Retiree & Veteran Affairs News 24 March 2015
“A LOT OF PEOPLE don’t realize that since 2010, defense has been cut 18 percent. It’s actually 24 percent if you count the effects of inflation. Defense is now 16 percent of the federal budget, and yet it has had to absorb 50 percent of the cuts under the Budget Control Act. And the world is not 18 or 24 percent safer now than it was when the Budget Control Act passed.” Rep. Mac Thornberry, R-Texas, Chairman, House Armed Services Committee, March 16, 2015.
Way to go, Rep. Thornberry!
MCHUGH ON BUDGET: ‘WE NEED TO STOP TALKING, START ACTING’ “We must have an end to sequestration this year,” Secretary of the Army John M. McHugh testified Tuesday before the House Armed Services Committee. “We need to stop talking and start acting.”
McHugh and Army Chief of Staff Raymond T. Odierno testified along with other service leaders before the House panel that largely supports an end to sequestration and a rise in defense spending over the caps set in 2011.
There is nothing new in an anti-sequestration message from Army leaders but the warnings are becoming more frantic. McHugh calls sequestration “an enemy here at home” and warns Army personnel levels, already considered by many to be too low, “will be reduced to unconscionable levels” if Congress fails to prevent or reduce the sequestration. Cuts, if they happen, would begin in January.
“Our Army, your Army, faces a dark and dangerous future unless the Congress acts now to end these ill- conceived and inflexible budget cuts,” Hugh said. “I want to be very clear here: every installation, every component, and nearly every program will feel the brunt of these cuts.”
The Army needs a minimum of 980,000 soldiers, McHugh said. That would be 450,000 active-duty troops, 335,000 in the Army Guard and 195,000 in the Army Reserve.
Under sequestration, the Army could end up with only about 25 percent of the force considered combat-ready, down from already low 33 percent measured today, Odierno said. The Army needs to be 70 percent combat ready, a process that requires money for equipment and spare parts, and money and time for training, Odierno said.
“If something bigger happens, we will not be able to respond in the way people expect of us,” Odierno said.
HOUSE REPUBLICANS have unveiled a spending plan that uses a budgetary gimmick to get the Defense Department more money, but not everyone is sold.
The idea from the House Budget Committee would result in a $617 billion defense budget for fiscal 2016, including the base budget and overseas contingency operations funding, without technically breaching the $523 billion defense cap set in the 2011 Budget Control Act. This is roughly equal to what President Obama requested, and would be about $38 billion over the 2015 budget.
The White House budget provided the extra money to defense by breeching the 2011 budget caps. The House Budget Committee plan technically follows the 2011 limits because it holds the base budget to $523 billion but increases the overseas contingency budget from the $51 billion requested by the White House to $94 billion. The total ends up about $1 billion more than the Obama budget.
The additional funds would be set aside in a reserve fund to be spent on things not in the base budget but not directly tied to overseas contingency operations. “It is vital that we ensure robust funding for national defense while maintaining overall fiscal discipline. In our budget, we do so by prioritizing our national defense and the needs of our men and women in uniform – providing resources through the creation of the Defense Readiness and Modernization Fund,” the committee explained.
It did not take long for members to weigh in. Rep. Mac Thornberry, R-Tex., chairman of the House Armed Services Committee said he would have preferred to boost base budget accounts rather than relying heavily on the OCO budget to make up for any shortfall in defense spending.
Rep. Michael R. Turner, R-Ohio, said that the use of war accounts is a "surrender" to sequestration. "That doesn't provide the consistency level that is necessary for the Department of Defense," he said.
Thornberry and thirty-one other GOP members of the Armed Services Committee Republicans urged the Budget Committee to set national defense funding at $577 billion for fiscal 2016, about $54 billion more than the mandated spending limits and $16 billion above the Obama administration’s request. That figure did not include $51 billion for OCO.
Before the resolution was even released, Chairman of the Senate Armed Services Committee John McCain called the budget resolution’s OCO a “gimmick.”
It appears the push-back from defense hawks worked. Facing the prospect of an open revolt, the House Budget Committee is poised to adopt an amendment that adds more money to the defense account. While their move may satisfy the defense hawks, it may rile the fiscal conservatives.
WITH JUST A WEEK AWAY from the budget committees starting to write tax and spending plans, there is no agreement on how to end sequestration, no agreement on increasing defense spending and not even an agreement on the president’s modest plan to slightly raise defense spending caps. Most Democrats don't want to protect defense spending unless domestic programs are also protected. Republicans are divided about whether defense spending should be increased at all.
Senate Armed Services Chairman John McCain, R-Ariz., said that he will not vote for his chamber’s budget resolution unless it raises defense spending.
McCain told CQ Roll Call that he expects to mark up a fiscal 2016 defense authorization at spending levels that exceed the caps imposed by sequestration. “We’re going to go past them. I will not have the responsibility on my hands of passing an authorization bill through the committee that puts the lives of our men and women in the military at risk,” McCain said.
IN RESPONSE TO A REQUEST from Congressional leaders, AUSA and its partners in The Military Coalition have outlined our position on recommendations made by the Military Compensation and Retirement Modernization Commission.
Several of the Commission’s recommendations we support; however, the two that would significantly overhaul the current retirement and health care benefit leave many unanswered questions. Accordingly, until we get all of our questions answered and we analyze the proposals further, we cannot support them. A major concern is what effect these major changes could have on the current and future force and their families.
IS THERE FINALLY AN END TO THE DOC FIX? Sen. Ron Wyden, D-Ore., the ranking member of the Senate Finance Committee hopes there is. Wyden said that instead of another temporary patch, the House is negotiating legislation that would permanently replace Medicare’s physician payment formula.
