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Before the U.S. House of Representatives Veterans’ Affairs Subcommittee on Health Regarding H.R. 2790, H.R. 3458, H.R. 3819, H.R. 4053, H.R. 4107, H.R. 4146, H.R. 4204 and H.R. 4231

January 17, 2008

HR 2790, amends title 38, United States Code, to establish the position of Director of Physician Assistant Services within the office of the Under Secretary of Veterans Affairs for Health.  Physician assistants are an extremely valuable resource for veterans who use the VA health care system.  To ensure that they are properly educated and trained, and that they are appropriately utilized in the programs and initiatives of the Veterans Health Administration (VHA), should be facilitated with the establishment of such a position.  Veterans will be well served if the directorship is filled with a physician assistant with uncommon vision and competence.

HR 3458, would direct the Secretary of Veterans Affairs to carry out a pilot program on the provision of traumatic brain injury care in rural areas.
While the goal of this bill, which calls for a pilot program, is laudable, we believe that the best treatment for TBI is to be had in the VA’s Polytrauma Centers of Excellence.  Additional treatment “back home” ought to be done by clinicians who can communicate with their counterparts at these Polytrauma Centers.

HR 3819,  the Veterans Emergency Care Fairness Act of 2007 would amend title 38, United States Code, requiring the Secretary of Veterans Affairs to reimburse veterans receiving emergency treatment in nonVA facilities for such treatment until such veterans are transferred to Department facilities, and for other purposes.  VVA strongly believes that veterans who receive emergency treatment in non-VA facilities until they can be transferred to a VA facility should be reimbursed for their out-of-pocket expenses. This should not be the onerous, often ugly, and lengthy process that it often is today, and which usually results in the veteran being stuck with the bill for this emergency care.  If they are not among the 1.8 million veterans who do not have health insurance, the VA should be able to – and does – bill their insurance carrier, which is right and proper.  

HR 4053, the Mental Health Improvement Act of 2007, would  improve the treatment and services provided by the Department of Veterans Affairs to veterans with post-traumatic stress disorder and substance use disorders, and for other purposes is one of the most important bills for your consideration.  As more and more troops, some disturbed, others shattered by their wartime experiences, come home, it is patently and painfully obvious that neither the Department of Defense nor the VA have enough medical professionals on staff to meet their needs. The British Medical Journal released a study led by DoD researchers that says that at least 1 in 9 returnees have problems with PTSD. Earlier DoD studies found a higher rate.

HR 4107, the Women Veterans Health Care Improvement Act, would amend title 38, United States Code, to expand and improve health care services available to women veterans, especially those serving in Operation Iraqi Freedom and Operation Enduring Freedom. Enactment should go a long way toward enhancing the health care services offered to – and needed by – women veterans.  Women now constitute 16-18 percent of our Armed Forces.  They are being killed and maimed in record numbers.  It is vital for the VA to gear up to meet their needs now and over the coming decades.

HR 4146,  would amend title 38, United States Code, to clarify the availability of emergency medical care for veterans in non-Department of Veterans Affairs medical facilities. This just seems to make a lot of sense.  Amending Section 1725(f)(1)(C) of title 38 by adding “ . . . with the determination of whether the veteran can be so transferred to be based both on the condition of the veteran and on the availability of a bed in a Department facility that is no geographically inaccessible to the veteran” just makes sense.  One has only to wonder why such a provision needs to be added into law. 

HR 4204, The Veterans Suicide Study Act, would direct the Secretary of Veterans Affairs to conduct a study on suicides among veterans, is based on two unfortunate realities: that suicide among veterans is a serious problem; and that there is a lack of information on the number of veterans who commit suicide each year.

HR 4231, the Rural Veterans Health Care Access Act of 2007, directs the Secretary of Veterans Affairs to carry out a pilot program to provide mental health services to certain veterans of Operation Enduring Freedom and Operation Iraqi Freedom.  VVA believes that this bill needs some careful treading.  While it is of the utmost importance that mental health problems be dealt with forcefully and in a timely manner, handing out vouchers for mental health services to veterans who reside in rural America is not necessarily the way to go – unless there is close communication with case managers and primary care clinicians at VA clinics and medical centers.

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