November Washington Update

November 15, 2017​​​​​​​​            Volume 23, Number 11
***PRIORITY***
The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit http://www.AirAccess30.org and share your story.

House VA Committee Conducts Hearing to Review Choice Reform Legislation

On October 24, 2017, the House Committee on Veterans’ Affairs conducted a legislative hearing to examine a number of important proposals. The hearing included two very important draft bills that offered direction for the reform of the Choice program administered by the Department of Veterans Affairs (VA). Paralyzed Veterans of America submitted a statement for the record for the hearing.

The focus of our testimony was on the draft bill presented by the House VA Committee—a bill that would eventually become H.R. 4242, the “VA Care in the Community Act”—and on the draft bill presented by the VA—the “Veteran Coordinated Access & Rewarding Experiences (CARE) Act.’’ PVA did not explicitly oppose either draft bill as presented.

We also emphasized in our testimony that before the Committee takes steps to reform the delivery of veterans’ health care in the community, it is important to affirm that specialized services are part of the core mission and responsibility of VA. In recent months, VA has indicated that, along with improving the delivery of care in the community to veterans, it plans to concentrate on expanding and improving what it considers “foundational services.” The Secretary has indicated that it considers spinal cord injury and disease (SCI/D) care and blinded care foundational services. However, he must make that policy unequivocally clear to all networks and all facilities. Additionally, we do not believe foundational services end with just those areas; there are many areas of service within VA that inform the principle of veteran-centric care. We appreciate the fact that the Secretary has committed to expanding SCI/D nurse staffing by approximately 1,000 new positions. These concerns about foundational services cannot be dismissed simply in the interest of focusing attention on more community care.

Congress should examine more closely how VA will monitor the quality of care veterans are receiving in the community. This question goes beyond a plan for care coordination. If VA is unprepared to retain ownership of responsibility for care delivered in the private sector, Congress will be helpless in conducting adequate oversight. PVA believes that the Committee and VA need to seriously consider the consequences for veterans when they are injured during the course of their treatment in the community. When veterans receive treatment at a VA medical center, they are protected in the event that some additional disability or health problem is incurred. Under 38 U.S.C. § 1151, veterans can file claims for disability as a result of medical malpractice that occurs in a VA facility or as a result of care delivered by a VA provider.

When PVA questioned VA as to whether these protections are conferred to veterans being treated in the community, VA officials confirmed in writing that this protection, as a matter of law, does not attach to the veteran in such circumstances. We continue to advocate for the inclusion of this protection in any final bill considered by the Committee. Unfortunately, the bill being considered in the House does not include these provisions.

PVA strongly supports the concept of developing a high-performing integrated health care network that would seamlessly combine the capabilities of the VA health care system with both public and private health care providers in the community. We believe that the design and development of VA’s network must be locally driven using national guidance, and it must reflect the demographics and availability of resources within that area. VA has taken the first steps toward this goal by conducting its pilot market assessments using three individual VHA facilities and their surrounding health care markets.

PVA also supports the Secretary’s plan to move the Department away from the current 30-day/40-mile eligibility standards in favor of a case-by-case clinical determination. The Committee’s draft bill targets the same desired end goal. Access decisions dictated by arbitrary wait times and geographic distances have no comparable industry practices in the private sector. This change would shift the organizational mindset and focus of VA to clinical outcomes instead of catering to arbitrary metrics governing access to care in the community. We have consistently advocated for this proposition before Congress and the administration, stating that eligibility and access to care in the community should be a clinically-based decision made between a veteran and his or her doctor. Establishing appropriate eligibility standards will be an integral part of a sustainable network.

The hearing agenda also included several other bills. PVA supported H.R. 1133, the “Veterans Transplant Coverage Act;” H.R. 2123, the “Veterans E-Health and Telemedicine Support (VETS) Act of 2017;” and H.R. 2601, the “Veterans Increased Choice for Transplanted Organs and Recover Act of 2017.” While we also supported the intent of H.R. 3642, the “Military Sexual Assault Victims Empowerment (SAVE) Act,” we expressed reservations about some of the underlying assumptions of the bill. Similarly, we expressed concerns about a draft bill that would require the Veterans Crisis Line to collect certain data from veterans who contact the line in crisis.

Subsequent to the hearing, the Committee attempted to mark-up H.R. 4242; however, a recent cost estimate provided by the Congressional Budget Office forced the Committee to withdraw the bill from consideration at this time.

PVA’s full written statement can be viewed at http://www.pva.org.

House of Representatives Passes Veterans Legislation

During the week of Veterans’ Day, the House of Representatives passed a long list of bills targeted at improving various services in the Department of Veterans Affairs (VA). That list includes:

• H.R. 918, the “Veteran Urgent Access to Mental Healthcare Act.” This bill would require VA to provide an initial mental health assessment and any subsequent mental health services required to meet urgent mental health care needs to former service members who would otherwise be ineligible for
such services because they were discharged from military service under other than honorable (OTH) conditions.
• H.R. 1066, the “VA Management Alignment Act of 2017.” This bill would require VA to submit a report regarding the roles, responsibility, and accountability of elements and individuals of VA, using the findings of the Independent Assessment, the Commission on Care, and relevant GAO reports as resources.
• H.R. 1133, the “Veterans Transplant Coverage Act.” This bill would authorize VA to provide all care and services needed for a veteran to receive an organ transplant from a live donor, regardless of whether the donor is eligible for VA health care or whether the health care facility is part of the VA.
• H.R. 1900, the “National Veterans Memorial and Museum Act.” This bill would designate the Veterans Memorial and Museum in Columbus, Ohio, as the National Veterans Memorial and Museum.
• H.R. 2123, the “Veterans E-Health and Telemedicine Support Act (VETS) Act of 2017.” This bill would give the VA Secretary the legislative authority to allow VA providers to practice telemedicine across state lines.
• H.R. 2601, the “Veterans Increased Choice for Transplanted Organs and Recovery (VICTOR) Act.”
• H.R. 3122, the “Veterans Care Financial Protection Act of 2017.” This bill directs VA to work with federal agencies and states to develop and implement standards that protect individuals who are eligible for increased pension from dishonest, predatory or otherwise unlawful practices.
• H.R. 3562, a bill to authorize the Secretary of Veterans Affairs to furnish assistance for adaptations of residences of veterans in rehabilitation programs.
• H.R. 3634, “the Securing Electronic Records for Veterans Ease (SERVE) Act of 2017.” This bill would make BAH documentation available online to all veterans, which would help confirm a veteran’s monthly housing stipend and simplify their home or apartment rental process.
• H.R. 3656, a bill that would provide a headstone or marker for all eligible non-veterans who die on or after November 11, 1998.
• H.R. 3657, a bill that would authorize VA to provide headstones and markers to eligible spouses and dependents who are buried or interred at tribal veterans cemeteries.
• H.R. 3705, the “Veterans Fair Debt Notice Act.” This bill instructs VA to use plain language in its debt notices to provide a clear explanation of why VA is alleging that the veteran owes such a debt.
• H.R. 3949, the “Veteran Apprenticeship and Labor Opportunity Reform (VALOR) Act.” This bill would simplify an approval process by allowing companies to register their apprenticeship programs with one central approval agency.
• H.R. 4173, the “Veterans Crisis Line Study Act of 2017.” This bill would require VA to conduct a study on the outcomes and efficacy of the Veterans Crisis Line based on an analysis of national suicide data and data collected from the VCL.

PVA generally supported all of the bills that were considered and approved by the House. In testimony earlier this year, we did express concerns about the data collection process that would occur to support H.R. 4173, particularly what the impact might be of trying to obtain this type of information from veterans who are in crisis.

VA Considering Proposed Cuts to VA Special Purpose Funds

In October, PVA became aware of VA’s plan to move nearly $1 billion dedicated to programs such as Women’s Health, Mental Health, Research, and Suicide Prevention, to a general purpose fund for an unclear purpose. While the VA has claimed that it will be used to reinvest in “foundational services”—which includes spinal cord injury/disease care, there has been no guarantee that will actually occur at this point. It seems the real impact of this dramatic shift of funds from special purpose to general purpose is to provide more resources and flexibility to Veterans Integrated Service Networks (VISNs) and Medical Center Directors. PVA has long argued for the need for medical centers to be fully equipped to meet the needs of their patients. And while we understand the ultimate goal of this shift of resources we are deeply concerned by such a dramatic realignment of resources and the potential impact on veterans.

VA has not provided VSOs or Congress any detailed explanation for how the proposed cuts to critical programs will better serve veterans. Given the magnitude of the proposed repurposing and the potential to devastate critical programs, PVA and others in the VSO community have been diligently engaging with VA to pause the move until the extent of the impact is understood. Several members of Congress, including the Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies have reached out to Secretary Shulkin as well to get clarification.

We will continue to monitor this action as the consequences for some key programs in VA could be severe. While VA has promised that “foundational services” will benefit from this shift, we do not believe that it should be at the expense of other critical services within VA.

PVA Hosts Roundtable with Senate Commerce Leaders on Air Travel Accessibility

On November 8, 2017, PVA hosted a roundtable with the Senate Commerce, Science, and Transportation Committee on improving access to air travel for veterans with disabilities. The purpose of the roundtable discussion was to focus on how disability-related provisions in S. 1872, the “TSA Modernization Act,” and S. 1405, the “FAA Reauthorization Act of 2017,” would lay the ground work for ensuring safe and effective access to air travel for all people with disabilities. The roundtable provided an opportunity for PVA leaders to share their travel experiences and for Senators and staff to learn more about their concerns. Senators engaged leaders about the frequency of wheelchair damage, service animals, and the general accessibility of air travel.

PVA National President David L. Zurfluh, PVA National Secretary Larry Dodson, PVA National Vice President Charles Brown, and Interim Executive Director Carl Blake were joined at the event by Senate
Commerce Committee Chairman John Thune (R-SD), Ranking Member Bill Nelson (D-FL), and Senator Tammy Duckworth (D-IL). Heather Ansley, Associate General Counsel for Corporate and Government Relations and Lee Page, Senior Associate Advocacy Director, served as moderators for the event. Representatives for Wounded Warrior Project, the American Legion, and VetsFirst also participated.