Without a permanent solution or another patch, the cuts of about 21 percent will take effect April 1.
In 1997, Congress created the Sustainable Growth Rate or SGR, in order to control Medicare spending by tying it to the rest of the economy’s growth. It worked fine until health care costs started outpacing the economy. The “doc fix” refers to short-term patches Congress passes to keep the amount paid to physicians who treat Medicare beneficiaries stable. Because payment rates in the TRICARE program are tied to Medicare rates, this affects many military beneficiaries and is a concern to AUSA.
In a statement, Sen. Wyden said, “I’ve been in Congress long enough to be skeptical of rumors, but what we are hearing from the House suggests there is real movement to fully repeal and replace the flawed formula for paying Medicare providers known as SGR.”
“If what we’re hearing is true, it’s good news and moves us closer to something I’ve been working tirelessly to achieve – a payment formula that stands on its own, doesn’t require annual, and expensive ‘patches,’ and which opens the door to improving the way care is delivered,” Wyden added.
The good news is tempered by comments House Ways and Means Chairman Paul Ryan, R-Wis., recently made to attendees at a hospital conference. Ryan said that there isn't consensus on how to pay for a permanent repeal and that Congress “will have to buy time” and pass another short-term bill to avert the cuts.
NEW LEGISLATION SPOTLIGHT on a bill that would permit retired members of the Armed Forces who have a service-connected disability rated less than 50 percent to receive full concurrent receipt of both retired pay and veterans' disability compensation, including Chapter 61 disability retirees with less than 20 years of service.
Introduced by Senate Minority Leader Harry Reid, D-Nev., S.271 addresses a long-time AUSA goal. Testimony recently offered to the House and Senate Veterans’ Affairs Committees by AUSA Vice President for Education LTG Guy Swan, USA, Ret., urged that the disability offset be eliminated completely.
“The principle behind eliminating the disability offset for those with disabilities over 50 percent is just as valid as those 49 percent and below,” Swan said.
We strongly believe that military members earn their retired pay by service alone, and that those unfortunate enough to suffer a service-caused disability in the process should have any VA disability compensation from the VA added to, not subtracted from their service-earned military retired pay.
AN AUSA SALUTE goes to Senate Armed Services Committee Chairman John McCain, R-Ariz., and the ranking member Jack Reed, D-R.I., for recognizing the devastating effect sequestration is having on the Defense Department.
In a letter to the Senate Budget Committee leadership, McCain and Reed wrote, “It is difficult to overstate the destructive impact on our military that has been wrought by the BCA with sequestration, which requires nearly $1 trillion of defense spending cuts over ten years. While the Bipartisan Budget Act of 2013 provided welcome relief from some of the worst effects of sequestration for FY 2014 and 2015, that relief was partial, temporary, and ultimately did little to provide the kind of certainty that our defense and military leaders need to plan effectively for the future and make longer-term investments for our national security. The effects of these arbitrary spending cuts have been devastating to the capabilities, readiness, morale and modernization of our armed forces.”
Question of the Day: Has sequestration impacted your professional or personal life? That’s the topic of discussion on AUSA’s Firing Line. Please visit this link and let us know. Our ability to provide real-life consequences to Congress bolsters our case for ending sequestration.
The bottom line of the McCain/Reed letter: The Defense Department needs more money to avoid a “national security crisis of the first order.” How much more? $577 billion, plus whatever is needed for war accounts, which are not capped by law and which for fiscal 2016 would amount to $50.9 billion under the president’s budget proposal. That amount is considerably more than the $561 billion requested by the president’s budget request and higher than the $523 billion cap in the budget law.
JOINT HEARINGS held every year by the House and Senate Veterans’ Affairs Committees give AUSA and other service organizations the opportunity to present their legislative agendas. AUSA Vice President Lt. Gen. Guy Swan, USA, Ret., provided testimony for the joint hearing scheduled to be held this week.
In his statement, Swan said, “The inherently difficult nature of military service has never been more self-evident than during the recent and current conflicts. AUSA considers veterans benefits to have been duly earned by those who have answered the nation’s call and placed themselves at risk – these are not “entitlements.”
Swan added, “As elected representatives, you must be responsible stewards of the federal purse because each dollar emanates from the American taxpayer. AUSA emphasizes that the federal government must remain true to the promises made to her veterans. We understand that veterans’ programs are not above review, but always remember that the nation must be there for the country’s veterans who answered the nation’s call.”
§ Has long endorsed a 21st century GI Bill that is built on the principles of simplicity, equity and adequate reimbursement of the cost of education/ training. Accordingly, we urge Congress to hold hearings regarding a unified architecture for all GI Bill programs for active duty, Guard and Reserve under the principle of awarding benefits according to length and type of duty performed.
§ Encourages Congress to raise education benefits for National Guard and Reserve servicemembers under Chapter 1606 of Title 10.
§ Urges that the thousands of disabled veterans left out of the concurrent receipt of retired pay and veterans’ disability compensation legislation be given equal treatment and that the disability offset be eliminated completely.
§ Believes that a member who is forced to retire short of 20 years of service because of a combat disability must be “vested” in the service-earned share of retired pay at the same 2.5 percent per year of service rate as members with 20+ years of service.
§ Supports continuing congressional efforts to help homeless veterans find housing and other necessities, which would allow them to re-enter the workforce and become productive citizens.
THESE GOALS and other issues related to veterans were among the topics discussed at a Veteran Leadership Roundtable held by the Republican leadership last week.
Veterans’ Committee Chairman Rep. Jeff Miller told AUSA’s Assistant Director for Government Affairs Julie Rudowski and other representatives from military and veteran’s service organizations that he is determined to hold the VA “accountable” for its actions with regards to veteran health care.
