VETERANS: Senator Murray Questions VA Secretary Over Bush Budget that Raises Fees on Veterans and Predicts Fewer Veterans Will Need Inpatient Mental Healthcare

(Washington, D.C.) – Today, U.S. Senator Patty Murray (D-Wash) questioned Department of Veterans Affairs Secretary James Nicholson about President Bush’s proposed veterans’ budget for fiscal year 2008.

Murray expressed her frustration that once again the VA is seeking to raise user fees and double drug co-payments for some veterans.

“I’m very concerned that this budget closes the VA’s door to thousands of our nation’s veterans. It includes new fees and increased co-pays that will discourage veterans from accessing the VA. And it continues to bar Priority 8 veterans from enrolling in the VA healthcare system,” Murray said.

Murray also sought an explanation for why the VA plans to see fewer veterans for inpatient mental healthcare in the coming year.

“When the President has proposed a surge in troops to Iraq, when the men and women in uniform are being deployed for their second and third tours of duty, and when more and more of our troops are coming home with PTSD and other mental health care needs, I don’t understand how the VA can assume that they will treat fewer patients for inpatient mental health care,” Murray said.

In addition, Murray questioned the VA’s estimates of how many veterans it will serve in the next fiscal year. Finally, she mentioned the VA’s troubled emergency room policy after the death of a Spokane-area veteran and asked the Secretary to provide further answers in writing.

Senator Murray’s opening statement and Q&A with Secretary Nicholson follows:

Thank you very much Chairman Akaka and Senator Craig. I appreciate you holding this very important hearing on the President’s budget proposal for fiscal year 2008. And I want to thank the veteran’s service organizations, who put so much work into crafting the Independent Budget, and I think it’s very important we hear what they have to say as well. I appreciate them being here.

I want to welcome back Secretary Nicholson. Mr. Secretary, as I said to you privately before we started, thank you so much for the new CBOC in Northwest Washington and the new vet center in Everett. These are issues we’ve been working on for a number of years, and our vets in Northwest Washington are really pleased that someone is finally moving the ball forward, and I want to thank you for that publicly.

Mr. Chairman, with our troops fighting overseas and more veterans being created each and every day, it’s critical that we do everything in our power to make sure that this budget provides for our veterans. In the past, the VA has been dramatically wrong in its budget projections. I think we all agree we can never let that happen again.

Mr. Secretary, you and I both agree that the VA’s health care system is among the best in the country once you get in the door. But it’s getting in the door that’s the problem.

I’m very concerned that this budget closes the VA’s door to thousands of our nation’s veterans. It includes new fees and increased co-pays that will discourage veterans from accessing the VA. And it continues to bar Priority 8 veterans from enrolling in the VA healthcare system.

I am also very concerned that the VA is still underestimating the number of veterans from Iraq and Afghanistan that will seek care in the VA. In FY 2006, the VA underestimated the number of patients it would see by 45,000. For the current fiscal year (FY 2007), the VA has been forced to revise its projection up by 100,000 veterans.

Now the VA is projecting that it will see 263,000 Iraq and Afghanistan vets in 2008, yet I am told by some that the VA should actually be preparing to care for more than 300,000 returning veterans. Frankly, I think it’s very important that we don’t underestimate this number. We’ve seen the past failures in the VA to accurately project the numbers, and I think it’s important that this committee get it right.

While this budget increases funding for the VA over previous years, it barely keeps pace with inflation and other built-in costs. It falls far short of the Independent Budget recommendation. And this budget assumes cutbacks in veterans’ healthcare in 2009 and 2010. We need to focus on that, Mr. Chairman, because we can’t project out the care of some of these veterans in the short term. We have to make sure they’re covered in the long term, and this budget doesn’t do that.

This budget also assumes a decrease in the number of inpatient mental health patients, when all signs point to an increase in need. When the President has proposed a surge in troops to Iraq, when the men and women in uniform are being deployed for their second and third tours of duty, and when more and more of our troops are coming home with PTSD and other mental health care needs, I don’t understand how the VA can assume that they will treat fewer patients for inpatient mental health care.

Mr. Chairman, I think our veterans deserve a better budget than has been presented to us. They deserve a budget that is based on real numbers and real needs. We all know too well what happens when the VA gets shortchanged. It isn’t bureaucrats in D.C. that suffer. It is the men and women who have served us so honorably that pay the biggest price. I hope that through strong oversight of this committee and your leadership that we will make sure we are presenting a budget that reflects the needs we have in front of us.

MURRAY: I wanted to follow up on the chairman’s line of questioning on the need for inpatient mental health care. I too was really disconcerted to see the budget request projecting fewer veterans needing inpatient mental healthcare. I understand the philosophy of trying to do more and more outpatient to reach more people that way, but it just seems to me – when 1 in 3 Iraq war veterans are estimated to be seeking mental healthcare, many of our service members are now on their second or third or even fourth deployments. We’re hearing about the intensity on the ground and what our men and women are facing and the consequences when they return home, and the President now sending up to 48,000 more troops, it just seems to me that we’re going to need more inpatient psychiatric services, not less and I want to hear your rationale on that.

You made a comment that just struck me because you said that no veteran has been denied inpatient mental healthcare, yet we heard about a highly publicized case of an Iraqi war veteran with two purple hearts named Jonathan Schulze who tragically took his own life. The press reports were that he asked for help from the VA twice and was told that he was 26th on the waiting list. He was from Minnesota, but there’s also a case in Illinois and Iowa. It just seems to me when you have that many red flags going you can’t just arbitrarily say no one’s being denied care, and I think we have to say there are red flags out there. We need to find out what’s going on. So I’ll ask you two questions. We’re hearing about these cases that say veterans are being denied care when they ask for it, and secondly, how can you predict a lower demand for inpatient psychiatric services in the budget when we know there are going to be increasing consequences as the years progress?

NICHOLSON: Thank you Senator Murray, several important questions, I like having the opportunity to respond. First, our budget for psychiatric inpatient care is actually up. I’m looking at it, we’re asking for a billion, six million dollars…

MURRAY: Right, your budget requests increased, but you are projecting that fewer veterans will need inpatient healthcare.

NICHOLSON: Well, let me give you the capacity figures, what we’ve anticipated our needs to be is what we should request from you the money to fill. In our capacity for mental health, is currently being utilized at 70% and for polytraumatic care, and our polytraumatic centers, is 80%, so we have in the case of mental health in general 30% capacity available, in the case of polytraumatic capacity we have 20% available. Let me also address…

MURRAY: Are you talking nationwide 20% available because you know, if those facilities aren’t where our veterans are it doesn’t make any difference, they’re not going to travel 5,000 miles to get inpatient care.

NICHOLSON: Well, I mean you know that we have 154 inpatient facilities around the country and almost a thousand other points of access for veterans to come in to be screened, to be referred. I want to address the other point that you raised to the extent that I can, and I’m limited by the privacy regulations because the family has not given us a waiver to discuss this, but the case that you mentioned from Minnesota which comes up often, that veteran was seen by our facilities in Minnesota 46 times. So that’s about all I can say.

MURRAY: OK, and I understand extenuating circumstances in all cases, but it’s not an isolated case, we’re hearing about cases elsewhere. But my question to you is do you really think that we’re going to see fewer veterans needing access to inpatient mental healthcare?

NICHOLSON: We’re projecting that we’re going to be getting somewhat fewer in this time frame.

MURRAY: Well, my time’s out, and I want to ask another quick question. But Mr. Chairman, I think we have to be careful not just to project numbers on the hopes of keeping the budget down, but really looking at what we’re going to need to pay for because of inpatient care. And as you stated and I’ve referred to, we do have many veterans who are in their second, third, possibly fourth tour. We have 48,000 additional troops being sent, and we are seeing a third of our veterans seeking mental healthcare, so I hope we look very carefully at those numbers as we put our budget together. But let me ask one other question really quickly in my time.

I wanted to ask about shorter hours at our urgent care in Spokane. I’m going to submit that for the record because we have a serious concern about that facility closing at 4:30 in the afternoon. We have one — if not more — cases of veterans who’ve died because they’ve shown up shortly after the facility closed. And there is a huge problem with how veterans receive their care if they don’t go to the VA facility not being paid for, that is an issue I want to address with you on another occasion.

But I also wanted to ask you about these increased user fees and co-pays because as you know I oppose that. I believe that anyone we ask to serve us should not be given an additional cost to get their healthcare, that’s not what they were told. But I am disturbed that in the proposal this year, that you asked to put that money from fees, should it ever be collected, back into the general budget rather than into the VA healthcare. It seems to me what that simply is saying to our veterans is we’re asking you to balance the federal budget now, and I find that even worse than the suggestion that they should pay co-pays. I wanted to ask you why you have changed that policy, and why you’re suggesting that in this budget.

NICHOLSON: The reason for that, Senator Murray, is that if you’ll recall other discussions that we’ve had about this, the revenue from that was assumed in the budget, and was used to pay for the needs of the application side of the budget. Having an experience where it’s not been approved, and then having a gap, instead of doing that, we didn’t assume it. And this budget, if you approve it without those measures, we’ll have the money that we need for the application.

MURRAY: So basically we can balance the budget if we charge our veterans fees? I just find that incomprehensible.

NICHOLSON: No no, I’m not being very artful in trying to explain it. If you deny it, there will be no gap in this budget and have to find it somewhere else.

MURRAY: For the VA?.

NICHOLSON: Right.

MURRAY: I know my time’s up, Mr. Chairman, thank you.

Note: Senator Murray submitted additional written questions to Secretary Nicholson for his reply.