PVA Hosts First Meeting of the RESNA Standards Committee on Air Travel

On November 7, 2017, PVA hosted the first meeting of the RESNA Standards Committee on Air Travel. The goal of the committee is to create air travel standards and guidelines for mobility devices, to include design, labeling, information cards, and airport personnel handling and training procedures. RESNA is a standards developing organization accredited by the American National Standards Institute (ANSI). The RESNA Assistive Technology Standards Board is the U.S. Technical Advisory Group to ANSI for the development of ISO (International Organization for Standardization) standards pertaining to assistive technology and other products for persons with disabilities.

PVA is an official member of the committee and works closely with the committee’s leadership. Moving forward, the committee plans to meet quarterly over the next year to work toward the goal of reducing damage to wheelchairs in air travel. PVA is joined by airlines, wheelchair manufactures, and other key stakeholders in these efforts.

Congress Prepares to Tackle Tax Reform by End of November

Efforts to make major changes in the tax code for the first time in 30 years recently moved forward in the House and Senate. As of press time for this newsletter, the House was preparing to vote on H.R. 1, the “Tax Cuts and Jobs Act,” while the Senate Finance Committee had begun working on its own version of the legislation with a vote expected in the full Senate after Thanksgiving. Proponents of these measures point to the anticipated economic growth that will ensue from reductions in corporate and individual tax rates and simplification of the tax code. Meanwhile, the nonpartisan Congressional Joint Committee on Taxation has produced analyses of the legislation showing almost 60 percent of U.S. households would see meaningful tax cuts in 2019. However, by 2027, because of changes to deductions and credits in the current tax code, less than half of Americans would experience a tax cut worth $100 or more, while about 1 in 5 would see their taxes go up compared with current law.

In a letter to the House Ways and Means Committee, PVA expressed strong opposition to provisions in the House bill that would eliminate several credits and deductions in the tax code of particular importance to veterans and people with disabilities. H.R. 1 would repeal the Work Opportunity Tax Credit that has helped companies hire almost 300,000 veterans with barriers to employment from 2013 to 2015.

The bill also would repeal the Disabled Access Tax Credit that was created in 1990 to help small businesses comply with the Americans with Disabilities Act. In addition, the House measure would eliminate the medical expense deduction which has softened the burden of over 9 million households facing high costs associated with long term disabilities and illnesses.

The initial Senate Finance Committee chairman’s mark of the tax measure did not include repeal of these credits and deductions. However, Congress must ensure that the final tax bill adds no more than $1.5 trillion to the deficit, which was the limit fixed in the House and Senate budget resolutions.

As a result, the conference committee that will be appointed to reconcile the House and Senate tax bills will be under considerable pressure to eliminate deductions and credits that add to the measure’s costs. Nevertheless, PVA will continue to press its support for these tax credits and deductions that advance the economic independence and community integration of veterans and people with disabilities.

FAIR Heroes Act Introduced

On November 9, 2017, Senator Bill Nelson (D-FL) and Senator Richard Blumenthal (D-CT) introduced S. 2117, the “FAIR Heroes Act,” that would make veterans who were medically retired from the military eligible for both Medicare Part B and TRICARE, a health care program for retired veterans and their families, and allow them to choose which health plan works best for them. Under current law, veterans who receive Social Security Disability Insurance (SSDI) benefits are required, by law, to purchase Medicare Part B coverage. In some cases, they must maintain that coverage even if they return to work. S. 2117 would give these veterans the choice to enroll in TRICARE instead of Medicare Part B. According to a press statement accompanying the bill’s introduction, this legislation could save many veterans up to $1,300 a year.

Currently, medically retired veterans who fail to purchase Medicare Part B coverage immediately upon becoming eligible, or who fail to maintain that coverage for at least eight years after returning to work, are forced to pay a late enrollment fee and higher premiums if they enroll in Medicare later in life. The late-enrollment penalty and higher premiums make Medicare coverage unaffordable for many of these veterans. The legislation seeks to change that, not only by giving these disabled veterans the option to enroll in TRICARE instead, but also by eliminating the eight-year Medicare requirement and late-enrollment penalties for those who were medically retired from the military.

PVA has endorsed this legislation because of many of our members are affected by this issue.

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October Washington Update

October 17, 2017​​​​​​​​Volume 23, Number 10
***PRIORITY***
The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit http://www.AirAccess30.org and share your story.

House VA Committee Holds Hearing on Asset Review Proposed Legislation
On October 12, 2017, the House Committee on Veterans’ Affairs conducted a legislative hearing to review a draft bill—the “Asset and Infrastructure Review (AIR) Act.” This legislation was originally discussed during a full Committee round table in September. Carl Blake, Associate Executive Director (AED) of Government Relations, testified on behalf of Paralyzed Veterans of America (PVA). PVA generally supports the intent of the legislation; however, we expressed some significant concerns with the proposal as presented.
The draft bill would require the Department of Veterans Affairs (VA) to undertake an asset review process that mirrors the BRAC process previously used in the Department of Defense (DOD). During the hearing, PVA expressed our support for the notion of rightsizing the VA’s infrastructure footprint. However, we emphasized that a BRAC-style process is not necessarily the optimal process to achieve that end. Representatives from the Government Accountability Office (GAO) and the Congressional Research Service (CRS) explained that the key to making the process work is spending all the time necessary to do advance planning, laying out the desired end goals and the processes needed to analyze the complete VA health care system. GAO explained that DOD had fully three years before a BRAC Commission was empaneled to consider the infrastructure alignment of DOD. Meanwhile, this bill establishes a process whereby the VA will complete all of its preparatory work within one year and the Commission will then submit its final recommendations to Congress within six months following that date (by May 2019), effectively giving VA and the Commission only 18 months to outline the complete realignment of the infrastructure footprint of the Veterans Health Administration (VHA). The draft legislation essentially ignores what GAO identified as the most critical point to ensure success of this process—time.
Moreover, this legislation appears to be putting the cart before the horse. We strongly believe that VA should have the opportunity develop and put into operation its integrated health care network before any decisions are made about what the footprint of VA should look like. It makes no sense for VA to make decisions about what its infrastructure alignment will be without first understanding what its capacity to deliver services currently is and how an integrated network must be designed to enhance that capability. Central to that effort is the completion of a thorough market assessment before the network can be fully established and implemented. With that in mind, the draft bill requires modification to its overall timeline in order to accommodate more time for market assessment.
We also have serious concerns that fitting a BRAC model to VA presumes that the nature of the VA health care system is not fundamentally different from the DOD base alignment that was considered during its own BRAC process. This proposal ignores the fact that the DOD BRAC addressed a static military population and simply consolidated and moved units to fit its planned infrastructure alignment. It was relatively easy, though not politically, to simply move military families to new locations to support the force realignment. This fact does not apply to the VA health care system and the population it serves. Decisions to close or downsize a VA medical facility will have a direct impact on the veteran population being actively served in that selected community.
Our last concern is the impact initiating a BRAC process will have on current major and minor construction activities at VA. When VA initiated its Capital Asset Realignment for Enhanced Services (CARES) process nearly 15 years ago, the most devastating result of this process was the moratorium placed on virtually all construction for a two-year period while the process was conducted. Congress has compounded that problem every year since that time by woefully underfunding the major and minor construction requirements of VA. Many facilities are now in serious decline simply because they were not upgraded or modernized, and because Congress continues to provide inadequate funding for VA’s infrastructure needs, and now many of those facilities face the possibility of closure because of that neglect.
With the establishment of an Asset and Infrastructure Review Account we believe that Congress will continue to ignore its responsibility to provide critically-needed funding for ongoing construction projects in an effort to wait for the outcome of the Commission. This is an unacceptable proposition for PVA.
The prospects for this legislation remain uncertain. The Senate Committee on Veterans’ Affairs is much less inclined to take up similar legislation. The bill may also be unnecessary as the Secretary has already laid out plans to deal with unused and underutilized facilities.
To read PVA’s full written statement, please visit http://www.pva.org.

House VA Committee Conducts Roundtable on Choice Reform Legislation
On October 3, 2017, the House Committee on Veterans’ Affairs conducted a round table to discuss a draft bill that would make the Veterans Choice program permanent. The bill presumably reflects bipartisan efforts of both Chairman Phil Roe (R-TN) and Ranking Minority Member Tim Walz (D-MN). Carl Blake, AED of Government Relations, represented PVA at the round table and was accompanied by Lana McKenzie, AED for Medical Services, who offered key insights into the ideas being considered by the Committee and how the provision of spinal cord injury (SCI) care will fit into this proposal.
PVA generally supports the draft bill that has been presented. The bill authorizes the development of an integrated health care network to support the VA health care system. Veterans would be assigned a primary care provider either within the VA or in the community dependent upon availability. Access to the community would then be governed by a determination of clinical need between the veteran and his or her primary care provider, the availability of services at the local VA medical center or in the community, and the performance of the local VA in providing those services in a timely, quality manner. Veterans needing specialty care must be referred into the community. Much of the structure of this proposal mirrors the concepts of an HMO.
Our emphasis during the round table was on ensuring proper coordination of care, particularly when veterans with catastrophic disabilities such as spinal cord injury are referred to providers in the community. We also recommended that the Committee revise the draft bill to allow more time for the completion of market assessments that will outline the capacity of VA to provide services. We do have concerns that those market assessments are focused too much on examining a way to allow for the community to provide more care when gaps are identified, rather than also outlining potential alternatives that will expand VA’s internal capacity.
The bill also lacks an urgent care benefit that many veterans’ service organizations and key stakeholders have recommended in the past. In fact, the VA’s draft community care plan presented earlier this year included an urgent care benefit. We have argued that urgent care options for veterans would potentially relieve significant pressure on the emergency care and primary care functions at the VA.
This legislation will be considered in a legislative hearing by the House VA Committee later in October. It remains unclear how the House and Senate VA Committees will resolve the significant differences that currently exist between the bills they are considering.
Of note, at the end of the round table, Chairman Roe emphasized that the notion of unfettered choice is a false choice. He explained that the only people who get unfettered choice in their health care in America are those who pay completely out of pocket. Otherwise, all other people seeking health care do so through a type of managed care. This is a critical point as some continue to advocate for unfettered choice within VA.

