June 5, 2003

WASHINGTON - Legislation introduced in the House of Representatives by Congressman Lane Evans (D-Ill.) is a bold step toward providing dependable, stable, and sustained funding for veterans health care, according to the Disabled American Veterans (DAV).

The Assured Funding for Veterans Health Care Act of 2003 (H.R. 2318) calls for a fundamental change in the way government funding is provided for the Department of Veterans Affairs (VA) medical care system. "This shift in VA health care funding from a discretionary to a mandatory program would guarantee adequate resources to care for sick and disabled veterans," said DAV National Commander Edward R. Heath, Sr.

"Skyrocketing medical costs, decades of inadequate, inflation-eroded appropriations, and increasing demand for medical services have severely hampered timely access to quality health care for our nationís sick and disabled veterans," Commander Heath said.

As the President's Task Force to Improve Health Care Delivery for Our Nation's Veterans recently noted in its final report, there is a significant mismatch in VA between demand and available funding. If left unresolved, the report warns, this imbalance will delay veterans' access to care and could threaten the quality of VA health care.

"The Assured Funding for Veterans Health Care Act would close the gap between funding and demand for veterans health care and eliminate the year-to-year uncertainty about funding levels that has prevented the VA from being able to adequately plan for and meet the constantly growing needs of veterans seeking treatment," Commander Heath said.

Similar legislation already has been introduced in the Senate as the Veterans Health Care Funding Guarantee Act (S. 50).

"Hundreds of thousands of veterans waiting six months or longer to see a doctor and hundreds of thousands more unable to enroll for VA health care because for decades policy makers and politicians in Washington have short-changed the veterans health care system budget," said Commander Heath. ďWith adequate funding assured, it would no longer be necessary for the VA to curb outreach efforts and ration care to veterans."

It is crucial that guaranteed funding legislation be enacted this year to ensure that all eligible veterans - including those injured in Operation Iraqi Freedom and the war on terror - have access to timely, quality health care.

The DAV is asking members of Congress to sign a pledge to actively support and work for the prompt passage of guaranteed mandatory health care funding for our nation's sick and disabled veterans.

The nearly 1.3 million-member Disabled American Veterans, a non-profit organization founded in 1920 and chartered by the U.S. Congress in 1932, represents this nationís disabled veterans. It is dedicated to a single purpose: building better lives for our nation's disabled veterans and their families.


by Marlis Majerus 

June 4, 2003

Military recruiters were so eager to enlist young men during World War II and the Korean War, it seems they promised them almost anything -- including a lifetime of health care coverage for troops still serving after twenty years. Records show that even top military officials encouraged those offers. But a federal appeals court ruling says only congress has the authority to grant such benefits and the government is not liable for claims. 

The Supreme Court declined to hear the case, which means the rule stands. That makes Congress the last hope for filing suits. The Defense Authorization Act of 2001 granted lifetime benefits for veterans like the ones offered decades ago, but leaves medical bills before 2001 for the vets to pay themselves. 

June 6, 2003

On June 2, the Supreme Court elected not to hear an appeal by veterans who had sued the government over promised health care. A federal appeals court had ruled earlier that recruiters' promises of free lifetime medical care made to retirees who entered service before mid-1956 and served at least 20 years, and their spouses, were not legally binding on the government. Retired Air Force Col. Bud Day, a Medal of Honor recipient and former prisoner of war, had hoped the Supreme Court would overturn that decision. Day had filed the suit on behalf of veterans William Schism (now deceased) and Robert Reinlie. The Supreme Court's decision came in spite of a brief filed by the Military Officers Association of America stating that "it is not enough to hold parades or tie yellow ribbons. We must honor their commitment and sacrifice by assuring that the government honors its commitments to them."

June 6, 2003

Sen. Harry Reid, D-Nev., has arranged a chance for his concurrent receipt proposal to come to the floor as an amendment to the Senate's 2004 authorization bill. The measure would authorize full concurrent receipt of military retired pay and VA disability compensation for military retirees, including Reserve retirees and disability retirees with at least 20 years of service. The success of the plan, if any, should be known this week. 


High Court Ends Retirees' 7-Year Quest for 'Free' Care 
by Tom Philpott 

June 6, 2003 

A seven-year court challenge by elderly military retirees, who say the government reneged on promises of free lifetime health care, came to an end June 2, when the U.S. Supreme Court declined to hear their appeal. In refusing to accept the case for review, the justices let stand a Nov. 18, 2002 decision by the U.S. Court of Appeals for the Federal Circuit in Washington, D.C. that recruiter promises of free lifetime care were not backed by statute and therefore not binding contracts on the government. Retired Air Force Col. George "Bud" Day, lawyer for the retirees, said he was "extremely disappointed" that the high court declined review "at a time when we have young people committed to war in the Middle East and when the honor of the country, in terms of doing what we say we're going to do, is at stake."

