Jacquelyn Martin/AP Photo
Patrice Sullivan, whose boyfriend, a Marine, died from suicide, helps to remove 5,000 small American flags representing suicides of active and veteran members. The Iraq and Afghanistan Veterans of America (IAVA) placed the flags on the National Mall to raise public awareness about veteran and military suicide, Washington, D.C., October 2018.
The influence of health care industry interests and ideological groups like the Koch-backed Concerned Veterans for America was on full display last week, when a hearing of the House Committee on Veterans’ Affairs (HVAC) considered legislation to deal with the vexing problem of veteran suicide. Before, during, and after the hearing, Republicans launched a series of attacks on the integrity of the committee’s Democratic Chairman Mark Takano of California, who has dared to question a Trump administration bill that would further outsource veteran care to the private sector.
The bill, deceptively titled the Improve Well-Being for Veterans Act, would, in the name of reducing veteran suicide, fund millions in grants to a plethora of private-sector providers outside the Veterans Health Administration (VHA) networks. These providers would be tasked with conducting outreach; helping with social support and delivering outpatient mental health treatment; and potentially other types of medical care, to the highest-risk veterans.
While not a massive privatization measure like the VA Mission Act, the Improve Act is arguably more dangerous, as it begins paying for health care services for veterans and their families in the private sector, without pre-authorization or oversight by the VHA.
The rumor on Capitol Hill is that the Trump administration essentially drafted the Improve Well-Being for Veterans Act, and then handed it over to two Republican congressmen, Representative Jack Bergman of Michigan and Senator John Boozman of Arkansas. Because it masquerades as a suicide prevention bill, it quickly racked up hundreds of co-sponsors across the political spectrum from conservative Republicans to Democrats like Senator Elizabeth Warren.
Numerous veteran stakeholders and policy experts, including the Disabled American Veterans, American Legion, American Psychological Association, and the Veterans Healthcare Policy Institute (Full disclosure: We are VPHI fellows) warned that the bill would create a third lane of clinical care outside the VHA and the private network established by the Mission Act. This would further fragment care, eroding the whole intent of the Mission Act, which was to create one coordinated program. Although one of the goals of the Improve Act is to reach geographically-underserved veterans in rural and remote areas, the law does not require that grantees be located in remote regions. In fact, providers can be based in urban areas close to existing VA mental health clinics.
The act contains no serious oversight. There is, for example, no requirement that any of the care provided be evidence-based. More troublingly, the proposal does not require grant recipients to track or attempt to prevent any veteran’s suicide. Grantees must only demonstrate that they have measured veterans’ “mental resiliency and mental health outlook.” As multiple mental health experts told the Prospect, these terms have no agreed upon definition.
The initial cost of the bill is a minuscule $85 million to $170 million over three years, but that’s just to get the grants started. In last week’s hearing, Takano, the HVAC chairman, warned that the bill as structured would carelessly throw money at a serious problem.
Takano has introduced alternative legislation for discussion that would give grants only to entities that provide critical support services to veterans—such as help with housing, employment, and financial problems. All of these factors can adversely impact veterans’ mental health and increase suicide risks. Takano’s bill would exclude groups delivering clinical and health care services that replicate both what the VHA provides as well as what private sector groups are now delivering under the VA Mission Act, preventing the creation of a third lane of clinical care.
“The urgency of addressing veteran suicide should not be the pretext for allowing VA money to go to providers who are not held to account for measurable outcomes, who are not subject to oversight,” Takano said.
VA leaders have largely refused to engage with Takano or his alternative measure. During a meeting in Takano’s office late last month that included House Speaker Nancy Pelosi, Takano directly confronted Veterans Affairs Secretary Robert Wilkie over his pugnacious approach to the bill before imploring him to work productively to find a way forward.
Throughout his testimony at last Wednesday’s hearing, Wilkie continued employing the same strong-arm tactics he and the administration have used to lobby legislators. At one bizarre point, Wilkie, a Navy veteran and self-described war historian, falsely claimed that the VA had not cared about veteran suicide until Trump came into office. He then questioned Takano’s commitment to veterans’ issues.
Takano did not serve in the military, but his parents and grandparents were sent to Japanese internment camps during World War II. “Don’t imply, Mr. Secretary, he said, “that I care any less about the veterans who are committing suicide. We want to get it right. There are high stakes in terms of getting it right and there are high stakes in terms of getting it wrong.”
Wilkie also made clear he would award grants to groups who provide equine therapy. Although this is an activity that many veterans enjoy, there is no solid evidence that it helps prevent suicide.
Hours before the Veterans’ Affairs Committee hearing, the Republican ranking member Phil Roe, M.D., a long-time advocate of outsourcing VHA care to the private sector, floated a newly-amended bill. The proposal didn’t address Takano’s and others’ concerns, suggesting an attempt to freeze the committee chair out of his own committee’s deliberations.
