TREA WASHINGTON UPDATE FOR NOVEMBER 20 2009
HAPPY THANKSGIVING
Next week Congress will adjourn to celebrate Thanksgiving, but exactly when is not quite clear. On Saturday night we expect that the Senate will have its first vote on its’ newly rolled out proposed health care bill. (This vote will see if the bill will get onto the Senate floor.) The Senate’s Homeland Security and Government Affairs Committee held the first hearing on the shooting at Ft. Hood and the question of homegrown terrorism (though without the cooperation or approval of the White House.) The House of Representatives passed their version of the Medicare “doc fix” (please see below) and has started to work on their estate tax bill; so we don’t know how long they dare to be away. It is becoming very clear that Congress will be in session until shortly before Christmas.
While Congress is focused on health care reform and health care reform and health care reform, many of our issues have been moving forward.
We don’t expect to put out an Update next week unless something urgent happens. May we wish you and your families a very Happy Thanksgiving.
1. Senate Passes Military Construction-VA Funding Bill; Now On To Conference
2. Senate Passes Its Veterans Package
3. House Passes Its Version of Medicare “Doctors Fix”
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1. Senate Passes Military Construction-VA Funding Bill; Now On To Conference-On Tuesday, the Senate passed its version of the Military Construction-VA bill for FY2010. The bill includes $133.9 billion, including $76.7 billion in discretionary funding and $48.2 billion in advanced funding for VA medical care for FY2011. The bill (HR3082) passed unanimously (100-0) after a dramatic fight over an amendment that would have prohibited any funding to build or upgrade any facilities to hold detainees from Guantanamo in the United States. Senator James Inhofe’s (R-OK) Amendment was voted down 57-43.
There are several differences between the Senate and previously passed House bill which will now have negotiated in conference. The Senate immediately announced their conferees. They are Senators: Tim Johnson (D-SD); Daniel Inouye (D-HI); Mary Landrieu (D-LA); Harry Byrd (D-WV);Patty Murray (D-WA); Jack Reed(D-RI); Ben Nelson(D-NE);Mark Pryor(D-AR); Patrick Leahy (D-VT);Kay Bailey Hutchison (R-TX); Sam Brownback(R-KS);Mitch McConnell(R-KY); Susan Collins (R-ME); Lisa Murkowski(R-AK); Thad Cochran(R-MS). The House has not yet announced its conferees.
Since the advanced funding appears in both House and Senate versions of the bill and at the same amount this push has been successful. Chairman of the Senate’s Appropriations Military Construction-VA Subcommittee Senator Tim Johnson (D-SD) said: “This funding will ensure that the VA has a predictable stream of funding and that medical services will not be adversely affected should another stopgap funding measure be needed in the future.
Differences in the two versions of the bill include:
· $133.7 billion and $77.9 billion in discretionary funding in the House version compared to $133.9 billion and $76.7 billion in discretionary spending in the Senate’s version
· Different funding for the building of a cybersecurity data center
· A Senate Amendment sponsored by Chairman Tim Johnson (D-SC) sets aside $50 million to renovate 40 to 50 vacant buildings on VA campuses to help homeless vets. It was funded by cutting the same amount from the homeowners fund that provides mortgage relief for military families who are required to relocate.
As you can see the differences are not dramatic-so we think we will see a finished bill very soon. The advanced funding provision and the amount of funding this year has been a great success.
2. Senate Passes Its Veterans Package-Yesterday the Senate passed an omnibus package of veterans bills. The bill (S1963) had been held up for several days because of Senator Tom Coburn’s (R-OK) amendment calling for a cost offset. His amendment required an offset of the costs and would have ordered the State Department to transfer funds from its budget for supporting international organizations and peacekeeping activities. It went down 32-66.
The bill was then passed 98-0. It combined several different bills: S801, S252, S597, S498, S246, and S772. It authorizes approximately $3.7 billion for programs to help caregivers for veterans from the Iraq and Afghanistan wars (S801), improve health care in rural areas, focus on women veterans health care, provide VA dental care for some veterans and their families and survivors
Senator Coburn’s failed amendment would have also expanded the bill to cover all veterans rather than just those from the present wars. His hold caused a dramatic confrontation. Veterans’ Affairs Chairman Daniel K. Akaka (D-HI) said: “The cost of veterans’ health care is a true cost of war and must be treated as such. The cost of the underlying bill does not need to be offset. The price has already been paid, many times over, by the service of the brave men and women who wore our nation’s uniform.” Senator Coburn’s statement was: “I don’t have any opposition to veterans’ care. We’re supposedly anti-veteran because we think maybe we ought to pay for some things that we do around here. . . . I apologize to no one for having put a hold on this bill for a very good reason.”
3. House Passes Its Version of Medicare “Doctors Fix”-Also on Thursday, the House of Representatives passed a bill that would stop the scheduled cut in Medicare physician payments rates scheduled for this coming January. The bill (HR3961) blocked the 21% physician cut required by the formula originally passed in 1997. The various scheduled cuts in the last decade have been delayed by Congress from going into effect. These Medicare payments are critically important to any military retiree who uses TRICARE for Life, since both Medicare is first payer for TFL. If doctors stopped seeing Medicare patients due to the level of payments they could (and probably would) also stop seeing TRICARE patients.
The bill restructures the present payment formula in 2011, taking into account spending since 2009 “or, beginning in 2014, spending for the previous five years. It would provide two separate updates, one for evaluation, management and preventive services, and another for other services.”
It is not at all clear whether the Senate will go along with this version. Last month the Senate rejected another House bill dealing with what is now called the “docs fix” in Washington because there is no offset. The CBO says this bill will cost $210 billion in 10 years and there is no offset in this proposal either.