Day represents Lt. Cols. Robert L. Reinlie and the estate of William O. "Sam" Schism, who died in March. Both retirees began their careers during World War II and the Korean War. Had the case gone to trial, Day would have sought class action status to represent 1.5 million retirees who entered service before June 7, 1956. Retirees who joined on or after that date were excluded because they came in under a law that, for the first time, limited on-base medical benefits for retirees to "space-available" care. For older retirees, the lawsuit sought up to $10,000 apiece in reimbursement for Medicare Part B premiums paid since age 65.

Day began the legal battle in 1996 and his retiree volunteers formed a support group called Class Act. More than 23,000 elderly retirees, officers, and enlisted donated $100 or $50 apiece to finance the court challenge. Day and clients lost two rounds in federal district court in Pensacola suit before a three-judge panel of the appeals court agreed to hear oral arguments in March 2000.

While the lawsuit and Day, a Medal of Honor recipient for heroism leading fellow prisoners of war in Vietnam, attracted national attention, Medicare-eligible retirees won two extraordinary legislative victories. In 2002, Congress enacted TRICARE-for-Life and the TRICARE Senior Pharmacy program. It was the biggest expansion in government-funded health benefits in decades. This left many retirees satisfied that the promise of lifetime health care had been restored.

Day and his clients disagreed. While older beneficiaries could now use TFL and drop costly Medicare supplements, Day argued that older retirees still should not have to pay Medicare Part B premiums and should be reimbursed for past premiums. "Paying a hundred bucks a month is not free," he said. But TFL did amount to a huge improvement in benefits, "about 90 percent" of what Day sought through the lawsuit.

Class Act members credit the lawsuit for a turnaround by Congress on retiree health benefits. But other forces were also at work. Service associations had been pounding on lawmakers about declining medical benefits for years. Retirees began a grassroots movement, organized on the Internet, to protest denial of military medical benefits at age 65. Roadside billboards complained of broken health care promises.

Pressure for Congress to act peaked in 2000, an election year and a year the government was reporting budget surpluses. Finally, the entertainment industry raised appreciation for wartime sacrifices of "the Greatest Generation" with books and movies such as "Saving Private Ryan."

Day said representing this generation in court, working with Class Act volunteers, "has been one of the most rewarding things I've ever done," second perhaps only to "combat." Regardless of what city he visits, he said, some retiree or spouse or surviving spouse will "walk up to me and say, 'Hey Bud Day, thanks a million for TRICARE for Life'."

But Day said he worries about the long-term impact on veterans of the 9-to-4 appeals court decision that the Supreme Court won't review. It could handcuff court challenges involving contract or quasi-contract disputes between the government and veterans, he said. "As soon as a guy files a claim, they're going to file a motion to dismiss and rely on this case," Day said.

Though the justices, without comment, declined to review the case, "I suspect the rationale was that the legislature should fix this," Day said. So with the court options exhausted, Day said he and Class Act will turn its resources toward Congress to try to win passage of legislation to restore free lifetime health care.

One such bill is HR 58, the "Keep Our Promise to America's Military Retirees Act," introduced by Rep. Chet Edwards (D-Texas). It would offer elderly retirees, spouses, and survivors fully paid enrollment in the Federal Employees Health Benefits Program available to federal civilian employees. It would also make FEHBP available, with premiums, to military retirees under 65 as another health coverage option.

Day said the goal is to win support from most, if not all, members of Congress from Florida, and then move on to other big military retiree states such as California, Texas, and Virginia. Class Act, he said, may seek more members and donations.

If there is money left over when the group's goal is achieved, or its efforts run out of steam, the balance in Class Act accounts will be donated to a worthy military-related entity, Day said, like a museum or service relief organization.

"I anticipate we will win that legislative war, downstream," Day said. "I'm real confident Congress will support us." 

Want to comment on this article? Send Tom an e-mail at Want to see reader responses to previous Military Update columns? Click here to go to the latest Military Forum. 

Syndicated columnist TOM PHILPOTThas covered military affairs for more than 25 years, including six as senior editor of Navy Times. He writes free-lance magazine articles, primarily on defense issues. His work has appeared in Washingtonian, Reader's Digest, and Kiplinger's Personal Finance magazines. His book, Glory Denied, is now available in paperback. To send feedback on MILITARY UPDATE columns, e-mail Tom at 



Stephen Barr can be reached by e-mail at
By Stephen Barr
June 9, 2003

Low Turnout 
Before Congress provided military retirees older than 65 with comprehensive health care coverage, it ordered a pilot project to see whether military retirees would be interested in coverage through the Federal Employees Health Benefits Program, which provides insurance to civil service and postal retirees.

Last week, the General Accounting Office produced a lengthy report on the pilot project, which ran from 2000 to 2002. Enrollment in the test project peaked in 2001 with 7,521 people, just as Congress decided to go ahead with the comprehensive program dedicated to military retirees.