Miller also expressed concern that the new VA Choice Card program was not properly “rolled-out” by the VA and that confusion still exists within the veteran population.
The Veterans Access, Choice, and Accountability Act of 2014, signed into law by the president in August 2014, required the VA to establish a temporary program to improve veterans’ access to health care by allowing eligible veterans to use eligible health care providers outside of the VA system.
Miller also discussed the disability claims backlog. He said that just because the VA has removed the case from their rolls, it doesn’t mean the case is closed. If a veteran is still waiting for a benefit, his case is still part of the backlog.
AUSA VICE PRESIDENT LT. GEN. GUY SWAN, USA, RET., attended a congressional roundtable on military and veteran’s issues led by House Minority Leader Nancy Pelosi and Rep. Tim Walz, D-Minn., and attended by several other Democratic leaders.
Swan and other association leaders were able to voice their concerns and lay out their top issues to the congressional leaders on topics such as the devastating impact of sequestration, recommendations by the Military Compensation and Retirement Modernization Commission and the provisions of the fiscal 2016 DoD budget.
NEW LEGISLATION INTRODUCED by Reps. Rob Wittman, R-Va., and Matt Cartwright, D-Pa., would help military spouses more easily re-enter the workforce by offering a tax credit to any spouse who has to renew or transfer a professional license due to a military Permanent Change of Station (PCS) order.
The Military Spouses Job Continuity Act (H.R. 1100) would provide a tax credit of up to $500 when a military family moves across state lines and would be applicable for the renewal or transfer of a professional license in a range of fields including child care, nursing and health services.
Similar legislation was introduced in the Senate by Bob Casey, D-Pa.
House and Senate Committees Pass Controversial Budgets
Politics is the way things work in Washington, D.C., so when we write about what is happening in Congress we do our best explain the politics of the issues in a neutral way. Since the Republicans are now in control of both the House and the Senate, what happens among the Republicans is key to what legislation will or will not pass.
In the elections last year, Republicans promised, among other things, to balance the budget within ten years and to stop the dysfunction in Congress and run it like it is supposed to be run. They are now in the process of seeing if they can keep those promises.
In our previous update we told you about the FY2016 budgets that both the House and the Senate would be working on last week. Here is what has happened as of the time this is written.
On Thursday morning of last week the House Budget Committee passed its FY2016 budget on a party-line vote. According to an article in the Politico newspaper, “Speaker John Boehner (R-Ohio) and other GOP leaders, in an effort to win support for the budget resolution from defense hawks, want to pump tens of billions of dollars in new funds into the “Global War on Terror” without reducing spending elsewhere, a move that would increase the deficit.”
Because it would increase the deficit, fiscal conservatives in the Republican House caucus refused to support the initial plan. As a result, House Speaker John Boehner and his leadership team decided to go with second plan that moved “… the resolution through the Budget panel first without the additional defense money, and then add the Pentagon funding back via the Rules Committee, before the proposal hits the House floor… .”
So in order to try and get a budget passed that would satisfy the two groups in their caucus, the Republican leadership passed a balanced budget that did not increase defense spending through the Budget Committee. Next, the Rules Committee, which has the authority to do virtually anything during the course of consideration of a measure, including rewriting parts of a bill, will add in the additional defense spending. The bill will then go to the floor of the House to be voted on. So while the bill will not technically violate the Budget Control Act, it will add additional spending that is not paid for, at least in its entirety, and will add to the budget deficit.
Here is how a report in Bloomberg described what happened: “While the budget proposes keeping the fiscal 2016 spending caps set by the 2011 Budget Control Act, Public Law 112-25, it attempts to circumvent those limits by increasing the overseas contingency operations account, which funds war operations, to $94 billion. Of that, $19.5 billion would be contingent on finding offsets. The White House has requested $58 billion in war funding. In later years, the budget plans for increasing the defense caps and reducing non-defense discretionary spending. By 2021, defense spending would be $45 billion above what the law would now allow and non-defense spending would be $84 billion below the law’s limit.”
After the vote, House Budget Committee Chairman Tom Price (R-Ga.) released this statement: “The House Budget Committee has taken a strong step forward in addressing the nation’s fiscal and economic challenges.” He continued, “The committee’s approval of our balanced budget proposal follows months of honest discussion and debate by our members in consultation with our colleagues in the House to put forth a package of positive solutions.”
However, another Republican said this: “I’m really struggling with the $90 billion” in the contingency fund, said Representative Mick Mulvaney (R-S.C.), who is a co-founder of a group of House fiscal conservatives who call themselves the Freedom Caucus.
“Off-budget is the wrong way to spend taxpayer money,” Mulvaney said. “You are breaking the law -- not the letter but the spirit,” he said, by not considering such spending to be an increase because it isn’t subject to budget caps.
And still another Republican said, “I do not want a budget that uses budgetary tricks to appear strong on national defense, but is actually leaving our warfighters $20 billion short,” Rep. Doug Lamborn (R-Colo.) said in a statement. “I hope that Chairman Price reconsiders and finds a way to make all of the OCO funding real dollars.”
According to Politico, passing a spending plan is also a basic test of whether GOP leaders can even run their conference.
“For 53 of the last 60 years, the federal government has spent more than it has taken in — 53 of the last 60 years. It’s unacceptable,” Boehner said. “To this day, now in his seventh year in office, the president has never proposed a budget that balances. Our budget will balance, but it’s also about growing our economy, growing jobs and building economic strength for our future.’”
Also last Thursday the Senate Budget Committee passed its FY2016 budget. According to Bloomberg, that plan “… would maintain spending levels set by the Budget Control Act of 2011 for defense, starting at $523 billion in 2016 and rising to $549 billion in 2018. The idea is to create a separate ‘reserve fund,’ forcing Congress to later reach a deal to increase spending on defense. But the costs would have to be offset with other cuts in the budget so that it does not add to the deficit over a decade — no easy task.