Amendment Addressing Passengers with Disabilities Added to TSA Modernization Bill
On October 4, 2017, the Senate Commerce, Science, and Transportation Committee marked up S. 1872, the “Transportation Security Administration (TSA) Modernization Act.” At the markup, the Committee accepted a PVA-supported amendment on improving the screening of passengers with disabilities. The amendment was sponsored by Chairman John Thune (R-SD), Ranking Member Bill Nelson (D-FL), Senator Roy Blunt (R-MO), and Senator Maria Cantwell (D-WA).
The amendment includes several provisions that would improve the travel experience for people with disabilities. One provision would require TSA to work with disability and veterans’ service organizations to develop specific training requirements for TSA personnel regarding the proper screening of passengers who use wheelchairs, indwelling medical devices, prosthetics, and service animals. As part of this process, TSA would be required to revise its current training to implement needed changes.
Another provision would require TSA to record each disability-related complaint, identify the most frequently concerns raised or accommodations requested, and determine the best practices for addressing the most frequent complaints and accommodation requests. The amendment would also require signage at security checkpoints informing passenger with disabilities of their right to request assistance with disability-related complaints. Importantly, it would also improve accountability by requiring TSA to report to Congress on an annual basis metrics related to the experiences of passengers with disabilities.
PVA will continue to work with Committee staff in the coming weeks to ensure additional protections for passengers with disabilities in transiting security are addressed before the bill heads to the Senate floor.

House and Senate Budget Resolutions Assume Cuts to Medicare, Medicaid and Social Security
On October 4, 2017, the House of Representatives approved its 2018 budget resolution that lays the groundwork for its tax reform plans through the process known as reconciliation. Adopting an overall $4.1 trillion spending plan for the federal government for fiscal year 2018, the budget resolution contains a set of instructions to Congressional committees to turn the budget resolution into implementing legislation.
Contained in the budget resolution are instructions to House committees to find $487 billion in savings over ten years from Medicare, $1 trillion in savings from Medicaid and $5.4 billion from Social Security. Proposed changes for Medicare include a gradual increase in the eligibility age from 65 to 67, raising income related premiums for Parts B and D (the physician services and prescription drug programs])of Medicare and converting this program for older Americans and people with disabilities to a premium support system of financing. If enacted, Medicare beneficiaries would be given a flat payment or voucher with which to buy health insurance either under traditional Medicare or through the private market. All plans competing in the program would have to match the benefits and services of traditional Medicare and insurers could not deny coverage to any beneficiary. Although the impact on beneficiaries of this plan is unclear, previous analyses by the Congressional Budget Office have indicated that a premium support system would increase costs for those enrollees in traditional Medicare. The $1 trillion in cuts to Medicaid are assumed to come from adoption of provisions that were included in previous House-passed health care reform bills such as turning Medicaid into a block grant to the states and ending the Medicaid expansion.
For Social Security, the budget resolution proposes reducing Social Security Disability Insurance (SSDI) benefits to those beneficiaries receiving Unemployment Insurance compensation. Such a move could prove to be a work disincentive for SSDI recipients who attempt a return to work but lose their jobs through no fault of their own. The vote in the House in favor of the FY 2018 budget resolution was on a nearly party-line voted of 219 to 206.
The Senate is expected to take up a similar budget resolution as soon as the week of October 16. Passing the budget resolution through both chambers sets in motion the process known as reconciliation by which changes to the tax code can be passed with a simple majority of 51 votes in the Senate. The changes proposed in the budget resolution to Social Security, Medicare and Medicaid are only a road map for authorizing committees to turn into legislation. However, PVA remains concerned over their potential harm to beneficiaries and will oppose measures that adversely affect the earned benefits of older Americans and people with disabilities.

Advocacy Staff Participate in Site Visit on Improving Air Travel Accessibility
In October, PVA Associate General Counsel Heather Ansley and Senior Associate Advocacy Director Lee Page travelled to Minden, NV, to meet with Peter Axelson of Beneficial Designs. The meeting was meant to educate our staff regarding Mr. Axelson’s research into accessible air travel. Specifically, Mr. Axleson and Beneficial Designs received a 2014 award from PVA’s Research Foundation to investigate assistive technology for non-ambulatory passengers in air travel. Staff had the opportunity to walk through the research protocol and learn more about the various boarding chairs and lift systems designed to help people with disabilities board and deplane an aircraft.

While in Nevada, staff also had the opportunity to meet with John McGuinness of HAYCOMP of Australia, a company that manufacturers lift devices for persons with disabilities including aviation lifters. Information about their product can be found at: http://www.haycomp.com.au/aviation-lifters/. The lift device is able to assist a person with complete immobility on an off an airplane as an alternative to the standard aisle chair. HAYCOMP is working with the PVA Florida Gulf Coast Chapter and the coordination committee for the 38th National Veteran Wheelchair Games that will be held in Orlando, FL, from July 29-August 4, 2018. The lift will be available in Orlando to assist veterans who need the assistance it provides to board and deplane in a safe and effective manner.

President Issues Executive Order to Expand Health Insurance Options
In the wake of Congressional inaction on repealing the Affordable Care Act (ACA), President Donald Trump signed an executive order (EO) on October 12 directing several federal agencies to issue regulations to broaden Americans’ access to lower cost health insurance options. The EO focuses on promoting greater use of three different types of health coverage plans: so-called association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).
The Labor Department (DOL) is given 60 days to develop proposed regulations to make it easier for small businesses and individuals to join together to purchase health insurance through nationwide association health plans. Association health plans already exist but DOL could amend rules so that these plans fall under similar regulations governing large-employer health insurance policies. Large employer health insurance plans are not required to abide by all of the ACA mandates such as coverage of prescription drugs, rehabilitation services or other essential health benefits. While this move could allow AHPs to restrict coverage based on medical history, the administration has said that employers participating in these plans would not be allowed to exclude employees or develop premiums based on health conditions.
DOL as well as the Departments of Treasury and Health and Human Services were assigned the two other tasks covered by the EO. Within 60 days, they are to devise proposed regulations to expand the availability of short-term health insurance policies, which also don’t have to comply with ACA protections, for those with pre-existing conditions. Typically used by persons who are between jobs, these STLDI plans are not required to offer the comprehensive set of benefits called for under the ACA and were limited by the ACA to no longer than 90 days. The order extends the term of these plans to a year. Within 120 days, these same three agencies are directed to propose regulations or revised guidance to increase the use of HRAs, to expand the ability of employers to offer HRAs to their workforces, and to allow HRAs to be used in conjunction with non-group coverage.
Critics of these proposals are concerned that allowing these health plans to sell more limited benefits and exclude persons with high cost health conditions may draw younger and healthier people to them, leaving older persons and those with disabilities or chronic conditions in the ACA health exchanges. That in turn would cause insurance premiums in ACA plans to spike, making insurance increasingly unaffordable and possibly leading to greater numbers of people without insurance.
All of the proposals contained in the executive order must go through the regulatory rule-making process so it may be at least six months before any changes are finalized by Labor, Treasury and HHS.

Okie Open Bass Tournament

The first stop on the PVA tour was Eufalua Lake Oklahoma, and I was ready to get started to fish. I always look forward to the season because I get to see old friends from around the U.S. and get to talk about our families while fishing and get to talk a little smack when you reel in the big one or if you win.

There are two divisions in which to fish, the first and most popular is the boat division. They pair you up with an able body boat captain and you fish Saturday and Sunday. The second in which I fish is the bank division in which also you fish both Saturday and Sunday. Both are quite enjoyable and I would recommend any of our members to get out and come fish with us.

There are eight stops to the tour starting at Oklahoma and ending in Virginia and if you don’t think you could do it, only I can say that there are a variety of mobility injuries from amputees to quads. So please consider to come try to fish with us.

August Washington Update

August 14, 2017                                                                Volume 23, No. 8

***PRIORITY***

The Government Relations staff is still looking for stories about problems that our members have experienced during air travel.  Please visit www.AirAccess30.org and share your story. 

Congress Approves Choice Funding Extension

Prior to leaving for the August recess, the House of Representatives and Senate approved legislation that would provide additional funding to keep the Department of Veterans Affairs (VA) Choice program operating. Due to significant increases in utilization of the Choice program over the last 6 months, the VA faced the prospect of the program running out of funding by August 15th. In an effort to relieve that problem, Congress approved a bill that provides approximately $2.1 billion to keep the Choice program running for an additional six months. The bill also includes funding to open 28 capital leases that have been held up for budget reasons for nearly two years, as well as provisions to improve workforce innovation, recruitment and retention of providers in the VA health care system.

Unfortunately, Congress will be forced to deal with this issue again six months from now. A long term solution for how VA will manage its community care programs, which includes the current Choice program, has not been finalized. Meanwhile, the House and Senate Committees on Veterans’ Affairs are already developing their own legislative solutions to community care. They range from VA coordinating all community care decisions to veterans having unfettered choice to decide when and where they will seek care.

PVA has already testified on a couple of occasions this year on the future of the Choice program. In the spring, the VA unveiled its own C.A.R.E. program that it hopes to make the basis of all of its community care going forward. However, much work remains to reach a consensus on the final program, to include how VA will invest in and sustain its “foundational commitments” (spinal cord injury/disease care, blinded rehabilitation, prosthetics, etc).

Congress Approves Permanent Change to the Post-9/11 GI Bill

The latest update to the Post-9/11 GI Bill made its way through Congress prior to the August recess and now awaits the President’s signature. The “Harry W. Colmery Veterans Education Assistance Act of 2017,” wielded strong bipartisan support throughout both chambers of Congress allowing the bill to be fast-tracked to the President’s desk. After a unanimous vote in the House, the Senate followed suit by passing the bill by voice vote.

The bill’s namesake, the Forever GI Bill, comes from the elimination of the “use it or lose it rule” that requires the benefit to be used within fifteen years. In today’s world, it is common for veterans to make career changes later in life. This makes it all the more important to retain education benefits that can help facilitate successful transitions. One significant change makes all Purple Heart recipients eligible for 100 percent of the benefit. Because the benefit percentages are based on time in service, veterans removed from service due to wounds sustained in combat were often unable to reach the full 100 percent rating.

The bill addresses a number of other inadvertent inequities as well. One deals with the Fry Scholarship. Surviving spouses and children of service members who die in the line of duty after September 10, 2001, who are utilizing the GI Bill to attend school are currently ineligible for the Yellow Ribbon Program which fills the gap between the GI Bill benefit amount and full tuition at private institutions. Another oversight in the original law precluded reservists mobilized in support of a Department of Defense (DOD) combatant command and when Governors’ request federal assistance in responding to major disasters or emergencies from counting that service time for eligibility.