The turnout was not especially impressive for the pilot project, considering that it was open to 120,000 of the more than 1.5 million military retirees and dependents 65 and older.

Most military retirees who knew about the project told GAO that they were satisfied with their health care coverage, saying it had better benefits and lower costs than could be obtained through the FEHBP project. Among the small proportion that did enroll, they viewed the pilot project as providing better benefits, such as coverage for prescription drugs.

Interestingly, the military enrollees were, on average, younger and less sick than their FEHBP counterparts, GAO found. During the first year of the project, the cost of health care for the military retirees was $3,529 a person, compared with $5,313 for their civil service and postal counterparts in FEHBP, GAO said.

Under the 2001 Defense Authorization Act, Congress decided to supplement the Medicare coverage received by military retirees. Retirees were given access to prescription drugs through the military's Tricare pharmacy program. Military retirees who enrolled in Medicare Part B, which covers doctors and outpatient hospital care, became eligible to join Tricare for Life. It offers benefits not provided by Medicare.



© 2001 The Washington Post Company



Web Posted : 06/09/2003 12:00 AM 

Military veterans who fall on hard times and die destitute and homeless historically have ended up in paupers' graves.
Now, thanks to the nation's largest funeral provider, veterans in 11 cities across the country, including San Antonio, will receive free funerals with full military honors.

Express-News staff writer Carmina Danini reports that Service Corp. International, parent company of Dignity Memorial, which operates several funeral homes in San Antonio, has established a burial program for homeless veterans.

The Dignity Memorial funeral homes ó Sunset Funeral Home, Sunset Northwest, Roy Akers Funeral Chapel and Zizik Kearns Riebe Saunders Funeral Home ó provide a full range of funeral services for homeless veterans, including a casket, transportation, preparation and burial clothing, at no charge.

The program, Danini reports, is operating in St. Louis, Houston, El Paso, Dallas, Denver, Kansas City, Washington, Chicago, San Diego, and Louisville.

Those who served our country and were honorably discharged merit the honor and respect of a military funeral.

It's what a person did during his lifetime, not material wealth, that matters in the end. 


by Tom Philpott
June 13, 2003 

With a shove from Congress, the Department of Defense will take several actions next year to make two million TRICARE Standard users feel less like the neglected stepchildren of military health care. Ed Wyatt, principal deputy assistant secretary of defense for health affairs, said the effort will include developing a list of physicians who accept Standard patients and reimbursements, and doing more to educate both beneficiaries and physicians on the TRICARE Standard program. Users of TRICARE Standard, formerly called CHAMPUS, "have legitimate concerns about access" to care in some areas of the country, Wyatt said. "We're going to address their concerns."

The department agrees that not enough has been done in recent years to keep the "third tier" of military medicine "a first rate benefit," Wyatt said. Defense health officials have been focused on improving TRICARE Prime, the military's managed care program, and implementing TRICARE-for-Life, the insurance supplement to Medicare for service elderly. Another health care option, TRICARE Extra, is a preferred provider plan that offers discounts to non-Prime patients who use network doctors.

Last March, beneficiary groups complained to a House panel that the Standard program has been neglected and a rising number of doctors won't accept Standard users as patients. They urged lawmakers to force Defense officials to help Standard patients more, by creating and making available lists of physicians who accept Standard patients. They also said patients and providers lacked current information on Standard benefits.

In response, the House version of the 2004 defense bill urges DoD to develop an "outreach" plan for Standard users to help them understand their coverage, obtain health care provider information, and ease other program difficulties. The Senate bill directs the defense secretary to ensure "continued viability and adequacy" of TRICARE Standard benefits.

Wyatt said whatever final guidance Congress provides, Defense officials are committed to educating beneficiaries and providers on the Standard benefit, and to making available to beneficiaries lists of providers in their area who recently have accepted Standard patients. But the lists, Wyatt cautioned, will provide assistance, not guarantees. "Providers choose to participate in TRICARE, as in Medicare, on a case by case basis," he said. Some physicians manage their practices to accept only a limited number of TRICARE Standard patients. So the kind of list we might produce would not guarantee that if you went to a doctor, [he or she] will accept assignment."

Beneficiary groups also complained last March about a requirement that TRICARE Standard patients living within 40 miles of a military hospital or clinic get a statement from the facility that it can't provide the necessary care. Without a "non-availability statement," or NAS, TRICARE Standard will not cover the treatment.

Wyatt said the onerous NAS requirement will all but disappear when new TRICARE support contracts take effect next year. Under a delayed provision of law enacted a few years ago, the secretary of defense will have to notify Congress 60 days in advance that a certain hospital needs to impose an NAS requirement on a certain procedure. He can do so for one of three reasons: to maintain medical readiness, to sustain a patient base for graduate medical education, or to save the government a lot of money.

