MOAA recently shared its legislative priorities for veterans at a joint Senate and House Veterans’ Affairs Committee hearing, part of work to strengthen and sustain the largest public integrated health delivery system in America.

The VA operates at 1,389 medical sites with over 9 million veteran enrollees, though only a little over 6 million are patients receiving care in the system. About 400,000 employees work in the VA, 90% of whom are employed in the Veterans Health Administration (VHA).

Health care is essential for veterans who often have many chronic or life-threating conditions requiring ongoing and specialized medical care. MOAA has worked hard to keep VA health care one of our top priorities by working closely with VA, the administration, and Congress.

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It is imperative the VA has the necessary resources, funding, and staffing to deliver timely access to high-quality health care. Equally important is the need to preserve and enhance VA’s unique core health system mission functions — clinical, education, research, and national emergency response.

The VHA has served veterans and the nation for over 150 years, and the pandemic and recent history of disasters have proven these services essential during times of crisis.

MOAA has identified a series of top priorities for the VHA. Click the links below for more details on each topic:

• Predictable Funding. Preserving VHA’s foundational missions and services through the annual appropriations process to secure funding by the start of each fiscal year.
  
  
• Oversight and Accountability. Focusing on solving systemic leadership, oversight, and accountability issues highlighted in government audits and reports.
  
  
• Caregiving, Long-Term Care, and Extended Care. Prioritizing and accelerating access to caregiving support, as well as long-term and extended care programs and services.
  
  
• Women, Minority, and Underserved Veterans. Eliminating disparities faced by these groups, and expanding access and services to ensure equitable delivery of health and benefits among all veteran populations.
  
  
• Behavior Health and Suicide Prevention. Ensuring the VA continues executing enacted legislation to improve access and delivery of behavioral health and suicide prevention services.
  
  
• Health Care Workforce. Stabilizing and modernizing the workforce and support systems.

Predictable Funding

The COVID-19 pandemic and other domestic and international crises continue to wreak havoc and uncertainty. Health care systems around the country, including the VA, are left wondering when or if we will reach a state of certainty, or what will be the “next normal.”

MOAA and our veteran service organization partners are concerned about what the ongoing crises and budget threats will mean for current and future policy, which could dramatically alter VA’s funding requirements.

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Like other federal agencies, the VA has endured countless delays in receiving annual appropriations each year. This is a worrying trend to MOAA — a situation all too common rather than the exception for funding the federal government.

Congress must prioritize and preserve VA’s foundational missions and services through the annual appropriations process by securing funding by the start of each fiscal year to meet VA mission requirements.

Oversight and Accountability

MOAA remains concerned about VA’s ability to execute the enormous volume of legislation amassed since the passage of the MISSION Act to modernize the VHA and address systemic problems, weaknesses, and/or challenges identified by watchdog departments like the Government Accountability Office (GAO) and the VA Office of Inspector General (VA OIG) since 2015.

The secretary of Veterans Affairs is further challenged in fully addressing systemic issues by not having the under secretary for health (USH) and under secretary for benefits (USB) positions filled for well over a year. The USH has remained unfilled for over five years, though current and former VHA officials have done exceptional work performing the duties of this consequential position in addition to other duties. MOAA was pleased to see two nominees recently put forward by the administration on these positions

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We urge lawmakers to expedite confirmation of these nominees and to remain laser-focused on VHA’s leadership, oversight, and accountability issues by conducting ongoing hearings and other activities to ensure successful resolution of systemic problems highlighted in GAO and VA OIG reports. To a veteran, caregiver, family member, or survivor, resolving systemic oversight and accountability issues will go a long way in building trust and confidence in their health care system.

Caregiving, Long-Term Care, and Extended Care

Though the VA published its final regulation on Oct. 1, 2020, to improve and expand its Program of Comprehensive Assistance for Family Caregivers (PCAFC) as mandated in the MISSION Act, the department continues to struggle with the rollout of the new program.

After a yearlong delay setting up the case management system, confusion continues over how the VA has written and is executing the PCAFC regulations limiting eligibility. A great deal of frustration and angst exists over high denial rates and lack of consistency in how the VHA is implementing the regulations for legacy system applicants and those applying under the new system.

[RELATED: Check Out MOAA’s Updated Caregiver Resources]

MOAA is thankful Secretary Denis McDonough acknowledged problems with the rollout, particularly addressing the high rate of denials during a Dec. 1 hearing where the Senate Committee on Veterans’ Affairs examined the state of the VA after his first year in his position. McDonough promised he would come back to Congress with a recommendation for reducing the high denial rate, which he recognizes was not the intent of the MISSION Act. MOAA looks forward to learning more about the secretary’s plans in the coming weeks.

