White House Seeks $125 Billion for Veterans in 2011

The White House has announced a proposed $125 billion budget next year for the Department of Veterans Affairs (VA). The proposal calls for expanding health care to a record number of veterans, reducing the number of homeless veterans and processing a dramatically increased number of new disability compensation claims.

“Our budget proposal provides the resources necessary to continue our aggressive pursuit of President Obama’s two over-arching goals for veterans,” said Secretary of Veterans Affairs Eric K. Shinseki. “First, the requested budget will help transform VA into a 21st century organization. And second, it will ensure that we approach Veterans’ care as a lifetime initiative, from the day they take their oaths until the day they are laid to rest.”

The $125 billion budget request, which has to be approved by Congress, includes $60.3 billion for discretionary spending (mostly health care) and $64.7 billion in mandatory funding (mostly for disability compensation and pensions).

“VA’s 2011 budget request covers many areas but focuses on three central issues that are of critical importance to our Veterans – easier access to benefits and services, faster disability claims decisions, and ending the downward spiral that results in veterans’ homelessness,” Shinseki said.

Veterans advocacy group Veterans for Common Sense (VCS) strongly endorses the VA’s $125 billion budget, according to spokesperson Paul Sullivan. “Specifically, we thank President Barack Obama and VA Secretary Eric Shinseki for increasing funding by nearly $300 million to end homelessness by the end of 2014,” he said.

However, Sullivan said he thinks our new Iraq and Afghanistan veterans as well as our Gulf War veterans should get more funding. “Tragically, the scope of the Iraq and Afghanistan war casualties reached far above any worst case scenario,” he said. “As of June 2009, VA reported 480,000 veteran patients from the two wars. VA also reported 442,000 disability claims filed. Nearly 300 first-time Iraq and Afghanistan war veterans flood into VA medical facilities every day.”

VCS is disappointed that the VA does not have an accurate casualty estimate and a long-range strategic casualty plan, Sullivan said. Two months ago, the VA estimated 419,000 Iraq and Afghanistan war veteran patients treated by the VA through the end of September 2010.

“VA’s estimate was wrong,” Sullivan. “At the current rate of nearly 9,000 new patients per month, a more realistic VA estimate should have been a cumulative total of 615,000 patients treated as of September 2010. VA’s 200,000 patient underestimation is a colossal failure because VA may lack the mental healthcare providers, disability claims processors, and education benefit processors to meet the need of this increasing cohort of veterans.”

Reducing Claims Backlog

The president’s budget proposal includes an increase of $460 million and more than 4,000 additional claims processors for veterans benefits. This is a 27 percent funding increase from the 2010 level.

The 1,014,000 claims received in 2009 were a 75 percent increase over the 579,000 received in 2000. Shinseki said the department expects a 30 percent increase in claims – to 1,319,000 – in 2011 from 2009 levels.

One reason for the increase is the VA’s expansion of the number of Agent Orange-related illnesses that automatically qualify for disability benefits. Veterans exposed to the Agent Orange herbicides during the Vietnam War are likely to file additional claims that will have a substantial impact upon the processing system for benefits, the secretary said.

“We project significantly increased claims inventories in the near term while we make fundamental improvements to the way we process disability compensation claims,” Shinseki said.

Long-term reduction of the inventory will come from additional manpower, improved business practices, plus an infusion of $145 million in the proposed budget for development of a paperless claims processing system, which plays a significant role in the transformation of the VA.

According to the Veterans Benefits Administration (VBA), more than one million veterans now wait 161 days for an initial answer for a disability claim, Sullivan said. “VCS is highly alarmed that VA’s 2011 budget request shows VBA taking a staggering 190 days to process an initial claim – that’s an unacceptable one month addition to the current delays facing our veterans and families,” he said.

Targeting Mental Health, Preventing Suicides

“The 2011 budget proposal continues the department’s keen focus on improving the quality, access and value of mental health care provided to veterans,” Shinseki said.

The spending request seeks $5.2 billion for mental health, an increase of $410 million (or 8.5 percent) over current spending, enabling expansion of in-patient, residential and out-patient mental health services, with emphasis on making mental health services part of primary care and specialty care.

The secretary noted that one-fifth of the patients seen last year in the VA’s health care facilities had a mental health diagnosis, and that the department has added more than 6,000 new mental health professionals since 2005, bringing to 19,000 the number of employees dedicated to mental health care.

The budget request will enable the department to continue expanding its programs for post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), along with the diagnosis and treatment of depression, substance abuse, and other mental health problems. Shinseki called PSTD treatment “central to VA’s mission.”

The proposed spending will continue the VA’s suicide prevention program. Since July 2007, the department’s suicide prevention hotline has received nearly 225,000 calls from Veterans, active-duty personnel and family members. The hotline is credited with saving the lives of nearly 7,000 people.

Michael Blecker, executive director of Swords to Plowshares, said he appreciates the proposed increased spending on mental health. Swords to Plowshares is a San Francisco-based veterans service agency that provides a full continuum of care to low-income and homeless veterans.