Clearing any of those hurdles will not be "a trivial process," Wyatt said, so most Standard users will never face an NAS requirement again. DoD will begin developing more specific initiatives to improve TRICARE Standard after meeting with beneficiary groups. "Whatever we implement we want to make sure it answers questions they have," he said. But for sure, Wyatt said, "there will be some kind of education effort. There will be some kind of effort to help beneficiaries find providers."

Publication of a TRICARE Standard handbook also is likely, he suggested. Health officials would draw upon lessons learned in educating mobilized Reservists on new health benefits during the war on terrorism.

Military Tax Breaks

House Republican leaders felt heat from military taxpayers when they removed a package of service tax breaks from the $350 billion tax bill before President Bush signed it earlier this month. But a new solution is in the works. Rep. Bill Thomas (R-Calif.), chairman of the House Ways and Means Committee, has combined the military tax package with legislation to protect child care tax credits, another sore point for many in the original tax bill.

HR 1308, the All-American Tax Relief Act of 2003, was expected to win quick House approval. It would extend to members of the Armed Forces and the Foreign Service the same capital gains tax exclusions on proceeds from home sales that have been available to less transient taxpayers for six years. The provision would be retroactive to home sales since May 1997.

The bill also would allow drilling Reservists and National Guardsmen new tax deductions of up to $1500 a year for lodging and travel expenses when serving and staying overnight more than 100 miles from home. The military death gratuity of $6000 would be made fully tax exempt; survivors now pay taxes on half of it. 

The Senate in March passed a more generous military tax relief package. Differences in the two bills could be worked out during a conference committee or the two chambers could continue to "ping pong" the long-awaited military tax breaks between them, until they get a bill they can agree on or time expires for another session of Congress. 

Want to comment on this article? Send Tom an e-mail at Want to see reader responses to previous Military Update columns? Click here to go to the latest Military Forum. 

Syndicated columnist TOM PHILPOTThas covered military affairs for more than 25 years, including six as senior editor of Navy Times. He writes free-lance magazine articles, primarily on defense issues. His work has appeared in Washingtonian, Reader's Digest, and Kiplinger's Personal Finance magazines. His book, Glory Denied, is now available in paperback. To send feedback on MILITARY UPDATE columns, e-mail Tom at

June 13, 2003

On the heels of the Supreme Court's refusal to hear an appeal by veterans who had sued the government over promised health care, the veterans' attorney has announced a new attack. The attorney, retired Air Force Col. Bud Day, a Medal of Honor recipient and former prisoner of war, said they are going to contact every member of the Florida delegation in the House and in the Senate and look for a commitment of support. Then they'll work their way through the states, he added. He was referring to some 23,000 members of the Class Act Group,founded to support and finance the lawsuit. Day expects assistance from Sen. John McCain, R-Ariz., who was a cellmate in a North Vietnamese prison camp during the Vietnam War.

June 19, 2003

Last week Rep. Jim Marshall, D-Ga., filed a discharge petition in support of HR-303, which would eliminate the offset of retired pay that many military retirees pay in exchange for disability compensation from the Department of Veterans Affairs. If the petition gains 218 signatures, the bill will go to the floor for debate and for a vote. The bill has 352 cosponsors. Military Officers Association of America president, retired Navy Vice Adm. Norbert R. Ryan, Jr., said, "It's time to convert that overwhelming support into legislative action. It's time for our cosponsors to step up, sign this discharge petition, and demand a vote that will put this into law." 

June 19, 2003

One requirement for eligibility for Tricare for Life is enrollment in Medicare Part B. Some 90,000 military retirees and spouses never enrolled in Part B, either because they expected lifetime care in military treatment facilities that subsequently were closed or because they live overseas where Medicare doesn't pay. Many of those would use TFL except for the severe late-enrollment penalties for Part B. According to the Military Officers Association of America, the Senate Finance Committee has agreed to include an amendment by Sen. Blanche Lincoln, D-Ark., to the Medicare pharmacy coverage bill. The amendment would eliminate the late-enrollment penalty for TFL beneficiaries who first signed up for Part B between January 1, 2001 and December 31, 2004. It also would permit year-round enrollment through 2004. It would delay receipt of Part B coverage until January 2005 for new late enrollees, although a House bill would implement the change this year.

June 19, 2003

In the aftermath of the Supreme Court's refusal to hear an appeal for the government to make good on its promise of lifetime medical care for military retirees who entered service before mid-1956 and served at least 20 years, Congress is considering relief by legislation. The Military Retiree Health Care Relief Act would give affected military retirees a refundable tax credit for their Medicare Part B premiums. Meanwhile, the Tricare Retirees Opportunity Act would eliminate late-enrollment "penalty" fees that military retirees or their eligible family members pay because they followed the Defense Department's advice not to enroll in Medicare Part B. American Legion commander Ronald F. Conley says that military retirees held up their end of the deal by serving honorably on active duty for at least 20 years, and Congress should pass the legislation that goes a long way toward keeping the promise.