Other changes include a long-overdue increase in monthly payments for Dependents’ Education Assistance (DEA) by approximately $200. However, the eligibility time period will be reduced from 45 months to 36 months. Most, if not all, GI Bill benefits now cover 36 months of education time, which equates to approximately four school calendar years. The bill also encourages more students to enter into science, technology, engineering and math (STEM) programs, and it restores benefits to students whose schools closed or lost accreditation in the middle of a semester, costing the veteran a semester of eligibility without actually earning any credits.

While the provisions in the bill were far from controversial, the bill got off to a rocky start as VSOs battled over how it would be funded. The original proposal that had widespread support would have mimicked the Montgomery GI Bill, which required active duty service members to pay a nominal amount of their salary into the program to become eligible. Some groups, however, balked at forcing service members to pay for this benefit. The visceral backlash sunk the bill initially. It regained momentum, however, and was ultimately successful using a different funding mechanism which aligns Basic Allowance for Housing (BAH) rates for GI Bill users with current DOD rates for active duty service members. The GI Bill’s current rates were higher than DOD rates, and the reduction in amount will ultimately cover the cost of expanding the GI Bill.

Senate Approves Appeals Modernization Act

On August 2, 2017, the Senate moved appeals modernization one step closer to becoming a reality. H.R. 2288, the “Veterans Appeals Improvement and Modernization Act of 2017,” was introduced and overwhelmingly passed in the House earlier this year. The Senate tacked on a few more technical refinements and passed the bill under voice vote just before the August recess. Despite being in recess, the House passed the appeals modernization bill by unanimous consent (meaning there were no objections to the minor technical changes) on August 11, 2017.

Once the bill is enacted into law, the earliest changes are expected to be seen approximately eighteen months after enactment. The massive overhaul of the disability claims and appeals process has long been in the works, but the new law will require extensive efforts to implement and widespread changes to the regulations that govern the process.

PVA Files Lawsuit over Wheelchair Damage Rule

At the end of July, PVA filed suit against the Department of Transportation (DOT) for abruptly rolling back a rule intended to make airline travel safer and easier for passengers with disabilities. The rule, which requires domestic airlines to track and report data on lost and damaged wheelchairs and scooters, was delayed by the Administration without seeking input from people with disabilities. DOT originally published the rule in November 2016, following a five-year rulemaking process that included input from air travelers, consumer and disability advocacy groups, and airlines.

The rule was scheduled for implementation in January 2018. In March 2017, DOT abruptly delayed the rule’s implementation date by one year, until January 2019, without providing the public any notice or opportunity to comment, in violation of the Administrative Procedure Act. DOT claimed the delay was necessary due to implementation “challenges” faced by the airline industry. However, the only evidence of these challenges DOT presented was a single email the agency received from the airline industry.

Since DOT’s decision, PVA has informed Administration officials and members of Congress about how the rule’s delay will hurt people with disabilities and asked that DOT allow these critical protections to move forward. Together with the complaint, PVA filed a motion to reinstate the rule’s original effective date. The case was filed in the United States District Court for the District of Columbia.

Senate Effort to Repeal and Replace Affordable Care Act Fails

In a series of votes over the course of a week in late July, the Senate rejected a variety of proposals intended to repeal all or parts of the Affordable Care Act (ACA) and replace the 2010, health care law with dramatically different provisions that would have resulted in increased numbers of uninsured Americans and millions more exposed to insurance discrimination due to pre-existing health conditions and disabilities. Senators were first presented with an amendment to the bill that passed the House of Representatives in May that would have capped and cut Medicaid by over $700 billion, eliminated most home and community based services programs in Medicaid, adjusted downward the ACA’s affordability tax credits and allowed insurers to sell health plans that imposed lifetime caps on benefits and excluded from coverage many services vital to people with disabilities. That bill—the “Better Care Reconciliation Act (BCRA)”—failed on a vote of 43 to 57.

The Senate then considered a motion to repeal the entire ACA with nothing to replace it. The effective date of the repeal would have been delayed for two years under the assumption that Republicans would draft a replacement plan during that period. The Congressional Budget Office (CBO) estimated that this proposal would have resulted in 32 million more uninsured over the next decade. That proposal also failed with all Democrats and seven Republicans voting against the measure.

During the course of the week, numerous motions were made to send the bill to the appropriate committees with instructions to conduct hearings on the proposals to amend the ACA, obtain CBO scores and receive input from stakeholders affected by suggested changes to the law. All of these efforts failed along with other motions designed largely for political messaging purposes

In a final effort to pass something that could ostensibly go to conference with the House-passed bill, the Senate GOP leadership put forward what was called “Skinny Repeal and Replace.” This amendment would have eliminated both the individual and employer mandates of the ACA as well as the medical device tax but left the remainder of the ACA intact. Even so, this measure would have destabilized insurance markets, added 16 million Americans to the ranks of the uninsured and still have cut Medicaid by over $200 billion. Moreover, there were serious concerns among Senators on both sides of the aisle that a conference report would be drafted in secret and return with provisions reinstating insurance discrimination, making steep reductions in financial assistance to make insurance affordable and even more damaging cuts to Medicaid. These were the concerns that had compelled the opposition of Senators Collins and Murkowski throughout the debate and which led them to vote “No” on this final package. Their votes, coupled with the 48 Democratic votes against the amendment, set the stage for one of the most dramatic scenes witnessed in the Senate in years.

Earlier in the week, Sen. John McCain (R-AZ) returned to the Senate after being diagnosed with an aggressive form of brain cancer to vote in favor of advancing the debate on health care reform. Sen. McCain made a very eloquent statement about the failure of the Senate to pursue bipartisan solutions to health care reform and to follow “regular order” on this very important legislation. Regular order is a Senate term of art which means that the health care bill or bills would have been considered in committee hearings, been open to amendment, received full vetting by the CBO and provided opportunities for those affected by the proposals to testify. In the early morning hours of July 28, the vote on the “skinny repeal” was defeated when Sen. McCain shockingly voted against the measure.

At the beginning of debate, PVA sent a letter to all Senators echoing the concerns expressed by Sen. McCain. Lack of transparency in the development of the Senate bill and the method under which the legislation was put forward meant that many of PVA’s objections to the legislation could not be addressed. As written, the Senate bill would continue to exclude the children of catastrophically disabled veterans covered by CHAMPVA from its provisions ensuring dependent insurance coverage up to age 26. Unanswered questions remained regarding the availability of affordability tax credits for veterans who are not enrolled in the VA health care system if the Senate bill had become law. Perhaps most significantly, little attention was paid to the impact of Medicaid cuts to over 2 million veterans that rely on that program and what that might mean for increased demand on the VA health care system. The VA Secretary himself had expressed concern about potential new demand on the VA health care system if these veterans lose Medicaid coverage but without hearings on the bill there was no chance to examine this issue.

There is increasing bipartisan consensus that something must be done to help those in the small employer and individual insurance markets who face increasing premiums, excessive deductibles and loss of health plan choices. Perhaps most urgent is an impending need to fund the ACA’s cost sharing subsidies for lower income health plan customers. Insurers will soon be making decisions for 2018, about their participation in the health insurance exchanges based on these subsidies.

Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), the chairman and ranking member of the Health, Education and Labor Committee, plan to hold hearings in September to explore options for shoring up the financing of health insurance exchanges and other fixes to the ACA that have bipartisan support. Meanwhile, in the House, a Problem Solvers Caucus that is almost evenly comprised of Republicans and Democrats has begun putting together proposals that would increase the number of workers from 50 to 500 for companies subject to the ACA employer mandate and create a federal stability fund to help states reduce premiums and other costs for those with expensive medical needs.

It remains to be seen how far these discussions will progress after the August recess in light of other demands on Congressional time, such as completion of the budget and the need to increase the debt limit. PVA will nonetheless be encouraging Congress to pursue a more open and bipartisan approach to health system reforms that respond to the needs of all Americans, including veterans and people with disabilities.

 

July’s Washington Update

July 18, 2017 Volume 23, No. 7

***PRIORITY***

The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit www.AirAccess30.org and share your story.

Senate Committee on Aging Considers Military Caregivers

On June 14, 2017, Senator Elizabeth Dole testified before the Senate Special Committee on Aging regarding the needs of military caregivers. Joining the Senator’s remarks with his own testimony was Hidden Heroes ambassador and actor, Ryan Phillipe. A second panel included veterans, their caregivers, and researchers from the RAND Corporation who shared the findings of a report commissioned by the Elizabeth Dole Foundation outlining the critical needs of caregivers.

There are currently 5.5 million veteran and military caregivers. Many post-9/11 service connected veterans have found support through the VA Comprehensive Family Caregiver Program. However, the majority of veterans with service-connected disabilities are remain ineligible. Senator Dole extolled the moral urgency of correcting this inequality. And while most members of the committee ardently agreed to expansion in principle, the cost of the effort remains a concern not yet alleviated.

Additionally, Senator Dole illustrated the toll of the duties of caregiving on those providing it. The wellbeing of the caregiver is directly linked to the wellbeing of the veteran. As a caregiver’s health declines or is interrupted so too does the quality of assistance. Other deleterious factors in providing care are the loss or insecurity of income. Caregivers often decrease the hours they can work or quit their jobs altogether to care for a veteran. Caregivers, similar to their veterans, often experience devastating isolation in their roles that can take them out of their communities and social interactions necessary to maintaining emotional wellbeing.

The Elizabeth Dole Foundation works to raise awareness of the role of caregivers in our society. Last September, the Foundation launched Hidden Heroes to push forward solutions to the daily challenges caregivers face. PVA has developed a relationship with the Foundation to advance legislation that will expand eligibility for the Comprehensive Family Caregiver Program permanently.

PVA Testifies Before Subcommittee on Economic Opportunity

On June 29, 2017, Gabe Stultz, Legislative Counsel for PVA, testified before the House Veterans’ Affairs Committee, Subcommittee on Economic Opportunity. The Subcommittee considered a number of bills, including efforts to better track bonuses and the reasons behind transfers of VA employees. PVA testified specifically on a draft proposal that would restructure the way home adaptations are delivered as part of the Independent Living Services in the Vocational Rehabilitation and Employment (VR&E) program. For anyone qualifying for home adaptations under the VR&E program, the draft bill would have the VA’s Specially Adapted Housing (SAH) office carry out the actual delivery of services.