“That differs sharply from a House Republican plan drafted by Georgia Rep. Tom Price, which calls for an increase in defense spending to $574 billion in 2017 and $599 billion in 2018. But the House does an end run around the budget caps by proposing $94 billion in emergency spending in 2016 to fight the war against terrorism, a plan critics in both parties deride as a gimmick. The Senate budget plan caps emergency overseas contingency funding at $58 billion.
The Senate plan also “… calls for $5.1 trillion in spending cuts in order to balance in 10 years. Most of the deficit reduction would come from $4.2 trillion in cuts to entitlement programs over the decade and by holding military spending to the caps in the 2011 Budget Control Act, Public Law 112-25.”
An amendment was added during the deliberations by Senator Lindsey Graham (R-S.C.) that would increase defense spending in 2016 by $36 billion, which matches the amount leaders in the House hope to add to their budget.
Graham’s amendment would pay for the increase by cutting assumed defense spending after 2021. However, Graham said the budget that was passed does not go far enough to overhaul costly entitlement programs.
Graham was quoted elsewhere as stating, “The real debate comes from people who are going to run for president on our side — [they need to] lay out a plan of what they will do to come up with the long-term unfunded liabilities,” Graham said. “The retirement of the baby boomers is as much of a threat to our livelihood as foreign terrorism.” [emphasis ours]
This week the respective budgets are scheduled to go to the floors of the House and Senate for debate. But because they are so controversial it remains to be seen if either body can pass their budget before they leave Washington for their two week spring break.
So to summarize, in order to pass a balanced budget, but also increase defense spending, not raise taxes, and not end the mandatory budget cuts required by sequestration (the Budget Control Act) the Republican majorities in the House and Senate Budget Committees have passed budgets that reduce spending and keep within the requirements of the Budget Control Act (BC). But in order to increase defense spending, the House wants to add $94 billion to the overseas contingency fund, which funds war operations primarily in Afghanistan, but also now in Iraq and other places. That money does not count against the requirements of the BCA but it would increase the deficit.
The Senate would increase defense spending also, but not as much as the House. It also does not put as much money into the overseas contingency fund, but it creates a new “reserve fund” which would increase defense spending. In order to offset that new spending it would cut the amount of money it thinks the defense budget would be spending in 2022.
We support ending sequestration in order to fully fund the defense budget. The additional money that the House and Senate would put into the overseas contingency fund would not give DoD the kind of help it needs because those funds are limited in how they can be spent.
We realize this is very complicated, but what happens with these budgets is critical with regard to the spending decisions Congress makes this year. They could have a major impact on the pay and benefits of active duty military, retirees, veterans and survivors.
We will be following these developments very closely and continue fighting to protect the hard earned benefits of all military personnel.
HVAC Chairman Calls for Firings in VAMC Denver Fiasco
Last week Chairman of the House Veterans' Affairs Committee Jeff Miller called for the Department of Veterans' Affairs' Construction Principal Executive Director Glenn Haggstrom and VA Office of Construction and Facilities Management Executive Director Stella Fiotes to be fired when it became known that the construction of the new VA Medical Center in Denver, Colorado was going to be more than $1 billion over budget.
Additionally, Chairman Miller is citing the authority that Congress gave the Secretary of the VA in the Veterans Access, Choice and Accountability Act to rescind the bonuses given to all VA officials who were in charge of construction projects in Denver, Las Vegas, New Orleans and Orlando. All of those projects are hundreds of millions of dollars over budget and years behind schedule.
We are supportive of legislation introduced by Congressman Mike Coffman (R-CO) that would make the Army Corps of Engineers responsible for finishing the VAMC in Denver, rather than the VA itself.
The delays and cost overruns are an unconscionable waste of taxpayer resources. Further, delaying the delivery of much-needed services to America's veterans is just another example of VA failing to carry out its mission.
VA Eliminates Net Worth as Factor in Determining Health Care Eligibility
Currently, VA combines a veteran’s income and assets when making income-based eligibility determinations for health care benefits and copayment obligations. Effective 2015, VA will only consider a veteran’s gross household income and deductible expenses from the previous year when making such determinations. This change will expand health care access to low-income veterans and reduce out-of-pocket costs for thousands of veterans. VA estimates that 190,000 veterans will become eligible for reduced health care costs over the next five years. To read more about this change, visit: http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2684
VA Accepting Applications for 2015 National Golden Age Games
This year’s National Golden Age Games will take place in Omaha, Neb., from August 8 to August 12, 2015. The event encourages participants to make physical activity a central part of their lives, and supports VA’s comprehensive recreation and rehabilitation therapy programs. Competitive events include air rifle, badminton, bowling, cycling, dominoes, track and field, golf, horseshoes, nine ball, shuffleboard, swimming, and table tennis. VA will be accepting applications through May 15, 2015. To learn more about this event, visit: www.veteransgoldenagegames.va.gov
Eight MIAs Identified
The Defense POW/MIA Accounting Agency has announced the identification of remains belonging to eight servicemen who had been missing and unaccounted for from World War II, Korea and Vietnam. Returned home are:
- Army Air Forces 2nd Lt. Harry B. McGuire, 718th Squadron, 449th Bomber Group, 15th Air Force, lost over Italy on Jan. 30, 1944.
- Army Air Forces 2nd Lt. Edward F. Barker, Headquarters Squadron, 8th Air Service Group, lost over Papua New Guinea on Sept. 30, 1944.
