A 20-year strategic plan laying out massive consolidation and construction for new Department of Veterans Affairs (search) health care facilities has taken on a whole new urgency now that a wave of new vets with special health needs is expected to enter the system, advocates say.
But many worry that the plan does not take into account the number of new veterans with mental health and long-term inpatient care needs and express concern that new and necessary projects to expand care are not being funded adequately and won't be ready for years to come.
About 143,000 military personnel are currently stationed in Iraq, and nearly 12,000 U.S. soldiers have been wounded while there. Steve Robinson, director of the National Persian Gulf War Resource Center (search), said that of the 300,000 men and women who have left the military since the missions in Iraq and Afghanistan began in 2002, about one-third have gone to the VA for medical care.
“There’s a wave coming,” Robinson said.
“They are not going to have the resources to build the new clinics they say we need,” said Rep. Michael Michaud, D-Maine, who represents a state in which 16 percent of its population is comprised of veterans. Many of them live in rural areas with no easy access to a VA hospital.
Several members of Congress and representatives from veterans service organizations say they have mixed feelings about the Capital Asset Realignment for Enhanced Services (search) plan, whose 2004 recommendations were widely accepted by former VA Secretary Anthony Principi (search) and partly funded by Congress last year.
The recommendations entail $6 billion worth of projects projected for the next 20 years and include the consolidation and closure of facilities and services, 156 outpatient clinics, new full-service hospitals and nursing care facilities in 36 states.
The plan is the result of a six-year study and follows nearly a decade of closures and consolidations as the VA strove to become more efficient and responsive to what it sees as the new health care reality of the 21st century.
“Rather than state-by-state actions, CARES sets the stage for a systematic, data-driven national plan to maximize veterans’ access to quality care,” Principi said in his May 2004 report to Congress.
He said the drive toward outpatient rather than inpatient care has left buildings vacant. Some VA campuses are lacking the necessary services to help veterans, particularly in the south and southwest, where the population of older veterans has grown.
“Our facilities are out of step with changes in the practice of medicine, the veterans we serve and with statutory changes in the VA health care benefits package,” he said.
The VA says it has 7 million veterans enrolled in its health care system and expects to take care of 5.2 million patients in 2006. Principi said in May that he expected 33 percent of the total veteran population will be using VA health care services in 2022 — up from 24 percent today.
To make CARES a reality, the VA recently announced its 2006 five-year priority plan for capital projects, which would include the opening of two new hospitals in Las Vegas and Orlando, Fla. It also includes the consolidation of facilities in Ohio, Pennsylvania and Mississippi and will enhance existing facilities based on projected needs in other states.
Principi said $1 billion a year should be spent over the next five years to get these projects done.
New Injuries to Take Into Account
While on paper many of the projects are inclusive — taking into account specialized needs such as spinal cord and brain injuries, which have been frequent among the soldiers wounded in Iraq — some are wary that they are not being funded accurately, and worse, they do not take into account the reality of the near future.
“They are still not taking [into] account the young people who are returning today,” said Rick Weidman, government affairs director for Vietnam Veterans of America (search). He told FOXNews.com that the CARES plan not only underestimates mental health and long-term inpatient care, but it was crafted long before the extent of Iraqi war injuries was realized.
Joe Violante, national legislative director for Disabled American Veterans (search), said DAV expressed its concerns about adequate mental health facilities long before the CARES commission was formed in 1998. He said the growing trend in contracting out counseling and substance abuse services as well as shutting down inpatient care worried many advocates.
“I think these programs, over the long haul, have been scaled back in regards to mental health,” he said, also noting that despite the promises of the CARES plan, VA personnel across the country are complaining about hiring freezes and a decrease in contract services.
“While they have construction money and money for long-term leases, they don’t have the staff, which concerns us greatly,” Violante said. “That changes the whole landscape.”
Cathy Wiblemo, deputy director for health care at the American Legion (search), said many of the CARES projects are laudable, but they need a faster timeline to get them completed.
“They’ve been working very hard, but it’s very slow and they are not there yet,” she said. "It's very frustrating."
Prospects for 2006
The 2006 VA budget proposed by President Bush seeks $70.8 billion, a 2.7 percent increase over 2005 levels. The request includes $750 million for CARES projects and $2.2 billion in enhanced mental health services — $100 million more than last year.
"This budget demonstrates the president's ongoing commitment to provide the very best health care and benefits to those veterans who count on VA the most," new VA Secretary Jim Nicholson said in a statement last month.
The Senate has since passed its own VA budget, adding $410 million to the president's proposal.
While veterans' advocates and Democrats say the budget increases will not cover the needs of incoming veterans, others say they are giving the VA the tools to prepare for future realities.
“Am I concerned? Yes,” said Rep. Jeb Bradley, R-N.H., who said CARES will continue to be supported by Congress through adequate funding. According to the VA, the 2006 CARES budget allotment would bring total allocations to $2.15 billion.
“But at the same time, we’ve had significant increases for veterans spending over the last several years," he said. "I believe the VA will be able to take care of those veterans returning from Afghanistan and Iraq.”