June 19, 2003

Last March, beneficiaries told a House panel that Tricare Standard (formerly CHAMPUS) has been neglected and that a rising number of doctors won't accept Tricare Standard patients. They said that Tricare should publish lists of providers who accept Standard patients, and that patients and providers needed current information about Tricare Standard. In response, the House version of the fiscal '04 defense bill urges DoD to develop an outreach plan for Tricare Standard. The Senate version directs DoD to ensure continued viability and adequacy of Tricare Standard benefits. Beneficiaries also complained about a requirement that Tricare Standard patients living within 40 miles of a military treatment facility procure a non-availability statement from the facility in order to obtain care from Standard providers. Ed Wyatt, principal Defense deputy for health affairs, has stated that the non-availability requirement will virtually disappear when Tricare support contracts take effect next year. 

June 19, 2003

The Department of Veterans Affairs has revised its application form to make requesting a VA grave marker easier. The new form, Application For Standard Government Headstone or Marker (VA Form 40-1330), includes information about expanded eligibility for a government marker. For deaths on or after September 11, 2001, Public Laws 107-103 and 107-330 made markers available for use on veterans' graves that were already marked with privately furnished headstones or markers. The laws require the Secretary of Veterans Affairs to recommend to Congress by Feb. 1, 2006, whether this new benefit should continue. The new form will let VA track the benefit's use. In January 2002, VA introduced a fax service for submitting applications. Instructions, as well as the fax number, 1-800-455-7143, are at The application form on the website can be filled in and printed for submitting by mail or fax. For information call 1-800-697-6947.


June 20, 2003
by Tom Philpott

Moving fast on a key recommendation from a presidential task force, the House Veterans Affairs Committee chairman has introduced a bill to require "full funding" of VA health budgets to ensure timely care to almost all enrolled veterans, including many with no service-connected ailments. The Veterans' Health Care Full Funding Act "would take the politics out" of VA health budgets and eliminate an "intolerable" waiting list of patients seeking care, said Rep. Chris Smith (R-N.J.), committee chairman. A fellow Republican on the committee, however, said politics, in fact, is driving this bill. The "full funding" mandate, said Rep. Steven Buyer (R-Ind.), is evidence that the task force exceeded its charter and allowed commissioners with ties to veterans organizations to "hijack" the process.

Smith's bill, HR 2475, would create an independent panel of economists to set health care funding levels for the Department of Veterans Affairs, based on the needs of patients enrolled in Priority Groups 1 through 7. Group 7 is vets with no service-related ailments and incomes above a national VA means test. But their earnings still fall below a government index of pay adequacy in their geographic area.

The President's Task Force to Improve Health Care Delivery for Our Nation's Veterans released its report in late May, saying that veterans deserve predictable access to care. One way to do that is to mirror full-funding protections that Congress set for DoD budgeting to ensure care to elderly military retirees under TRICARE-for-Life.

A second part of HR 2475 would force VA to meet its own access-to-care standards. If a patient seeking non-emergency care, for example, can't be seen within 30 days, VA would have to contract for a non-VA provider.

Rep. Rob Simmons (R-Conn.), health subcommittee chairman, joined Smith in launching the bill. Despite a 49-percent rise in VA health care budgets since 1996, hundreds of thousands patients still wait six months or more to see a primary care physician, Smith said. That's because the system has seen a 70 percent rise in patients over the same period.

Not all of the growth is from open enrollment. VA made a dramatic shift in care delivery, expanding from 170 VA hospitals into hundreds of local, more accessible clinics.

Buyer blames the clogged VA health care system, not on a funding shortfall but on the "mistake" he and other committee members made in '96 in voting for open enrollment to keep the new clinics full. The Congressional Budget Office had warned then that it would create a mismatch between demand and resources.

Rosy predictions by committee leaders and veterans groups that the move would be "budget neutral" -- thanks to system efficiencies, co-payments charged Group 7 and 8 enrollees, and collections from employer health insurance plans for VA-provided care -- were wrong, Buyer said.

Priority 7 and 8 veterans added $2 billion, or about 10 percent, to VA health care costs last year. Buyer said many of these veterans only enrolled sought care to get VA drug discounts. Committee report language from '96 on expanding VA eligibility said the bill "would not permit the VA simply to serve as a veterans' drugstore." Yet that has happened, he said.

Open enrollment is to blame for the bottleneck in care, Buyer said. "But instead of addressing the issue on Group 7s and 8s, veterans' groups are saying, 'just give us the money.' They are using language far beyond what they ever talked about. Some even say every veteran is to be treated the same."

