Point Papers

2008

POINT PAPERS


FY 2009 VA HEALTH CARE BUDGET

The Issue

For FY 2009, the Administration requests $41.2 billion for veterans’ health care, a $2.1 billion increase over the FY 2008 appropriation level.  This includes approximately $2.5 billion from medical care collections.  Although this represents another step forward in achieving adequate funding for the VA, it still falls short of the recommendations of The Independent Budget.  For FY 2009, The Independent Budget recommends approximately $42.8 billion for total medical care budget authority, an increase of $3.7 billion over the projected FY 2007 appropriation and $1.6 billion over the Administration’s request. 

We once again disagree with the Administration’s desire to implement an enrollment fee and an increase in prescription drug co-payments.  This year, just as last year, the President’s recommendation proposes an indexed annual enrollment fee ranging from $250 to $750 depending on a veteran’s income for Priority 7 and 8 veterans and an increase in prescription drug co-payments from $8 to $15.  Recent estimates indicate that these proposals will force nearly 200,000 veterans to leave the system and more than 1,000,000 veterans to choose not to enroll.  Congress has soundly rejected these proposals in the past and we call on them to do so once again. 

Although our health care recommendation does not include additional money to provide for the health care needs of Category 8 veterans currently being denied enrollment into the system, we believe that adequate resources should be provided to overturn this policy decision.  The VA estimates that a total of well over 1,500,000 Category 8 veterans would have been denied enrollment into the VA health care system by FY 2009.  Assuming a utilization rate of 20 percent, we believe that the total cost to reopen the health care system to these veterans is approximately $1.4 billion. 
 
For Medical and Prosthetic Research, the Administration has recommended $442 million, a significant cut of approximately $38 million below the FY 2008 appropriations level.  The Independent Budget recommends $555 million.  Research is a vital part of veterans’ health care, and an essential mission for our national health care system.  At a time of war, the government should be investing more, not less, in veterans’ biomedical research programs. 

Despite an increase in the request for health care funding this year, the budget and appropriations process over the last number of years demonstrates conclusively how the VA labors under the uncertainty of how much money it is going to get and when it is going to get it.  In order to address this problem, The Independent Budget supports a new funding mechanism that would provide for sufficient, predictable, and timely funding.  We are currently working on a proposal that will address these fundamental goals of budget reform.   

PVA’s Position

  • Appropriate $42.8 billion for VA medical care, a $3.7 billion increase over FY 2008.
  • Appropriate $555 million for medical and prosthetic research, a $75 million increase over FY 2008.
  • Provide sufficient, predictable, and timely funding for veterans’ health care.

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THE DOLE-SHALALA AND VETERANS’ DISABILITY BENEIFTS COMMISSION REPORTS

The Issue

Paralyzed Veterans of America (PVA) views the release of the Dole-Shalala Commission and Veterans’ Disability Benefits Commission (VDBC) reports as a positive step in ensuring that the needs of the men and women returning from Iraq and Afghanistan are addressed.  PVA believes that two basic benchmarks must be established when assessing the recommendations included in both reports.  First, no current benefit or service for today’s veterans should be diminished, including the reduction of resources for those benefits or services, to achieve the recommendations.  Second, there should be no distinction made between combat and non-combat related disabilities or where the disabling event occurred.  Unfortunately, the Dole-Shalala Commission report seems to ignore the second benchmark while also allowing for the possibility that the first benchmark might or might not occur.  As such, we believe the Veterans’ Disability Benefits Commission report will more appropriately address the needs of today’s and tomorrow’s veterans as it affirms these two benchmarks. 

There are certain key components of both reports that we believe are absolutely essential to improving the VA benefits delivery system.  We fully support the Dole-Shalala recommendation to establish a single medical examination with a clear delineation of the responsibilities of the Department of Defense (DOD) and Department of Veterans Affairs (VA).  Currently, DOD and VA are already testing a pilot program that addresses this idea.  We also support enhanced services for families including expansion of Family Medical Leave Act.  This provision would address some of the hardships experienced by service members’ families as they accompany their spouse of family member through the recovery process. 

Likewise, we support the VDBC recommendation to immediately increase compensation rates up to 25 percent as an interim and baseline future benefit for loss of quality of life, pending development and implementation of a quality-of-life measure in the Rating Schedule.  Moreover, we support the VDBC recommendation to consider increasing special monthly compensation, to address the more profound impact on quality of life of veterans who have incurred severe disabilities, such as spinal cord injury.

PVA will not support legislation that simply implements the recommendations of the Dole-Shalala report, as the negative components outweigh the positive.  It is critically important that Congress take a holistic approach to improving the veterans’ benefits system, incorporating recommendations of both reports into any legislation introduced. 

