⚡NIMITZ NEWS FLASH⚡

“Legislative Hearing on: Discussion Draft, Standardizing Treatment and Referral Times Act; Discussion Draft, No Wrong Door for Veterans Act; Discussion Draft, Providing Veterans Essential Medications Act; Discussion Draft, Veterans Supporting Prosthetics Opportunities and Recreational Therapy Act; Discussion Draft, To direct the Secretary of Veterans Affairs and the Comptroller General of the United States to report on certain funding shortfalls in the Department of Veterans Affairs; H.R. 217, CHIP IN for Veterans Act (Rep. Bacon); H.R. 1107, Protecting Veteran Access to Telemedicine Services Act of 2025 (Rep. Womack); H.R. 1336, The Veterans National Traumatic Brain Injury Treatment Act (Rep. Murphy); H.R. 658, To amend title 38, United States Code, to establish qualifications for the appointment of a person as a marriage and family therapist, qualified to provide clinical supervision, in the Veterans Health Administration; Discussion Draft, Copay Fairness for Veterans Act; Discussion Draft, Saving Our Veterans Lives Act; and Discussion Draft, Women Veterans Cancer Care Coordination Act”

House Veterans Affairs Committee, Health Subcommittee Hearing

March 11, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (Panel One):

• The Honorable Jack Bergman: Member of Congress, Washington D.C.

• The Honorable Gregory F. Murphy: Member of Congress, Washington D.C.

• The Honorable Steve Womack: Member of Congress, Washington D.C.

• The Honorable Don Bacon: Member of Congress, Washington D.C.

• The Honorable Sylvia R. Garcia: Member of Congress, Washington D.C.

• The Honorable Lauren Underwood: Member of Congress, Washington D.C.

• The Honorable Christopher R. Deluzio: Member of Congress, Washington D.C.

Witnesses & Written Testimony (linked) (Panel Two):

• Dr. Thomas O'Toole: Deputy Assistant Undersecretary for Health for Clinical Services, U.S. Department of Veterans Affairs, Veterans Health Administration

• Dr. Antoinette Shappell: Deputy Assistant Under Secretary for Health for Patient Services, U.S. Department of Veterans Affairs, Veterans Health Administration

• Dr. Thomas Emmendorfer: Pharmacy Benefits Management, U.S. Department of Veterans Affairs, Veterans Health Administration

• Dr. Jeffrey Gold: President, University of Nebraska System

Witnesses & Written Testimony (linked) (Panel Three):

• Ms. Sue Morris: President, Veterans Trust

• Mr. Brian Dempsey: Director of Government Affairs, Wounded Warrior Project

• Dr. Andrew Kozminski: Medical Director of Hyperbaric Medicine, University of Iowa Health Care

• Mr. Ed Harries: President, National Association of State Veterans Homes

• Mr. Jon Retzer: Deputy National Legislative Director for Health, Disabled American Veterans

Keywords mentioned:

• VA budget oversight, sports prosthetics, mental health support, hyperbaric oxygen therapy, suicide prevention, public-private partnerships, essential medications, community care coordination, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), access, infrastructure, workforce cuts, clinical trials

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairwoman Mariannette Miller-Meeks mentioned the introduction of 12 bills, including those aimed at fostering public-private partnerships, advancing hyperbaric oxygen therapy (HBOT) research, and enhancing VA budget oversight. She spotlighted four bills that she sponsored, including the Veterans SPORT Act, which would ensure athletic prosthetics are medically necessary for amputee veterans, and the No Wrong Door for Veterans Act, which would reauthorize the VA's Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSPG Fox SPGP). Additionally, she presented the Providing Veterans Essential Medications Act, aimed at ensuring state veterans homes can afford high-cost medications, and the START Act, which would improve community care referral validity for veterans facing provider shortages.

• Ranking Member Julia Brownley expressed concern that the Committee was holding a legislative rather than an oversight hearing amid upheaval at the VA due to mass firings, contract terminations, and budget constraints. She criticized the Trump administration’s plan to cut 80,000 VA jobs, arguing that these reductions harm patient care by eliminating key positions such as procurement professionals, supply chain staff, and human resources personnel. She cited multiple reports from across the country of veterans experiencing delayed or canceled medical appointments due to staffing shortages. While acknowledging the legislative agenda, the Ranking Member pointed to these systemic workforce issues, warning that no amount of new legislation would be effective if the VA lacked the personnel to implement it.