Because the Loan Guaranty office currently administers both the SAH and SHA grants, the effect would be to consolidate all administrative authorities for home modifications under one office within VA. The HISA grant would remain separate and continue to be administered by the Prosthetics and Sensory Aids department within the Veterans Health Administration (VHA). PVA called for oversight to ensure that as VA consolidates the administrative functions that it does not suddenly increase the workload in the SAH program without a corresponding increase in staff.

PVA Participates in Public Hearing on Implementation of the Veterans Mobility Safety Act

In December 2016, Congress enacted the “Veterans Mobility Safety Act,” a bill that requires VA to ensure that vehicle adaptations are carried out by qualified individuals. While VA has standards for the specific equipment being installed on vehicles, it never had any standards for who was installing that equipment. Simply put, the safety of the equipment itself is irrelevant if the person installing it is incompetent.

The law called for VA to develop a policy related to safety certification for installers. VA began the process by soliciting comments from stakeholders in writing back in February of this year. On June 13, 2017, VA continued this process by hosting an in-person hearing where stakeholders could voice their opinions. Fred Downs, Prosthetics Consultant for PVA, provided an oral statement on our organization’s behalf. The following is an excerpt from the oral statement and highlights our main position on the matter:

When PVA first involved itself in the passage of the Veterans Mobility Safety Act, our biggest concern was ensuring that as safety standards for installing automotive adaptive equipment were implemented, the end user would not be negatively impacted. The risks as we saw them were that, either by design or by poor implementation of this law, veterans might begin to lose access to vendors who have long provided disabled veterans with safe products.

VA is charged with developing safety standards, but these standards were not intended to govern the entire industry. They are only supposed to serve as a benchmark by which others are judged. VA’s standards should only be directly employed when a provider fails to present certification from the product manufacturer or a trade association that incorporates adherence to stringent safety standards as part of its membership.

This law should not be viewed as an opportunity for VA to expand regulations on the industry. The goal is to identify providers who are offering substandard installations and unwilling to adhere to basic industry safety standards. When those providers are identified, they should face a choice: become certified under VA’s standards or stop doing business with VA.”

We remain concerned that VA has not developed a sound policy yet to ensure proper implementation of these requirements. We will continue to work with VA staff to ensure that this necessary change is not haphazardly carried out.

House and Senate FAA Reauthorization Bills Include Provisions to Improve Air Travel for Passengers with Disabilities

PVA’s efforts to improve air travel for passengers with disabilities have led to the inclusion of disability-related provisions in the House and Senate versions of the Federal Aviation Administration (FAA) Reauthorization bills currently pending on Capitol Hill. Many of these provisions are similar to those found in the S. 1318, the “Air Carrier Access Amendments Act,” that is strongly supported by PVA.

The “21st Century Aviation Innovation, Reform, and Reauthorization Act” (H.R. 2997), the House’s version of the FAA Reauthorization, includes four disability-related provisions as passed by the House Transportation and Infrastructure Committee on June 27. Sections 541, 542, and 543 would establish a select subcommittee on passengers with disabilities to advise the Secretary of Transportation, require a study concerning airport accessibility and air carrier training policies, and mandate research into the feasibility of allowing passengers with disabilities to fly from their wheelchairs. An amendment added during the committee’s markup would also require the Department of Transportation (DOT) to move forward in promulgating rules on service animals, lavatories on single-aisle aircraft, and in-flight entertainment.

As passed out of the Senate Commerce, Science, and Transportation Committee on June 29, S. 1405, the “FAA Reauthorization Act of 2017,” would require a study concerning airport accessibility, a determination on the feasibility of using in cabin wheelchair restraint systems, and the creation of an advisory committee on the air travel needs of passengers with disabilities to advise the Secretary of Transportation on implementation of the Air Carrier Access Act (ACAA). The Senate FAA Reauthorization also includes a requirement for airlines to provide wheelchair and scooter information to DOT beginning January 1, 2018. This requirement was delayed by the Department earlier this year. Other provisions added during the committee’s markup include an airline passengers with disabilities bill of rights, increased civil penalties for harm to assistive devices or passengers with disabilities due to ACAA violations, and a requirement for hands on training for those who provide that type of assistance to passengers with disabilities.

Both the House and Senate versions of the FAA Reauthorization are currently pending floor action. Each includes provisions unrelated to the disability sections that may make it difficult for either bill to pass. The current FAA authorization expires at the end of September. Congress must take action to either extend the current authorization or pass a reauthorization before that time.

In the meantime, PVA will continue to seek additional co-sponsors for S. 1318, and support for further amendments to the FAA Reauthorization bills to foster additional improvements in air travel for passengers with disabilities.

Senate Health Care Reform Bill Introduced

On June 22, 2017, Senate Majority Leader Mitch McConnell released the Better Care Reconciliation Act (BCRA), the Senate’s version of a bill to “repeal and replace” the Affordable Care Act (ACA). Developed largely in secret by a few allies of the Majority Leader, the bill was intended for a quick vote under simple majority rules prior to the July 4th Congressional recess. However, strong bipartisan opposition to the measure, including among moderate and conservative Republicans, arose and forced Leader McConnell to postpone the vote. A revised version of the bill was unveiled on July 13. The majority leader has been working to corral the necessary 50 votes (Vice President Pence would be the tie breaker) to proceed under reconciliation rules. Among the provisions of the bill in its latest form are:

Cuts to Medicaid – In addition to phasing out the ACA’s Medicaid expansion, which has covered roughly 340,000 veterans nationwide, according to FamiliesUSA, the Senate bill would, according to the Congressional Budget Office, reduce spending in the basic Medicaid program by 35 percent by 2036. Under the limits on Medicaid funding contained in the bill, states would likely be forced to severely restrict the populations covered and services provided by the program. This could put at risk approximately 1.75 million veterans currently covered by traditional Medicaid.

  • Pre-existing condition exclusions – The BCRA permits states to waive portions of the ACA’s essential health benefit (EHBs) requirements. The ACA requires that certain benefits be included in any insurance plan offered on the individual and small group market. These EHBs include outpatient services, emergency room care, hospitalization, maternity care, mental health and substance abuse services, prescription drugs, rehabilitative and habilitative services, lab tests, preventative care, and pediatric care. With a state waiver, insurers would be able to deny numerous services that people with disabilities, and others with pre-existing conditions rely upon. It would also mean that individuals living in one state may be able to access the services they need, while those in another state may not. People with pre-existing conditions could technically still be able to purchase insurance, just not the insurance that includes the services they need at a cost they can afford.

 

  • Lifetime and annual limits on benefits – The ACA limits the amount that insurers can charge annually to individuals and families for out-of-pocket payments. The Senate proposal would make it easier for states to apply to the federal government to waive these limits. Similarly, while there is language in the bill that continues the prohibition on lifetime coverage caps, these only apply to limits on essential health benefits. If a state changes or eliminates the essential benefit options, lifetime coverage caps could effectively be reinstated. This would have a disproportionate impact on individuals with disabilities who depend on many services now required to be offered under the EHB rules.
  • Creation of high risk pools – A state stability fund is proposed to help states bring down premiums and start programs that lower costs for insurers and consumers. The bill includes more than $180 billion for this fund. Prior to the ACA, 35 states had created high-risk pools to offer coverage to state residents with pre-existing conditions that made them uninsurable. Features adopted by the states to limit enrollment, and thus costs, included premiums set well above the standard non-group market rates, 6 to 12 month exclusion periods for pre-existing conditions, lifetime and annual dollar limits on coverage and deductibles between $1000 and $5000.

 

  • Other provisions – The revised bill retains several of the taxes included in the ACA such as the 3.8 percent investment income tax on people making over $200,000 a year, a tax on incomes of health insurance executives and the Medicare health insurance tax that was created to extend the life of the Hospital Insurance trust fund. The newest version of the BCRA includes $45 billion in funding to address the opioid crisis. Another new provision in the bill would allow funds in Health Savings Accounts to go toward insurance costs.
  • Cruz amendment – An amendment is expected to be offered by Sen. Ted Cruz (R-TX) allowing health plans with slimmer benefits packages to be sold on and off the health market exchanges under the assumption that this would make these insurance plans cheaper. However, insurers would also be required to sell at least one ACA-compliant plan. Critics of this amendment fear that segmenting the market in this fashion would drive younger, healthier people to the minimalist plans, leaving older, sicker constituents with the more expansive health plans. This would likely cause premiums for the more robust insurance plans to increase significantly. To protect insurers who attract a disproportionate share of “high risk” individuals, the bill will include a $70 billion fund to offset costs for these companies.

Since the 115th Congress began debating health care reform, PVA has expressed its strong desire that these deliberations be done in a bipartisan fashion under regular order with stakeholders given an opportunity to consider and weigh in on various policy options. By using reconciliation, which requires only a 50 vote margin to win passage, to advance the Senate’s legislation, several issues of particular concern to PVA will go unaddressed. For example, the children of catastrophically disabled veterans covered by CHAMPVA will continue to be excluded from current policies that provide for dependent insurance coverage up to age 26. There have been some questions whether the tax credits meant to make health insurance affordable would be available to veterans who are eligible but not enrolled in the VA health care system. PVA has been informed that reconciliation procedures preclude the opportunity to clarify this issue.

The new version of the BCRA retains almost $800 billion in Medicaid cuts over ten years. Between traditional Medicaid, the Medicaid expansion as well as the ACA premium tax credits, there has been a 40 percent decrease in uninsured non-elderly veterans between 2013 and 2015.1 Most of these veterans are older than 45, the age group most adversely affected by the Senate bill’s provisions allowing older individuals to be charged up to five times the standard premium amount.

Some of these veterans may be able to enroll in the VA health care system under current rules but others, because of policies that bar enrollment to certain veterans above modest income thresholds, will be denied access to the VA. Congress could act to open up the VA health care system to all veterans but it is unclear whether the VA has the budgetary and system capacities able to handle even half of the veterans now covered under Medicaid.

As of the deadline for the Update, the BCRA was tabled as several Republican senators have come out in opposition to the bill, including Sen. Rand Paul (R-KY), Sen. Susan Collins (R-ME), Sen. Jerry Moran (R-KS), and Sen. Mike Lee (R-UT). Sen. McConnell has indicated that he may bring a simple ACA repeal bill to the floor for consideration given the failing support for the BCRA. PVA staff will continue to monitor this effort and reach out to chapters as this debate continues.