Buyer could have been referring to Robert W. Spanogle, national adjutant of the American Legion. He was one of three task force commissioners to dissent on the "full funding" recommendation. Budgets aren't fully funded, he said, until all enrolled veterans, including Priority Group 8, are provided timely care.

In testimony June 17 before the House committee, Spanogle criticized arguments made by Buyer and others that VA health care was intended only for "core veterans", those disabled through service or in financial need.

"Contrary to comments made during commission meetings, there are no 'core veterans'," he said. "A veteran is a veteran. The 'traditional' veteran treated in VA medical facilities are any veteran needing medical care."

The influence of veterans' groups, Buyer said, pushed the task force beyond its charter of greater cooperation between VA and DoD health care to address the full-funding issue. If HR 2475 is enacted, it could add many billions of dollars a year to VA budgets. Chairman Smith, however, called the task force report "magnificent" and said he was grateful commissioners "felt that it was within their purview to make this bold but important recommendation."

In one of the final task force meetings, Spanogle said, he and two other commissioners "were warned by a colleague not to wear veterans' advocacy on our sleeves." He ignored the advice. "I consider fighting for the rights of every American veteran," he said, "a badge of honor." Treating all veterans the same, warned Buyer, means some of the most deserving can't get timely care -- unless VA budgets climb sharply. "Right now there are so many 7s and 8s trying to gain access, and they have more political clout because there are more of them. Politicians will play to the numbers," Buyer said. He won't join them this time.

"I'll stand to defend those who were injured in peace, wounded in war, and the indigent. Those are the ones we ought to take care of. Not guys like me." 

June 27, 2003

New Benefits for Veterans and Surviving Widows: New VA Hospitals and National Cemeteries To Be Built

(Washington) - Comprehensive legislation (H.R. 2297) to expand and extend benefits to veterans and their surviving spouses cleared the House Committee on Veterans' Affairs in a markup session today. The Committee also approved legislation (H.R. 1720) to authorize $1.1 billion in new VA health care construction projects, legislation (H.R. 1516) to open five new national cemeteries for veterans and their families, and five other bills (H.R.116, H.R. 2357, H.R. 2433, H.R. 2595, H.Con.Res. 159) to assist and honor America's veterans.

"The package of bills approved today will make a tangible difference in the lives of millions of veterans and their families," said Congressman Chris Smith (NJ), Chairman of the Committee on Veterans' Affairs. "The new investments in health care facilities and national cemeteries authorized today are long overdue and much needed," he said.

Smith, who sponsored H.R. 2297, the Veterans Benefits Act of 2003, highlighted several provisions of that bill, including one for widows of veterans who want to remarry. "This legislation would correct an injustice for our Gold Star Wives, those who lost their husbands through service to our nation. This provision, which Rep. Michael Bilirakis of Florida has championed for years, would finally allow surviving spouses of veterans to be able to remarry after age 55 without being penalized with the loss of widow benefits, such as widow's pension or burial rights," said Smith.

H.R. 2297, as amended, would also:

∑ Expand the Montgomery GI Bill program for self-employment training programs;

∑ Make permanent the State Cemetery Grants Program;

∑ Reinstate a VA pilot program to provide vocational training to newly eligible VA nonservice-connected pension recipients;

∑ Increase the specially adapted automobile grant from $9,000 to $11,000;

∑ Increase the specially adapted housing grant from $48,000 to $50,000 for the most severely disabled veterans and from $9,350 to $10,000 for other severely disabled veterans;

∑ Add cirrhosis of the liver as a presumed service-connected disability for former POWs;

∑ Eliminate the requirement that a POW be held for 30 days or more to qualify for presumptions of service-connection for several specific disabilities;

∑ Expand benefits eligibility to those children with spina bifida born to Vietnam-era veterans who served in Korea near the demilitarized zone between October 1, 1967 and May 7, 1975;

∑ Make the VA home loan program for members of the Selected Reserve permanent;

∑ Adjust the funding fee charged to Selected Reserve home loan applications to the same amount as that paid by active duty service members;

∑ Reinstate the Department of Veterans Affairs' vendee loan program;

∑ Mandate that the Department of Labor place staff in veterans' assistance offices at overseas military installations 90 days after date of enactment; and

∑ Extend certain compensation and burial benefits to certain Philippine WWII-era veterans residing in the U.S. Smith praised Veterans Health Subcommittee Chairman Rob Simmons (CT) and Benefits Subcommittee Chairman Henry Brown (SC) for their "the hard work and dedication of their respective Subcommittees in bringing forth such comprehensive packages of bills to expand benefits and improve the delivery of services to veterans." "Chairman Simmons' bill to invest in VA's health care infrastructure, H.R.1720, is absolutely vital to properly maintaining the VA health care system," said Smith. As amended and approved by the Committee, H.R. 1720, the Veterans Health Care Facilities Capital Improvement Act, would authorize $1.1 billion over two years for major medical facility construction projects to improve, renovate, replace, update or establish VA patient care facilities, including:

∑ $98 million for an inpatient tower at West Side Division in Chicago;

∑ $48 million for seismic corrections in San Diego;

∑ $50 million to renovate inpatient wards and research facilities in West Haven, Connecticut;

∑ $90 million for a new medical facility in Columbus, Ohio;

∑ $45 million for a joint VA-DOD clinic in Pensacola, Florida;

∑ $3 million for a lease of an outpatient clinic in Charlotte, North Carolina; and

∑ $6.5 million for a lease of an outpatient clinic and benefits office in Clark County, Nevada.