PVA’s Position

  • Congress must ensure that any current benefit or service for today’s veterans is not diminished, including the resources for those benefits or services. 

 

  • Congress must ensure that any changes made to the disability system do not make a distinction between combat and non-combat related disabilities or where the disabling event occurred.

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ELIMINATE CO-PAYMENTS FOR CATASTROPHICALLY
DISABLED CATEGORY FOUR VETERANS

The Issue

In 1985, Congress approved legislation which opened the VA health system up to all veterans.  In 1996, Congress again revised that legislation with a system of rankings establishing priorities for enrollment.  Within that context, PVA worked hard to ensure that those veterans with catastrophic disabilities, no matter if those disabilities were service-connected or non-service connected, would have a higher enrollment category.  If the primary mission of the VA health care system is to provide for the service disabled, the indigent and those with special needs, catastrophically disabled veterans certainly fit in the latter priority ranking.  The VA had an obligation to provide care for these veterans.  The specialized services, including spinal cord injury care, unique to VA, should be there to serve them.

To protect their enrollment status, veterans with catastrophic disabilities were allowed to enroll in Category Four even though their disabilities were non-service connected and regardless of their incomes.  However, unlike other Category Four veterans, if they would otherwise have been in Category Seven or Eight, they would still be required to pay all fees and co-payments, just as others in those categories do now for every service they receive from VA.

PVA believes this is unjust.  VA recognizes their unique specialized status on the one hand by providing specialized service for them in accordance with its mission to provide for special needs.  The system then makes them pay for those services.

Unfortunately, these veterans are not casual users of VA health care services.  Because of the nature of their disabilities they require a lot of care and a lifetime of services.  Private providers don’t offer the kind of sustaining care for spinal cord injury found at the VA.  Other federal or state health programs fall far short of VA.  In most instances, VA is the only and the best resource for a veteran with a spinal cord injury, and yet, these veterans, supposedly placed in a priority enrollment category, have to pay fees and co-payments for every service they receive as though they had no priority at all.

The Administration’s legislative proposals for an indexed annual enrollment fee of $250 to $750 and increases in prescription drug co-payments from $8 to $15 would have a severe negative impact on these veterans.  They quite simply create an even higher burden thereby penalizing these veterans for seeking the only source of the health care they need.  We strongly urge Congress to correct this financial penalty.  If a veteran is a Category Four because of a catastrophic disability, then treat that veteran like all other Category Fours and exempt him or her from fees and co-payments.

PVA’s Position

  • Eliminate the requirement that Category 4 veterans who are catastrophically disabled, and would otherwise be enrolled in Category 7 or 8, pay any fees or co-payments.

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PROTECTION OF SPECIALIZED SERVICES

The Issue

Specialized services, such as spinal cord dysfunction care, are part of the core mission and responsibility of the VA.  These services were initially developed to care for the unique health care needs of veterans.  The VA’s specialized services are incomparable resources that often cannot be duplicated in the private sector.  However, these services are often expensive, and are severely threatened by cost-cutting measures and the drive toward achieving management efficiencies.

The provision of specialized services is vital to maintaining a viable VA health care system.  Specialized services are part of the primary mission of the VA.  The erosion of these services would lead to the degradation of the larger VA health care mission. 

PVA is uncertain about the future of the current VA health care system, and the role specialized services will play in that system.  In recent years, members of the House of Representatives and the Administration have supported a need to re-focus the VA health care system on its “core constituency.”  Part of this new focus could potentially include reducing funding and cutting services for increasing numbers of currently eligible veterans.  Specialized services cannot afford a reduction in critical staff that is already stretched to the limit. 

Furthermore, restructuring plans and moves by some to begin down the path of privatization heighten the risk not only to specialized services, but to the entire VA health care system.  With growing pressure to allow veterans to seek care outside of the VA, the VA faces the possibility that the critical mass of patients needed to keep all services viable could significantly decline.  All of the primary care support services are critical to the broader specialized care programs provided to veterans.  If primary care services decline, then specialized care is also diminished. 

PVA’s Position

  • Ensure that the VA has the necessary resources to protect and improve specialized services and maintain the VA as a comprehensive health care system.         
  • Provide effective and ongoing oversight concerning the VA’s specialized services. 