Social Security Trustees Issue Annual Report on System’s Status

On July 13, 2017, the Social Security Trustees released their annual report on the current and projected financial status of the Social Security trust funds. The 2017 Trustees Report highlights that the Social Security system continues to operate well for the American people. The Social Security system’s financial outlook remains stable, and can continue to pay all scheduled old age, survivors, and disability benefits until 2034. With modest increases in revenue, Social Security will be able to pay full benefits throughout the century and beyond. The 2017 Trustees Report finds that Social Security is fully solvent until 2034, but faces a moderate long-term shortfall.

In 2016, Social Security took in roughly $35 billion more in total income, including interest, than it paid out. Its reserves were $2.85 trillion at the end of 2016. If Congress does not act before 2034, the reserves would be drawn down, and revenue coming into the Trust Funds would cover about 77 percent of scheduled benefits. The Trustees Report also projects that Social Security’s Disability Insurance (SSDI) trust fund by itself can pay all scheduled benefits until 2028—5 years longer than projected in the 2016 Trustees Report. If Congress takes no action before 2028, the Trustees project that thereafter the SSDI trust fund will be able to pay about 93 percent of scheduled benefits.

Royal Caribbean Disability Advisory Board Meets

In June, Susan Prokop, PVA Senior Associate Advocacy Director, attended the meeting of the Royal Caribbean (RCCL) Disability Advisory Board to receive updates on the company’s efforts to make its cruises accessible and to promote itself as an inclusive employer to people with disabilities. PVA was appointed as a member of the Advisory Board in 2016.

Members of the advisory board heard presentations on Royal Caribbean’s efforts to track special needs requests and training modules developed for customer contact center staff to assist guests with disabilities. The cruise line has also recently established an employee resource group (ERG) for staff with disabilities in three of its call center sites in South Florida, Wichita, Kansas and Springfield, OR. RCCL hopes to use this ERG to engage with local chapters of its three disability advisory boards.

1 Urban Institute, April 2017, “Veterans Saw Broad Coverage Gains Between 2013 and 2015”

June’s Washington Update

June 19 2017                                                                    Volume 23, No. 6

***PRIORITY***

The Government Relations staff is still looking for stories about problems that our members have experienced during air travel.  Please visit www.AirAccess30.org and share your story. 

Administration Finally Releases its FY 2018 Budget Request

On May 23, 2017, the President finally released his Administration’s detailed Budget Request for all federal programs, including the Department of Veterans Affairs (VA), for FY 2018. The request includes a fair increase for VA programs (despite most other federal agencies getting significant cuts). The budget proposal does include a significant reduction in funding for Major and Minor Construction in VA, as well as cuts to Medical and Prosthetic Research, the Veterans Benefits Administration, and Information Technology.

The House Committee on Veterans’ Affairs subsequently held a hearing on the President’s Budget Request on May 24, 2017 followed by a hearing before the Senate Committee on Veterans’ Affairs on June 14, 2017. PVA Associate Executive Director of Government Relations Carl Blake testified for the Senate VA Committee hearing. In testimony, PVA expressed serious concerns with the VA’s plan for continued funding through a mandatory account.  We believe that Congress must reject continued funding of the Choice program through a mandatory account and place it in line with all other community care funded through the discretionary Community Care account established previously.

Additionally, we expressed strong opposition to two legislative proposals that are being used to fund the Choice program continuation—round down of cost-of-living adjustment (COLA) payments to the nearest whole dollar and the elimination of Individual Unemployability (IU) for veterans who reach Social Security eligibility age (62). It is beyond comprehension that the Administration would propose such a benefit reduction in order to pay for a flawed funding mechanism for a program (Choice) that sometimes provides health care access to non-service connected disabled veterans. Eliminating IU benefits for veterans over the age of 62 provokes numerous questions. Will veterans who have statutorily protected evaluations (the 20-year rule) also be subject to reduction? Will those dependents using Chapter 35 education benefits based on their sponsor’s IU rating be forced to drop out of school? Will those veterans on IU who are covered by Service-Disabled Life Insurance at no premium be forced to now pay premiums in order to keep coverage? What about state benefits, such as property tax exemptions or state education benefits that are based on 100 percent VA disability ratings? How will this proposal affect efforts to combat veteran suicide and homelessness? The impact of the answers to these questions clearly dictates that Congress should reject this proposal out of hand.

PVA’s formal written statement for the record on behalf of The Independent Budget—co-authored with DAV and VFW can be viewed at www.pva.org.  support for the Senate bill.

PVA Testifies Before Senate Committee on the Evolution of the Choice Program

On June 7, 2017, the Senate Committee on Veterans’ Affairs held a hearing entitled “Examining the Veterans Choice Program and the Future of Care in the Community.”  Gabe Stultz, Legislative Counsel for PVA, testified on PVA’s behalf. This testimony marked Gabe’s first opportunity to testify before the U.S. Congress. VA Secretary David Shulkin unveiled during the hearing what he hopes will be the next iteration of the Choice Program, called the C.A.R.E. (Coordinated Access and Rewarding Experiences) Program. PVA has contributed extensively to VA’s planning efforts over the last year and into the new administration, and while we support many of the major components being offered, we still have concerns over a number of details and omissions.

The major change to the previous plans for expanding the Choice program is a change to the eligibility standards. Current eligibility is determined by whether the veteran will have to wait more than 30 days for a needed service or if the veteran lives more than 40 miles from a VA facility. The new eligibility would be based on a clinical decision that would consider whether the service is available at VA, how long the wait times are, and whether it is feasible to force the veteran to travel to VA for the services. This decision would be made by the VA clinician based on conversations with the veteran instead of a bureaucrat or administrator.

The second component allows VA to offer Choice to all veterans who are affected when the quality of a particular service line falls below the local community standards. VA will identify underperforming service lines, such as urology or cardiology, within its own system, and then it will compare those services with the individual local health care market. If the service line is also underperforming as compared to the local market, VA will allow veterans needing those services to use the community until that service line is fixed.

Finally, a new addition to the plan is for veterans to have the ability to utilize walk-in clinics two times per year subject only to the copayment structure they use with VA. Any visits after two will be charged a copayment of $50, regardless of service-connection.

The hearing covered the basics of this plan. However, Senator Patty Murray (D-WA) pointed out a few details that looked reminiscent of privatization plans highlighted in a straw man document used by the Commission on Care last year. She pointed out a few pilot project authorizations that would allow VA to try out different payment models and governance structures reminiscent of the ideas recommended by Concerned Veterans for America.

PVA continued to express our concern that all of the attention is focused on expanding Choice while failing to plan simultaneously for strengthening VA’s own specialized services. We noted that the Secretary has committed verbally to PVA that VA will increase nursing staff levels by more than 1,000; however, we need to see definitive action taken on this promise. VA must invest in its own foundational services, such as SCI/D care, in order to successfully build a high-performing network.

Senator Tester also highlighted PVA’s testimony on the importance of ensuring that veterans getting care in the community are protected in the event of medical malpractice. In an exchange with PVA, he stressed the point to his colleagues that veterans out in the community are not eligible for service-connected status due to malpractice. If a veteran is injured receiving care inside a VA medical center, he or she is eligible for service-connection under 38 U.S.C § 1151.

Going forward, VA has proposed legislative text, and it is our understanding that the Hill will also be offering legislative packages in the coming weeks representing the future of VA care delivered in the community. To read PVA’s full written statement, please visit www.pva.org.

Bi-Partisan Accountability Bill Passed by Congress

On June 13, 2017, the House of Representatives approved the “VA Accountability and Whistleblower Protection Act,” which was previously passed by the Senate, ensuring that the bill will become law. The bill was originally introduced by Senate VA Committee Chairman Johnny Isakson (R-GA) and Ranking Member Jon Tester (D-MT). The legislation was also co-sponsored by Senator Marco Rubio (R-FL). PVA offered our strong support for this critical piece of legislation. The principle goal of the legislation is to allow the Department of Veterans Affairs (VA) to terminate bad employees faster while also strengthening protections for whistleblowers. The bill streamlines the VA’s process for reviewing and firing employees who engage in misconduct or perform poorly without sacrificing their due process rights.

Subsequent to passage of the bill, PVA Executive Director Sherman Gillums offered the following statement in support of the bill:

“No other large healthcare system rivals VA’s competence to deliver specialized services at a national level, such as spinal cord injury and disease and polytrauma care, or synthesizes access to healthcare, benefits, support, and peer mentorship better than VA. But what VA needs most right now is the one ‘ability’ it presently lacks and can no longer be taken for granted — accountability. Whether that means better protecting whistleblowers, shortening the reprimand process, or recouping ill-gotten bonuses and relocation expenses, achieving a state of being answerable to the public, the Congress, and most importantly, veterans, will be dictated by the worst behavior the VA Secretary has to tolerate. This bill will be a major step toward having to tolerate such behavior no more.”

PVA also had the opportunity to participate in a press conference following House passage of the bill where we reiterated our support for stronger accountability. Our support is based on our exposure to problems during our annual site visits to VA medical centers that have resulted from lack of proper accountability of VA employees at several levels.

Air Carrier Access Amendments Act Introduced in the Senate

On June 8, 2017, Senator Tammy Baldwin (D-WI) introduced S. 1318, the “Air Carrier Access Amendments Act.” This legislation would make needed improvements to the Air Carrier Access Act (ACAA) and provide increased opportunities for stakeholders to work with airlines and the U.S. Department of Transportation to improve the air travel experience for passengers with disabilities. Four original co-sponsors, Senators Richard Blumenthal (D-CT), Edward Markey (D-MA), Maggie Hassan (D-NH), and Tammy Duckworth (D-IL), joined with Senator Baldwin in supporting the legislation.

Over 30 years ago, President Ronald Reagan signed the ACAA into law. The ACAA prohibits discrimination based on disability in air travel. Despite progress, too many travelers with disabilities still encounter significant barriers, such as damaged assistive devices, delayed assistance, and lack of seating accommodations. Unlike most other civil rights laws, the ACAA lacks a guaranteed private right of action. Consequently, people with disabilities typically receive little if any redress to their specific grievances.

Access for people with disabilities in air travel must move into the 21st century. Otherwise, people with disabilities will be left behind unable to compete in today’s job market or enjoy the opportunities available to other Americans.

