Veterans Face Another Round of Threats to Health-Care Networks

Veterans Face Another Round of Threats to Health-Care Networks

In September, The American Prospect reported that budget cuts at the Veterans Health Administration would have eliminated the system’s ten Patient Safety Centers of Inquiry. After protests from leading patient safety experts and members of Congress, the centers were saved. But late last month, brand new threats emerged that could jeopardize the VHA’s ability to serve mentally ill, homeless, and female veterans; prevent veteran suicide; and increase access to needed services.

An internal VHA memo signed by Poonam Alaigh, then acting under secretary for veterans affairs for health, informed VHA deputy under secretaries, chiefs of staff, and network directors that they are free to shift almost $1 billion in funds allocated to specific VHA programs either to their general operating budgets or to finance Veterans Affairs Secretary David Shulkin’s five new VHA priorities. Shulkin’s priorities include outsourcing more care from the VHA to private-sector hospitals and doctors as well as creating more suicide prevention programs.

The memo obtained by the Prospect has caused a stir at the agency’s downtown Washington headquarters and the funding transfers were temporarily put on hold.  But after agency officials conduct a detailed review, some cuts may still go forward.

Homeless veterans advocates are deeply disturbed that the list of targeted programs includes more than $265 million in spending for the Housing and Urban Development’s VA Supportive Housing (HUD/VASH) program’s social workers who work with homeless veterans. The HUD/VASH program “is the chief strategy to reduce veteran homelessness,” says Randy Shaw, who directs the Tenderloin Housing Clinic in San Francisco.

“The HUD/VASH program has allowed VHA case managers to work in partnership with local and municipal homeless programs to reach chronically homeless vets,” says Michael Blecker, the executive director of Swords to Plowshares, a San Francisco veteran service organization. “Allowing the program to literally be zeroed-out sends the worst message to all the VHA partners who have helped make the program so successful.” Anything that jeopardizes HUD/VASH social workers or vouchers, Shaw agrees, would be “disastrous.”

Other programs on the chopping block include $30 million in additional mental health initiatives and $21 million for coordinators who help Iraq and Afghanistan veterans transition to civilian life. Potential downsizing or elimination of the delivery of mental health and rehabilitation services, suicide research, and myriad of other programs jeopardize the secretary’s stated commitment to preventing veteran suicide among veterans.  

The new shifts in funding also target funding for spinal cord injury programs, rehabilitation programs, and amputation care for those who have suffered disabling injuries on and off the battlefield. The plan also includes trimming almost $26 million allocated to Mental Illness Research Education and Clinic Centers. These Centers do pioneering research on the causes and treatments of mental disorders and translate this new knowledge into routine clinical practice with veterans. 

Almost $23 million in funding for occupational health and safety programs could be eliminated and some training programs for VHA staff have already been canceled. These programs teach staff how to safely lift and handle vulnerable veterans in VHA hospitals and nursing homes as well as how to deal with “disruptive” veterans who are a danger to themselves as well as those who care for them. Programs to prevent workplace violence have also been targeted. After much prodding from women veterans and groups like the Iraq and Afghanistan Veterans of America (IAVA) the VHA initiated many programs to better serve women veterans. Potential cuts, however, include $6 million devoted to women’s health.

Although the secretary insists he wants to increase veterans’ access to needed services and recruit staff to fill the VHA’s 34,000 vacancies, potential shifts in funding away from primary and geriatric care, and telehealth, will also affect access. If the secretary is really committed to expanding access to VHA services, why is the VHA’s “Educational Debt Reduction” program, used to provide incentives to recruitment in rural areas, on the list?

The memo tries to soften the blow of these proposed cuts by suggesting that giving medical and regional directors the flexibility to use funds allocated for specific programs as they see fit won’t “completely eliminate” specific programs. This optimistic assessment ignores current fiscal reality at the VHA. The cost of outsourcing VHA care to the private sector, has, according to another internal VA memo been a “major driver, in budget shortfalls for VHA facilities across the country.”

Medical centers and regional offices have been strapped for cash to fund operating expenses. Without additional infusions of funding, directors will be very tempted to use these newly available funds to pay for day-to-day operations.

VHA officials would not have to resort to the types of choices that could inflict more pain on the men and women who have fought in the country’s wars, if President Trump backed adequate funding levels for the agency. Ken Watterson, president Dallas Veterans Resource Center and founder of Homeless Veteran Services of Dallas, says Washington needs start listening: “It’s time for veteran service organizations— and veterans—to make it clear that balancing the budget on the backs of veterans is not the choice they want.”