In addition, H.R. 1720 would require the Secretary to develop a specific plan for meeting the future inpatient hospitalization needs of veterans who live in southern New Jersey and certain counties in the state of Texas, as well as consider a joint VA-Navy medical facility proposal in Charleston, South Carolina. The Committee also approved H.R. 116, to authorize a new major medical facility - possibly a joint venture with the Air Force - at the site of the former Fitzsimons Army Medical Center on the University of Colorado campus at Aurora. H.R. 116, sponsored by Rep. Joel Hefley of Colorado, authorizes $300 million for this project.

H.R. 1516, the National Cemetery Expansion Act of 2003, sponsored by Rep. Jim Gerlach (PA), and as amended by the Committee, directs VA to establish five new national cemeteries in the following areas: southeastern Pennsylvania; Birmingham, Alabama; Jacksonville, Florida; Bakersfield, California; and Greenville/Columbia, South Carolina. This legislation would require the Secretary of Veterans Affairs to submit a report to Congress within 120 days of enactment setting forth the five areas where those cemeteries will be established, a schedule for establishment, the estimated cost associated with establishment, and the amount of Advance Planning Funds obligated for this purpose. The bill would also require the Secretary to Nsubmit to Congress an annual report that updates the information included in the initial report until the five cemeteries are completed.

During the Committee's markup session, the following bills were also approved:

∑ H.R. 2357 would expand VA health care services by requiring the appointment of chiropractors. Although VA has previously been directed to develop chiropractic care programs, to date they have failed to appoint a single chiropractor. H.R. 2357 also extends health care services to Filipino WWII veterans residing in the United States.

∑ H.R. 2433, sponsored by Rep. Ciro Rodriguez (TX), would authorize VA to provide prioritized health care to veterans were who participated in Project 112/Project SHAD tests. These tests, which involved exposure to chemical and biological toxins or stimulants, were conducted by the Department of Defense at their Deseret Test Center from 1962 through 1973. In the past year, the Department of Defense has released information about these secret Cold War-era tests and has worked with VA to identify and notify those veterans who participated in the tests, most of them unknowingly. H.R. 2433 will ensure that those veterans who did participate in these tests are able to receive medical evaluation, and if necessary, treatment at VA health care facilities. H.R. 2433 also authorizes premium pay for Saturday duty to health care workers with direct patient-care responsibilities.

∑ H.R. 2595, sponsored by Chairman Smith and Ranking Member Lane Evans (IL), would restore the operation of the Native American Veteran Housing Loan Program during fiscal year 2003 to the scope of that program as in effect on September 30, 2002. In June, the Department of Veterans Affairs stopped making loans under the Native American Direct Loan Program because of a $5 million limitation contained in the 2003 Appropriations Act, resulting in a number of new home construction projects being stopped. H.R. 2595 will allow both new home construction, as well as refinancing to resume for Native American veterans at the levels authorized in prior years.

∑ H. Con. Res. 159, sponsored by Rep. Jerry Moran (KS), declares Emporia, Kansas, to be the founding city of the Veterans Day holiday, and recognizes the contributions of Alvin J. King and the Honorable Ed Rees for their role in the enactment into law of the national observance of Veterans Day on November 11 of each year. 

All eight bills approved by the Committee will be reported to the full House of Representatives for further consideration and possible floor action in July.

June 27, 2003

Relatively few Medicare-eligible military retirees and their families enrolled in the Federal Employees Health Benefits Program under a three-year pilot project, according to the General Accounting Office. Almost 30 percent of those eligible who did not enroll said the costs were too high. Other reasons given for non-enrollment were satisfaction with their existing coverage and concern about receiving Medicare coverage whenthe pilot program ended. From a total of 123,000 who were eligible to enroll, the program's highest number of enrollees was 7,521, according to the report. For a complete copy of the report, click on

June 27, 2003

Rep. Lane Evans, D-Ill., has introduced HR-2318, which would require the Treasury to fully fund the Department of Veterans Affairs health care system. The bill, which would kick in for fiscal 2005, would require funding based on the consumer price index and the number of enrollees in the system. The Fleet Reserve Association has endorsed the bill, stating that FRA is especially concerned about the VA's expectations of income from new fees paid by some Category 7 and all Category 8 veterans. Category 8s are veterans with no service-connected disabilities who have higher incomes than the geographical means test levels. However the term "higher income" can be misleading and the results devastating. For example, Evans has stated that, in some communities, veterans with incomes of more than $24,644 sometimes have to choose between prescription drugs and heat or groceries.