“We certainly appreciate the increase [in mental health care spending]. That’s important to recognize,” he said. There definitely is an increase in needs for help tending to returning veterans’ mental health concerns, Blecker said. Also, he said, “It’s important for us that the resources float down to the community” and local organizations.

“Many veterans who need care first seek help at local organizations like Swords, so we’re happy that they’ve made commitments to improve care and increase services, but they need to do more to collaborate with mental health organizations who can reach out and help identify those who have untreated mental health illnesses such as PTSD,” he said.

Also, with budget cuts in California, any additional spending on mental health care is welcome, Blecker said.

However, Sullivan said, “The VA and Department of Defense must hire more medical professionals, especially mental health professionals.” Furthermore, “our government needs to perform pre- and post-deployment medical exams, launch a broad national anti-stigma campaign encouraging veterans to seek medical care, and place full-time, permanent VBA claims staff at every military discharge location and every VHA medical center.”

Reaching Rural Veterans

For 2011, the VA is seeking $250 million to strengthen access to health care for 3.2 million veterans enrolled in the VA’s medical system who live in rural areas. Rural outreach includes expanded use of home-based primary care and mental health.

A key portion of rural outreach – which shows promise for use with veterans across the country – is the VA’s innovative “telehealth” program. It links patients and health care providers by telephones and includes telephone-based data transmission, enabling daily monitoring of patients with chronic problems.

The budget provides an increase of $42 million for the VA’s home telehealth program. The effort already cares for 35,000 patients and is the largest program of its kind in the world.

Eliminating Homelessness

The budget proposal includes $4.2 billion in 2011 to reduce and help prevent homelessness among veterans. That breaks down into $3.4 billion for core medical services and $799 million for specific homeless programs and expanded medical care, which includes $294 million for expanded homeless initiatives. This increased investment for expanded homeless services is consistent with the VA secretary’s established goal of ultimately eliminating homelessness among Veterans.

On a typical night, about 131,000 veterans are homeless. They represent every war and generation, from the “Greatest Generation” to the latest generation of veterans who served in Iraq and Afghanistan. To date, the VA operates the largest system of homeless treatment and assistance programs in the nation.

Serving Women Veterans

The 2011 budget provides $217.6 million to meet the gender-specific health care needs of women veterans, an increase of $18.6 million (or 9.4 percent) over the 2010 level. Enhanced primary care for women veterans remains one of the department’s top priorities. The number of women veterans is growing rapidly and women are increasingly using the VA for their health care.

Shinseki said the expansion of health care programs for women veterans will lead to higher quality care, increased coordination of care, enhanced privacy and dignity and a greater sense of security among women patients.

Among the initiatives for women in the 2011 budget proposal are expanded health care services in Vet Centers, increased training for health care providers to advance their knowledge and understanding of women’s health issues and implementing a peer call center and social networking site for women combat veterans. This call center would be open 24 hours a day, 7 days a week.

Delivering World-Class Health Care

During 2011, the VA expects to treat 6.1 million patients, who will account for more than 800,000 hospitalizations and 83 million outpatient visits.

The total includes 439,000 veterans who served in Iraq and Afghanistan, for whom $2.6 billion is included in the budget proposal. That’s an increase of $597 million – or 30 percent – from the current budget.

The proposed budget for health care includes:

• $6.8 billion for long-term care, an increase of $859 million (or 14 percent) over 2010. This amount includes $1.5 billion for noninstitutional long-term care;
• Expanding access to the VA health care system for more than 99,000 veterans who were previously denied care because of their incomes;
• $590 million for medical and prosthetic research; and
• Continuing development of a “virtual lifetime electronic record,” a digital health record that will accompany veterans throughout their lives.

The VA is requesting $54.3 billion in advance appropriations for 2012 for health care, an increase of $2.8 billion over the 2011 enacted amount. Planned initiatives in 2012 include better leveraging acquisitions and contracting, enhancing the use of referral agreements, strengthening the VA’s relationship with the Defense Department and expanding the use of medical technology.

Preserving National Shrines

“VA remains steadfastly committed to providing access to a dignified and respectful burial for Veterans choosing to be buried in a VA national cemetery,” Shinseki said. “This promise requires that we maintain national cemeteries as shrines dedicated to the memory of those who served this nation in uniform.”

The requested $251 million for cemetery operations and maintenance will support more than 114,000 interments in 2011, a 3.8 percent increase over 2010. In 2011, the department will maintain 8,441 acres with 3.1 million gravesites. The budget request includes $37 million to clean and realign an estimated 668,000 headstones and repair 100,000 sunken graves.

Building for the Future

Also, $1.15 billion requested for major construction for 2011 includes funding for medical facilities in New Orleans; Denver; Palo Alto, California; Alameda, California; and Omaha, Nebraska. Also budgeted for 2011 are major expansions and improvements to the national cemeteries in Indiantown Gap, Pennsylvania; Los Angeles; and Tahoma, Washington, and new burial access policies
that will provide a burial option to an additional 500,000 veterans and enhance service in urban areas.

A requested budget of $468 million for minor construction in 2011 would fund a wide variety of improvements at VA facilities.