SUMMARY OF KEY POINTS (PANEL ONE)

• Rep. Steve Womack spoke in support of the Protecting Veteran Access to Telemedicine Services Act, which would allow VA healthcare providers to permanently prescribe controlled substances via telemedicine. He explained that during the COVID-19 pandemic, an in-person consultation requirement was waived, allowing veterans to receive vital medications remotely. He argued that making the exemption permanent is necessary to prevent longer wait times and barriers to care, particularly for rural veterans who must travel long distances to see providers.

• Rep. Sylvia Garcia introduced the Women Veterans Cancer Care Coordination Act, which aims to improve the coordination of breast and gynecological cancer care for women veterans. She noted the growing population of women veterans and the increasing need for specialized cancer care. While the VA has established oncology programs and partnerships with community providers, she argued that many veterans face delays and miscommunication due to a lack of coordination. Her bill would create regional cancer care coordinators to guide veterans through their treatment, improve provider communication, and reduce bureaucratic burdens.

• Rep. Greg Murphy advocated for the Veterans National Traumatic Brain Injury (TBI) Treatment Act, which would establish a pilot program for HBOT for veterans with posttraumatic stress disorder (PTSD) and TBI. He cited statistics on veteran suicide rates and argued that HBOT has been successfully used for various medical conditions, including cognitive and mood disorders. He referenced a meta-analysis study supporting the therapy’s effectiveness and highlighted the success of nonprofit programs already using HBOT to treat veterans. He criticized the VA for not offering this alternative therapy, calling it "medical malpractice" to withhold an effective treatment.

• Rep. Chris Deluzio presented the Saving Our Veterans' Lives Act, which aims to prevent veteran suicide by distributing gun lock boxes to veterans, including those not enrolled in VA health care. He cited VA reports indicating that most veteran suicides occur among individuals outside the VA system, making outreach efforts crucial. While acknowledging the VA’s suggested changes to the bill, he expressed openness to amendments to strengthen its impact.

• Rep. Lauren Underwood spoke in support of the Copay Fairness for Veterans Act, which would eliminate copays for preventive health care services at the VA. She noted that private insurance plans have been required to provide free preventive care under the Affordable Care Act, but VA health care still charges veterans for essential services like cancer screenings, diabetes management, and mental health evaluations. She said that removing these financial barriers would improve veterans' long-term health outcomes.

SUMMARY OF KEY POINTS (PANEL TWO)

• Dr. Thomas O’Toole began by addressing the No Wrong Door for Veterans Act, stating that while the VA supports its intent to extend suicide prevention grants, some amendments need further discussion. He also voiced the VA’s support for the START Act, which would standardize the timing of community care referrals but noted the need for clarity to prevent unintended consequences. Dr. O’Toole expressed opposition to the Saving Our Veterans' Lives Act due to concerns over its broad scope and funding limitations. The VA also opposed the Veterans National TBI Treatment Act due to a lack of scientific evidence supporting HBOT.

• Dr. Jeffrey Gold, president of the University of Nebraska system, testified in support of the CHIP IN for Veterans Act, which seeks to make permanent a program allowing public-private partnerships in VA facility construction. He highlighted the success of this model in Omaha, where such a partnership led to the creation of a state-of-the-art ambulatory care center that greatly improved veterans’ healthcare services. Dr. Gold outlined plans for a $2.19 billion Project Health initiative, which aims to replace aging academic medical facilities and provide high-quality medical care, training, and clinical trials. He proposed integrating a new VA hospital into this development, leveraging private-sector efficiencies and philanthropic support to reduce costs, accelerate construction, and enhance care for veterans in Nebraska and western Iowa.

• Rep. Don Bacon praised the Omaha Ambulatory Care Center, built under the CHIP IN initiative, as one of the best VA facilities in the country, citing its efficiency in completing projects on time and under budget. He urged support for making this program permanent to replicate similar successes nationwide, reporting that Omaha already has $100 million in private investment ready for a new VA inpatient facility.

• Ranking Member Brownley expressed disappointment that the VA opposed her VA Marriage and Family Therapist Equity Act, arguing that the VA is an outlier in requiring therapists to graduate from a specific accreditation program. She asked for an update on the National Standards of Practice Initiative and whether the VA would reconsider its stance. Dr. O’Toole confirmed that the National Standards of Practice Initiative was ongoing, aiming to minimize state-by-state variance in accreditation and licensure. He acknowledged the value of marriage and family therapists (MFTs) in the VA but cited concerns about a lack of statutory requirements for supervisor roles and state-to-state variations.