- Army Air Forces 2nd Lt. Alvin Bleethe, 393rd Fighter Squadron, 367th Fighter Group, 9th Air Force, lost over Germany on Nov. 26, 1944.
- Army Air Forces 2nd Lt. Stephen V. Biezis, 575th Bombardment Squadron, 391st Bombardment Group, 9th Air Force, lost over Germany on Dec. 23, 1944.
- Army Air Forces 2nd Lt. John W. Herb, 1st Air Division, 359th Fighter Group, 368th Fighter Squadron, lost over Germany on April 13, 1945.
- Army Sgt. Wallace J. Dawson, Company L. 3rd Battalion, 9th Infantry Regiment, 2nd Infantry Division, lost in South Korea on Feb. 14, 1951.
- Air Force Chief Master Sgt. Edwin E. Morgan, 6252nd Combat Support Group, lost over Laos on March 13, 1966.
- Army Staff Sgt. Bunyan D. Price Jr., 2nd Battalion, 34th Armor Regiment, 1st Cavalry Division, lost in Vietnam on May 2, 1970.
Vets' Fellowships Available
Veterans who are within two years of finishing graduate degrees, or prevented from finishing such degrees because of service obligations, could qualify for a government-sponsored fellowship. Launched by Secretary of State John F. Kerry in October 2013, the Veterans Innovation Partnership provides successful applicants with a path to building networks that would foster careers in foreign affairs. Activities include forging opportunities in U.S. government foreign-affairs agencies, as well with public and private employers. The application deadline is March 27. Applications received by March 20, the first cut-off date, will receive first consideration. To apply, visit www.vipfellowship.org on the Web.
Bill Would Facilitate Long-Term Care
Veterans would gain increased access to long-term health care, under a measure now pending before the Senate. The bill, sponsored by Sens. Joe Manchin, D-W.Va., and John Hoeven, R-N.D., would allow veterans to use their VA benefits to cover costs of staying in nursing homes near their communities. Private extended-care providers presently can offer services to veterans, but many such facilities have been prevented from doing so because of red tape. The measure would eliminate such obstacles by allowing VA to make agreements with long-term care facilities along the same easier terms the government enters with private facilities that provide services for Medicare and Medicaid recipients. A comparable bill, sponsored by Reps. Jackie Walorski, R-Ind., and Tulsi Gabbard, D-Hawaii, is pending before the House.
Groundbreaking Device Being Tested By VA May Put End to Pressure Ulcers
Pressure ulcers (commonly known as bed sores) are one of the most troublesome and painful complications for patients during a long hospital stay, but a joint project between the Department of Veterans Affairs (VA) Center for Innovation and General Electric (GE) Global Research may one day make pressure ulcers a thing of the past. A multi-disciplinary team of scientists have combined an array of sensing and analytical tools, including motion analysis, thermal profiling, image classification/segmentation, 3-D object reconstruction and vapor detection into a single medical sensing handheld probe to assess and monitor the progression of bed sores or pressure ulcers. The device is currently in pilot testing at the Augusta, Georgia, VA Medical Center Spinal Cord Injury Unit. The probe integrates multiple sensing capabilities with analytics and user support features to more acutely measure pressure ulcer formation and/or to determine if an ulcer is healing. “The collaboration with GE is another example of the innovative work VA is doing with our private sector colleagues to advance the science of health care for our Veterans,” said Dr. Carolyn Clancy, VA’s Interim Under Secretary for Health. “We are pleased to work with GE to pilot a technology that holds the promise of revolutionizing the protocol for preventing and treating painful bed sores. We know that if patients are not turned on a regular basis, they can develop bed sores during their hospital stay as pressure builds up on their skin. By combining physical inspection with the technology capable of allowing real-time monitoring, we may be able to prevent ulcers from forming or advancing. This innovation is about providing the best care to our Veterans and collaborations like this one with GE helps us do just that.” Individuals with spinal cord injuries with loss of sensation and mobility are particularly at risk for developing pressure ulcers. In U.S. hospitals alone, an estimated 2.5 million patients per year develop pressure ulcers, which require treatment. “Pressure ulcers are a very pervasive, but also very preventable condition for hospital patients,” said Ting Yu, GE’s Principal Investigator on the pressure ulcer prevention and care program. “The device can help detect the earliest signs of ulcer formation. It also provides a more objective and comprehensive assessment of the wound to understand its progression. We’re now testing this device with VA in a clinical setting to see if it provides the kind of information that will help hospitals reduce and one day eliminate pressure ulcers from developing with patients.” For other notable innovative VA research initiatives visit http://www.research.va.gov/ ###
VA Eliminates Net Worth as Health Care Eligibility Factor
The Department of Veterans Affairs is updating the way it determines eligibility for VA health care, a change that will result in more Veterans having access to the health care benefits they’ve earned and deserve. Effective 2015, VA eliminated the use of net worth as a determining factor for both health care programs and copayment responsibilities. This change makes VA health care benefits more accessible to lower-income Veterans and brings VA policies in line with Secretary Robert A. McDonald’s MyVA initiative which reorients VA around Veterans’ needs. “Everything that we do and every decision we make has to be focused on the Veterans we serve,” said VA Secretary Robert A. McDonald. “We are working every day to earn their trust. Changing the way we determine eligibility to make the process easier for Veterans is part of our promise to our Veterans.” Instead of combining the sum of Veterans’ income with their assets to determine eligibility for medical care and copayment obligations, VA will now only consider a Veteran’s gross household income and deductible expenses from the previous year. Elimination of the consideration of net worth for VA health care enrollment means that certain lower-income, non-service-connected Veterans will have less out-of- pocket costs. Over a 5-year period, it is estimated that 190,000 Veterans will become eligible for reduced costs of their health care services. In March 2014, VA eliminated the annual requirement for updated financial information. VA now uses information from the Internal Revenue Service and Social Security Administration to automatically match individual Veterans’ income information which reduces the burden on Veterans to keep their healthcare eligibility up to date. That change better aligned VA’s health care financial assessment program with other federal health care organizations. Veterans may submit updated income information at www.1010ez.med.va.gov/, or by visiting their nearby VA health care facility. For more information, visit www.va.gov/healthbenefits or call VA toll-free at 1-877-222-VETS (8387).