The Air Carrier Access Amendments Act (S. 1318) will address these problems by:

  • Strengthening ACAA enforcement through referral of certain complaints to the U.S. Attorney General, increased civil penalties for damaged wheelchairs, and a private right of action.
  • Ensuring airlines acquire airplanes that meet broad accessibility standards. Improved structural access includes safe and effective boarding and deplaning processes, procedures, and equipment, along with better stowage options for assistive devices.
  • Improving training for air carrier personnel and their contractors, including requiring heightened training for personnel who assist with the boarding and deplaning process.
  • Requiring the Secretary of Transportation to work with stakeholders to develop an Airline Passengers with Disabilities Bill of Rights.
  • Creating a U.S. Department of Transportation Advisory Committee on the Air Travel Needs of Passengers with Disabilities.

PVA urges its members to contact their U.S. Senators and ask them to co-sponsor this important legislation. It is our hope that this legislation will be attached to the FAA Reauthorization currently pending in Congress. It is critical that we show widespread support for S. 1318 in the coming weeks.

President’s Budget Proposes Cuts to Important Disability Programs

While the Administration’s FY 2018 Budget Request provides some increases to the VA, it proposes significant cuts in a number of programs important to people with disabilities. Those programs are outlined below:

Social Security – In a reversal of campaign promises not to cut Social Security, the President’s proposed 2018 budget recommends over $74.2 billion in cuts over ten years from Social Security, including $72.4 billion in proposed reductions to Social Security’s disability programs. The budget projects nearly $50 billion in savings would be generated through Social Security demonstration programs to help disability beneficiaries to stay at work or return to work. Cuts of this magnitude would likely be accomplished through stringent work requirements and other measures aimed at reducing benefits or cutting off eligibility entirely for those who do not comply with the work rules.

At the same time, the budget also proposes offsetting unemployment benefits and disability payments for a savings of $2.5 billion. Beneficiaries who attempt to work, but get laid off from a job through no fault of their own, may qualify for Unemployment Insurance benefits that their employers have paid for. Cuts to these benefits would put beneficiaries’ ability to meet their day to day living expenses at risk and would create disincentives by punishing people who attempt to work. Another $10 billion in savings would be achieved by reducing retroactive SSDI benefits to six months from the current 12 months retroactive payments, which has been the standard since 1958. The average disabled worker receives approximately $1,170 per month in SSDI and those affected by this change could lose over $7,000 per year by this cut. The budget proposes to cut an additional $4 billion out of Social Security—including the retirement, survivors’, and disability programs.

Department of Health and Human Services – The budget proposes more than $1 trillion in Medicaid cuts (estimates have been as high as over $1.4 trillion) over the next 10 years from a combination of repealing and replacing the ACA and an estimated $610 billion in additional cuts. Block grants in the President’s budget would make even further cuts than those allowed under the American Health Care Act (AHCA). The budget also proposes a $142.4 million decrease in overall funding for the Administration for Community Living and level funds one component of the nationwide Independent Living system at $78 million. However, the budget consolidates money for a second Independent Living account with funding for State Councils on Developmental Disabilities and Traumatic Brain Injury funding into one “Partnership for Innovation, Inclusion, and Independence.” The funding for this new Partnership line item is $45 million, a $57 million loss from the $102 million combined for all these programs in funding in FY 2017. The cuts resulting from this consolidation would be detrimental to all three programs.

Department of Labor – The President’s budget proposes to eliminate roughly one fifth of the Department of Labor’s (DOL) overall budget. To achieve a $2.5 billion cut, the document calls for the elimination of “duplicative, unnecessary, unproven, or ineffective” programs while focusing on “highest priority functions” but provides few details on particular program reductions or eliminations. One of the few specifics in the document concerns the Office of Disability Employment Policy (ODEP) which is directed to eliminate “less critical technical assistance grants.” Advocates are concerned that the Job Accommodation Network (JAN), one of the main grant programs, may fall victim to these budgetary directions. The DOL budget proposal also includes elimination of the Office of Federal Contract Compliance Programs (OFCCP) which oversees implementation of VEVRAA and Section 503 governing federal contractor obligations to recruit and hire targeted veterans and people with disabilities. These OFCCP functions would be transferred to the Equal Employment Opportunity Commission (EEOC). Civil rights supporters are concerned that such a move would impede the work of both the OFCCP and the EEOC as each have distinct missions and expertise, and thereby undermine the civil rights protections that employers and workers have relied on for almost fifty years.

Update on the ADA Education and Reform Act of 2017

The ADA Education and Reform Act of 2017, H.R. 620, has gained additional co-sponsors in recent weeks. PVA opposes H.R. 620 because it would ultimately lead to decreased accessibility in public accommodations under Title III of the ADA. The legislation was introduced in January by Representative Ted Poe (D-CA), with co-sponsors Representatives Scott Peters (D-CA), Ken Calvert (R-CA), Ami Bera (D-CA), Jackie Speier (D-CA), and Michael Conaway (R-TX).

As of June 14, the following members have signed on as co-sponsors:

  • Representative Pete Aguilar (D-CA)
  • Representative Ralph Lee Abraham (R-LA)
  • Representative J. Luis Correa (D-CA)
  • Representative Doug Collins (R-GA)
  • Representative Bill Foster (D-IL)
  • Representative Jeff Denham (R-CA)
  • Representative Krysten Sinema (D-AZ)
  • Representative Paul Mitchell (R-MI)
  • Representative Darrell E. Issa (R-CA)
  • Representative Bobby Rush (D-IL)
  • Representative Tom Emmer (R-MN)
  • Representative Terri Sewell (D-AL)
  • Representative Mike Coffman (R-CO)

Please contact your Representatives to let them know that PVA opposes this legislation. We are opposed to H.R. 620, because it would require a person with a disability to send a very specific letter of notification to the owner or operator of a non-compliant business prior to being able to file a lawsuit. There is no penalty under the ADA that accrues for the length of time that a business was out of compliance. As a result, businesses (large and small) could decide to simply wait until a person with a disability provides them with the required notice before taking any action to meet ADA accessibility requirements. We believe that businesses should proactively seek to comply with the ADA and work with the ADA National Network and other entities for any needed technical assistance.

The bill is pending before the House Judiciary Committee and may be marked up by the full committee in the coming weeks.

ADA Symposium

In May, National Advocacy staff attended the annual National ADA Symposium in Rosemont, Illinois. Hosted this year by the Great Plains ADA Center, this annual conference brings together disability advocates, subject matter experts, government officials and service providers for three days of workshops and networking opportunities. Sessions ranged from basics about the Americans with Disabilities Act and its enforcement to advanced workshops delving into specific components of disability law such as internet accessibility, workplace leave policies as employment accommodations, and accessible housing requirements under the International Building Code, Architectural Barriers Act and ADA.

Ann Raish, Acting Chief of the Department of Justice Disability Rights Division, presented an update on that agency’s work in enforcing the ADA’s Title II (State and local governments) and Title III (public accommodations) and continued efforts to implement the 1999 Supreme Court Olmstead decision calling for federal programs to serve people with disabilities in the least restrictive environment. Other workshops focused on what is likely to happen to long term services and supports in the wake of revisions to the Affordable Care Act, how service animals are treated under different disability rights laws, emergency preparedness for people with disabilities, and ADA requirements for light rail and commuter transportation systems. The 2018 ADA Symposium will take place in Pittsburgh, PA.

PVA Participates in Afghan Disability Rights Conference

The Embassy of Afghanistan hosted a disability rights conference from May 23-24 during which PVA was invited to take part in an employment panel on the second day of the meeting. Organized by the U.S. Council on Disabilities (USCID), the U.S.-Afghan Women’s Council, and Georgetown University Center for Child and Human Development, the conference was a follow up to the first National Conference for Persons with Disabilities held in Kabul, Afghanistan in the fall of 2016. A 2012 signatory to the United Nation’s Convention on the Rights of People with Disabilities, Afghanistan has over 600,000 people with disabilities in that small country. The Georgetown University meeting was intended to highlight progress and challenges since the 2016 conference and bring together advocates and subject matter experts from the U.S. with their Afghan counterparts to discuss practical approaches for inclusive education, public health care and employment programs and policies.

The theme of the conference’s first day was “From Policy to Programming” and featured presentations on education reforms as well as public health and vocational training initiatives being undertaken by the government and various non-profit organizations in the country. Attendees were welcomed by Dr. Hamdulla Mohib, Afghanistan’s Ambassador to the U.S., who spoke of the challenges implementing a law adopted by his country requiring that 3 percent of government jobs be reserved for individuals with disabilities. Many of the difficulties faced by Afghanistan in living up to the spirit of this law would sound familiar to many Americans with disabilities including inaccessible buildings, lack of funding resources and stigma. A hopeful note was sounded in a video by First Lady of Afghanistan Rula Ghani who highlighted her commitment and that of President Ghani to measures assuring integration of people with disabilities into society. She was followed by a keynote address from Judy Heumann, former Senior Advisor on International Disability Rights at the U.S. State Department. Heumann urged the Afghan attendees to monitor construction of schools, civic facilities and health centers built with U.S. foreign aid and to raise objections if they fail to include accessible features. Conference delegates also heard from disability rights leader retired Senator Tom Harkin and Tim Shriver, chairman of the Special Olympics.

On the second day of the conference, USCID hosted the Afghan delegates at its offices for a full day of panel presentations from U.S. policy experts and advocates on the three main topics covered by the conference. Susan Prokop, Senior Associate Advocacy Director for PVA, took part in an employment panel along with representatives from RespectAbility and TransCen. In her remarks, Susan discussed the history and scope of vocational services offered to U.S. veterans and described PVA’s own vocational rehabilitation program, Paving Access to Veterans Employment (PAVE). Posts from the conference can be found on Twitter at #AFGDisabilityConf.

 

 

 

May Washington Update

May 16, 2017 Volume 23, No. 5

***PRIORITY***

The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit http://www.AirAccess30.org and share your story.

Bi-Partisan Accountability Bill Introduced

On May 11, 2017, Senate VA Committee Chairman Johnny Isakson (R-GA) and Ranking Member Jon Tester (D-MT) introduced the “VA Accountability and Whistleblower Protection Act.” The legislation was also co-sponsored by Senator Marco Rubio (R-FL). PVA offered our strong support for this critical piece of legislation. The principle goal of the legislation is to allow the Department of Veterans Affairs (VA) to terminate bad employees faster while also strengthening protections for whistleblowers. The bill streamlines the VA’s process for reviewing and firing employees who engage in misconduct or perform poorly without sacrificing their due process rights.