• The Ranking Member inquired about the VA’s current lock box distribution program for suicide prevention, stating that while she supported Rep. Deluzio’s bill, she wanted to understand what was already being done. She asked how veterans or providers would know the program existed. Dr. O’Toole described the lock box program, which provides gun storage devices to veterans identified at moderate-to-high suicide risk. He stated that the VA educates both veterans and providers about the program to ensure its use. Ranking Member Brownley argued that any veteran should be able to request a lock box, not just those identified through a provider.

• Rep. Abe Hamadeh questioned whether the VA should undergo an annual forensic audit to ensure transparency in financial planning. Dr. O'Toole repeatedly deferred to the Comptroller General and did not provide a direct opinion on the audit’s necessity.

• Rep. Hamadeh asked how the SSPG Fox SPGP had been most effective and what improvements could be made. Dr. O'Toole stated that the program had been very successful, particularly in extending its duration and requiring grantees to inform veterans of emergency suicide care. However, he raised concerns about the bill’s award cap and the additional per-grantee payment, which he argued could be logistically challenging under federal grant regulations.

• Rep. Hamadeh then turned to Dr. Gold, asking about the biggest advantages of the public-private partnership model used for the Omaha VA project and how it could be replicated nationwide. Dr. Gold reported that the partnership significantly reduced costs and expedited construction. He noted that the VA’s estimated $136 million cost was reduced to $56 million in federal spending, with the project completed on budget and ahead of schedule.

• Rep. Sheila Cherfilus-McCormick asked whether VA hospitals need dedicated community care coordinator teams to help veterans navigate between VA and community providers. Dr. O'Toole strongly supported the role of care coordinators, stating that no veteran should have to manage cancer treatment alone. He claimed that a seamless transition between VA and community care was essential to prevent delays and miscommunication.

• Rep. Cherfilus-McCormick then asked Dr. Gold whether clinical trial coordinators and other healthcare coordinator positions should be exempt from workforce reductions to prevent disruption in life-saving research. Dr. Gold agreed that access to clinical trials was critical, particularly in cancer treatment and chronic diseases. He stated that veterans should have access to cutting-edge treatments and that adequate staffing was essential for running clinical trials.

• Rep. Kimberlyn King-Hinds inquired about how the SSPG Fox SPGP was ensuring that resources effectively reached veterans in remote and underserved areas, such as U.S. territories. Dr. O'Toole responded that the grantee selection and monitoring process was designed to ensure that services reached veterans regardless of location.

• Rep. Maxine Dexter criticized proposed VA budget cuts, arguing that a $23 billion reduction in advance funding and the planned 83,000 workforce reduction would negatively impact veteran healthcare. She asked whether implementing new VA initiatives would be easier or harder without guaranteed funding. Dr. O'Toole responded that having proper authorizations for funding was necessary for implementing new programs.

• Rep. Dexter asked whether it would be easier or harder to implement new initiatives without enough staff. Dr. O'Toole agreed that staffing was crucial but avoided directly addressing the impact of the workforce reductions. Rep. Dexter also asked whether VA-provided care coordination was superior to private sector alternatives. Dr. O'Toole stated that VA care coordination was strong, but he deferred to subject matter experts for comparative quality data.

• Rep. Herb Conaway raised concerns about changes in the No Wrong Door for Veterans Act, which now required grant recipients to serve a "significant number of veterans" rather than demonstrating good outcomes. He asked how "significant" would be measured. Dr. O'Toole acknowledged the ambiguity and shared concerns about how performance would be assessed under the new grant structure.

• Rep. Conaway then asked Dr. O'Toole about the Veterans National TBI Treatment Act and the potential benefits of HBOT for treating TBI and PTSD. Dr. Antoinette Shappell stated that VA and Department of Defense (DoD) studies had repeatedly shown that HBOT was no more effective than a placebo for these conditions. Dr. Conaway pointed out that NIH studies suggested otherwise and asked if alternative treatments were being explored. The VA witnesses confirmed that the department was continuously reviewing scientific literature and was open to considering other evidence-based therapies.

• Rep. Bacon revisited the CHIP IN for Veterans Act, asking Dr. Gold to clarify the cost savings the VA had achieved in Omaha and what could be expected from a new inpatient facility. Dr. Gold stated that the current VA estimate for the new facility was $1.56 billion, but by using the public-private model, costs could be reduced by at least $500 million. Rep. Bacon asked the VA witnesses about their stance on making the CHIP IN program permanent. Dr. O'Toole responded that the VA supported the bill, highlighting that two projects had already been completed under the pilot program, with a third in progress.