Against a Deadline to Fix Medicare/Tricare Payments to Doctors
We have written in the past about the “doc fix,” which is short hand for the broken payment system that the Medicare program has been operating under since 1997. Included in the Balanced Budget Act of that year was the creation of the Medicare Sustainable Growth Rate (SGR), which is a formula for determining physician payments for services, given to Medicare patients. The formula was supposed to ensure that the yearly increase in the expense per Medicare beneficiary does not exceed the growth in the nation’s GDP.
However, the SGR quickly proved unworkable and for years Congress has been enacting temporary “fixes.” To offset the cost of these fixes, other providers — including in the long-term care sector — have seen reimbursements slashed.
TREA is concerned with this issue because Tricare payments are tied to the Medicare payments and doctors who won’t take Medicare patients will not take Tricare patients either. This is an increasing problem as more and more doctors are deciding not to take any new Medicare/Tricare patients, or even continue to see the Medicare/Tricare patients they now have.
The current short-term fix expires at the end of this month. If Congress doesn’t act, doctors will receive more than a 20 percent cut in what they are paid for treating Medicare patients.
Last week it was reported that leaders in the House of Representatives from both parties are negotiating to try and find ways to permanently replace the SGR formula. Just in case Congress can’t craft a permanent solution in the next two weeks, the negotiators also are discussing a three-month “doc fix,” according to aides who weren’t authorized to publicly discuss the negotiations.
It was reported that one idea brought up by the Speaker of the House John Boehner is to only partially offset the cost of eliminating the SGR, which is estimated to cost $175 billion. The figure also includes the cost of extending expiring Medicare programs, including reimbursements for community hospitals. These programs have been typically extended in “doc-fix” legislation.
However, it is by no means certain that such legislation can pass the House because a large group of conservative Republican members in the House have demanded that the cost of the fix be offset elsewhere in the budget because they do not want to raise taxes or borrow the money to pay for the fix. The difficulty in doing that is precisely why Congress has kept passing temporary fixes for the last several years.
VA Proposes Rule Change to Restrict Aid and Attendance Qualifications
The Department of Veteran’s Affairs is proposing new rules on who can get monthly Aid & Attendance benefits. The VA feels the rules are needed to prevent people from “gaming” the system by giving away assets and then applying for aid. However, We feel that there should be much more discussion before this vital benefit is restricted from people when it can help veterans desperate to stay at home and not go to a nursing home.
The Aid & Attendance benefit provides money to needy veterans and surviving spouses who require daily assistance for necessary activities such as eating, bathing and dressing. For now, if a veteran or surviving spouse has less than $80,000 in assets—not including a house or car—and that veteran has a high deductible medical expenses that net out his/her income, they may qualify. A single veteran’s maximum monthly benefit is $1,788, and a surviving spouse’s is $1,149, tax-free.
The proposed rules would establish a new combined net worth and income limit of $ 119,220, impose a 36-month look-back period on asset transfers (like Medicaid’s Congressionally-mandated five-year look-back period), and a penalty period of up to 10 years related to gifts. There’s a new tougher definition of medical expenses deductible from income, and a proposed IRS matching program.
The new gifting rules and penalties for making gifts (all gifts in the look-back period are presumed to have been made to qualify for benefits) are strict. There’s no allowance to give away money to your church, or say for a wedding gift to a grandchild. As an example, a veteran who gives away $50,000 would get a 28-month penalty. That is, he wouldn’t qualify for benefits for 28 months. A widow would be penalized for 44 months.
One of the main problems with the proposed rule is that it does not account for age: if a 65 year old veteran and an 85 year old veteran make a gift to get below the asset threshold, they are punished for the same amount of time. Under the current rules, the VA takes longevity into account to determine when net worth is excessive.
Further, it currently takes six to nine months to process a new application. There is no telling how long the application process can take if the VA has to now go back through 3 years of financial records.
VA Establishes MyVA Advisory Committee
Highly Respected Group of Outside Leaders to Advise VA Secretary
The Department of Veterans Affairs (VA) has announced the establishment of the MyVA Advisory Committee (MVAC). The Committee brings together skilled experts from the private, non-profit and government sectors to assist in reorienting the Department to better meet the needs of Veterans. This Committee is charged with advising the Secretary of Veterans Affairs with a focus on improving customer service, Veteran outcomes and setting the course for long-term reform and excellence.
The Advisory Committee will meet multiple times per year and will engage in periodic reviews to ensure the Department achieves the goals of MyVA. The Committee will provide advice on competing short-term and long-range plans, priorities and strategies to improve the operational functions, services, processes and outputs of the Department, and will also advise on appropriate levels of support and funding necessary to achieve objectives. Further, the Committee will review implementation of recommended improvements and suggest any necessary course corrections.
Members of the Committee have extensive experience in customer service, large- scale organizational change and advocacy for Veterans.
“The success of MyVA will be Veterans who are better served by VA, so the work of this committee is incredibly important,” said VA Secretary Robert A. McDonald. “The collective wisdom of our committee members is invaluable and each of them understands that VA must improve customer service and focus the Department on the needs of our Veterans. They are dedicated to that mission and I am grateful for their principled service to our Veterans.”
The group will hold their first meeting in April.