The “VA Accountability and Whistleblower Protection Act” has three major provisions:

1. Increase accountability within the VA by:

a. Giving the VA Secretary the authority to expedite the removal, demotion or suspension of employees at the VA based on performance or misconduct.

b. Shortening the process to remove employees at all levels of the department when evidence proves that they have engaged in misconduct or are performing poorly.

c. Incentivizing managers to address poor performance and misconduct among employees by including these issues in the annual performance plan.

d. Prohibiting bonuses for employees who have been found guilty of wrongdoing.

e. Prohibiting relocation expenses for employees who abuse the system.

2. Protect whistleblowers by:

a. Codifying the Office of Accountability and Whistleblower Protection at the VA and mandating that the head of the office be selected by the President with the advice and consent of the Senate, giving Congress more oversight over the department.

b. Requiring the VA to evaluate supervisors based on their handling of whistleblowers.

c. Requiring the VA to provide department-wide training regarding whistleblower complaints once a year.

3. Strengthen VA leadership by:

a. Giving the VA Secretary additional flexibility in hiring and firing senior executives.

b. Removing bureaucratic barriers to holding senior executive accountable by expediting executive appeals and sending them directly to the VA Secretary.

c. Reducing benefits for employees who are disciplined or removed for misconduct.

Along with PVA, this legislation is supported by the American Legion, Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America, Military Order of the Purple Heart, the Project on Government Oversight, AMVETS, and Got Your 6.

PVA Executive Director Sherman Gillums offered the following statement in support of the bill:

Paralyzed Veterans of America has long called for measures that bring greater accountability and protects those employees who have the courage to call out fraud, waste, and abuse in the Department of Veterans Affairs. We firmly believe that the culture of a company, organization, or federal agency is shaped by the worst behaviors its leader is willing to tolerate. The “VA Accountability & Whistleblower Protection Act” is the first major step toward reshaping behavior in VA by tolerating bad behavior and poor performance no more. Our veterans deserve it; and so do the hardworking public servants of VA who are tired of being overshadowed by the performance of substandard managers and employees.

The focus will now turn to the House VA Committee to bring companion legislation forward. During the last Congress, the House and Senate VA Committees were unable to come to a compromise on accountability legislation; however, House VA Committee Chairman Phil Roe (R-TN) and Ranking Member Tim Walz (D-MN) have both offered support for the Senate bill.

House Subcommittee Holds Roundtable on Caregiver Support Programs

On April 27, 2017, the House Veterans’ Affairs Subcommittee on Health held a roundtable to examine how the Department of Veterans Affairs (VA) can improve the Caregiver Support Program, available to veterans of all eras, and the Comprehensive Family Caregiver Support Program, limited to veterans who were catastrophically injured after September 11, 2001. Members of the subcommittee and their staffs engaged representatives from the veterans’ service organization (VSO) community, the Veterans Health Administration (VHA), and the Department of Health and Human Services (DHHS).

At the forefront of the discussion was the date of injury eligibility requirement of the Comprehensive Family Caregiver Program. Members of Congress generally support expanding the program, but are deeply hesitant to approving this necessary change due to cost considerations. Some veterans groups support the idea of delaying expansion until the current program is made essentially perfect. This is a position that PVA strongly opposes. Representatives of the VA welcome the program’s expansion but expressed concern Congress would not provide them the support and resources needed to meet such an overwhelming need. PVA, DAV, VFW, and the American Legion continue to advocate expansion without hesitation.

Our position remains clear—it is unjust to provide critically needed support services to one group of veterans, and deny it to another, for no other reason than cost. PVA will continue to advocate for the Caregiver Support program to be properly resourced and the Comprehensive Family Caregiver Support Program to be opened to those who would otherwise be eligible, and are in critical need.

HVAC Pushes Forward with Appeals Modernization in the 115th Congress

On May 2, 2017, the House Committee on Veterans’ Affairs held a hearing on H.R. 2288, the “Veterans Appeals Improvement and Modernization Act of 2017.” The bill’s introduction follows on the heels of the recent Congressional round table hosted by the Chairman of the Subcommittee on Disability Assistance and Memorial Affairs, Mike Bost (R-IL). He and Ranking Member Elizabeth Esty (D-CT) are the original co-sponsors of the legislation.

The bill is an evolution from efforts throughout last year to present Congress with a new framework for processing disability claims and appeals. Much of the criticism last year dealt with the lack of a plan for implementation, a comprehensive risk assessment, and an understanding of what resources would be needed. There must be enough resources to ensure that VA does not leave behind veterans already who are already waiting while it starts a new program. PVA supports the new framework, and we also support this legislation’s requirements for extensive reporting by VA as it moves forward with implementation.

It is notable that the House and Senate have been working closely on this legislation, and shortly after the hearing it was announced that the Senate would be introducing a companion version of the House bill that has bipartisan and bicameral support.

PVA’s full statement for the record can be viewed at: http://docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=105902

VA Adopts New Standards for Medical Diagnostic Equipment

The U.S. Department of Veterans Affairs (VA) will adopt new accessibility standards issued by the U.S. Access Board to ensure access to medical diagnostic equipment (MDE) at its health care facilities. Under an agreement governing acquisition, the VA will require that new equipment meet the MDE standards which were published in January of this year. The VA’s health care network, the largest integrated health care system in the U.S., includes 152 medical centers, nearly 800 community-based outpatient clinics, and over 125 nursing home care units.

Access to MDE has been problematic for people with disabilities, including those who use wheelchairs and other mobility aids. The Board’s standards provide design criteria for examination tables and chairs, including those used for dental or optical exams, weight scales, radiological equipment, mammography equipment and other equipment used for diagnostic purposes by health professionals.

The MDE standards, as issued by the Board, are not mandatory unless adopted by a federal agency. The VA’s use of these standards will help it meet responsibilities under section 504 of the Rehabilitation Act which requires access to federally funded programs and services. Other entities, including health care providers and state and local governments, can voluntarily adopt and apply the standards as well.

For further information on the MDE standards, visit the Board’s website or contact Earlene Sesker at sesker@access-board.gov, (202) 272-0022 (v), or (202) 272-0091 (TTY). Questions about the new VA acquisition policy should be directed to Laurence Meyer at Laurence.Meyer@va.gov.

House Passes American Health Care Act

On May 4, 2017, the U. S. House of Representatives passed H. R. 1628, the American Health Care Act (AHCA), by a vote of 217 to 213. The bill would significantly modify the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. Twenty Republicans joined all of the Democrats in the House in voting against the measure. The bill is not a complete repeal of the ACA, as has been promised by Republicans for seven years, but deals only with those parts of the ACA with budgetary implications in order for the Senate to pass it with a simple majority vote, a process none as reconciliation.

The AHCA reduces funding for subsidies provided under the ACA to make health insurance coverage purchased through the health exchanges more affordable and tilts the benefits of those subsidies toward younger people. However, it also creates tax credits that would be available to people to purchase health plans outside the exchanges. The measure eliminates a number of taxes, including those on health insurers, under the ACA that were designed to pay for its provisions. Instead of a mandate that individuals carry health insurance, H.R. 1628 would allow insurers to charge those with coverage gaps longer than 63 days a one-year, 30 percent surcharge on their insurance premiums. In addition, the House bill cuts over $800 billion from Medicaid over ten years and, in 2020, would end the ACA’s expansion of Medicaid through which some 11 million Americans have gained health care coverage. The bill also eliminates funding for several public health programs aimed at preventing bioterrorism and disease outbreaks.

The AHCA would make a number of changes to the types of health insurance plans that would be available by changing the rules governing protections for those with pre-existing conditions and by eliminating requirements that health plans cover certain benefits. States would be allowed to seek a waiver from the Department of Health and Human Services (HHS) so that insurers could charge higher premiums to those with pre-existing conditions. If HHS does not respond to a state’s request within 60 days, those changes would automatically go into effect. As part of a waiver application, states would have to set up a high risk insurance pool or design a subsidy program of their own for residents with pre-existing conditions who might be priced out of the insurance market as a result of the waiver.

In a letter to the House, PVA expressed concern about a number of the provisions in H.R. 1628 that could have harmful effects on veterans and people with disabilities. Under the bill’s changes to financing of Medicaid, the federal government would no longer share in the costs of providing health care services and community services beyond a capped amount. This would eliminate the enhanced federal match for the Community First Choice Option under Medicaid that provides attendant care services in the community. Thanks to this program, many poor veterans with serious non-service connected disabilities have been able to move from nursing homes into their communities. Data from the Robert Wood Johnson Foundation shows that the Medicaid expansion that would be eliminated by the bill has helped thousands of veterans and their caregivers.

By allowing states to seek waivers that would permit insurers to charge higher premiums to people with pre-existing conditions, people with disabilities and expensive health conditions could again be exposed to significantly higher medical costs. The waivers would also relieve states of the ACA’s requirement that certain essential health benefits must be provided, including crucial services for people with disabilities such as prescription drugs, rehabilitative and habilitative services and devices, preventative and wellness services and chronic disease management. In combination, these changes would very likely make it difficult for people with pre-existing conditions to find affordable plans that cover basic health care services.

For veterans and PVA members in particular, the AHCA continues several problematic policies of the ACA as well as troubling new provisions that could affect the ability of many veterans and their family members to afford health insurance in the private market. Those provisions include:

• Retains coverage of adults up to age 26 on parents’ health policies but continues to exclude CHAMPVA beneficiaries—dependents of the most catastrophically disabled veterans—from this benefit.

• Fails to remove the prohibition on enrollment into the VA health care system for Priority Group 8 veterans, thus denying these veterans access to a viable option for health care.

• Offers tax credits meant to make health insurance affordable to anyone except those eligible for a host of other federal health programs, including those “eligible” for coverage under Title 38 health care programs. This would prevent many veterans who may be “eligible for” but not enrolled in the VA health care system from accessing these tax credits intended to help people buy insurance.

The Senate has begun to discuss parameters of a health care reform bill but is not expected to use H.R. 1628 as the basis for its efforts. Over the coming months, PVA plans to reach out to the Senate committee leadership involved in developing its legislation to ensure that veterans and people with disabilities are not disadvantaged in the process.