[House Hearing, 106 Congress]
[From the U.S. Government Publishing Office]
VIEWS OF VETERANS' SERVICE ORGANIZATIONS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON NATIONAL SECURITY,
VETERANS AFFAIRS, AND INTERNATIONAL
RELATIONS
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTH CONGRESS
FIRST SESSION
__________
MARCH 18, 1999
__________
Serial No. 106-9
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.house.gov/reform
______
__________
U.S. GOVERNMENT PRINTING OFFICE
67-052 WASHINGTON : 1999
COMMITTEE ON GOVERNMENT REFORM
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
CONSTANCE A. MORELLA, Maryland TOM LANTOS, California
CHRISTOPHER SHAYS, Connecticut ROBERT E. WISE, Jr., West Virginia
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
STEPHEN HORN, California PAUL E. KANJORSKI, Pennsylvania
JOHN L. MICA, Florida PATSY T. MINK, Hawaii
THOMAS M. DAVIS, Virginia CAROLYN B. MALONEY, New York
DAVID M. McINTOSH, Indiana ELEANOR HOLMES NORTON, Washington,
MARK E. SOUDER, Indiana DC
JOE SCARBOROUGH, Florida CHAKA FATTAH, Pennsylvania
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
MARSHALL ``MARK'' SANFORD, South DENNIS J. KUCINICH, Ohio
Carolina ROD R. BLAGOJEVICH, Illinois
BOB BARR, Georgia DANNY K. DAVIS, Illinois
DAN MILLER, Florida JOHN F. TIERNEY, Massachusetts
ASA HUTCHINSON, Arkansas JIM TURNER, Texas
LEE TERRY, Nebraska THOMAS H. ALLEN, Maine
JUDY BIGGERT, Illinois HAROLD E. FORD, Jr., Tennessee
GREG WALDEN, Oregon JANICE D. SCHAKOWSKY, Illinois
DOUG OSE, California ------
PAUL RYAN, Wisconsin BERNARD SANDERS, Vermont
JOHN T. DOOLITTLE, California (Independent)
HELEN CHENOWETH, Idaho
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
David A. Kass, Deputy Counsel and Parliamentarian
Carla J. Martin, Chief Clerk
Phil Schiliro, Minority Staff Director
------
Subcommittee on National Security, Veterans Affairs, and International
Relations
CHRISTOPHER SHAYS, Connecticut, Chairman
MARK E. SOUDER, Indiana ROD R. BLAGOJEVICH, Illinois
ILEANA ROS-LEHTINEN, Florida TOM LANTOS, California
JOHN M. McHUGH, New York ROBERT E. WISE, Jr., West Virginia
JOHN L. MICA, Florida JOHN F. TIERNEY, Massachusetts
DAVID M. McINTOSH, Indiana THOMAS H. ALLEN, Maine
MARSHALL ``MARK'' SANFORD, South EDOLPHUS TOWNS, New York
Carolina BERNARD SANDERS, Vermont
LEE TERRY, Nebraska (Independent)
JUDY BIGGERT, Illinois JANICE D. SCHAKOWSKY, Illinois
HELEN CHENOWETH, Idaho
Ex Officio
DAN BURTON, Indiana HENRY A. WAXMAN, California
Lawrence J. Halloran, Staff Director and Counsel
Robert Newman, Professional Staff Member
Marcia Sayer, Professional Staff Member
Jonathan Wharton, Clerk
David Rapallo, Minority Counsel
C O N T E N T S
----------
Page
Hearing held on March 18, 1999................................... 1
Statement of:
Robertson, Steve, director, National Legislative Commission,
the American Legion; Dennis Cullinan, director, Legislative
Services, Veterans of Foreign Wars; David Woodbury,
national service director, AMVETS; Richard Wannemacher,
Jr., associate national legislative director, Disabled
American Veterans; Rick Weidman, director of Government
Relations, Vietnam Veterans of America; and Paul Sullivan,
executive director, National Gulf War Resource Center...... 11
Letters, statements, etc., submitted for the record by:
Cullinan, Dennis, director, Legislative Services, Veterans of
Foreign Wars, prepared statement of........................ 26
Filner, Hon. Bob, a Representative in Congress from the State
of California, prepared statement of....................... 4
Robertson, Steve, director, National Legislative Commission,
the American Legion, prepared statement of................. 14
Sullivan, Paul, executive director, National Gulf War
Resource Center, prepared statement of..................... 77
Wannemacher, Richard, Jr., associate national legislative
director, Disabled American Veterans, prepared statement of 44
Weidman, Rick, director of Government Relations, Vietnam
Veterans of America, prepared statement of................. 61
Woodbury, David, national service director, AMVETS, prepared
statement of............................................... 36
VIEWS OF VETERANS' SERVICE ORGANIZATIONS
----------
THURSDAY, MARCH 18, 1999
House of Representatives,
Subcommittee on National Security, Veterans
Affairs, and International Relations,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 8:32 a.m., in
room 2154, Rayburn House Office Building, Hon. Christopher
Shays (chairman of the subcommittee) presiding.
Present: Representatives Shays, Souder, Mica, Terry,
Blagojevich, and Sanders.
Staff present: Lawrence J. Halloran, staff director and
counsel; Robert Newman and Marcia Sayer, professional staff
members; Jonathan Wharton, clerk; David Rapallo, minority
counsel; and Earley Green, minority staff assistant.
Mr. Shays. We are going to call this hearing to order.
Good morning. Our early start today is one measure of the
importance the subcommittee places on the views of national
veterans' service organizations. Before the crush of meetings
and votes overtakes the day, and before our agenda fills for
the year, we feel it is essential to hear from those who served
in our country's armed forces and whose daily mission is to
help others who did the same.
In previous hearings, the General Accounting Office, the
Inspector General, and representatives from the Department of
Veterans Affairs described the many challenges confronting a
department managing a $43 billion in health, compensation, and
other benefit programs for more than 25 million veterans and
their families. They mentioned chronic claim processing delays,
uncertain health-care quality protections, inaccurate data
systems, and budget inequities within and between regions.
Our witnesses today bring a unique perspective to these
issues. They risked their lives and helped make the United
States of America the great Nation it is today. It is a
perspective which provided invaluable to our work and the Gulf
war veterans' illnesses, and one I know will inform and improve
our continuing VA in Defense Department oversight.
Welcome to all of you, and we look forward to your
testimony.
What I would like to do is to invite my colleague, Robert
Filner, from California--he serves on the Veterans Affairs
Committee and is, I believe, the ranking member--the Benefits
Subcommittee, an important subcommittee for the issues we are
dealing with, so I would like to invite him to make a
statement.
Then I am going to swear you in, and then we are going to
hear from you all.
Mr. Filner. Thank you, Mr. Chairman, and I do appreciate
your courtesy to allow a Member of the minority to have a quick
statement. I would like to submit my full statement for the
record. Second, I want to thank you for all your work in the
last Congress, and in the coming Congress, on the Persian Gulf
war illness. You have brought us, more than anyone, closer to
the truth on this issue. We still have a ways to go, but I
appreciate your courage and your leadership on this issue.
Last, your oversight on this issue is very important. You will
hear from organizations who have put together, not only a
budget guideline for us to go by, but, of course, their
lifelong commitment and their organizations' commitment to
veterans is unquestioned, so when they speak, it is good for us
to listen. I thank you for providing the forum for them.
Most of the organizations--I think all the organizations
before you--have endorsed what is called the Independent Budget
for the Year 2000, and several played a role in putting that
budget together. What their budget provided in a very succinct,
professional, and convincing manner, what do we need to make
sure that we fulfill our contract with our Nation's veterans?''
They concluded that the President's budget was woefully
inadequate, that approximately $3 billion more was needed just
to keep even with the present budget. Many of us on the
Veterans Affairs' Committee agreed with them. The budget, as
submitted by the President, left the VA healthcare system
drastically underfunded, in danger of actual collapse. The
budget for the GI bill is far short of realistic needs and
failing as a readjustment benefit and as a recruitment
incentive. Desperately needed staffing increases included in
the budget appear to be phony, little more than ``shell
games.'' The National Cemetery system has been underfunded for
years, and the money needed for the most basic repairs and
upkeep is unavailable.
These are drastic problems. This is no way to treat those
who have made sure that we have a country that is worthy of
defense. Veterans have been wronged by this budget, and now it
is time for Congress to right that wrong.
We need, Mr. Chairman, to unite as a Congress, to unite as
both parties, to unite with these organizations, to make sure
an adequate budget is passed by this Congress.
I think I use a dirty word here, but the ``caps,'' with
respect to Veterans Affairs, have to be broken. There is no way
that we can do justice if we are going to stay within the caps
that were given to us. There is an urgency and frustration in
the budget and in the testimony of these gentlemen in front of
you that I have not heard before.
They are telling us that they have done more than their
fair share to balance our budget, and now they expect us to be
their advocates. They are reminding us that America is safe and
free only because of the hardships and sacrifices that they
have suffered.
Let me just read you one statement, Mr. Chairman, from the
independent budget.
As the administration and Congress develop budgets and
policies for the new millennium, we urge them to look up from
their balance sheets and into the faces of the men and women
who risked their lives to defend our country. We ask them to
consider the human consequences of inadequate budgets and
benefits denials for those who answered the call to military
service.
I take that to heart.
They have outlined what is needed for healthcare, the GI
bill, the benefits package, for Persian Gulf war veterans, Mr.
Chairman. The funding, for example, in the budget that was both
presented by the President and most likely will come out of
Congress as it exists now, does not adequately fund the
legislation for Persian Gulf war veterans that you put forward
and was passed by the House and the Senate last year. Without
that money, the VA system will not be able to absorb the
additional Persian Gulf war veterans who will be eligible for
healthcare under the new law that you led the fight for.
So we have a lot of work to do. I appreciate your kindness
and courtesy, your courage, your leadership, Mr. Chairman. We
have to do right by these veterans.
[The prepared statement of Hon. Bob Filner follows:]
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Mr. Shays. Thank you, Congressman Filner. Let me just say,
this is--I never think of this as a majority or minority. You
are an equal partner in this process and have been very
helpful, and I really thank you for being here.
Mr. Blagojevich is on his way and just wants to make sure
that we get started.
So I am going to introduce our witnesses. Mr. Steve
Robertson, director, National Legislative Commission, the
American Legion; Mr. Dennis Cullinan, director, Legislative
Services, Veterans of Foreign Wars; Mr. David Woodbury,
national service director, AMVETS; Mr. Rich Wannemacher, Jr.,
associate national legislative director, Disabled American
Veterans; Mr. Rick Weidman, director of Government Relations,
Vietnam Veterans of America; and Mr. Paul Sullivan, executive
director, National Gulf War Resource Center.
I would invite our witnesses to stand and we will
administer the oath in this committee, and then we will hear
your testimony. Thank you.
[Witnesses sworn.]
Mr. Shays. For the record, all of our witnesses responded
in the affirmative.
It is very nice to have Congressman Terry from the great
State of Nebraska. I always love watching them play football
among other things.
Mr. Terry. So do I--[laughter.]
Mr. Shays. If we could just start in the manner I called
you. And we are going to hear all your testimony. We don't have
a light up there. We have a timer here. Let me just tell you
our restraints. Our restraint is that technically we are
supposed to adjourn by 9:30. We can go on a little beyond, but
we are going to be having a top-secret briefing on our defense
system and one that they have requested that we not have
hearings during that time, but we can run over a little bit.
STATEMENTS OF STEVE ROBERTSON, DIRECTOR, NATIONAL LEGISLATIVE
COMMISSION, THE AMERICAN LEGION; DENNIS CULLINAN, DIRECTOR,
LEGISLATIVE SERVICES, VETERANS OF FOREIGN WARS; DAVID WOODBURY,
NATIONAL SERVICE DIRECTOR, AMVETS; RICHARD WANNEMACHER, JR.,
ASSOCIATE NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN
VETERANS; RICK WEIDMAN, DIRECTOR OF GOVERNMENT RELATIONS,
VIETNAM VETERANS OF AMERICA; AND PAUL SULLIVAN, EXECUTIVE
DIRECTOR, NATIONAL GULF WAR RESOURCE CENTER
Mr. Robertson. Thank you, Mr. Chairman.