AAFES Customers Are Less Satisfied
The Army and Air Force Exchange System, or AAFES, suffered a 9.3 percent one-year drop in its score on the annual American Customer Satisfaction Index, with a 68 percent satisfaction score that puts it tied with Wal-Mart and slightly below the Family Dollar and Dollar General chains in the category for department and discount stores. The average ranking for this type of store is 77 percent satisfaction. The top store in the category, Nordstrom, had a ranking of 86.
What to watch: AAFES' low ranking could be a statistical problem because it has scored in the mid-70s on the satisfaction index for two decades. AAFES's sales have been declining, thought to be the result of reductions in the size of the military that have reduced the customer base, but exchange system managers are working on ways to improve customer service.
Seven Korean War Soldiers Identified
The Defense POW/MIA Accounting Agency has announced the identification of remains belonging to seven Army soldiers who had been lost and unaccounted-for since the Korean War. Returned home for burial with full military honors are:
- Sgt. 1st Class Donald R. Strum, Company C, 19th Infantry Regiment, 24th Infantry Division, who was lost in North Korea on Nov. 4, 1950.
- Cpl. Robert Higgins, 21, of Bucks County, Penn. He was assigned to Battery C, 15th Field Artillery Battalion, 2nd Infantry Division, when lost in battle in South Korea on Feb. 13, 1951.
- Sgt. Floyd J.R. Jackson, 20, of Warrensburg, Mo., died while a POW in North Korea on Feb. 13, 1951. He was assigned to Headquarters Company, 3rd Battalion, 31st Infantry Regiment, 7th Infantry Division, which made up part of the 31st Regimental Combat Team.
- Pfc. John R. Bowers, of Greenville, S.C. He was assigned to Company L, 3rd Battalion, 9th Infantry Regiment, 2nd Infantry Division, when lost in South Korea on Feb. 14, 1951.
- Sgt. Arnold V. Andring, 25, of Gary, Minn., died while a POW in North Korea after being captured on Feb 14, 1951. He was assigned to Company L, 3rd Battalion, 9th Infantry Regiment, 8th Army.
- Pfc. Lotchie J.R. Jones, 18, of Jasper, Tenn., died while a POW in North Korea on Feb. 28, 1951. He was assigned to Company B, 1st Battalion, 8th Cavalry Regiment, 1st Cavalry Division.
- Cpl. Lindsey C. Lockett, 25, of Henrico, Va., died while a POW in North Korea on May 31, 1951. He was assigned to Medical Detachment, Headquarters Battery, 503rd Field Artillery Battalion, 2nd Infantry Division.
VA Releases Key Findings of Clinical Review of Opioid Practices in Tomah Clinical and Administrative Reviews Still Ongoing
Washington – The Department of Veterans Affairs (VA) today released key findings and recommendations of its initial clinical review into opioid prescription practices at the Tomah VA Medical Center (VAMC). Based on these preliminary findings, the team recommended that VA consider a more in-depth evaluation of the clinical and administrative practices at the Tomah VAMC. An administrative review team from VA’s Office of Accountability Review (OAR) is continuing to look at allegations of retaliation against employees and other accountability issues related to Tomah VAMC leadership. Investigators from the independent VA Office of Inspector General and the Department of Justice’s Drug Enforcement Administration have also been on site. Yesterday, VA announced the accelerated deployment of a nationwide opioid therapy tool for use at all Veterans Health Administration (VHA) facilities. In January, Secretary of Veterans Affairs Robert A. McDonald directed Interim Under Secretary for Health Dr. Carolyn Clancy to lead a comprehensive review of medication prescription practices at the Tomah VA Medical Center. Dr. Clancy charged the Clinical Review Team to assess the practice patterns, controlled substance prescribing habits, and administrative interactions with subordinates and clinical leadership as related to prescribing practices. The release of the key findings comes as VA’s Deputy Secretary Sloan Gibson met today with employees and stakeholders in Tomah. Go to this highlighted link, for a summary of Phase One Clinicial Review Findings.
DOD’s Electronic Health Record will be Obsolete Before it is Built
An article in Forbes is claiming that the Department of Defense’s electronic health record (EHR) project, which is just being bid on at this point, will be obsolete before it is ever deployed. Known as the Defense Healthcare Management Systems Modernization and estimated to cost at least $11 billion, it will be the most expensive investment in an EHR system that this country has ever made. The contract requirements are intended to “leverage commercial industry through open competition to ensure best value,” emphasizing “modular open architecture requirements to facilitate rapid technology insertion and avoid vendor lock,” according to Forbes.
While the project is supposed to avoid “vendor lock,” which means an inability to look to other companies to provide problem solving solutions, upgrades, and price competition, the project manager apparently told Politico he envisions the contract as “an extensive prenuptial agreement and no divorce.” If that means what most people think it means, then one of the core principles of the project is already doomed to failure.
Further, if DOD selects will be an “off-the-shelf” product that is “state of the market” in the healthcare sector of the US economy, then it is planning to spend $11 billion on an EHR system that looks like a proprietary enterprise software system of the sort that many major hospitals have installed. From Forbes:“If you don’t know what an enterprise software system is, the first sentence in Wikipedia’s entry on the subject gets to the point: ‘Enterprise software…is purpose-designed computer software used to satisfy the needs of an organization rather than individual users.’”
Lastly, the healthcare sector as a whole has underwhelmed analysts when it comes to implementing EHRs - the vast majority of hospital EHRs are bloated, inefficient and do not communicate well with each other. This is exactly what DOD does not want, and by copying what the private sector has done they are letting down America’s service members, their families, retirees and taxpayers.