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SUPPORT ADA RESTORATION ACT, S. 1881/H.R. 3195


The Issue
In 1990, Congress passed the American with Disabilities Act with overwhelming support from both parties and President George H.W. Bush.  Congress issued a broad mandate:  prohibit unfair discrimination in workplaces, public transportation systems, businesses, and other programs or services.  Congress intended to protect anyone who is treated less favorably because of a current, past, or perceived disability. 
In subsequent Supreme Court decisions in ADA employment cases, coverage has been wrongly limited to those people who are “disabled enough” to be covered under the ADA.  A plaintiff must currently demonstrate that a disability is not effectively managed by medication or other measures, or that they are “prevent[ed] or severely restrict[ed]” from performing an activity central to “most people’s daily lives”.  Unless they can establish this standard, an individual cannot challenge the discriminatory actions, even if intentional, of a covered entity.  Therefore people whose disability prevents them from doing a job-related activity would not be covered if that particular activity is not one that the general population performs.
Counter to the historic practice of broad interpretation of civil rights laws, the Court shifted the focus of ADA cases to the personal limitations of the plaintiff, and away from the issue of discriminatory conduct. This is a nationwide problem that requires an appropriate Congressional fix.
PVA’s Position

PVA supports the ADA Restoration Act, S. 1881/H.R. 3195.  This bill has bi-partisan sponsorship in both the House and Senate.  It will restore original Congressional intent by requiring courts to focus on the alleged discriminatory action by the covered entity.  The individual is required to prove that he or she was treated less favorably “on the basis of disability” rather than dispute allegations that he/she is not disabled.  Plaintiffs still must prove that discrimination occurred and employers may still defend by proving that the individual is not otherwise qualified to do the job.

The ADA Restoration Act does not expand the ADA, but restores its original intent.  It guarantees that the individual with disabilities will be judged on personal performance rather than by personal limitations. 

PVA asks you to cosponsor S. 1881/H.R. 3195 and seek prompt passage of this important civil rights legislation.

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H.R. 2943, BENEFIT RATING ACCELERATION FOR VETERAN ENTITLEMENTS (BRAVE) ACT

The Issue

It is often overlooked that veterans with a significant disability rating from the Department of Veterans Affairs (VA) are likely to be eligible for Social Security benefits as well.  Military servicemen and women are covered by Social Security and many National Guard and Reservists have considerable work histories.  These individuals will also be eligible for Social Security Disability Insurance (SSDI).  According to the VA, as of September 30, 2006, there were 401,000 veterans under age 65 with service-connected disabilities rated from 70 to 100 percent.  That level of severity of disability almost always qualifies a veteran for Social Security disability benefits.  Unfortunately, the Social Security Administration (SSA) does not currently recognize disability determinations made by the VA, forcing veterans with disabilities to go through two medical evaluations to qualify for benefits to which they are entitled.

PVA’s Position

Paralyzed Veterans of America (PVA) supports H.R. 2943, the Benefit Rating Acceleration for Veteran Entitlements (BRAVE) Act.  H.R. 2943 breaks down the bureaucratic silos that veterans and their families face by allowing veterans with 100% service-connected disabilities to be found automatically eligible for Social Security disability benefits.  This legislation would ensure that veterans with disabilities receive all the support they are owed without forcing them and their loved ones to endure redundant applications and unnecessary delays.  Moreover, this bill will lessen the administrative burden on SSA at a time when that agency is struggling to handle an increasing workload with limited financial resources.

PVA urges Congress to support and pass H.R. 2943.

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SUPPORT H.R. 4202, THE INCLUSIVE HOME DESIGN ACT

The Issue

Currently, single-family homes and townhouses are exempt from the accessibility requirements of the Fair Housing Act and Section 504 of the Rehabilitation Act.   As a result, most of this housing inventory is built in a manner that makes if difficult and costly to convert into an accessible home.  For many people with disabilities, their only options are to live in a multi-family housing unit or to spend money either renovating or custom-building a home for accessibility. 

Representative Jan Schakowsky (D-IL) has reintroduced the Inclusive Home Design Act (IHDA).  The measure, H.R. 4202, requires a basic level of architectural access, whenever practical, in Federally-assisted, newly-constructed housing not currently covered by law.  The basic accessibility elements include at least one zero-step entrance on an accessible route at the front, side or back of the home, or through an attached garage--wherever is most feasible for the given terrain; interior passage doors on the main floor of the home providing a minimum of 32 inches of clear passage space; a useable bathroom with at least a toilet and sink on the main level; blocking in the bathroom walls for later installation of grab bars, if and when they are needed; and electrical and climate controls, such as light switches, sockets and thermostats, located at reachable heights.  The requirements refer only to the main floor of the home. Requirements for a zero-step entrance can be waived if the terrain offers extreme difficulty or would require excessive costs. 

The types of federal financial assistance that would require these features include grants, loans, subsidies, land given or sold at less than market value, tax credits, mortgage assistance, loan guarantees, or insurance, provided by or from the Federal government, or use of Federal personnel. 
PVA's Position
Paralyzed Veterans of America of America supports H.R. 4202, the Inclusive Home Design Act because it would create new accessible homes that would be added to the housing stock in communities.  Not only is this accessible housing inventory critically important for many severely disabled veterans but it will become increasingly necessary as the population ages.   PVA urges Congress to support and pass H.R. 4202.

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