I am going to try to summarize my statement. I would
request that my full statement be submitted for the record.
Mr. Chairman.
Mr. Shays. Yes?
Mr. Robertson. My full statement be submitted----
Mr. Shays. Yes----
Mr. Robertson [continuing]. For the record, and I will try
to summarize----
Mr. Shays. Yes. I am going to wait until my colleague gets
here to make sure that we make it official that it will be in
the record, but it--[laughter]--will be.
Mr. Robertson. OK, sir.
Mr. Shays. Thank you.
Mr. Robertson. I am going to summarize my remarks so that
we can open up the discussion for dialog.
The last time I took an oath like that, it wound up 20
years of military service, so I get a little edgy when I have
to raise my hand.
Mr. Chairman, the American Legion appreciates this
opportunity to present testimony on critical issues facing
agencies and programs within your jurisdiction.
It is important to remember that the costs of war and peace
go on long after the guns are silenced, the treaties are
signed, the dead are buried, and the parades are over. It is
our service members that take an oath of allegiance to support
and defend the Constitution at the risk of personal safety.
They endure many hardships and sacrifices to fulfill that
promise. What awards and benefits this Nation provides them
should reflect its gratitude for dedicated service. Medals and
ribbons are appropriate, but do not heal the mental and
physical scars of war or make a broken body whole.
Turning to issues of national security, the first area
deals with Tricare, DOD's newest version of military healthcare
delivery. Mr. Chairman, this single issue represents one of the
biggest lies ever told to service members. If you retire from
the armed forces, you and your dependents will receive medical
care from the military, at no cost, for the rest of your lives.
In 1973, I was commissioned in the U.S. Air Force. This
promise was made to me and, in fact, was a practiced policy.
Now, military retirees are allowed to participate in a
federally subsidized healthcare program called Tricare. The
degree of healthcare coverage military retirees and their
dependents receive is based on how much money they are willing
to--or in many cases, able to--pay.
As radical as paying for an entitlement seems, they are
only allowed to participate in this program until they become
Medicare-eligible. Once they become Medicare-eligible, they are
ineligible for Tricare. At a point in their lives when demands
for quality healthcare are the greatest, they lose the very
healthcare system that they have depended on for the vast
majority of their adult lives.
The American Legion is not surprised to hear about the
recruiting and retention problems of the Armed Forces. After
all, your best recruiters are your alumni. Should you decide to
hold hearings on Tricare. The American Legion is prepared to
participate and offer some workable solutions.
Mr. Chairman, the next issue is concurrent receipt. The
American Legion sees this issue as among the greatest
inequities in the Federal Government. Under current law, if a
military retiree has a VA service-connected disability, the
veteran loses $1 of military longevity retirement pay for every
VA compensated dollar received.
Military retirees are the only Federal retirees penalized
in this manner. Concurrent receipt represents a bean-counter's
compensation concept, not the thanks of a grateful Nation.
Turning now to the area of veterans' affairs, I must
express the disappointment in the President's budget request
for fiscal year 2000 for the VA. The entire veterans' community
agrees that it is inadequate. The American Legion supports the
Veterans Affairs Committee's views and estimates to add $1.9
billion and hope that Members will demand the budget resolution
reflects such an increase.
Although VA funding is not directly under your
jurisdiction, there are three funding mechanisms that need your
attention: the Medical Care Collection Fund [MCCF], the
Veterans Equitable Resource Allocation [VERA], and Medicare
Subvention. All three of these programs directly impact
veterans' healthcare funding systems. Again, the American
Legion would welcome the opportunity to participate in any
hearings you hold.
Another issue deals with legislation enacted last Congress
to amend title 38 of the United States Code and now denies due
process to a small percentage of veterans. Without the benefit
of congressional hearings, Congress chose to deny some veterans
their right to receive a service-connected disability rating
for a medical condition related to their service in the Armed
Forces. I can't help but notice the picture of Representative
former-Chairman Brooks up there with his cigar in his hand.
The group that I am talking about, the American Legion
adamantly opposes the decision to deny a select group of
veterans with tobacco-related illnesses their right to receive
service-connected disability, should they be able to prove that
it is connected with their military service. This needs to be
repealed. It was wrong; it was unethical. It was immoral; it
was flat wrong to do that.
Another area of great concern is the long-term healthcare
for both military retirees, their dependents, and veterans. The
long-term care for military retirees, their dependents, and
veterans is basically nonexistent. And it is very ironic that
today, one of your other subcommittees is holding a hearing on
long-term care for Federal employees, and there is nobody from
the military there to represent them.
In the area of international relations, the American Legion
has two areas of concern--the administration's certification of
Vietnam and the Orderly Departure Program.
Thank you, Mr. Chairman, for the opportunity to testify
today. I hope that this is just the first of many appearances
before your committee.
[The prepared statement of Mr. Robertson follows:]
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Mr. Shays. Thank you very much. You covered a lot in 6
minutes. [Laughter.]
Mr. Dennis Cullinan.
Mr. Cullinan. Thank you very much, Mr. Chairman, and
members of the subcommittee and concerned Members of Congress.
On behalf of the men and women of the Veterans of Foreign
Wars, I would express our deep appreciation for inviting us to
participate in today's important hearing.
Mr. Chairman, in preparation for this hearing, in
discussions with your staff, I asked what it was that I should
address here today. And it was suggested to me that I should
talk about those things that truly trouble us, as an
organization, an organization of veterans' advocates--the
things that wake us up at 3 a.m.--and those are some of the
things that I intend to discuss here today.
Securing sufficient funding for the VA medical care system
has now taken on such a note of urgency that if we fail in this
regard, its continuing existence as a viable healthcare
provider for veterans is very much in doubt. Similarly,
inadequate funding continues to undermine the effectiveness of
the Veterans Benefits Administration, and veterans are
suffering as a consequence.
The administration's proposed fiscal year 2000 budget for
the Department of Veterans Affairs would be devastating to our
Nation's veterans. If the Congress does not step forward and
increase the funding provided for this purpose, VA's ability to
provide quality, timely, accessible healthcare for veterans
will do irreparable harm.
The VFW hears daily complaints of increasing waiting times
for veterans to see a specialty provider, such as an orthopedic
doctor or a dermatologist. This is happening throughout the
country. More egregious in the specific, however, is the 1-year
wait for hip replacement surgery in Ann Arbor, and the 1-year
wait for dentures in Maine, and the 1-year wait for dermatology
appointments in New Orleans.
Then there is the veteran in Louisiana who is 50 percent
service-connected, has a significant skin condition, and cannot
get a dermatology appointment for 7 months. A 100 percent
service-connected disabled veteran in a private nursing home
under VA contract in Rhode Island since Korea for his service-
connected condition, was told that VA could no longer afford
the cost of keeping him there, and that he could afford to pay
for his own care, himself. His removal from the home was only
halted through VFW intervention.
A New Jersey veteran in a VA nursing home for 15 years was
threatened with expulsion. This was due to cost-driven mission
change to eliminate all long-term care. Once again, it was only
VFW intervention that prevented him from being thrown out.
These are only a few of the examples of the tragic,
nationwide epidemic, an epidemic of increased waiting times and
delays in getting appointments which, in these examples, can
only be interpreted as a denial of care. And it will get worse,
this year and next, because of this proposed budget, if the
Congress doesn't act.
Mr. Chairman, you are, of course, familiar with the
numbers, the statistics, but this is a situation--this is a
human tragedy in the making, a human tragedy that needs to be
addressed before more veterans suffer, wrongly and for no good
reason.
There are other issues to be addressed--the aging veteran
population. As you know, Mr. Chairman, at this point in time,
long-term care is not mandated under law and because of cost-
driven mission changes like the one I cited just earlier, long-
term care capability is being steadily eroded, eliminated from
the Department of Veterans Affairs. This, in the face of a
rapidly aging population, just at a time when our World War II
veterans need such care, the VA's already limited capability is
being diminished. This is wrong.
Another area of concern--waiting times to receive
treatments in specialty clinics continues to get worse. Calls
from veterans have indicated, for instance, more than a 1-year
delay to receive dentures in Network 1 and more than a 1-year
delay to receive orthopedic surgery in Network 11. We have also
seen an increase in the number of calls received about
obtaining timely appointments in clinics such as cardiology,
dermatology, podiatry, ophthalmology, and a variety of other
specialty clinics. Pharmacy waiting times have worsened over
the past year. Calls about 1- and 2-hours' waiting times to
receiving medications are commonplace. Waiting times are
increasing because staff has been reduced, and the outpatient
workload has increased. With staffing reductions to take place
in the near future, this problem will surely get worse.
And then there are other upcoming challenges; you
referenced it briefly earlier. The VA is about to undertake
treating veterans suffering from hepatitis C, and they have to
do this. This is the only correct and right thing to do, but
the money to pay for it isn't there. This can only result in
tragedy, if not remedied.
Emergency room care is another issue. Right now, there are
veterans who would go for emergency room care--service-
connected veterans--who would seek emergency room care outside
of VA, and VA won't cover the costs, even if it is for their
service-connected problem.
And a newer horizon--you discussed Persian Gulf briefly
earlier. Persian Gulf is an issue which has yet to be resolved,
although much progress has been made in the right direction.
But this augers for future challenges. In this day and age,
there are going to be more and more small conflicts. And with
these small conflicts, they will have their own particular
problems. A tough thing to meet, and the last thing we need is
a reduction of funding.
I would also say here, addressing the issue of the caps,
the VFW, of course, salutes the action in the Senate Budget
Committee the day before yesterday, in providing an additional
$1.1 billion in discretionary money for VA. Of course, VA
hardly has that money at this point in time, and we only urge
that the House follow suit.
In fact----
Mr. Shays. Could I ask, is that--you said $1.1 million?
Mr. Cullinan. Billion.
Mr. Shays. Billion; I am sorry--$1.1 billion. But is that
above the President's budget or above----
Mr. Cullinan. That is above the----
Mr. Shays. Or above the baseline----
Mr. Cullinan. Yes, that is above----
Mr. Shays [continuing]. That we had last year, or we are in
this year?
Mr. Cullinan. It is above the baseline. It is above the
baseline.
Mr. Shays. So it is significantly more than----
Mr. Cullinan. Although----
Mr. Shays. Yes.
Mr. Cullinan [continuing]. In spending authority.
The point I would make here, though, is even more is
required. The independent budget has identified the need for
about $3.2 billion. Nonetheless, we salute the fact that they
took the initiative to go that far, and we ask that the House,
now, even go further.
The Veterans Benefit Administration continues to encounter
serious problems in its ability to render quality, timely
decisions in the adjudication of veterans' claims for benefits,
especially those for compensation. Contributing to these
problems is the escalating amount of appeals--now slightly over
100,000--to be processed in those offices, primarily in
response to the number of remands from the Board of Veterans
Appeals.
We are absolutely convinced that inadequate staffing is now
the root cause of the Veterans Benefit Administration quality
problems. Statistics confirm this supposition. The VBA has gone
from 13,856 employees in fiscal year 1992 to approximately
11,200 presently, a 20 percent reduction in less than 6 years.
What is immediately required is an infusion of additional
employees to replace normal attrition. And I would add to that
that they need to be carefully trained employees who have the
inclination and the intellectual wherewithal to undertake that
highly rigorous calling.
The ``Fiscal Year 1999 Veterans' Independent Budget and
Policy'' document provides justification for an increase of 500
employees in the compensation and pension service. Congress
must now immediately act and provide the necessary appropriated
funding to reverse the deleterious employee reduction in VBA,
if we hope to have any further success toward achieving the
goal of timely and proper claims adjudication for veterans.
Once again, this is not simply a matter of statistics, but
it is a human tragedy that needs to be addressed.
Mr. Chairman, and members of the subcommittee, this
concludes my written statement. Once again, I will thank you
for having included us in this important forum, and I will, of
course, be happy to respond to any questions you have.
[The prepared statement of Mr. Cullinan follows:]
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Mr. Shays. Thank you very much.
Mr. Woodbury.
Mr. Woodbury. Mr. Chairman, AMVETS----
Mr. Shays. Could you move the mic closer to you, and I
think push it down a little bit.
Mr. Woodbury. OK.
Mr. Shays. And it won't stay down. [Laughter.]
Mr. Woodbury. Can you hear me all right?