Proposed Change to GI Bill Would Give Vets More Flexibility
Not all veterans go to college after they serve in the military. In fact, as a percentage, more veterans become entrepreneurs after their time in service than their civilian counterparts. Recognition of this fact has led to a proposed change to the popular post-9/11 G.I. Bill that would allow veterans to use their education benefits as a no-interest loan to start their own businesses.
Currently, 40 percent of separating veterans don't use the G.I. Bill's education benefits, which are valued at about $186,000 when tuition, housing allowances and book stipends are considered... The proposal seeks to solve the problem facing many young veterans with a business dream - access to capital. The projected value of the Post-9/11 GI Bill could then be used to qualify for a low interest loan at a fixed rate.
There are also plans for mentorship and training programs to help the business succeed.
According to military.com, “before a veteran could access that funding for loan collateral, the business plan would have to be vetted and approved by an independent board of business experts. The veteran would also have to attend a boots-to-business course at an accredited university.”
With that done, the veteran would then apply to access the capital in their G.I. Bill as a no-interest loan to be paid back over 10 years.
The proposal is not without precedent: after World War II Congress passed the Servicemen's Re-Adjustment Act of 1944 which helped veterans receives small business loans. That legislation also provided for the original G.I. Bill.
The main drawback from our perspective is the fact that the vast majority of startup businesses fail, even with proper mentorship and training. This is a worthwhile and promising proposal, but this simple fact means that We will have to study it much further to figure out what kind of acceptable financial risks Congress should be promoting for America’s veterans.
March is Women’s History Month
March is Women’s history month and the Department of Defense is making a very big deal of it. To see a comprehensive report on American women’s contributions to the U.S. Armed Forces, please go to: http://defense.gov/home/features/2015/0315_womens-history/
Also see the movie Women Warriors: A Vision of Valor, a film featuring TREA PNP Dottie Holmes. Simply click the Women Warriors icon in the lower portion of the blue banner on the right-hand side of our website or click this link http://trea.org/misc.html
VA Accelerates Deployment of Nationwide Opioid Therapy Tool
The Department of Veterans Affairs (VA) is accelerating the deployment of a state-of-the-art tool to help protect Veteran patients using high doses of opioids or with medical risk factors that put them at an increased risk of complications from opioid medications. The tool, referred to as the Opioid Therapy Risk Report, is being made available now to all staff in the Veterans Health Administration (VHA). Over the past week, VA’s Interim Under Secretary for Health, Dr. Carolyn Clancy, has reached out to over 2,000 primary care providers in VHA clinics throughout the country to promote the use of this novel tool. It includes information about the dosages of narcotics and other sedative medications, significant medical problems that could contribute to an adverse reaction and monitoring data to aid in the review and management of complex patients. “All of American medicine is aiming to better understand how to treat severe pain, and Veterans receiving care in the VA health care system typically suffer from higher rates of chronic pain than the general public,” said Dr. Clancy. “While opioid medications may be appropriate in some cases of chronic pain, we are dedicated to using them safely and providing effective pain care to our Veterans. It is critical that we ensure system-wide implementation of the Opioid Therapy Risk Report in the weeks ahead.” The Opioid Therapy Risk Report allows VA providers to review all pertinent clinical data related to pain treatment in one place, providing a comprehensive Veteran-centered and more efficient level of management not previously available to primary care providers. VHA is actively deploying training aids to providers and facilities now and over the next several weeks to familiarize them with how to utilize this tool in their daily practice. Overuse and abuse of prescription opioids is a significant public health issue, particularly since patients in pain are at risk for potential negative outcomes including unintended overdose, adverse medical reactions, and mental health complications. VA established the Opioid Safety Initiative (OSI) in 2012 to enhance safe and effective pain care for Veterans. As a result, there are currently: 91,614 fewer patients receiving opioids; 29,281 fewer patients receiving opioids and benzodiazepines together; 71,255 more patients on opioids that have had a urine drug screen to help guide treatment decisions; 67,466 fewer patients on long-term opioid therapy #
The Veterans Health Administration (VHA) wrongly shifted more than $96 million in medical-support funds to the VA's Health Care Claims Processing System, the department's inspector general has determined. The appropriations "are only authorized for administering medical, construction, supply and research activities," the IG stated in its March 2 report of the improper activity. The report recommended that the VA establish a better oversight process, and reallocate the misappropriated money for use in health care-related activities for which they were intended.
Each service except the Air Force does a less-than-thorough job of identifying how many members are separated because of non-disabling mental health issues, according to the Government Accountability Office (GAO). While guidelines call for the use of specific separation codes to identify such conditions, the Army, Navy and Marine Corps tend to use more vague identifiers that relate to "condition, not disability," according to a Feb. 13 GAO report. The Army believes identifying mental-health issues on separation forms could create trouble for former members when they look for civilian jobs. Navy officials told GAO that they were "unaware" that policies had changed in 2008. GAO countered by stating that standardization is necessary, and there are ways to protect a separating service member's privacy while complying with guidelines. "Without up-to-date and consistent policies and oversight processes, DoD [the Defense Department] and the military services cannot ensure that service members separated for non-disability mental conditions have been afforded the protections intended by … separation requirements and that service members have been appropriately separated for such conditions," the report stated.
Following the House's suit, the Senate is considering a measure that would authorize revocation of bonuses paid to Department of Veterans Affairs officials who were involved in the recent waiting-list manipulation scandal. Sens. Jerry Moran (R-Kan.), Claire McCaskill (D-Mo.), and Kelly Ayotte (R-N.H.) sponsored the measure, which is now pending before the Senate Veterans' Affairs Committee. The bill would require any VA official held culpable for their role in manipulating waiting lists to indicate that veterans were receiving timely treatment when in fact they were not. The House passed a comparable measure, H.R. 280, in mid-February.