• Chairwoman Miller-Meeks asked whether public-private partnerships could extend beyond facility construction to sharing expensive medical equipment and services. Dr. O'Toole confirmed that the VA already had deep academic partnerships, with 70% of U.S. doctors training at VA facilities.

• Chairwoman Miller-Meeks asked how the CHIP IN pilot program had contributed to Omaha’s success. Dr. Gold credited the 501(c)(3) partnership model, which enabled faster, cost-efficient construction while maintaining high standards.

• The Chairwoman then asked why the SSPG Fox SPGP needed to be quickly reauthorized. Dr. O'Toole stressed that the program was crucial for suicide prevention and that reauthorization before the program sunsets is essential.

• Chairwoman Miller-Meeks inquired whether the START Act would help veterans receive continuous care under community care referrals. Dr. O'Toole agreed that the bill aligned with VA policy goals and would help ensure that veterans received care for the full episode of treatment rather than just a single appointment.

SUMMARY OF KEY POINTS (PANEL THREE)

• Ms. Sue Morris testified in favor of making the CHIP IN program permanent. She illustrated the success of the Omaha VA Ambulatory Care Center and credited it to private sector involvement, strong VA leadership, and the ability to optimize construction standards while avoiding scope creep. She recommended expanding the CHIP IN for Veterans Act to include leased land, minor construction projects, and other veteran facilities beyond healthcare.

• Mr. Brian Dempsey advocated for the Veterans SPORT Act and supported renewing the SSPG Fox SPGP, emphasizing the importance of public health approaches to suicide prevention. Mr. Dempsey also endorsed the Protecting Veteran Access to Telemedicine Services Act, which would maintain remote access to controlled substances for veterans relying on telehealth, especially those in rural areas.

• Dr. Andrew Kozminski spoke in favor of the Veterans National TBI Treatment Act, claiming that HBOT has a long-standing safety record and has shown promising results in improving cognitive and psychiatric symptoms. He acknowledged concerns about oxygen toxicity seizures but assured the Committee that trained professionals could manage such risks. Dr. Kozminski stressed the importance of creating a controlled VA program to ensure proper treatment rather than leaving veterans vulnerable to unregulated alternative providers.

• Mr. Ed Harries supported the Providing Veterans Essential Medications Act. He detailed cases where veterans were denied access to state homes due to the inability of the VA to reimburse for expensive medications, despite private nursing homes receiving such reimbursements. He also shared instances where state homes incurred significant financial losses or were forced to dispose of expensive medications due to restrictive VA policies. Mr. Harries urged Congress to correct this inequity to ensure that veterans could choose where they receive care without financial barriers.

• Mr. Jon Retzer supported the Veterans SPORT Act for expanding access to adaptive prosthetics, the Saving Our Veterans Lives Act for promoting secure firearm storage, and the Marriage and Family Therapist Qualification Act to improve mental health services. Additional endorsements included telemedicine expansion, women’s cancer care coordination, and the No Wrong Door for Veterans Act to extend community mental health services. While supporting the Veterans National TBI Treatment Act, Mr. Retzer recommended prioritizing additional research on HBOT to ensure its effectiveness before widespread implementation.

• Ranking Member Brownley asked Mr. Retzer to elaborate on why the Women Veterans Cancer Care Coordination Act is beneficial, especially in light of previous legislation like the MAMMO Act, the SERVICE Act, and the PACT Act. Mr. Retzer discussed the importance of care coordination for women veterans, as VA infrastructure is not designed to sustain all women's healthcare needs. He noted that partnerships with affiliates are necessary to ensure access to specialized care, and he mentioned how the legislation would also support male veterans suffering from breast cancer due to toxic exposures.

• Ranking Member Brownley inquired about the implications of proposed budget cuts, particularly regarding the 83,000 VA layoffs and the $23 billion reduction in PACT Act funding. Mr. Retzer expressed hope that Congress, the administration, and VA leadership would work together to ensure bipartisan support for strengthening the VA’s infrastructure, staffing, and technology.

• The Ranking Member then asked whether safeguards should be added to the Veterans National TBI Treatment Act, which currently lacks limitations on where veterans can receive HBOT for TBI and PTSD. Dr. Kozminski agreed that ensuring treatment at accredited facilities would be best for patient safety and supported amending the bill to include such safeguards.

• Rep. King-Hinds asked what additional research or oversight is needed for exploring HBOT while balancing veterans’ safety. Mr. Retzer stated that research over the years has started to show more promise in the effectiveness of HBOT for TBI and PTSD. He underscored DAV’s support for continued VA and NIH research to ensure evidence-based, safe clinical practices for alternative care options.

• Rep. King-Hinds asked about safeguards for prescribing controlled substances via telehealth to veterans, particularly those in remote areas. Mr. Retzer stressed that the VA must ensure clear communication between providers and veterans so they fully understand the risks and interactions of their medications. He cited challenges in remote areas, like Alaska, where infrastructure limitations make coordination between VA and community care providers difficult. He hoped that the modernization of electronic health records would enhance patient safety.

• Rep. Kelly Morrison asked Mr. Dempsey to expand on the importance of care coordination for improving health outcomes for women veterans, given the rise in cancer cases. Mr. Dempsey said that many women veterans receive cancer care in the community, making coordination between VA and private providers critical to avoiding service gaps. He noted that efficient communication and record transfers ensure a seamless experience for patients.

• Rep. Morrison inquired about the role of safe firearm storage in suicide prevention. Mr. Retzer shared his personal experience as a veteran with mental health challenges and explained how providing firearm storage options, like lock boxes, could be a life-saving measure. He noted that some veterans are not currently offered lock boxes despite meeting eligibility criteria.

• Rep. Dexter asked whether the No Wrong Door for Veterans Act has sufficient data to justify further grant program investment, given that only 4% of participants have been studied for outcomes. Mr. Retzer defended the program as a necessary alternative resource for veterans not enrolled in VA healthcare. He mentioned the importance of providing mental health services outside the VA system, especially for rural veterans, and recommended fiscal responsibility in the program’s implementation.

• Rep. Dexter followed up, asking what Congress could do to bolster suicide prevention efforts. Mr. Retzer stressed the need for adequate VA staffing, peer-to-peer support programs, and better communication between VA and veterans to ensure access to crisis services.

• Chairwoman Miller-Meeks asked about difficulties in executing the VA clinic construction in Omaha and whether improvements to the CHIP IN program were needed. Ms. Morris stated that construction ran smoothly but noted that the final months were challenging due to COVID-19. She credited successful coordination between VA and private contractors for ensuring timely completion. The Chairwoman asked whether waivers or exemptions were sought to reduce construction costs and time. Ms. Morris confirmed that reviewing and modifying VA construction and security standards allowed for $23 million in savings.

• Chairwoman Miller-Meeks inquired whether HBOT could help prevent amputations in veterans with chronic limb ischemia. Dr. Kozminski confirmed that HBOT has been proven effective as a salvage therapy for such cases.

• The Chairwoman asked if the VA’s current policy on reimbursing high-cost medications for state veterans’ homes was adequate. Mr. Harries disagreed, pointing out that rising drug costs and an increase in cancer diagnoses among veterans were straining state homes financially. He noted that the VA reimburses private community homes for the same medications but does not extend that support to state homes.

• Chairwoman Miller-Meeks then asked how the Veterans SPORT Act would benefit post-9/11 veterans. Mr. Dempsey explained that the bill would make it easier for amputee veterans to receive adaptive prosthetics for recreational activities. He noted that current VA policies often delay access to such devices unless veterans are in a formal clinical program.

• The Chairwoman asked whether the VA’s prosthetic policies are outdated and focused on older veterans with amputations from medical conditions like diabetes rather than younger, more active post-9/11 veterans. Mr. Dempsey stated that while he could not definitively say the VA’s system was outdated, many post-9/11 veterans are highly engaged in adaptive sports and require streamlined access to prosthetics.

• Ranking Member Brownley again criticized the focus on legislation over oversight, arguing that mass layoffs, contract terminations, and VA budget cuts would undermine veterans' care regardless of new policies. She warned that ongoing efforts to “dismantle” the VA system would make future improvements meaningless.

• Chairwoman Miller-Meeks countered that there was a $6 billion increase in the Toxic Exposure Fund, not a cut. She cited a $126 billion VA budget increase over four years and 60,000 new full-time VA employees, disputing claims that VA funding was being gutted. She restated that Congress must ensure efficient government spending to maintain high-quality veteran care.

SPECIAL TOPICS

JOIN THE NIMITZ NETWORK!

Enjoying our updates? Don’t keep it to yourself — forward this email to friends or colleagues who’d love to stay informed. They can subscribe here to become part of our growing community.