Additionally, efforts are mounting in the VHA to get out in front of the rising demand for care from an aging veteran population by extending care in the home or in smaller group settings. Veterans rely on VA long-term care for everything from occasional help around the house to around-the-clock assistance.

It is essential the VA accelerate and improve upon existing long-term extended care and other geriatric programs like palliative and hospice care. Congress and the VA must prioritize and accelerate access to all these caregiving support programs and services sooner rather than later.

Women, Minority, and Underserved Veterans

MOAA is pleased with the commitment of VA leadership to ensuring equity in the delivery of health care and benefit services to women, minority, and underserved veterans — and the recognition there is more work to be done for this rapidly growing population. The VA should be commended for successfully putting in place a comprehensive primary care strategy model to improve access to, and quality of, medical care.

However, the VA is still woefully behind in collecting quality data on race, ethnicity, and gender, and must implement immediate corrective actions across the enterprise. The pandemic has placed a spotlight on the barriers and disparities facing women, minority, and underserved veterans when seeking access to VA health care and services.

The VA has a lot of work ahead in implementing its strategy and eliminating barriers to care. This will require the full support of Congress to help the VHA resolve remaining cultural, administrative, operational, and governance gaps preventing women, minority, and underserved veterans from accessing the quality health care and services they need. MOAA looks forward to continuing our work with the VA and Congress to eliminate these disparities and expand access and services to ensure equitable delivery of health and benefits among all veteran populations.

Behavior Health and Suicide Prevention

MOAA is supportive of Congress’ and VA’s prioritization of behavioral health care and services for veterans, servicemembers, and their families. This remains an incredibly important time as the VA continues to implement a significant number of bills from previous years.

We continue to hear from our members that veterans struggle to schedule appointments and to coordinate care between the VA and community providers. Any delay of health care services for veterans with chronic mental and physical conditions can be devasting.

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MOAA’s Texas Council of Chapters shared an example of this struggle in accessing care:

“Veterans are getting the run-around in obtaining referrals to community care providers, even after waiting several months for an appointment with a VA provider. Many of these veterans have PTSD and can't get timely access to a mental health counselor, at the VA or in the community. Several others waited months for routine procedures like colonoscopies and shoulder surgeries.”

MOAA looks forward to working with Congress to ensure VA continues executing enacted legislation to improve access and delivery of behavioral health and suicide prevention services, and to pass current mental health and suicide prevention legislation. The VA needs more tools to address the mounting public health suicide crisis to ensure those who have served, or are serving, can survive and thrive.

Health Care Workforce

Maintaining VA’s human infrastructure is the most critical priority. While all the above priorities are important, there would be no health system if it were not for the clinical, management, and administrative staffs needed to care for veterans — these workers are the backbone of the VA health system. At the heart of any successful modernization or system improvement efforts in the VA is a strong and viable workforce.

However, the constant change and reforms since Sept. 11, 2001 – when wars put a spotlight on VA’s health care – is taking a toll on the dedicated medical providers and support staff employees responsible for delivering the high-quality care for which the VA is known.

These cracks already were forming when the COVID-19 pandemic crisis hit, with devastating impact globally. Before the pandemic, the VHA had over 39,000 heath care vacancies — today, the vacancy estimate is around 50,000.

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Clinical staffing shortages contribute to employee burnout, longer wait times, and more veterans sent to community providers despite preferring to receive care at a VA facility. These last two years of the pandemic have exacerbated such troubling trends while lowering morale and increasing trauma among the medical staff.

One MOAA member, while pleased with his care at the VA clinic in Hampton Roads, Va., said:

“I use Hampton VA for a significant amount of my health care. I am quite pleased with the VA Greenbrier Clinic and my primary care manager. The folks at the hospital have all been great. If there is one complaint it is the wait time to get specialty appointments. I had one clinic that took 3½ months to get an initial appointment. The process for additional test, evaluation and assessment will take another 4-5 months, with 1-2 months between appointments. Some of this is due to COVID and a number of elective procedures being pushed to the right, resulting in a backlog.”

MOAA is appreciative of McDonough’s recent announcement about the importance and urgency of investing in VA’s incredible workforce and plans for making the department a model employer where employees will want to work.

His 10-point human infrastructure plan addresses many of the systemic solutions MOAA has been advocating for in recent years. These are major steps; MOAA urges current and future secretaries to commit to carrying out the plan and requests support from Congress on VA’s investment in employees’ wages and other workforce incentives.

One of the elements of the plan and a bill MOAA endorsed in our testimony is the VA Nurse and PA Retention and Income Security Enhancement (RAISE) Act. The bill increases the rate of pay for certain nurses and other medical positions in the VHA. MOAA is grateful for Congress expediting passage of the bill, which was signed into law last week as part of the omnibus appropriations bill, H.R. 2471, to fund the federal government through the end of the 2022 fiscal year.