Mr. Shays. It worked fine.
Mr. Woodbury. We appreciate the opportunity to join you
this morning and provide testimony in support of your oversight
responsibilities concerning National Security, Veterans
Affairs, and International Relations issues.
Now, Mr. Chairman, at a time in our history when
unemployment is approaching record lows, the economy is strong,
and, for the first time in several decades, the national debate
seems increasingly focused on what to do with budget surpluses,
Americans generally may be content with their circumstances.
One can reasonably argue that, indeed, times are good. They
are, unless you happen to be in the military or a veteran
seeking healthcare or other benefits to which you may be
legally entitled. From their perspective, they sense that
America's gratitude for their service, patriotism, and
sacrifice may be a thing of the past.
We believe that, as a matter of urgent priority, your
agenda for the 106th Congress ought to embrace the precept that
without national security, there can be no long-term Social
Security. National security is underwritten by the men and
women in uniform today and the veterans who preceded them. Were
it not for their selfless, dedicated, and professional
commitment to our Nation through military service, the freedoms
we enjoy might be significantly diminished. ``What have you
done for me lately?'' seems to be a question many have
difficulty answering today. We seem incapable of recognizing
that today's military personnel, like the millions of veterans
who preceded them, maintain a 24-hour vigil around the world in
defense of America's freedoms. Their personal sacrifices today,
and throughout our history, seem now to go unnoticed and
unappreciated.
We are at peace today, thanks to our historically strong
military posture. Yet, even in the absence of war, we have
forces positioned around the world ready to respond to national
tasking. Whenever this Nation calls, they answer. And yet when
they call out for assistance, seemingly very few hear their
plea. The message veterans are hearing loud and clear is that
they are no longer important--the national agenda has other
more vital issues with which to deal.
Mr. Chairman, within the very broad continuum of oversight
responsibilities with which your committee is tasked, it seems
to us there are several related issues. For example, we do not
believe it is coincidental at a time when America is enjoying
unprecedented prosperity, that defense preparedness is down,
personnel retention within the military is down, and vital
programs, keyed to helping those veterans whose sacrifices
helped to get us to this preeminent international position
continue to receive benign neglect. These trends are troubling.
The message to both our active-duty military and veterans alike
is that their service, patriotism, and sacrifices are no longer
valued to the degree they once were. We believe this message
has to be reversed.
The Report of the Congressional Commission on
Servicemembers and Veterans Transition Assistance is now a
matter of public record. It discusses a number of key issues
affecting both active duty military and veterans which we
believe deserve careful review and action from the 106th
Congress.
Separately, AMVETS, in partnership with the Disabled
American Veterans, Paralyzed Veterans of America, and the
Veterans of Foreign Wars has introduced its Independent Budget
for Fiscal Year 2000. It identifies a funding shortfall in the
Department of Veterans Affairs budget in excess of $3 billion,
compared to the Clinton/Gore fiscal year 2000 submission.
As you are aware, the House Committee on Veterans Affairs
recently recommended a $1.9 billion increase to the
administration's VA budget, and while we commend Chairman Stump
for the leadership and support he continues to provide, this
recommendation still leaves us at least $1 billion short of the
funds required to sustain VA's programs at an adequate level.
We believe we cannot continue to ignore our
responsibilities to provide the support our veterans have
earned. We need to fully fund VA at the level required to
fulfill its mandate and, continue to hold its leadership
accountable for the stewardship of those funds allocated.
The Clinton budgets have historically ignored this
commitment. It is time to correct that problem. Failure to do
so will result in a continuing downward spiral in VA's ability
to deliver quality healthcare and other benefits which veterans
have earned and have a right to expect.
Finally, Mr. Chairman, there is the issue of America's
national security. We need to pay attention to the lessons of
history. Every time we have failed to sustain a strong, capable
military, war has been the result. Americans today should be
deeply concerned by the news that the military services are
losing their people, are failing to achieve their recruiting
goals, and are unable to man ships, aircraft, and other weapon
systems at acceptable operating standards due to funding
shortages.
Considering recent reports that China may now have both the
technology and means to deploy nuclear weapons, that the more
subtle threat of international terrorism is increasingly
possible, and that the threat of chemical and/or biological
agents is rising, our way of life continues to be very much at
risk.
America may be at peace, but considering events around the
world, it is, at best, an uneasy international environment in
which we live.
For these reasons, we strongly support recent initiatives
to increase DOD funding levels. We need to sustain our
investment in national defense. The price is not too great for
the value received.
Mr. Chairman, this concludes my testimony. I will be happy
to answer any questions.
[The prepared statement of Mr. Woodbury follows:]
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Mr. Shays. Thank you.
I just want to recognize the presence of our ranking
member, Mr. Blagojevich, and, also, Mr. Sanders.
And what we will do is, keep on going and hear our
testimony. So, Mr. Wannemacher, you are up.
Mr. Wannemacher. Thank you very much, and I want to say
that we really appreciate the opportunity to appear here before
you. I am pleased to appear before you and present the views of
more than 1 million men and women who are disabled veterans
from all wars.
On the critical issues facing the Department of Veterans
Affairs, many challenges confront VA today, and we appreciate
the opportunity to discuss them with you.
One of those challenges is the institution of the
appropriate measures to address the unique problems of our
Persian Gulf war veterans. Mr. Chairman, you have already
devoted a great deal of attention to that effort, and we
especially want to take this opportunity to express our
appreciation and commend you for your leadership on this issue.
In many ways, VA is an agency in crisis. While some of the
problems are complex and difficult to overcome, others are
susceptible to relatively straightforward, practical solutions,
but have been neglected for various reasons. Whether simple or
complex, the problems and their causes, in most instances, are
well defined, but the remedies are either held hostage by
politics of the Federal budget or depend on the will of VA
management to take decisive action.
Unquestionably, insufficient funding must bear a major
share of the blame for the current sad state of veterans'
programs. Regrettably, as obvious as it is that many of VA's
woes are directly or indirectly consequent to degradation of
years of inadequate resources, the administration's fiscal year
2000 budget provides no relief. Indeed, the recommended funding
for healthcare is so insufficient that it only pushes VA closer
to the precipice. That reality has become undeniable. While
they are not unanimous in their assessment of the extent of the
shortfall, your colleagues on the Veterans Affairs Committee
recognize the problem.
With inadequate resources, VA is already rationing
healthcare and denying or delaying urgently needed services to
a large number of veterans.
If Congress does not substantially increase appropriation
for healthcare, VA medical center directors will be forced to
do some of the following things--and they will have to do them
in Vermont, Connecticut, Nebraska, California, and Illinois:
eliminate entire primary care teams; discontinue healthcare for
thousands of sick and disabled elderly veterans who are
currently enrolled and depend on this healthcare as their only
source of healthcare; to terminate or furlough thousands of VA
medical care employees across the country; close entire VA
medical centers; discontinue contract nursing home care; shut
down hospice care units; and discontinue kidney dialysis for
service-connected veterans and other eligible veterans.
We also note that VERA has been given a bad name--
especially in the Northeast--since its inception. But the more
the inadequacy of the budget, the worse the name is going to
become, because all that VERA is, is the distribution system of
the budget.
For medical care, the administration has requested a budget
authority of $18.1 billion, which includes $17.306 billion for
appropriated funds, and then relies on $749 million to be
collected for the treatment of non-service-connected medical
conditions.
The independent budget, which Congressman Filner so
eloquently referred to, is an annual alternative assessment,
compiled by the DAV, PVA, AMVETS, and Veterans of Foreign Wars,
and we have calculated--as you have just heard from my
colleague--a $3 billion deficit. Regardless of that amount of
inadequacy, the impact in practical terms is shocking, partly
attributed to both the immediate effects of the budget and
partly because of the cumulative effects of past budgets that
did not provide the resources necessary to maintain the system
at the current service levels. For well over a decade, VA has
been faced with the dilemma of ever-increasing demand for
medical care and perennial inadequate budgets.
VA has never been able to meet its target for third-party
reimbursement. In fact, the best year that they did was in 1996
when they received 35 percent of what they had projected. In
hearings before the House Veterans Affairs Committee last
month, Dr. Garthwaite identified that currently this year, they
are not going to meet their budget requests for third-party
reimbursement. Now we inflate the projections, and the VA is
really going to suffer.
Also suffering is the prosthetics budget, which is frozen
again this year at $319 million. This is $56 million below what
the IB had recommended and is incorporated in that $3.2 billion
budget that the independent budget recommended.
Mr. Shays. I am going to ask you to speak maybe for 2 more
minutes?
Mr. Wannemacher. OK.
Mr. Shays. Thanks.
Mr. Wannemacher. The budget also reflects that one of the
most critical issues facing VA is hepatitis C. The VA estimates
that there is $135.7 million in new healthcare spending that
will occur in the year 2000. We applaud the administration for
taking this step of discovery, however, the budget does not
provide any new funding. Given the new challenges and the
potential for hepatitis C epidemic represents, there must be a
measure of comprehensive process to identify, treat, and
educate all veterans who may be at risk for this disease. A
registry of infected veterans would permit VA to track outcomes
and keep veterans notified of new developments. VA must monitor
its facilities and ensure that they follow the proper treatment
modalities.
This will conclude my remarks, and I thank you very much
for the opportunity.
[The prepared statement of Mr. Wannemacher follows:]
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Mr. Shays. Thank you very much.
Mr. Weidman.
Mr. Weidman. Thank you, Mr. Chairman. We appreciate the
opportunity for Vietnam Veterans of America to share some of
our concerns with you and your distinguished colleagues here
this morning.
I would just second everything my colleagues had to say
about the budget.
The budget is so woefully inadequate, one doesn't even know
how to comment on the irresponsibility of this administration
submitting such a woefully inadequate budget.
I am reminded of a story repeated to me by a wonderful
woman who is a national VA voluntary services coordinator for
our colleagues at the Jewish war veterans. She told us a story
that her father had told her often about adequate funding and
resources for whatever it is you are trying to accomplish.
There was a man in his village in Lithuania who decided
that, in order to economize, he would feed his horse a little
bit less every day. And that way, the horse wouldn't notice.
When he got down to one straw a day, the horse died.
It is not too precipitous to say that the VA system is
literally being starved to death. You can go to any VA medical
center in the country and see the effects of the budget cuts
that my colleagues have so eloquently pointed out in some
detail.
But I would urge you, not only to go to the VA medical
centers in your district, but you can go right up to North
Capitol here and try and explain to veterans at the VA medical
center here in Washington why it is that we are building an
atrium which will not add one whit--not add one whit--to the
quality of care or the range of services in medical care
available to them. At the same time, VA is cutting back on
prosthetics in that hospital, with people unable to get what
they need, and at the same time that the rehabilitation staff
and physical therapy staff have been reduced by almost 50
percent. This is a tough one. You can try and explain to them
it is a different part of the budget, but that is not what the
veteran sees. So the need for additional resources is clear and
apparent and pressing at this point.
Within the context of these budget cuts it becomes, then,
also, a convenient excuse about why they are not doing other
things that they should be doing.
Having said that, Vietnam Veterans of America believes
strongly that VA needs to make some fundamental changes in how
it allocates those dollars, and that begins with a ``mind set''
of the entire veterans' benefits and services structure. At the
VA medical system, in particular, it begins at the front door.
When you tell people who are not familiar with this system,
that no one asks when you walk through the front door of a VA
hospital in detail, ``What did you do in the war, Dad? What did
you do in the war, Mom?'' They are astonished, because they
believe that the VA system is there to, in fact, to address the
needs of veterans, as veterans. It simply does not happen.
A glaring example of that would be hepatitis C. Another
would be the maladies of DU exposure and perhaps heavy-metal
poisoning that the Gulf war veterans have suffered through.
What we are advocating here, and what we have talked with
Dr. Keyser and Dr. Garthwaite about--and will continue to
press--is for VA to be VA. The mission doesn't really change.
The means of accomplishing that mission changes, but the
mission, from our point of view, is veterans' healthcare and
not a general hospital system that happens to be for veterans
and ``let's see what we can do for those poor old guys and poor
old gals.'' It is a covenant that we made between the people of
the United States and the men and women who placed their life
and limb on the line in defense of the Constitution of the
United States that cannot be--it is that sacred. It is that
fundamental to our democracy that we honor that.
But one way of honoring that covenant is to make sure we
utilize our resources the best, and that begins with the
military history that documents all of the things that one may
have been subject to, given the time one served, what era,
where one served, what branch of service, and what one actually
did. That can be easily, and with virtually no expense, within
3 to 6 months, put on all of the computers and done at intake,
as everybody comes into the VA system, to pick up on their
neuro-psychiatric problems, to pick up on yellow fever for
World War II vets, strongliodies and melioidosis among Vietnam
veterans, et cetera.
Why is this important, and what does this have to do with
money? We churn people back and forth through this system
simply because we do not focus on ``wellness,'' which takes
into account the entire human being.
I want to just comment on two other things--or three
things--that are productive lines of inquiry that I would
suggest that you and your distinguished colleagues, Mr.
Chairman, address during the remainder of this year.
The first has to do with the battlefield as a ``hazardous
workplace.'' All too often, we have not thought of it that way.
That would get into agent orange and other adverse health
impacts for those of us who served in Vietnam--but in every
battlefield, not just in the Gulf war, but every battlefield in
the future, given the exotic weapons, will become more and more
a ``toxicological'' soup. The efforts to understand what we are
getting into, and the effect on our troops and personnel, as
well as on the civilian populace, is something that we believe
DOD has not adequately addressed. And the time to address it is
before you deploy the weapons, as well as going back and not
deny, deny, obfuscate, for the men and women who have already
been exposed.
So we would urge you to follow through with that because,
frankly, it doesn't matter whether it is the retinopathies that
veterans suffer are due to post-traumatic stress disorder or
whether they are due to exposure to agent orange or one of the
other chemicals we were exposed to in Vietnam.
Second is the whole area of zeroing in on the Ranch Hand
study, in particular. They are differing, widely and
dramatically, from their own protocol and the way in which they
are carried out; the pace is being deliberately slowed down, we
believe, and there are significant issues there where we would
be pleased to work with your staff.
And last, but not least, is the issue of studies. I know
that your jurisdiction may not cover HHS and others at this
point, but it would be worth zeroing in on ``where are research
dollars being spent?'' The problem for Vietnam veterans is that
the alliance and the Ranch Hand study is that it is too small a
sample size. We need to initiate other studies that can be
turned around relatively quickly, such as following up on the
National Vietnam Veterans Readjustment study, et cetera. NIEHS
needs to put resources in that.
And last, but not least, in that regard, Mr. Chairman, is
take a look at how VA uses its research dollars. The research
dollars are not there in order to just to benefit the medical
schools, although they may, as a commitment to the primary
mission of VA. The research dollars should be there in order to
look into and better treat the needs of veterans, as veterans.
But very few of those research dollars are being used to deal
with agent orange, post-traumatic stress disorder, DU, et
cetera, and other kinds of maladies that are specific and
particular to veterans, as veterans.
Mr. Chairman, thank you very much for this time. And I look
forward to answering any questions you may have, sir.
[The prepared statement of Mr. Weidman follows:]
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Mr. Shays. Thank you very much.
Mr. Sullivan.
Mr. Sullivan. Chairman Shays, members of the subcommittee,
on behalf of the 56 member organizations of the National Gulf
War Resource Center, I appreciate the opportunity to testify
today regarding matters important to the Gulf war veteran
community.
Mr. Chairman, every day Gulf war veterans are reminded of
the fact that the Gulf war rages on in Iraq with 1 million
Iraqis dead, plus the fact that another Gulf war rages in the
homes of more than 110,000 veterans here in America. More than
1 million United States troops are serving, or have served, in
the Gulf war. More than 110,000 of those claim illnesses
related to the war. An unexpectedly high number of 235,000 Gulf
war veterans have sought healthcare at the Department of
Veterans Affairs since 1991.
There are long-term consequences to war, and the war
against Iraq is no different--only the many types of new toxic
exposures are different. Here is what veterans want to know,
Congressmen.
``Why are my family, my friends, and I ill? How, when, and
where can I get the right medical treatment for my toxic
contamination? Who will cover the costs, especially if the VA
healthcare budget is underfunded? Finally, how can we prevent
such needless tragedies in the future?''
Due to failures at the Departments of Veterans Affairs and
the Department of Defense, Gulf war veterans were given the
burden of being forced to show we were ill and to show we were
exposed to toxins. Specific evidence--a lot of it revealed by
this subcommittee--shows Gulf war veterans are seriously ill at
higher rates than non-deployed veterans.
More to the point, according to the Department of Veterans
Affairs data, as of January 1, 1999, Gulf war veterans who
served in the Gulf region between 1990 and 1991 are 39 percent
more likely to have a service-connected disability than those
of the era who did not deploy. The future appears ominous,
Congressmen. Veterans who served from 1990 to 1991 in the Gulf
war are 53 percent more likely to have filed a claim. This may
mean many more VA claims are in the pipeline.
The military now admits widespread toxic exposures to
depleted uranium, hundreds of thousands; chemical warfare
agents, 100,000; oil well fire pollution, hundreds of
thousands; pesticides, hundreds of thousands; and military-
administered experimental drugs, more than 100,000--plus more
poisons.
Mr. Chairman, I will focus on only 4 subjects out of the 15
points listed in our written testimony, and I ask that it be
entered into the record.
The first subject that deserves your full attention is the
immediate implementation of Public Law 105-277. Mr. Chairman, I
am going to digress for a minute--and on behalf of the Gulf war
veterans, Congressman Sanders, Congressman Filner, we thank
you. That is now the law of the land.
Implementing the Public Law is our top priority for 1999.
President Clinton signed the Persian Gulf War Veterans Act of
1998 into law on October 21, 1998. It orders the VA to sign an
agreement with the National Academy of Sciences within 60 days
to investigate the more than 30 toxins associated with the
illnesses and to study the illnesses more prevalent among Gulf
war veterans. The VA has failed to enter into that agreement.
The VA's behavior results in delays in new medical research,
new treatment programs, new claims filings, timely adjudication
of claims, and the granting of service-connection to disabled
veterans. In short, no healthcare.
Under-explored areas of toxic research include: depleted
uranium, oil well fires, chemical warfare agents, experimental
shots and pills, pesticides, and synergistic combinations of
these. Areas of more prevalent adverse outcomes among veterans
include Lou Gehrig's disease and other neurological disorders,
cancers, immunological disorders, reproductive disorders, and
birth defects among the children of Gulf war veterans.
On December 8, 1998, the VA asked the Department of Justice
to review the new law. On March 12, 1999--Congressmen, I have
great news, the Department of Justice advised the VA that
Public Law 105-277 is valid and effective. Now the law must be
implemented.
We believe the VA must fund outreach about the new law to
veterans and those assisting veterans with filing claims. The
Resource Center stands ready to assist the VA with that
outreach.
The Resource Center is not alone in our support for the new
law. The independent budget, endorsed by more than 50 veterans'
groups, also calls for the immediate and full implementation of
the new law.
The second subject, Mr. Chairman, that merits your
immediate attention is the Resource Center's support for
funding of private research as well as research by the CDC, VA,
and DOD. Three weeks ago Congressman Sanders and 16 Gulf war
veterans groups attended the CDC conference in Atlanta. The
Resource Center believes that appropriate CDC research should
be funded--not discussed--that Gulf war veterans and our
advocates should participate in all research review panels,
that more conferences should be held, and that Gulf war
veterans should be included in future conferences.
Because the Gulf war rages on today in Iraq, with more than
1 million Iraqi dead, the best Government and private-sector
research is needed now into the many toxic exposures present in
the Gulf. This will improve medical care, improve toxic
detection and protection doctrine and training, plus improve
the Government's tarnished reputation among Gulf war veterans.
Our third subject that merits your attention is the VA
budget. We believe the VA needs $3.2 million more than what was
proposed by the administration and $1.3 billion more than what
was approved by the House Veterans Affairs Committee.
Since the current economic boom has created a Federal
budget surplus, the VA budget cap should be lifted.
Gulf war veterans are deeply concerned about underfunding
at the VA. This is because under Public Law 105-277, more than
235,000 Gulf war veterans--out of 1.2 million eligible--are
entering an already overburdened VA healthcare system. Flat-
lining appropriations during the war, while expenses soar and
the number of patients demanding care increases, is a recipe
for disaster.
Our fourth subject is that we hope you hold additional
hearings on anthrax and depleted uranium.
We understand you announced hearings for March 24 on the
experimental anthrax vaccine. Gulf war veterans have a lot of
questions about that, and we hope that your hearings will
address that.
In conclusion, Mr. Chairman, after legislative victory was
declared with the passage of Public Law 105-277, Gulf war
veterans thought the VA would get the message and start
addressing this issue with vigor. With their delays, it is
clear the VA still doesn't get it.
The new law and our efforts on behalf of veterans may all
be in vain unless there are ongoing congressional hearings,
unless Public Law 105-277 is implemented, unless vigorous,
unbiased research is funded, unless the VA has full funding for
healthcare, and unless there is extensive outreach to Gulf war
veterans.
Finally, the Resource Center strongly believes that
research delayed or not funding equals healthcare denied for
more than 100,000 sick Gulf war veterans. How long must we
wait, twisting in the wind, sick, and dying? How long? How
long, Mr. Chairman?
Thank you.
[The prepared statement of Mr. Sullivan follows:]
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Mr. Shays. Thank you, Mr. Sullivan.
Let me just get some housekeeping out of the way, first,
before I go into our questions.
I ask unanimous consent that all members of the
subcommittee be permitted to place any opening statement into
the record, and that the record remain open for 3 days for that
purpose. And without objection, so ordered.
I further ask unanimous consent that all witnesses be
permitted to include their written statement in the record. And
without objection, so ordered.
Let me say, at the outset, it is wonderful to have all of
you here and to have you put on the record what we need to know
and what we need to focus on. And say that this committee--as
you know, but stating this for general conversation--we don't
appropriate and we don't authorize. We look at programs for
waste, fraud, and abuse. But we have an advantage the other
committees don't have. One is that we have an interdisciplinary
look; we have VA and DOD. And, frankly, I asked to chair this
committee and brought VA with us--because it was under the
other committee I chaired--so that we would have the advantage
of looking at, for instance, Mr. Weidman, your point that we
need to track a veteran, a soldier, sailor, Air Force, Marine
record from day one. And that when they get in the VA, the
first question that should be asked is, ``What did you do in
the service?''--and go from there.
And so we can rightly apportion, then, work with the
authorizing committees to have them become law or have them be
appropriations, and that is, in fact, what we did with the
whole issue of our look at the Gulf war illnesses. So we are
interdisciplinary and we can look at.
And the other thing is that we are going to sometimes
offend the service organizations, because we don't know your
organization as closely as say the veterans do or the DOD does,
but, in that, we are going to break out of the box. For
instance, I might ask a question of, ``Why don't we just give a
veteran a card?'' And I know some of you don't like that, but I
am going to want that dialog. And that they can go to any
hospital in the world and get the best healthcare. Now I know
there are answers to that. I know that the hospitals focus in
on the special needs of veterans, and I know that you want to
know there is a place, and I know those other questions, but I
am going to want that kind of dialog as well.
Mr. Blagojevich is going to start the questions off. We are
going to, obviously, just keep moving because we don't want to
have a break and then have to have you come back.
Mr. Blagojevich. Thank you, Mr. Chairman.
I have a question for the whole panel, and it is a very
broad question. I think it is probably a good way to start out.
And what I have noticed as a common theme, irrespective of
what war the veteran fought in is that there seems to be two
factors that you guys are lamenting: insufficiency of funding
and lack of access to healthcare, which are, I think from a
moral perspective, very troubling.
If you can just briefly, anybody in the panel, or as many
of you that would like, tell us about how we got in this
position and why that happened.
Shall I just isolate somebody or do one of you want to
volunteer?
Mr. Wannemacher. Well, I would just say that, as you
recognized, it doesn't matter which war you are in, we all
became disabled or have--because of our economics--become
eligible for VA healthcare. Whether it be VA pensions or VA
compensation, all of us are eligible for VA education benefits.
And we all fought different wars for the same purposes, and
that was to keep America free. None of us went to war as a
Republican or a Democrat. We all went to serve that American
flag that sits behind you. And the inadequacy is in my written
statement and in my oral statement, also.
The consistent inadequacy of the budget has caused the
Veterans Administration to be trying to stay ahead. And now
they are at a point where they have reached a wall. The
efficiencies have been taken away within the VA. There are
still some efficiencies that might be able to be found, but as
veterans' age, consistently age, they need healthcare, and the
budget just hasn't kept up with that.
Mr. Robertson. The American Legion agrees with that. The
escalating cost of healthcare in the private sector has just
driven the price through the ceiling. And year after year,
after year, after year, after year, the veterans' organizations
kept saying, ``You are falling behind; you are falling behind.
You are a dinosaur system, and the rest of the world is out
here in this type of managed care healthcare.''
The problem is, is at one time, the VA healthcare system
was probably ``the example'' of medical care in the country. We
are affiliated with 107 medical schools. This is a teaching
institution for the future generations of healthcare providers.
And we are watching this system implode on itself.
And everybody is saying, ``Well, you know, we will just
throw a little bucks this way and a little bucks that way, and
it will pacify them for another year.'' We have gotten to the
point where veterans are being said, ``You have got to leave a
long-term care facility, and we will drop you off at the
homeless shelter.''
We are at a point when veterans come back from a war like
the Persian Gulf and say, ``We are sick; we need help. We need
medical attention.'' And you are telling us, ``Prove to us you
are sick.''
My God, let's talk logic here. That is not difficult to
understand. If you send me halfway around the world, and I come
back and say, ``I am sick,'' you have an obligation to take
care of me. I did your job; now you do yours.
Mr. Woodbury. There is a more fundamental reason, I think,
sir. VA and DOD are easy marks in the appropriation process. If
you are trying to make a ``bogey'' in some other program that
may be more political expedient, you can get the money from
DOD; you can get the money from VA, and you don't have the
advocacy in that appropriation forum that you have here. And I
think that is one reason we got ourselves in this position in
the first place.
Mr. Weidman. It is the public conception that VA does
everything for all veterans that people have that make it an
issue that becomes difficult to address. So if you feed that
horse a little bit less and a little bit less each year, and
the VA hospital is still down the road, and you haven't gotten
the message out that veterans quite literally are dying albeit
because they are denied needed care under, ``cost savings,'' VA
denies that is happening. And it is true, people aren't turned
away, but, you know, ``they use euphemism'' about
reorganization.
One of my favorites is they reorganized the Alcohol and
Drug Treatment Program in Albany, Stratton VA Medical Center.
What ``reorganization'' was, they closed the program there and
have a van every 2 weeks to take somebody 200-miles-plus to
Batavia. And folks who were ready to dry out and get clean
weren't going to wait 2 weeks. Therefore, they discontinued the
van because nobody used it. It is that kind of euphemism of not
denial of care.
And make no mistake about it; the savings mean services
denied to veterans, and I think that is how, little by little,
we slipped into the point where the horse is just about to die.
Mr. Cullinan. I would just add to that. I agree with my
colleague's apocryhal tale of the horse and the straw. And it
doesn't just pertain to funding. It pertains to the
efficiencies and the reductions and the realignments that have
been going on in the VA for over 10 years now, perhaps 20
years.
It is an ongoing--it has happened gradually, slowly. We
have protested; we protested, but seldom were we heeded.
Mr. Sullivan. Congressman, I would quickly answer that by
saying the public and many Members of Congress--I have met with
them--are under some bizarre false impression that the Gulf war
ended. There is a war going on, and when a war like World War
II or Vietnam ends, that doesn't mean that since the soldiers
are home, they are suddenly healthy and everything is done.
There is a public impression that the day the war is declared
over that there is closure. That is not true with war.
And the main thing I would like to impress upon the Members
here is that the Gulf war is continuing; we are bombing them
every day, and it is the most insane, moral outrage to consider
cutting veterans' benefits and healthcare while our troops are
dropping bombs and getting shot at and breathing in DU and
receiving experimental anthrax shots. It is insane.
Mr. Blagojevich. Thank you very much.
Mr. Shays. Mr. Terry.
Mr. Terry. Thank you, Mr. Chairman.
I have a short statement that will lead into a question
that, really, you hinted or stated in your statement, Mr.
Chairman, and that is, ``What is the future role of the VA
hospitals?''
Let me just say that I am not a veteran, but I am here
because I am very interested in the issues. I truly believe
that, even though there was no law passed, but this Government
made promises of healthcare. We need to uphold that promise
that was in the recruiting propaganda that you were given, the
promises that you were given when you made that oath. One of
the tasks I have assigned myself is to try and uphold that.
Again, that may require that we think out of the box on
occasion. How do we do that? If the No. 1 goal is to ensure
half the healthcare, my first question is going to be exactly
what the chairman raised. Does that necessarily mean a separate
healthcare physical system? Do we need the brick and the mortar
of the VA hospital? And let me tell you, I have taken your
advice. I visited our VA hospital; we have a great one in
Omaha, NE. A guy I have coffee with almost every morning that
has heart problems that is connected to--that is a service-
connected disability--moved back to Omaha from Texas because he
thought our facility was one of the best in the area or in the
Nation.
But I also hear, in visiting our VA facility, that they are
becoming more like a regular hospital with their administrative
duties, and having to fill out codes. What I am saying is, in
many ways, they are operating like the University of Nebraska
Hospital that is only 10 blocks away. So my first question is,
why do we need a separate system if our goal is to ensure
healthcare?
Mr. Cullinan. Mr. Terry, I would just say, first of all,
some of our best friends through the years have been non-
veterans in the Congress, so you should know that.
Mr. Terry. Good, and I appreciate that.
Mr. Cullinan. And I will briefly address--really, what you
have introduced here is a complete separate hearing or
hearings.
Mr. Terry. Yes.
Mr. Cullinan. What I would say, though, off the cuff, is
that, first of all, VA has a very special mission and a very
special expertise--caring for combat, disabled veterans. You
know, through the years, they have been in the forefront in
everything from trauma injury to prosthetics to certain
pharmacological concerns for veterans serving from, you know,
tropical maladies. So there is that issue.
Then there is another point. If it weren't for the
Department of Veterans Affairs, do we really believe that would
somehow keep the cost down to the system? Do we really believe
that private providers would somehow fill the gap for VA? We
don't think so, both from the perspective of cost and from the
perspective of those specialty areas.
You know, let's face it, if it weren't for the Department
of Veterans Affairs, I mean we would still have 100-pound
wheelchairs and probably wooden prosthetics. The reason for
that is, is that years ago, there was no money in it so the
private sector didn't pursue it. And that is true of a host of
other areas as well, so it is important.
Does VA have to change the way it does business? Yes, of
course it does, and it is starting to do that. There is some
pain and some trauma, in a metaphorical sense. But we also--
along with the complaints that we hear, we hear from veterans
who like the fact that there is now an outpatient clinic,
reasonably within access to their home.
Mr. Robertson. Mr. Chairman, Mr. Congressman, in answer to
your question, if Desert Storm had produced the ``mother of all
ground actions'' and our guys had been exposed to chemical and
biological agents that required long-term care, name me the
private hospital that would like 100,000 troops showing up at
their doors with diseases that maybe they don't know how to
take care of. You are talking about a system that is the backup
to the Department of Defense, that when it is time for the
balloon to go up and the DOD people deploy overseas and fight
on the battlegrounds and serve at field hospitals, there is not
a whole lot of private physicians that are going to want to
walk away from their practice and their 3 o'clock tea times to
go fight in the Persian Gulf.
So I think that there is a real mission that you need to
look at that is very valuable that the VA provides, and that is
the backup to the Department of Defense.
In answer to your question, Mr. Shays, about the credit
card--you have a system like that, and it is called
``Medicare,'' and it is not working very well either.
Mr. Weidman. I would just add, Mr. Terry, to that entire
issue, that if VA truly addresses the needs of veterans'
healthcare in a full and holistic way, then we need VA.
You may know already, sir, that over $1.2 billion is
already contracted out in medical services by VHA. I suspect
that number is going to go up dramatically in the future.
The real question at the heart of what you are talking
about is changing the power of relationships between the VA
versus the veteran who walks through the front door. That is
our interest. And if it took something like that in order to
change that ``power relationship'' between the individual
veteran who seeks care, then maybe that is the way to, at
least, look to proceed. But the real question here--is VA
hospital system, Veterans Health Administration, currently
addressing the needs of veterans, as veterans?
What I am talking about that, incidentally, is that all too
often when a veteran walks into a VA hospital in Omaha or
anyplace else in this country, they are regarded as a
supplicant, as a supplicant, and not as a veteran who is
deserving of dignity and respect--or at least are made to feel
that way by certain staff.
It is always remarkable to me how many people get good
treatment at the VA healthcare system, given how messed up the
system is and anatomizing in many ways. Contrary to people
preserving their dignity in the very way in which it is set up.
And if you can change that ``power relationship'' and have
quality assurance within the VA to focus on the needs of
veterans, as veterans, then, by all means, you absolutely need
a separate VA healthcare system.
Mr. Wannemacher. Just a short--the DAV did an analysis
comparing Medicare and VA. We took the $17 billion that VA has
and the appropriation from Medicare and we showed--our
executive director, Dave Gorman, did a commentary. ``In Modern
Healthcare,'' February 12, Mr. Gorman said there is a real good
reason why the Federal Government just can't even afford to
provide the same healthcare that the VA does.
One thing that wasn't mentioned--it was mentioned about
being an educator in that, but the research that VA provides,
also, is for the American economy. There would be, you know, we
have already discovered the pacemaker, the CAT scan, the
virtual elimination of tuberculosis--things that wouldn't have
happened without the Veterans Administration, just like there
would be a lot of advances that wouldn't have happened without
the space program. And to say that the Veterans Administration
should just go away like a bad penny is completely unwarranted.
And I agree with what was said, too--many of our strongest
advocates aren't veterans. You hear the rhetoric that, ``Well,
the Congress isn't doing the right thing because there is a
decreasing veteran population.'' I don't believe that; we don't
believe that.
Mr. Sullivan. Congressman, if I may answer your question. I
am considered a very, very harsh critic of the VA. The Resource
Center has been very, very vigorous in attacking the VA for not
doing what they are supposed to do to help out Gulf war
veterans.
That said, there are some people at the VA who really care
and who really work hard. And we have gone more to being
harshly critical to keeping them honest in their work. And
toward that end, the VA is actually looking into radioactive
depleted uranium toxic waste contamination among Gulf war
veterans. A lot of that came about as the work of the publicity
of this committee. That is something that only the VA can do.
Who else is going to breath in lung-fulls of radioactive toxic
waste on a battlefield in a foreign country?
The second is the vet centers--that is a beautiful VA
program that is a legacy of Vietnam veterans that opened up the
door for readjustment counseling for combat veterans of the
Gulf war when they came back. With that program, we may see
reductions, the saving of lives, because people had someplace
to go to talk about their war experiences.
That is something that only the VA is going to do, and it
is a moral and legal contract. So we may criticize the VA, up
and down until tomorrow, but it is something that we need, and
it has to be there because we are still fighting a war right
now.
Mr. Shays. Let me tell you how I am going to suggest we
continue. Obviously, each member is really not going to be able
to ask a lot of questions. We really have six excellent
witnesses. The purpose of this first hearing is to kind of just
introduce the issues, just to expose us. Be assured, we are not
going to recommend or do anything without extensive research
and involvement with your organizations, as it relates to the
VA.
We are really trying to determine what our agenda should
be. Should we focus in on what the hospitals do? Should there
be a different system, a combined system? I mean, obviously, we
all agree on the funding issue. So I just want to make that
point.
The other point I am going to make is that I am going to
leave at 10 o'clock, but I am going to give the gavel to any
Member who is going to stay--be it a Republican or Democrat,
and we can close the hearing with a Democrat, for instance.
Bernie, you may want to go on for awhile, and I will just
give you the gavel, but, also, acknowledge that Mr. Filner is
here, and since he is not an official member of this committee,
he is just having to wait until the end if he does want to ask
questions. But his involvement in this issue is paramount, and
we will be inviting him to participate in any future hearings
we have.
Also, may I just acknowledge the presence of Mr. Mica, who
chairs the committee I used to chair, which has HHS. And so he
gets involved in this issue, and we will be sharing some work
with him as well--and Mr. Souder, who serves, I think, on both
committees as well.
Mr. Sanders.
Mr. Sanders. Thank you very much, Mr. Chairman.
And we welcome Mr. Filner and congratulate him for his
outstanding work that he has done for veterans.
And, Mr. Chairman, let me congratulate you for the work
that you have done over the last several years in Gulf war
illness.
Steve, thank you very much for coming to Vermont to be part
of the Gulf war illness conference that we have. And, Rick,
thank you very much for your advice on agent orange, and that
is something that I hope very much, Mr. Chairman--I think there
is a scandal out there, and I think we should get to it. And,
Paul, thank you so much for all the great work you have done on
Gulf war illness. And, Dennis, and, David, and, Robert, I look
forward to working with you.
I am the only Independent in the U.S. Congress, so I
sometimes look at things a little bit different than my
colleagues, and sometimes a little bit franker than my
colleagues. Sometimes I say things that I regret having said
after I say them, but that is----
Mr. Shays. That just relates to your personality, not--
[laughter.]
Mr. Sanders. That is my personality--[laughter]--I know,
but I can't help it.
So, let me be as straightforward as I can.
I consider myself, along with some of the folks up here, to
be a very strong defender of veterans, and do you know why? I
happen to be an anti-war Congressman; I vote against the wars.
But I happen to think that when a man or woman takes the oath
and goes out and puts their life on the line and does
everything that is being asked of them, then this Government
has the moral responsibility of fulfilling its end of the
bargain. And if it doesn't do that, if that contract between
the Government and the men and women who put their lives on the
line is broken, then, this country does not stand for very much
at all. So, while we can argue about the wisdom of this or that
war, after the decision is made, it is the moral obligation of
this Government to stand with the people who are making the
ultimate sacrifice.
Now I happen to believe that the way the U.S. Congress, and
various administrations, have treated veterans is an absolute
disgrace. At this moment now, I am spending far more time than
I ever wanted to making sure that the VA hospital in White
River Junction, VT, has the services that it needs, that it
treats our people with the minimum standards that are required.
But I know that problem exists all over the country, and it is
an outrage.
Now I think it was Dennis who may have made the point--I
don't know that--who talked about this problem going on for 10
or 20 years under the Reagan administration, under the Bush
administration, under the Clinton administration, OK?
Now what I have a hard time understanding is that with
millions of millions of folks in your organizations, with an
understanding we are all politicians, and when I go home in my
State and I say, ``Do you think we should treat veterans with
respect and provide the care they need?'' Everybody says that
we should. So I don't understand how for 20 years, under
Republican administrations and under Democratic
administrations, veterans have not gotten their fair share.
I don't know if you have not been doing your job. I don't
know if we have not been doing our job, but somebody has
screwed up royally. Because I am tired of getting calls from
veterans in the State of Vermont who tell me that they are not
getting the care that they need. And Mr. Filner is getting
those calls; and every Member here is getting those calls.
Now I want to get back--and here is where I am going to get
into some trouble. I came in a little bit later and I think,
David, you were talking. And you were telling me how we need
that old anti-ballistic missile system to protect us from North
Korea. Right?
Or whatever--I may have not gotten the whole point.
Well, I find it amazing that when we need a few billion
dollars--and I am not sure that your proposal--your independent
budget may be too conservative--I would suggest that you need
more than that. But be that as it may, I find it rather amazing
that President Clinton is proposing $110 billion more for the
military over the next 5 years. The Republicans thinks that is
much too little; they want to put $150 billion into the
military over the next 5 years. And you are sitting here
telling us that you need a few billion dollars for the
veterans.
So when I go down on the floor today in opposition to the
ballistic missile system, you know what I am going to say? I am
going to say, ``Scratch that system and use that money for
veterans' medical care.''
And I want to know where your voice was 2 years ago on the
Balanced Budget Amendment, when we gave tax breaks to
billionaires. We have $115 billion in tax breaks, most of which
went to the very wealthy--but apparently we don't have enough
money for the veterans. We didn't have a few billion dollars to
make sure that our hospitals were open.
Now I am glad you are here telling us how important it is
to have a ballistic missile system. But when I hear the guys
who make billions off the ballistic missile systems, I don't
hear them telling us that it is important that we have an
adequate veterans' care.
So let me, respectfully, make this suggestion about how we
can all work better together. I am going to do everything I can
to go beyond this budget. I don't think that is enough. I don't
want to get any more calls from veterans in the State of
Vermont that they are not getting the care. I want more
outreach, because I think the VA hospital is not outreaching
enough, bringing in enough veterans.
I would respectfully make a suggestion that the veterans'
organizations fight like hell to protect the veterans, in terms
of the healthcare needs, that we start an investigation about
agent orange, that we are going to make some progress, finally,
in dealing with Gulf war illness, that we want to understand
the scandal of radiation illness and why the VA and the DOD did
not react appropriately to that, and that we want this
Government to keep its contract to the veterans.
As citizens of this country, you have every right in the
world to give your opinions on defense spending, and so forth
and so on. But I would hope very much that your focus would be
on the needs of veterans and work with us on those issues,
because I don't hear the guys from the DOD and the big
contracts because Lockheed-Martin doesn't come in here and say,
``Worry about the veterans.'' Lockheed-Martin has enough
lobbyists in here to take good care of themselves.
So now I have gotten you all angry. Steve, am I crazy?
Mr. Robertson. No, sir, you are not. And just for the
record, I want to tell you that the biggest opponents of war
are sitting at this table. We've been there, done that, got the
t-shirt, and we adamantly don't like war. But that, also, is
part of our philosophy in the American Legion, is to maintain a
strong national defense, to prevent us from doing this again.
My son just went into the Army Reserves, and I don't want
to see him going overseas into combat, any more than you do.
But I think that there is a balance that we have to strike. And
the American Legion and my colleagues here from the other
organizations have been fighting. But you have got to remember,
Congressman, we represent less than 1 percent of the U.S.
population. And you are right; there is a lot of people that
aren't in there fighting and battling with us on our side on
these issues, because we don't impact their lives day in and
day out. They forget the freedoms that they enjoy were
purchased with the blood of our comrades and many of ourselves.
And, you know, it is kind of, you know, ``when you need me, I
am here; otherwise, get out of my way and don't bother me.''
That is why, we, as veterans' organizations and military
service organizations are supposed to be the conscience of this
country to remind you when the scale is being tipped in the
wrong direction. And we are screaming. And I will tell you--I
will be very honest with you, Congressman. When military war
decorated combat service-connected veterans start showing up in
homeless shelters instead of long-term care facilities, when
hospitals are closing around the country and veterans are going
home to die, you will start hearing more people become
involved, because it will be family members who are saying,
``How can our country reach this level of disrespect for those
who have won the freedoms and are willing to die tomorrow to
protect you again?'' And if they call me tomorrow, I will pack
my bag, and I will be on the next plane if that is what it is
going to take to keep these freedoms.
Mr. Sanders. Steve, my question is, what goes on when
people are proposing tens of billions of dollars in tax breaks,
right now, and you are here asking for a few billion dollars
for veterans? And every person up here understands they are
needed. What is going on?
Mr. Robertson. The American Legion doesn't--[laughter]--
endorse tax breaks.
Mr. Sanders. I am not even asking----
Mr. Robertson. It is not part of our legislative portfolio.
Mr. Sanders. No. No, I am not suggesting that you do. But,
why--why, in your judgment, does that go on, Rick?
Mr. Weidman. I think it really comes back to that whole
analogy of slowly starving the horse. Somehow people don't get
it--as long as we don't close the hospital in my district. The
administration's budget was the equivalent of closing 26
hospitals. Some of us suggested to the Veterans Affairs
Committee that they take the unprecedented step of bringing it
immediately to the floor and rejecting it, or unanimously,
sending it back to the President, and said, ``For God's sake,
send us a serious budget that is going to address the
healthcare needs of veterans.'' And they did not do it.
If you take the next step--some of us suggested, privately,
but not publicly, that you take the step of--if you close some
hospitals first, instead of reducing all hospitals by little
bits, starving each one of the facilities. And you closed all
the hospitals in the budget committee members' district, by
God, you would have another $10 billion for the system. You
would, wouldn't you? But because it is by attrition. I think
that is one element.
The second thing is that popular conception that I talked
about before that veterans have too much, that is still driven
by a lot of people in our society. If you think about it for a
minute, if any other discrete group of Americans had their
healthcare costs frozen for 5 years in a row--suppose that the
Congress had decided to do that for African-Americans, all
African-Americans, suppose the Congress had tried to do that
for all women, suppose the Congress had tried to do that for
everybody of Lithuanian descent, then all hell would have
broken loose. But somehow, somehow, because it is veterans,
people think they can get away with it.
Mr. Mica, I am glad to see is here, because he played an
extraordinary role in trying to put some teeth back into the
veterans preferences. The same sorts of remarks that the
Federal unions made about veterans, they would not dare make
about any other discreet group of Americans. And Mr. Mica knows
all too well what I am talking about here. Well, they would
say, ``We want a quality work force, therefore, we don't want
veterans' preference.'' Excuse me? The same people you trusted
with the weapons that could destroy the world, that were worth
billions of dollars 2 years ago, now aren't worthy of being a
GS-9? And shuffling papers? Excuse me?
I mean it is just extraordinary. People deny that there is
``veticism'' within their society that is every bit alive and
well as sexism and racism within this society, but it is there.
Veterans are for Veterans' Day and for Memorial Day, and in
between time, those guys with funny hats can take care of
themselves because they already have too much. We have to
change that perception.
Beginning this May, it will be a relatively small effort,
but a lot of veterans are going to be focusing, the night of
the 27th or 28th, at a march on Washington, with a view toward
2000, of really feeling them all up, 1931. And if it takes
going back to the damn streets to do it, then that is what we
ought to do in order to crack through this myth. We have been
marginalized, at the same time everybody is paying a pieoa a
couple of times a year. And sometimes folks say, ``The only
good vet is a dead vet.'' That is why they honor us on
Veterans' Day and Memorial Day, for christ sake. What happens
in between? And I don't think it is an issue of whether--the
percentage within this society. I really don't believe it is
that. One of the finest veterans' advocates I have ever met is
on your staff, Jim Rader. There is a lot of people walking
around in Vermont because of Jim's work at the vet center in
the early 1980's. However, within the context of the society at
large, there is a Gulf, particularly in the generation in power
right now, between those of us who went--irrespectively of what
we thought about the policy--and those of us who did not go.
And I don't think you have to have served in order to be a
veterans' advocate, and you and Mr. Filner certainly are
representative of that. But it is true that, within the
Congress, when it comes to the nut of where the dough goes,
suddenly folks aren't there; $1.1 billion the Senate Budget
Committee finally provided on top of the President's budget.
And if you take the Medicare inflation rate for the last decade
and apply the same rate of Medicare and the Federal funding of
Medicaid, whichever--but a lot of people believe is
inadequate--the VA budget now would be over $22 billion a year
for VHA.
Mr. Shays. Let me just recognize Mr. Mica--but also say, I
know some of you had an obligation. If you do, feel free to go.
I know one reason we started it was because of the briefing on
the floor, but also because some of you had an obligation or
two.
I am going to ask Mr. Mica to have the floor. And then,
Bernie, you know, give you back the gavel if you want to be
here and if you want to pursue the questioning.
So, Mr. Mica, you have the floor.
And I am going to just apologize for leaving, but I have a
budget meeting that I have to go to, and then I want to try to
get on the floor to some of that hearing. I have not voted
against performance of the Defense, and I am leaning close to
doing that, thinking that we really need to do that.
So, I will give Mr. Mica the floor.
Mr. Mica [presiding]. I thank you, Mr. Shays, Mr. Chairman,
for holding this meeting, and I am really pleased to see that
we have organized this subcommittee in this fashion. I had
recommended that to the Speaker and to Mr. Burton and others
that we have National Security, Veterans Affairs, and
International Relations because I think that we do need to
conduct investigations. We do need to conduct oversight, and
this is a very good beginning.
So I thank you, Mr. Chairman. I thank you for your
testimony, and I also want to thank you for helping me to get a
few things passed, although, as you all know, it has been very
difficult, both on veterans' preference and expanding
healthcare access for our veterans, our military, and
dependents.
The availability of healthcare really disturbs me. Even
this past weekend, I was the recipient of calls at home for, in
fact, a veteran who was a survivor of the Bataan death march
who was not receiving adequate care, who I personally know and
admire. Those things really disturb me, when someone who--this
man has literally been through hell and back, and is one of the
few survivors we have, and to have to grovel for healthcare at
his age is just shameful for all of us. But, trying to do
something about this--this is not the only case. I hear it all
the time from people--the delays, the access to specialty care,
the waiting lists. Some of them die before they ever get
treatment or even to proper diagnosis, which disturbs me even
more. So I think what we need to do is look at how we can
develop that.
One of the things that we did try to do was open the
Federal Employees' Health Benefits Program, which will have a
small demonstration project. Are there other areas that you
think we can--and we need some immediate attention. We can't--
[laughter]--the tendency of Congress is to have a study, a demo
project--[laughter]--and most of the people die before we get
to where we want to be. But are there any specific ideas that
you have that we could address in the very short-term, in this
session now past, that would bring healthcare immediately to
these people who are on waiting lists, who need special kinds
of treatments, both for that type of treatment. Then the other
area I have a grave concern for is long-term care, because of
the aging demographics of particularly our World War II and our
Korean war--some of those veterans. Long-term care is a
disaster right now in trying to place folks. And sometimes when
we find the placement, it separates the veteran from the family
in a very awkward fashion.
So those are two areas, and maybe you could comment with
some suggestions.
Mr. Cullinan. Mr. Mica, for one thing, we are urging that
the Federal employee benefit package, the pilot you just
referenced, that should be implemented fully and now. We don't
see any reason to wait. Can that be accomplished quickly in
this Congress? Probably not.
We are looking for additional funding streams outside of
the conventional appropriations process--Medicare subvention,
allowing VA to collect and retain Medicare dollars for the care
it provides for Medicare-eligible veterans for their non-
service-connected disabilities. Can that be accomplished in
this Congress? I don't know; I would hope so, but when I say,
``I don't know,'' I am really saying, ``I think not.''
There are any number of areas. Right now VA has opened--
right now, it has pledged to enroll all seven categories of
veterans who come to it seeking healthcare. Does VA have the
money to sustain that? If this administration's budget goes
forward, without amendment or improvement, no, it doesn't.
There is something right now. But to sustain that effort, to
sustain VA and its ability to care for all veterans who want to
enroll into the system, that is something that we can do right
now that will be of a measurable benefit to veterans.
Mr. Mica. Thank you.
Mr. Robertson. Yes, sir. Under the Medicare subvention,
Medicare plus choice, why a veteran can't say, ``I am Medicare-
eligible; I am not service-connected; I am not currently
entitled to VA healthcare at no cost?'' Why they cannot choose
the VA healthcare system, as their healthcare provider, is
beyond me. And could that be done in one Congress? I think
absolutely. I think that the House Republican leadership in--
what was it--in 1992, when they came, had their contract with
America, and showed how much you could do in 100 days.
Well, I think if you set your mind to it in a bipartisan
manner, that anything can be accomplished in this chamber. And
I would strongly encourage that be a quick-fix. That is
something that I think would last for--be part of a solution to
your Medicare problems. If you have a managed care system that
you can put these people into, and it would bring money into
the VA healthcare system to offset those costs.
The other thing that is kind of a problem is the MCCF, the
Medical Care Collection Fund, offsets third-party
reimbursements against discretionary funding. Discretionary
funding was designed to take care of service-connected
veterans. But what happens under the budget accounting is that
they reduce the third-party reimbursements rather than add that
as a supplement, so that VA benefits as they collect more money
for treating non-service-connected veterans.
What you are doing now is you are using discretionary
dollars which are supposed to be healthcare dollars to pay for
non-service-connected conditions, and that is wrong. That is
fundamentally wrong.
Those are two things that I would recommend.
Mr. Mica. Sir.
Mr. Wannemacher. The Medicare subvention bill that was on
the floor last year that Representatives Thomas and Stump had,
the DAV's--only objection was that VA didn't have an accounting
system that was going to be able to guarantee that only
service-connected disabilities were going to be charged. The
DAV has long endorsed--and the independent budget has long
endorsed--Medicare subvention, and we call for it again this
year. And as Steve mentioned, in 100 days, you could get a lot
of things completed.
For a short term, you could probably do some things that
would help the Montgomery GI bill proposal that was made by the
Transition Commission. There are some good recommendations in
there, and we support that. We have seen some language that
there is about $881 million that would have to be appropriated
to provide an education tool for the Montgomery GI bill. There
is also some homeless projects. We have seen some language on
some homeless projects that could assist. It is only about $5
million needed to enhance Homeless Veterans Reintegration
Program.
Those are a couple, and I would be glad to submit some
others for you.
Mr. Mica. I would appreciate, actually, all of you
following up. I will try to get one of my staff assigned to
that. I no longer chair Civil Service, but we can get one of
our subcommittee staffers to work with you.
Did you have anything you wanted to add, then? Then, I am
going to turn to Mr. Souder.
Mr. Weidman. I think it could be done in one Congress, Mr.
Mica.
But the real problem is, is breaking out of the mind set as
``business as usual,'' and people say, well--in fact the
majority counsel for the House of Veterans Affairs Committee
said that to me about Vietnam Veterans of America legislative
agenda. ``This would be great if you were starting over.'' And
I said, ``Maybe we need to. Have you taken a look at what is
going on?'' Those aren't hypothetical stories about VA
hospitals, for instance, in the State of New York, discharging
homeless veterans after 4 o'clock because they know that the
State-funded shelters have to take them. I mean those are real
stories happening in Mr. Lazio's district right now. And we do
need the drive, and if certainly this committee can help raise
that conscientious among your colleagues--and I might add, as
importantly, among the public at large, because even in
Florida--in your district, Mr. Mica--people think that veterans
are well-taken care of. They do not understand that veterans
are not being well-taken care of, that people are literally
being denied services that are vital, that keep them alive.
Mr. Mica. Thank you.
Mr. Sullivan. Congressman, specifically related to Gulf war
veterans, because the Gulf war is a toxic soup with things that
folks never dreamed that would be on the battlefield, like
radioactive toxic waste and mixes of pesticides and
experimental pills to protect people against chemical warfare
agents, plus chemical warfare agents--the main thing Gulf war
veterans are looking for in healthcare is, the VA and DOD have
acknowledged widespread contamination to radioactive toxic
waste. At first they said it was nobody; then it was 30; then
it was 100; then it was 800. Now it is hundreds of thousands,
Congressman. When will the VA launch a comprehensive program
into depleted uranium contamination? The stuff is radioactive.
We are finding depleted uranium now, Congressman, in the semen
of Gulf war veterans. They want to know ``what does this mean?
Should I have kids?'' This is right in their face. Gen-X, that
is my generation, the young folks are asking every morning.
``Do we want to have kids?'' I mean that is a healthcare issue
right in our face that has implications for generations.
It also has implications on the experimental anthrax shot
the Pentagon is using. We need to know what kind of health
effects that has. Veterans want to know, when is the Pentagon
going to do some new research on this experimental vaccine?
They love to say, ``Oh, it is FDA-approved.'' There is no FDA
approval for the use of a vaccine against an unknown biological
airborne agent. The Pentagon is lying through their teeth. Now
what we have to find out is, when are we going to get
healthcare for the known and unknown, or yet to be known, side-
effects of the use of these experimental vaccines?
That is what Gulf war veterans want to know in a healthcare
answer, because the Gulf war was an exotic, toxic soup of
stuff, and we are waiting for answers, and we are trying to get
healthcare.
Thank you, sir.
Mr. Mica. Thank you, each of you, for your testimony. I
look forward to working with you. I think this is a good
beginning and a good opportunity to get an overview, and,
hopefully, our subcommittee with this new responsibility, can
be effective. Thank you.
And I would like to recognize now, the gentleman from
Indiana.
Mr. Souder. I thank the chairman.
One, I wanted just to say up front that I don't believe
that veterans' benefits ought to be separated or be viewed as
put in contrast with weapon systems, whether they be anti-
ballistic missile systems or other strong national defense,
because the last thing we want to do is have any current
soldier go into war and not have the best plane, the best
weapons; that is a nightmare. And as a country--as the
gentleman from the Legion said--we need to make sure that we
are protected as best as possible, because our goal is
``peace,'' not ``war,'' and as few wounded veterans and as few
civilians as possible.
At the same time, a number of these things, if we don't
address them, if we don't treat veterans fairly, in addition to
the equity question, when we are in a voluntary military, it
becomes a problematic question of how we are going to recruit
if we are not fair. Or are we going to go back to draft days?
So, it is not only an equity question, it is a practical
question that we are facing as a Government.
We all have many cases in our district. I have had a couple
that have come up to me with an unusual wrinkle, and I
wondered, first off, if--I have gone through your testimony. I
saw a couple of references that were tangential to this, but I
would appreciate it if you can make some allusions here or
check back, because it may be something we can actually,
fundamentally, address, in addition to the broader questions
that you have raised today.
One veteran--and it has to do not so much with war-related
injuries, because while the veterans' facilities are tightening
down and moving to more outpatient, it seems that if it is a
direct war-related injury, they are still trying to accommodate
that. But there are many injuries or health problems that come
up that weren't directly war-related, and then as they try to
seek outpatient service, what I have been running into, is
something like what we seen in senior citizens case of almost
it is requiring a ``spend down'' of any assets that the
individual has or using those up before they are eligible for
care, which wouldn't have happened in a veterans' hospital.
And, in particular, I had one whose wife was working as a
greeter at Wal-Mart, but because he had another pension, her
salary as a greeter at Wal-Mart, part-time, put him over the
cap, where he would lose his benefits if she didn't quit her
greeting job. And the argument was that his income sources were
less than the welfare benefits cap, and that veterans aren't
even up to what a welfare recipient can earn in the
discretionary income.
A similar, but a different variation of this--and then if
you can comment on these--that another veteran came to me the
other week where we, I think--it is a similar thing on tax cuts
and economic growth. Most veterans, after they leave the
military, have other jobs in the society. So they want to make
sure our society is functioning, that they have those jobs, but
then that means, often, that they have other benefits they have
accumulated which bring in pensions in addition to military
pensions or sources of income.
And this person was told--he was, I think, in the veterans'
hospital for 90 days, but because it wasn't long-term care--it
wasn't war-related, he now had to leave. The problem was, is to
get the intensive care that he now needed, it was going to cost
a large amount of dollars. But because he had assets and a
pension, he was not eligible for the subsidy because he was
above the so-called income level. Yet, once he paid his home
health costs of a constant care, that would use up all of his
income.
So part of my question here is, do you hear variations like
this? Because there are two fixes to this, possibly, at a
minimum could be. One is, is that the cost of the care related
to your income should be a calculation. A second should be that
there is no way a veteran should be treated less than anyone
else in the society, and wherever we have an income test for
benefit of eligibility, that the veterans ought to be at the
high-end of any scale like that, not at the low end.
Mr. Cullinan. Mr. Souder. In the first instance, you are
referring to a healthcare benefit?
Mr. Souder. Yes.
Mr. Cullinan. It is not supposed to work that way. And we
have a staff who would be glad--[laughter]--more than happy to
look into it. It is absolutely not supposed to work that way.
The second instance, you are touching on the issue of long-
term care. A number of us mentioned earlier, long-term care is
not mandated under law, and that is the problem. And VA, for
budgetary reasons, is actually eliminating, paring-down, its
ability--its already eliminated ability to provide long-term
care.
So really the answer is, is to get it mandated under law.
In other words, we want at least some veterans to be guaranteed
long-term care, under law. Then, we expect that the
appropriations support should follow to sustain that.
You know, second, in the issue--with respect to long-term
care, there are, given our current budget--what we would prefer
is, is a guarantee for all veterans long-term care, period.
Given the current budgetary climate, we are not going to
realize that soon, so perhaps, then, there are veterans who
would like to buy into VA as a long-term care provider. We
would certainly support that effort as well.
There are certain veterans--if a veteran needs long-term
care by virtue of a service-connected disability, he or she
should get it--no co-payments, no means test, nothing. There
are other veterans, though, who, of course--the veteran
population is considerably older than the aggregate, than the
population at large. There are a number of veterans who are
seeking access to VA's long-term care provider. Right now, they
are not getting it. As I already mentioned, VA is paring away
its limited ability to do that. These veterans should be able
to buy into VA, as a long-term care provider. And there are a
number of veterans, especially among military retirees, but
other veterans as well, who are very comfortable with VA and VA
services. They should have that option.
Mr. Wannemacher. I would just like to say, Mr. Souder, the
scenario that you put up, that veteran--right now the VA is
caring for all categories, whether they are service-connected,
non-service-connected, multi-millionaires; they can all receive
healthcare, under the proposal. But what you are referring to,
that individual that you referred to is classified, because he
is receiving non-service-connected pension, is classified as a
category 4. If he exceeded his income, he would be classified
as a category 7. And, under the current law, categories 7's are
subject to co-payments, so he would have to pay a co-payment on
his medical care, and that is probably what the frustration
was. You know, if my wife works, I am going to be classified as
a category 7 and, then, not entitled to VA pension and, then,
be subject to the co-payment.
And just one thing in your opening statement you said about
defense and not subjecting veterans to that. There is something
that you might want to share with your colleagues, that the
response would be without sacrifices made by veterans, we would
not have the level of peace and prosperity we enjoy today. The
President, when he recommended that the virtual integration of
VA and Department of Defense, when he said that, without
Defense, there would be no veterans, that is arrogance. That is
sheer arrogance. This country has to be a backup for DOD. The
Veterans Administration has to be able to provide the services
for veterans, and to think that DOD--that veterans owes
something to DOD is just ludicrous.
Mr. Robertson. Congressman, the long-term healthcare issue
is not unique--the problems they are facing are not unique to
the veterans community. We all know that.
The American Legion, several years ago--4 years ago--
developed a plan that we called the GI Bill of Health. And it
sets up the VA healthcare as a network, in which veterans that
are entitled to healthcare, i.e., service-connected veterans
and the other categories of veterans that qualify economically,
et cetera, would get their healthcare covered by the Federal
Government. All the other veterans, and their dependents, that
wanted to use the VA healthcare system could buy into the
system, just like they would be buying healthcare from Great
West or Aetna or whoever was selling those policies.
The idea being that veterans would be willing to pay for a
system that they wanted, a system that they could depend on in
their golden years, that there would be options for specialized
services, that if I wanted to buy into a long-term care
program, I could pay the VA, at the age of 45, start paying
them, in the event, that somewhere down the road, my wife and I
would need to be in a long-term care facility. This seems like
a logical business-like approach to meeting this problem.
One of the tragedies that we see in the veterans community,
is that we get a veteran taken care of in a State veterans'
home, only to have his wife who he has been married to for 60
years at the other end of the State in a federally subsidized
home, and the next time they are going to see each other is at
a funeral.
That is a tragedy. On the side of a VA hospital it says,
``to care for him who has borne the battle, and for his widow
and his orphan.'' We are doing a good job in relative terms
taking care of the veteran, but those other two are completely
out of the box.
And maybe it is time to look at a quasi-Federal Government-
type healthcare system for veterans. Because you remember,
military retirees--a lot of people forget this--but military
retirees are veterans, and we have them right now having
brought battles over in Tricare trying to figure out a place to
go. And to show you how the Government works, DOD has
contracted with however many private healthcare companies, for-
profit companies, to run Tricare, when VA has the same type of
network already in place. So why are we paying a private-sector
company to refer people back to military healthcare or back to
veterans healthcare? That just doesn't make sense. We think
that there can be some headway made in this area, and maybe
address some of the long-term care problems.
Mr. Mica. I thank the gentleman from Indiana.
And I would like to recognize Mr. Filner, from California.
Mr. Filner. Thank you, and I thank you for your courtesy.
Just quickly, a lot of these issues will be moot if a
budget is not adequate, so I think, you know, we all have to
focus on the budget at this moment. And I would just--I guess
in the tradition of Mr. Sanders, be very frank. We all have
flailed the President's budget--Democrat, Republican, all
VSO's, bipartisan, nonpartisan--but let's get off--the
President made a suggestion. Budget, by law and Constitution,
is Congress. He made his ideas, you guys, in my opinion, have
to move on band. He kept within, by the way, the budget caps
that the majority of Congress passed. So, it is not his budget,
it is really the balanced budget's budget.
I don't see you flailing at the Veterans Affairs Committee
budget that just came out. I mean the Legion now supports it,
which, even by the independent budget, is too small. So I think
we have to turn our attention to the congressional budget and
start attacking that and making us accountable.
Steve, you said your members are only 1 percent of the
population or--I mean the combined, I guess. Just give me those
2 million people, and I will pass anything in the Congress. You
guys have incredible power to deal with this issue.
As I understand the process--and my colleagues can correct
me if I am wrong--we have a budget resolution. It will be the
next stage in this process. It looks to me that the leadership
of the Congress is committed to keeping within the caps that we
had previously agreed to, which means that we are $3 billion,
plus, short of what we need for veterans.
I think your membership has to demand of their
representatives--I don't care, Republican, Democrat--that they
don't vote for that resolution unless there is a $3 billion
increase for veterans. Because what will happen in the
politics--and you have been all through this many times--if
there are no changing of those caps, folks are going to use you
and give lip service to you. They are going to propose ``X''
billion dollar increase if we cut the Housing budget, cut the
EPA budget. So we are all in a completely unattainable
situation. They are going to pit us, one against another, and
say, ``Oh, you are not for veterans. You voted to keep the
EPA.'' And I will make the same argument about the EPA that you
made about the Defense Department, you know--[laughter]--so
unless we increase those caps, we are dead, in my opinion. And
that is coming up next week, I think--at least in the House.
So I think you have to switch your attention away from the
President's budget. It has nothing to do with anything right
now, and say, ``Unless we get $3 billion more in that budget
resolution to be accountable to you.'' We are all giving lip
service; everybody is talking the talk. You know, we are all
for you. But unless they vote against that thing, it doesn't
mean anything, because there is nothing we can do after that
vote, except with untenably pitting forces against one another,
to raise the level of the budget to what we have talked about
today.
So, I--that is a political issue; I don't think it is
partisan, but I think you all have to begin to attack the
congressional budget--[laughter]--and not the Presidential
budget, and hold us accountable for that next vote that is
going to occur.
Mr. Wannemacher. Congressman, I----
Mr. Sullivan. Congressman Filner, I would like to be able
to restate what the Gulf war veterans said.
We believe the VA needs $3.2 billion more than what was
proposed by the administration and $1.3 billion more than what
was approved by the House Veterans Affairs Committee. Since the
current economic boom created a Federal budget surplus, the VA
budget cap should be lifted. Flat-lining appropriations during
war, while expenses soar and the number of patients demanding
care increases, is a recipe for disaster.
They might as well just close the VA.
Mr. Wannemacher. Congressman----
Mr. Filner. I would hope that the other five would agree
with you. [Laughter.]
Mr. Wannemacher. We would agree with that, and we, as you
know, we had our members--we were in town all this weekend, and
they were all sent out to talk about lifting the caps. And I
want to tell you that last year, Congress had no problem
lifting the caps when Transportation identified a need. They
took away $15 billion from the VA account. We wouldn't be in
this situation today if it wasn't for what happened last year.
So we encourage all of you that are still here, and I hope you
pass it on that the Veterans Administrations appropriations are
just inadequate and we need additional resources.
Mr. Sanders. So you are in agreement with what Paul said--
--
Mr. Wannemacher. Absolutely.
Mr. Sanders [continuing]. In terms of lifting the caps?
Mr. Wannemacher. Exactly.
Mr. Sanders. Is that true for all of you?
Mr. Cullinan. For our part, we are agitating to lift the
caps. We have our people addressing that specific issue. You
may have seen in the Congressional Monitor that we were
specifically saying, ``Raise the caps.''
Once again, am I optimistic? We are doing the right thing.
We are agitating to get those caps lifted. Are we going to do
it?
Mr. Sanders. OK. One of the reasons----
Mr. Robertson. Well, I am the odd man out, because the
American Legion, last October, testified before a joint session
of the Veterans Affairs Committee and said that we felt that we
were $1.9 billion low now, on what our current funding levels
were. And we asked the President's budget to include that
increase. We have been consistent with that number. We are at a
point where we are talking about need versus wants.
We, in our estimation, believe that the $1.9 is a solid
figure to meet the current needs of the VA. Does it make the
best VA in the world? No; but what we are talking about is what
we need to keep from shutting down hospitals and turning people
away. Do we need additional funding? Yes. And I, you know, the
$3 billion number is probably a good number to make us whole
again.
And the American Legion started our lobbying efforts last
October before the budgets were even introduced, and we have
continued that process. We, too, will have people in this next
week that will be attending a conference here in Washington.
But we are using the Internet, we are using our magazines and
our other publications to make sure that everybody understands
what needs to be done as far as the appropriations process.
And just for the record--and I don't think I am speaking
out of the school--and folks from the independent budget can
correct me if I am incorrect in my statement. But almost every
year, the independent budget has been around $2 to $3 billion
increase request, historically, for the last 10 years that I
can remember.
I am sorry, go ahead.
Mr. Cullinan. I know that this isn't quite the forum for
this. Actually, a number of years ago, the independent budget's
baseline was adjusted. And, actually, this touches on a
question that you posited a little while ago, Mr. Sanders. How
do we get into this past?
Perhaps we are trying to be too reasonable; I don't know.
Perhaps we are trying to be all too reasonable. I think that
you would say that we are. When we adjusted our baseline, the
situation then, we were about $6 to $7 billion out of whack
with reality. For the sake of creditability, that baseline was
adjusted. Was that wrong? I mean you would say, ``Yes.'' I can
see you----
Mr. Sanders. I think I would----
Mr. Robertson. But that is the problem we have had, is that
we have had two tiers--what we have been asking for versus what
we have been getting, and that gap has gotten wider over the
years to where we are at in the situation we are now.
So, do we all agree that, yes, we need a lot more money?
You are absolutely right.
What we are facing right now is what we are going to be
able to achieve. We are only talking $1.1 billion difference
between the two groups of numbers that we are throwing out
here, but the important thing is that it sets the baseline for
2001. That is the thing I am concerned about. If we wind up
getting nothing, then we have got--looking at a $4 billion
request for next year to make up for the shortfall we had this
year.
Mr. Weidman. I just wanted to add in, Mr. Filner, that the
difference between the $1.9 and the $3.2 billion--there is no
guarantee that the budget committee is going to come up even
$1.9 billion. What we are looking for is some leadership out of
the administration. Our executive directors all met with Vice
President Gore on Tuesday and said, ``You have to do
something.'' Frankly, we are not getting that leadership out of
the Secretary of Veterans Affairs that we have every right to
expect. Images of Nero come to mind. We need to have the
leadership of the administration. If the administration decides
to get into this budget battle as a player, those caps can be
lifted and, frankly, would make the jobs of those of you who
are pushing for $3 easier. You would have to break the budget
cap just to $1.9 billion. We need Presidential leadership on
this. Forty commitments to harms way in the last 6 years. That
seems to me to merit a response on the part of the President to
say, ``Gosh, we goofed on the VA budget. We are going to try to
get into this and raise the caps and do what is necessary in
order to start down the road toward fixing this problem.''
Mr. Filner. I thank the gentleman, and the leadership has
to come from everywhere, because they are not going to be
broken, even for the $1.9 billion or $1.1 billion that the
Senate passed anything, unless we have leadership and your
folks are politically involved at the grassroots.
Thank you, Mr. Mica.
Mr. Mica. Well, I want to thank the panelists of the
various veterans service organizations for being with us today,
for helping us launch our effort with this subcommittee which,
again, is entitled National Security, Veterans Affairs, and
International Relations.
I think we have had a good airing of some of the challenges
that face us, and I tend to be an optimist. I think if we all
work together that we can make some great progress,
particularly in this time when we are fortunate, as a Congress
and a Nation, to have a small, annualized surplus. Certainly,
our veterans should be first in line as a priority of the
Congress and the country.
With there being no further business to come before this
subcommittee this morning, I call this meeting adjourned.
[Whereupon, at 10:32 a.m., the subcommittee was adjourned.]