Because they faced undue pressure and misleading information from the administration, many of the bill’s current co-sponsors seemingly paid little attention to the substance of the bill. In recent months, the VA’s Office of Congressional and Legislative Affairs has consistently ignored critics of the bill and has been particularly aggressive in visiting scores of congressional offices to secure co-sponsors. Some long-time Capitol Hill activists have noted they’d never observed that level of direct pressure by the VA.
Nor had they seen a VA Secretary take the battle to the media so aggressively as Wilkie did two weeks ago in an op-ed on Military.com. He publicly pushed Takano to embrace the administration’s bill. After the hearing, The Hill published an op-ed by Rory E. Riley-Topping, who worked for former HVAC Chairman Jeff Miller, a Florida Tea Party Republican, Trump supporter, and adamant VA privatizer. Riley-Topping attacked Takano’s stance on the bill, as, of all things, injecting politics into veterans’ affairs.
The op-ed did not disclose that Riley-Topping was, from 2014 until spring 2018, a board member of the Veterans Bridge Home, which is poised to receive grant money under Improve. Her op-ed ends with a quote from AMVETS’ executive director Joe Chenelly, who actually calls for Takano’s ouster as HVAC Chairman.
“It seems like there are private organizations that smell blood in the water,” one source involved in the act’s passage told the Prospect. “They’ve come out of the woodwork, and are leveraging relationships with the VA Secretary to pass this bill.”
Sources say one of the most active advocates for this bill is Justin Brown, who, through his consulting firm, The Nimitz Group, has been actively lobbying for the Boulder Crest Retreat, which offers—for free—what’s called post-traumatic growth therapy to veterans at luxury retreats in Arizona and Virginia. The treatment is based on the idea that adversity can spur “Post Traumatic Growth.” (The VA has already established an informal partnership with Boulder Crest and released a flattering press release on the organization, even while official departmental guidance has cautioned against embracing the treatment.)
Boulder Crest’s website states emphatically that the organization believes that “a privately-funded model is the only way to generate the innovation, flexibility, and individualized care required to solve this problem.” Apparently, the allure of taxpayer dollars has led the group to rethink its hostility to government funding.
Brown is also a lobbyist for AMVETS, which has done intensive lobbying for Improve, and could receive funds should the bill pass. AMVETS recently launched its HEAL Program, which has hired a team of clinicians to provide a variety of services to veterans in need. Another entity that’s lobbied hard for the bill is Arkansas State University, a powerful institution in the home state of the Improve Act’s lead Senate sponsor, John Boozman. The university recently launched a clinical center for wounded veterans, which a top VA official visited last year.
Critics of the Improve Act believe that the VHA must maintain a crucial role in dealing with veteran suicide. Numerous studies have documented that the VHA’s mental health prescription practices vastly outperform the private sector. In treating depression, the VHA compares similarly to, and, on some metrics, is better than the private sector. Last year, an independently-evaluated departmental study found that, after three months of VHA mental health care, veterans reported decreased suicidal ideation and self-harming behaviors.
Efforts to reduce veteran suicide must address core reasons that veterans don’t seek treatment from the VHA (or any other entity.) As the Disabled American Veterans’ Deputy National Legislative Director Adrian Atizado testified at the hearing, the bill operates “from the perspective that veterans not using the VA want nothing to do with it, which in DAV’s view is a flawed assumption.”
Two studies, a 2010 survey of Veterans and a 2018 National Academies of Sciences, Engineering, and Medicine Evaluation found that veterans very often don’t seek VA care because they are unclear about their eligibility or don’t know how to apply for benefits. Increasing the VA’s budget for outreach, advertising, and marketing, and giving local VA facilities much wider latitude to reach out to veterans who are confused about their benefits or eligibility and are reluctant to get help or support when they are in crisis could ameliorate these issues. Popular VA-funded Vet Centers can also serve as a resource for mental-health care.
As to the concern about delays in care at the VHA evinced by a variety of committee members, Richard Stone, M.D. the VHA’s top executive, countered that the VA routinely treats veterans in crisis. “If there is an urgent need, we will see you today,” Stone testified.
The Improve Well-Being for Veterans Act faithfully follows the playbook of a cadre of private interests. Now that Democrats have the majority in the House, they can use their power to support a framework of solutions for the veteran suicide crisis that isn’t a stalking horse for privatization.
CORRECTION: An earlier version of this article stated that Rory Riley-Topping was a current board member for the Veterans Bridge Home. She served as a board member, an unpaid position, from 2014 to the spring of 2018. The story has been updated to reflect this. Ms. Riley-Topping says that she informed The Hill of this before writing her op-ed but they did not consider it worthy of disclosure.
