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Vets’ health care mission

At the time in his life when medical care mattered most, John Ellis found his had run out.

At 61, he had been insured by private insurance carriers for 40 years, his entire career in retail and sales. A couple of years ago, he found himself without a full-time job. Not yet eligible for Medicare, health care would have been out of reach for Ellis just as he was diagnosed with high blood pressure.

Fortunately, Ellis had made an investment as a young man that is paying off today. In 1961, he joined the Army National Guard, serving one year of active duty during the Berlin Crisis. When he enlisted, he was told that medical care would be provided through the Veterans Administration.

“When we signed up, we were told this is part of the benefit package we would have,” Ellis said in the primary care waiting room at the Spokane Veterans Affairs Medical Center. “Our country is fulfilling its promise to me 40 years later.”

Ellis and thousands of veterans in his situation are part of the reason the VA’s enrolled population has grown 134 percent since 1996. But as VA enrollment has boomed, the agency’s budget has not kept pace. With another generation of Americans fighting overseas, military and veterans’ issues have been hotly debated in this year’s elections and in Congress.

In Spokane, the VA medical center saw the number of its patients increase from 10,000 in 1995 to 20,000 this year, said Jane Schilke, the hospital’s associate administrator. With more than 200 Spokane-area veterans seeking enrollment each month, the hospital had a waiting list last year of about 3,000 veterans.

Early this year, VA Secretary Anthony Principi ordered waiting lists in VA hospitals throughout the nation eliminated.

“Today, there is no one waiting for health care at the Spokane hospital,” Schilke said. “New enrollees are being assigned to primary care providers.”

To accomplish this, the hospital has hired new employees including four doctors and, in some cases, increased the caseload of existing health-care providers, Schilke said. In addition to the three primary care clinics on the hospital’s third floor, an urgent- and specialty-care clinic recently opened on the third floor.

In the past three years, the hospital’s budget has grown from $64 million to more than $78 million, while the number of employees has increased from 533 to 600.

Once they get into Spokane’s VA hospital, veterans say, the quality of care they receive is outstanding. Most employees at the hospital are themselves veterans and many interviewed “off the record” for this report showed an extraordinary commitment to their patients.

“I’m sure they saved me from a stroke or something more severe,” Ellis said. “They are always good to me.”

Mandatory funding?

But veterans’ service organizations and others involved in veterans’ issues have serious concerns about the level of VA funding over the past several years.

“It’s not that they don’t try at the Spokane VA. The care is terrific,” said Lanny Myers, of Kettle Falls, junior past department commander of the American Legion in Washington state, who is a patient at the Spokane hospital.

His organization and every other major veterans’ service group seeks mandatory VA funding based on enrollment and adjusted annually for inflation. Such a measure, co-sponsored by Sen. Patty Murray, D-Wash., was defeated by Senate Republicans in July.

Rep. George Nethercutt told the News Tribune of Tacoma last month that he opposes mandatory funding for VA health care because it could affect the flexibility needed to meet the changing needs of veterans.

Democratic senator and presidential candidate John Kerry supports mandatory funding while President Bush opposes it.

“Congress and the president must be accountable and be able to react to changing times or new demands placed on the VA system,” Bush has told the Disabled American Veterans, according to the group’s Web site.

“Until we get mandatory funding, it will be a political battle all the time,” Myers said earlier this year, when state veterans were engaged in a fight to keep the VA from closing its medical center in Walla Walla.

Though the facility was spared, he and other veterans found the VA’s proposal to close hospitals outrageous at a time when new veterans would be returning from Iraq and Afghanistan.

The Veterans Health Care Eligibility Reform Act of 1996 gave the VA legal authority to expand its health care system to include non-indigent, nondisabled veterans if they paid a nominal co-payment.

According to a position paper of the Vietnam Veterans of America, the law gave the secretary of Veterans Affairs the responsibility to determine eligibility for enrollment based on available resources. Though the law did not set a level of funding or a standard of care, it categorized veterans into priority groups to manage enrollment.

Since 1996, as health care inflation put insurance beyond the reach of millions of people in the private sector, the VA rolls more than doubled while appropriations increased only 40 percent, according to figures provided by the office of Murray, who sits on the Veterans Affairs Committee.

Faced with these numbers, Secretary Principi last year suspended new enrollments of Priority 8 veterans, those whose disabilities are not service-related and whose incomes exceed a regionally adjusted threshold, effectively barring an estimated 164,000 veterans from enrolling in the system. In the area served by the Spokane Veterans Affairs Medical Center, the threshold is an annual income of around $30,000.

In its 2005 budget request, the Bush administration seeks $26.6 billion for VA health care, a 2.7 percent increase over this year. That is $1.2 billion less than Principi said was needed to adequately care for veterans. The budget proposal would require that Priority 8 veterans pay an annual enrollment fee of $250, as well as $15 drug co-payments and $20 appointment co-payments. Congress rejected the fee increases last year.

In addition, the administration’s budget assumes $1.29 billion in savings through “management improvement and efficiencies” that the House Committee on Veterans Affairs called “laudable,” but unlikely to be realized.

“The committee is not confident that optimistic plans and goals would produce the high-dollar reductions in costs the administration projects in its budget request,” the House committee said of the administration’s VA budget request for 2005.

New patients

In the current fiscal year, Congress appropriated $25.9 billion for veterans’ medical care. Next year’s appropriation is unlikely to be voted on before the November elections. The Senate has passed a resolution seeking a $2.5 billion increase, and the House is seeking a $1.5 billion increase over 2004, according to a report prepared by the minority staff of the Senate Veterans Affairs Committee.

In May, the Associated Press reported that more than 20,000 soldiers had sought care from the VA since returning from the current global war on terrorism. Many of these returning veterans have been surprised at how quickly they were able to enter the VA system.

“We make sure that when an Iraqi Freedom or Afghan vet comes, we see them right away,” Schilke said.

And unlike the treatment returning Vietnam veterans received, this time the VA is prepared for cases of post-traumatic stress disorder, which so far has affected about 15 percent of veterans returning from the war on terrorism, the VA reports. Every veteran enrolling in the VA system receives an initial screening for PTSD and is screened annually thereafter.

“This won’t be like Vietnam,” Schilke said. “We are much smarter now in how to deal with the stress of battle.”


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