted funding for mental health care services and enacted legislation making it easier for the VA to attract mental health care professionals. This is a step in the right direction, but I believe we can do better. We owe it to our veterans to bring all available resources to bear to ensure access to proper treatment.” Roby’s bill has been referred to the House Committee on Veterans Affairs. Watch Roby discuss her new bill below:
