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Legislative Hearing

House Veterans Affairs Committee, Health Subcommittee Hearing

December 17, 2024 (recording here)

HEARING INFORMATION

Witnesses (Panel One):

• The Honorable Mike Bost: Member of Congress, Washington D.C.

• The Honorable Celeste Maloy: Member of Congress, Washington D.C.

• The Honorable Andy Biggs: Member of Congress, Washington D.C.

• The Honorable Brian J. Mast: Member of Congress, Washington D.C.

• The Honorable Chip Roy: Member of Congress, Washington D.C.

• The Honorable W. Gregory Steube: Member of Congress, Washington D.C.

• The Honorable Julia Brownley: Member of Congress, Washington D.C.

• The Honorable Mark Takano: Member of Congress, Washington D.C.

• The Honorable Greg Landsman: Member of Congress, Washington D.C.

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

• Ms. Hillary Peabody: Acting Assistant Under Secretary for Health for Integrated Veteran Care, Veterans Health Administration, U.S. Department of Veterans Affairs

• Dr. Erica Scavella: Assistant Under Secretary for Health for Clinical Services, Veterans Health Administration, U.S. Department of Veterans Affairs

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

• Mr. Cole Lyle: Director of Veterans Affairs & Rehabilitation, The American Legion

• Mr. Darin Selnick: Senior Veterans Affairs Advisor

• Mr. Patrick Murray: Director, National Legislative Service, Veterans of Foreign Wars

• Ms. Mary-Jean "MJ" Burke: First Executive Vice President, National Veterans Affairs Council, American Federation of Government Employees

Keywords mentioned:

• Choice, community care, access standards, privatization, suicide prevention, women veterans, flexibility, the MISSION Act, coordination of care

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairwoman Mariannette Miller-Meeks stated that the hearing would cover 10 bills designed to improve access to VA community care and ensure that veterans’ healthcare needs were met without bureaucratic hindrances. She noted the importance of codifying existing access standards to help veterans choose care outside the VA when qualified. She also spotlighted the role of inpatient programs in providing potentially lifesaving mental health and substance use treatment and reiterated the need to remove bureaucratic barriers.

• Ranking Member Julia Brownley expressed interest in the various bills under consideration, specifically her own legislation aimed at examining the VA’s menopause treatment and research efforts. She praised Full Committee Ranking Member Mark Takano’s bill to address physician staffing shortages through a new scholarship program and Rep. Greg Landsman’s bill to improve the evaluation of VA suicide prevention programs. However, she voiced disappointment that half of the bills seemed to reduce the VA’s role in providing care, warning against overreliance on private care options that could weaken the VA’s ability to deliver timely, culturally competent, and high-quality care.

SUMMARY OF KEY POINTS (PANEL ONE)

• Full Committee Chairman Mike Bost introduced the Complete the Mission Act of 2024 (H.R. 10267), designed to ensure that VA care standards are upheld and that the VA’s bureaucracy does not impede veterans’ access to timely health services. He stated that the original MISSION Act expanded VA healthcare options for veterans and that the new bill would codify those access standards. Chairman Bost claimed that community care was VA care, reaffirming that the VA was created for veterans, not for itself. He pointed to the urgency of providing veterans with mental health and substance use care at community-based residential programs.

• Full Committee Ranking Member Mark Takano presented the Supporting Medical Students and VA Workforce Act (H.R. 10381), aimed at addressing physician shortages by creating a scholarship program through the Uniformed Services University of the Health Sciences. He explained that this initiative would produce doctors with military cultural competencies who could serve in VA facilities for up to 10 years. Ranking Member Takano stressed that as more veterans seek VA care, especially from rural areas, it is crucial to increase the VA’s staffing capabilities.

• Rep. Brian Mast discussed the Emergency Community Care Notification Time Adjustment Act of 2024 (H.R. 8481), which would change the deadline for notifying the VA of emergency care outside the VA system from 72 hours after admission to 72 hours after discharge. He argued that expecting immediate notification was unfair to veterans who might be incapacitated or recovering from surgery. Rep. Mast believed this commonsense reform would prevent unfair financial burdens and improve the overall healthcare experience for veterans in emergencies.

• Rep. Greg Landsman introduced the What Works for Preventing Veteran Suicide Act (H.R. 9924), which would require the VA to develop best practices for suicide prevention programs. He explained that current prevention efforts were not always data-driven and that the bill would ensure taxpayer dollars funded only effective strategies. By identifying and reinforcing successful programs, he hoped to prevent more veteran suicides.

• Rep. Chip Roy discussed the Veterans Access to Direct Primary Care Act (H.R. 5287), proposing a five-year pilot program within the VA’s Center for Innovation to explore direct primary care models. He argued that direct primary care could reduce bureaucratic complexity, give veterans more freedom in their healthcare choices, and offer a more patient-centered experience. Rep. Roy noted that the private sector's success in direct primary care demonstrated its potential for improving veterans’ care.

• Rep. Celeste Maloy described her bill to simplify the process for veterans in rural areas to receive eyeglasses (H.R. 10012). She claimed that current policies require veterans to travel long distances to VA facilities for services that could easily be completed by local providers. She stressed that these unnecessary burdens discourage some veterans from obtaining needed care. Rep. Maloy requested that the VA reconsider its opposition to this measure, arguing that it is essential to serve veterans who live far from urban medical centers.

• Rep. W. Gregory Steube spoke on his Veterans’ True Choice Act (H.R. 214), which would grant service-connected disabled veterans the option to receive care through TRICARE Select and TRICARE For Life. He highlighted rampant VA failures and delays, including preventable vision loss, as evidence that veterans deserve the freedom to seek quality care outside the VA. Rep. Steube argued that this proposal was not an attempt to dismantle the VA, but rather to ensure that veterans could access timely, high-quality care near their homes.

SUMMARY OF KEY POINTS (PANEL TWO)

• Ms. Hillary Peabody expressed the VA’s commitment to providing high-quality care and its concerns about legislation that would reduce its role in delivering and coordinating services for veterans. She acknowledged that while increased choice was a goal, proposals that diverted resources from core VA programs could ultimately diminish care quality. Ms. Peabody mentioned that VA facilities consistently outperform many private sector hospitals in outcomes and patient satisfaction. She stated that the VA looks forward to working with Congress to maintain and enhance its veteran-centric care model.

• Ranking Member Brownley asked why the VA opposed codifying existing regulatory access standards in Chairman Bost’s bill and how VA wait times compare to those in the private sector. She also asked if the VA shared the Inspector General’s (IG) concerns about unethical rehabilitation facilities exploiting veterans and whether Chairman Bost’s bill included any safeguards against these practices. Ms. Peabody explained that codifying current standards would limit the VA’s flexibility to adjust to market changes and would require congressional action for future modifications. She noted the VA’s generally shorter wait times compared to community care and confirmed that the VA was working with the IG on investigations into predatory providers.

• Ranking Member Brownley inquired about safeguards in Chairman Bost’s bill against scammers in substance use treatment. Dr. Erica Scavella stated that she would need to review the bill for specific safeguards but affirmed that the VA aims to ensure proper screening and prevent predatory organizations from exploiting veterans.

• Rep. Greg Murphy shared his experience as a community care specialist and questioned what he should tell veterans who are dissatisfied with VA care and long wait times. He voiced his frustration over inadequate records transfer and inefficiencies within VA facilities that hindered patient care. Dr. Scavella acknowledged pockets of inefficiency and ongoing efforts to improve productivity, as well as initiatives to ensure better records-sharing and interoperability with community providers. She recognized that community care often involved more complex, specialty cases with longer wait times and pledged to continue addressing these concerns.

• Rep. Morgan Luttrell criticized the VA’s opposition to a proposed Zero Suicide Demonstration Project bill and the department’s ongoing inability to significantly reduce veteran suicide rates. He questioned why the VA would oppose measures aimed at reducing suicides when current approaches had not solved the problem. Dr. Scavella explained that the VA was early in implementing recent legislation with multiple grant programs and needed more time to assess their effectiveness. She noted that some demographics had shown improvements and that the VA planned to continue refining suicide prevention strategies based on forthcoming data.

• Rep. Nikki Budzinski asked how diminishing the VA’s direct care role in favor of privatization would affect the department’s additional missions, including research, training, and emergency response. Dr. Scavella stated that shifting patients and resources away from VA facilities could reduce the complexity and volume of cases VA clinicians and trainees handle, thereby undermining the VA’s educational pipeline and research efforts. She mentioned that fewer in-house cases would make it harder to recruit and retain high-quality providers, ultimately weakening the VA’s capacity to train future healthcare professionals and respond effectively to national health emergencies.

• Rep. Amata Radewagen asked why unelected bureaucrats at the VA, rather than elected officials, should determine when veterans have a choice in their health care. She also asked if telehealth was being used to reduce community care eligibility. Ms. Peabody replied that the VA opposes codifying access standards because health care is ever-changing, and the department needs the flexibility to adapt to industry changes. Dr. Scavella added that telehealth is offered based on clinical appropriateness and veteran comfort, not as a method to deny face-to-face community care if it is genuinely needed.

• Rep. Matt Rosendale criticized the VA’s opposition to bills expanding community care. He argued that the VA had obstructed the MISSION Act by not informing veterans of community care and making it difficult for them to access it. Ms. Peabody responded that the VA supports veterans having a say in where they receive care, but maintained that decisions need to be clinically justified. Rep. Rosendale expressed frustration that the VA did not trust veterans to know what they needed and cited rural situations where it was impractical to require travel to VA facilities rather than allowing veterans to choose local community care.

• Rep. Maloy voiced concerns that rural veterans face undue burdens to receive something as simple as eyeglass fittings and that the VA’s existing contracts do not cover these services locally. She said that the VA claimed it did not need legislation for these changes, yet had not taken action, and pointed out the two-year rulemaking process. Ms. Peabody stated that the VA recognizes the inconvenience and intends to address the issue through contractual modifications rather than codifying it into law. Rep. Maloy encouraged the VA to work collaboratively on solutions rather than resisting reforms.

• Chairwoman Miller-Meeks asked whether veterans should have agency in their healthcare decisions and questioned if a veteran’s request for an in-person appointment could justify eligibility for community care. She reviewed a case where a veteran faced a three-month wait for an in-person primary care appointment but could be seen via telehealth sooner. The Chairwoman asked if VA data on wait times combined telehealth and in-person visits. Ms. Peabody and Dr. Scavella stated that they would review how wait times were calculated and noted that the VA tried to offer appropriate options. The Chairwoman stressed that telehealth should not disqualify a veteran from community care if the veteran preferred in-person services, especially given rural and logistical challenges, and encouraged the VA to ensure veterans retained genuine choice in their health care.

SUMMARY OF KEY POINTS (PANEL THREE)

• Mr. Cole Lyle expressed the American Legion’s support for strengthening the VA’s direct care system while maintaining community care as a necessary relief valve, emphasizing that the individual veteran should remain the central focus. He stated that some bills would remove veterans and their providers from critical decision-making, which the Legion opposed, and instead endorsed legislation like the Complete the Mission Act of 2024 that codified access standards and supported timely, veteran-centered care. He also supported legislation that promoted effective suicide prevention programs and improved care for women veterans.

• Mr. Darin Selnick stated that veterans deserve excellent care either through VA facilities or community providers. He provided examples of the VA’s shortcomings and delays in treatment, arguing that the department often prioritizes institutional preservation over veterans’ well-being. He expressed support for the Veterans True Choice Act, the Veterans Health Care Freedom Act, and the Complete the Mission Act, all of which would give veterans greater autonomy and flexible care options. He reiterated that these reforms would ensure VA care was truly veteran-centric, letting veterans choose what worked best for them.

• Mr. Patrick Murray shared that recent VFW surveys showed most veterans preferred the VA as their main healthcare provider but often desired improvements to access and infrastructure. He supported the Complete the Mission Act and suggested strengthening it by reviving the Asset and Infrastructure Review (AIR) Commission to address the VA’s infrastructure challenges and ensure modern, seamless healthcare delivery. Mr. Murray stressed that community care had to be fixed to function effectively, without forcing veterans into a polarizing debate between all-private or all-public care. He called for coordinated, timely community care and urged the VA to use existing tools to deliver consistent access to veterans.

• Ms. Mary-Jean "MJ" Burke expressed concern that several proposed bills would accelerate the privatization of VA care, ultimately diminishing the integrated, evidence-based care veterans deserved. She argued that increased referrals to private care strain VA resources and that privatization efforts seem ideologically driven. Ms. Burke opposed bills that removed VA coordination or undercut VA financing, while also critiquing existing access standards for being too rigid and one-size-fits-all. She supported legislation promoting effective suicide prevention programs, capping emergency care expenses, and initiatives to strengthen VA staffing and training.

• Ranking Member Brownley asked Mr. Murray why veterans enjoyed receiving care at the VA, specifically whether it was because VA providers understood them better than community providers. Mr. Murray replied that many veterans appreciated the VA’s “one-stop shop” model, where multiple services could be accessed in one place. He noted that private healthcare systems did not offer such integrated care. He also said that the VA should not treat community care as a threat, but rather embrace it when the VA could not meet certain needs like prenatal care for pregnant veterans.

• The Ranking Member then turned to Ms. Burke, asking how the Choice Act and the MISSION Act impacted frontline VA employees. Ms. Burke explained that the complexity of rules and continuous increases in community care referrals created confusion and instability, leading to potential burnout. She claimed that while VA employees supported providing needed care, budget complexities and ever-increasing community care referrals challenged the sustainability of the VA’s direct care system. Ranking Member Brownley also inquired about the impact of growing community care usage on VA staff morale, recruitment, and retention. Ms. Burke replied that it could increase patient loads and reduce job satisfaction.

• Rep. Maloy asked Mr. Lyle if the American Legion knew of gaps similar to the eyeglass fitting issue in community care networks. Mr. Lyle responded that while the eyeglass gap was somewhat unique, the main gap was the VA’s inconsistent adherence to regulatory community care access standards. Rep. Maloy also asked Mr. Murray about balancing veterans’ desire for VA care with geographic challenges faced by rural veterans. Mr. Murray suggested revisiting the AIR Commission recommendations for improving infrastructure and placing clinics in underserved areas, reducing the need for rural veterans to travel long distances for VA care.

• Rep. Budzinski noted her concern about legislation potentially leading to the privatization of VA care. She asked Ms. Burke why codifying the existing community care access standards could be problematic. Ms. Burke explained that rigid, one-size-fits-all standards reduced the VA’s flexibility to respond to varying clinical needs and patient outcomes. She recommended focusing on best medical interests rather than uniform metrics and reaffirmed that VA care often equaled or surpassed community care quality.

• Chairwoman Miller-Meeks asked each witness why the MISSION Act was enacted. Mr. Lyle, Mr. Selnick, Mr. Murray, and Ms. Burke each explained that the MISSION Act aimed to ensure veterans could receive timely care, modernize the VA system, and address the issues discovered after the Phoenix VA scandal where veterans died waiting for treatment. The Chairwoman highlighted the importance of having community care as a backup for when VA facilities could not meet veterans’ needs. She also questioned Ms. Burke’s concerns about codifying access standards, pointing out that these standards were meant to ensure timely care rather than privatize VA services.

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