The day before the House passed its bill the Senate’s Minority Leader Senator Mitch McConnell (R-KY) said: “Senate Democrats recently tried to pass a so-called doc fix that would have forced seniors to pay higher premiums — on top of the half a trillion dollars they want to cut from Medicare. Fortunately, this bill was rejected by a wide bipartisan majority. While we all think this problem needs to be addressed, this is not the way to do it. And I’m confident that should a similar bill pass the House later this week, we’ll reject it again.” On the other hand everyone on both sides of the aisle thinks something must be done about the pending 21% cut. More on this soon.
4. VA Announces Projects To Aid Vietnam Era Women Veterans and Improve VA’s Relationship With America’s Medical Schools-Below please find press releases from the VA announcing new efforts to study the needs of Vietnam Era Women Vets and to improve the relationship between them and our Nation’s Medical Schools.
Secretary
Shinseki Announces Study of Vietnam-Era Women Veterans
Comprehensive
Study Will Help VA Provide High-Quality Care
WASHINGTON –Secretary of Veterans Affairs Eric K. Shinseki announced the Department of Veterans Affairs (VA) is launching a comprehensive study of women Veterans who served in the military during the Vietnam War to explore the effects of their military service upon their mental and physical health.
“One of my top priorities is to meet the needs of women Veterans,” said Secretary Shinseki. “Our Veterans have earned the very best care. VA realizes that women Veterans require specialized programs, and this study will help VA provide high-quality care for women Veterans of the Vietnam era.”
The study, which begins in November and lasts more than four years, will contact approximately 10,000 women in a mailed survey, telephone interview and a review of their medical records.
As women Vietnam Veterans approach their mid-sixties, it is important to understand the impact of wartime deployment on health and mental outcomes nearly 40 years later. The study will assess the prevalence of post-traumatic stress disorder (PTSD) and other mental and physical health conditions for women Vietnam Veterans, and explore the relationship between PTSD and other conditions.
VA will study women Vietnam Veterans who may have had direct exposure to traumatic events, and for the first time, study those who served in facilities near Vietnam. These women may have had similar, but less direct exposures. Both women Veterans who receive their health care from VA and those who receive health care from other providers will be contacted to determine the prevalence of a variety of health conditions.
About 250,000 women Veterans served in the military during the Vietnam War and about 7,000 were in or near Vietnam. Those who were in Vietnam, those who served elsewhere in Southeast Asia and those who served in the United States are potential study participants.
The study represents to date the most comprehensive examination of a group of women Vietnam Veterans, and will be used to shape future research on women Veterans in future wars. Such an understanding will lay the groundwork for planning and providing appropriate services for women Veterans, as well as for the aging Veteran population today.
Women Veterans are one of the fastest growing segments of the Veteran population. There are approximately 1.8 million women Veterans among the nation’s total of 23 million living Veterans. Women comprise 7.8 percent of the total Veteran population and nearly 5.5 percent of all Veterans who use VA health care services. VA estimates women Veterans will constitute 10.5 percent of the Veteran population by 2020 and 9.5 percent of all VA patients.
In recent years, VA has undertaken a number of initiatives to create or enhance services for women Veterans, including the implementation of comprehensive primary care throughout the nation, staffing every VA medical center with a women Veterans program manager, supporting a multifaceted research program on women’s health, improving communication and outreach to women Veterans, and continuing the operation of organizations like the Center for Women Veterans and the Women Veterans Health Strategic Healthcare Group.
The study, to be managed by VA’s Cooperative Studies Program, is projected to cost $5.6 million.
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Secretary
Enhancing Partnerships with Medical Schools
Accepts Report
of Blue Ribbon Advisory Panel
WASHINGTON – To ensure Veterans receive 21st century care, Secretary of Veterans Affairs Eric K. Shinseki has vowed to strengthen the partnership between the Department of Veterans Affairs (VA) and the schools that train the nation’s health care professionals.
“Schools of medicine and other institutions of higher education for health care professionals have been essential partners with VA in caring for Veterans for over 60 years,” said Secretary Shinseki. “VA is strengthening that relationship to ensure it provides accessible, world-class health care for the men and women who have served this nation in uniform.”
Shinseki’s remarks came in response to a report by a blue-ribbon panel appointed to advise VA on strengthening relationships with medical schools and other colleges and universities for health care professionals.
Two key recommendations from that report, which are among the 50 for which Shinseki said VA will have an implementation plan by January, are:
· Formation of a standing, federally-chartered advisory committee to help VA realize the full potential of its partnerships with health professional schools; and
· Examination and streamlining of policies and procedures that impede those partnerships.
The report reaffirms the vital importance of academic affiliations and calls for VA to strengthen its partnerships with the academic community to enhance health care for Veterans.
VA manages the largest medical education and health professions training program in the United States. VA facilities are affiliated with 107 medical schools, 55 dental schools and more than 1,200 other schools for health care professionals. Each year, 100,000 health professionals are trained in VA medical centers. About two-thirds of the physicians practicing in the United States have had some of their professional education in the VA health care system.
“We welcome this opportunity to build even stronger bonds that will benefit not only the Veterans we serve, but also the tens of thousands of health professional trainees who receive some of their professional education in VA facilities,” said Shinseki.
The Blue Ribbon Panel on VA-Medical School Affiliations, which included members from within and outside VA, was chartered under the Federal Advisory Committee Act in 2006. It was led by Dr. Jordan Cohen, professor of medicine and public health at George Washington University and president emeritus of the Association of American Medical Colleges.
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