January 2, 2004
by Tom Philpott

Defense Department officials have defeated a White House budget initiative that would have raised prescription fees for military retirees, their spouses and survivors next October. The plan included imposing first-ever co-payments on retiree prescriptions filled at base pharmacies.

Higher pharmacy fees remain a possibility by October 2005.

The Office of Management and Budgetís plan, which was sent to the Pentagon Dec. 16 as a "draft Program Budget Decision" for fiscal 2005, would have raised fees on retirees and their families. Co-pays under the TRICARE mail order and TRICARE retail benefit would climb to $20, up from $9, for name-brand drugs, and to $10, up from $3, for generic drugs.

Also, the same $20 or $10 fees would be charged retirees using military pharmacies, breaking a long-tradition that all prescriptions filled on base on free to eligible beneficiaries. The OMB plan would have taken effect Oct. 1, 2004.

"The bigger news is itís not going to happen," said a senior DoD official Dec. 31. "We wonít do anything in [the] Ď05 [budget]. We may study it and look at whether or not we should do something in ĎO6."

Administration sources first alerted the Air Force Sergeants Association to the OMB plan before Christmas. AFSA sounded an alarm with other associations. OMB documents obtained by AFSA said imposing higher drugs co-pays on retirees, their spouses and survivors "could generate significant revenues," from $728.3 million in fiscal 2005 up to $954.7 million by 2009, a five-year defense budget gain of $4.2 billion.

James D. Staton, AFSAís executive director, warned President Bush in a Dec. 29 letter that the plan would break faith with "those who sacrificed a good portion of their lives for this nation" and sends "an awful signal" to "those currently serving and considering a military career."

Staton warned Bush too that "military veterans and retirees are beginning to waiver in their support of this administration in light of repeated gestures of indifference and disrespect."

Other associations also reacted vigorously and by New Yearís Eve the OMB plan had been withdrawn, at least as part of the 2005 defense budget, which will be delivered to Congress by late January.

"This was one of those ideas that got a little bit ahead of rational-thinking people and is back in the box," said the DoD official. "We said, `Look, we planned to look at this issue in a very deliberate way. Give us that opportunity.í And thatís where weíre going to come out on it."

Department officials, "at the highest level," he said, agreed "it was not the right thing to do, nor the right time to do it."

Behind the OMB idea is concern that pharmacy costs "are rising everywhere," including in DoD, and co-payments have proven effective in the civilian healthcare industry for controlling costs. While imposing fees for prescriptions on base is controversial, the Defense official said it will remain among options to be weighed in the year ahead.

"That might be a good idea but I havenít seen the data that tells me it is," the official said. He added, "[W]e clearly need to help guide people to mail order and generic drugs," less costly alternatives. Higher co-pays, he said, "is one way to guide people to thatÖItís not about making money. Itís about implementing best business practices. My personal view at this point is that [Military Treatment Facilities] should remain just as they are. But for the many people who shop in the retail market, we ought to incentivize them to use mail order."

The OMB document said proposed $20 and $10 co-pays for military retirees would match fees at VA hospitals. Thatís incorrect, unless OMB also plans to order higher fees for VA prescriptions in fiscal 2005. Currently, VA facilities provide drugs at no charge for service-related conditions and charge $7 on other prescriptions.

James E. Lokovic, director of government relations for AFSA, rejected the administrationís notion of applying business strategies to earned benefits.

"Damn it, these people earned it and the government owes them," he said, referring to free lifetime benefits including for drugs on base. "Itís disgusting that they would even float this notion. This government has a debt to [military retirees] and ought to be budgeting for itÖ.You cannot run military benefit programs like a business."

With the start of the TRICARE Senior Pharmacy Program in April 2001, and the rising popularity of the TRICARE retail benefit, DoD drug costs rose from $855 million in 1996 to more than $3 billion in 2002. They are expected to hit $7.6 billion by 2010.

Defense officials still plan soon to unveil a "uniform formulary," perhaps this April when the new TRICARE support contracts take effect. The plan will broaden the list of drugs stocked at base pharmacies and available by mail, but will adopt a new three-tier co-pay scheme to curb growth in the TRICARE retail benefit. Drugs not included in the expanded uniform formulary still would be available in the retail network but at higher "non-formulary" co-pay of $22 for a 30-day supply. Proponents say thatís still below the more than $30 average charged under commercial plans for non-formulary drugs. But service associations view $22 as too high, even for non-formulary drugs, and will fight it, with congressional action if necessary.