Texas Conservative Coalition Research Institute
Senate Committee on Veteran Affairs & Border Security
February 24, 2020
Regarding the Committee’s Charges:
Interim Charge on Veteran Health Care: Examine the adequacy of long-term health care services and support options for veterans in Texas. Identify under-served areas and barriers to accessing quality care for both institutional as well as home and community based settings. Discuss the potential impact of federal reforms, such as the implementation of the Veterans Affairs MISSION Act on care delivery. Make recommendations to best leverage federal assistance and create greater efficiencies in veteran health care delivery.
Interim Charge on Veteran Mental Health: Review suicide prevention strategies and programs identified by the federal Defense Suicide Prevention Office and make recommendations to connect at-risk individuals with available resources as they transition into veteran status.
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Executive Summary
Few issues manage to cross the political aisle and form alliances as much as those intended to assist veterans. The willingness to dedicate, and sometimes lay down, one’s life for love of country is the ultimate sacrifice and, thankfully, most Americans regard that sacrifice with the utmost respect. However, despite the fact that veteran-related issues have broad support, health and mental health services for veterans have drawn widespread coverage, largely due to a breakdown in ensuring veterans get the services they need. While both federal and state leaders are eager and genuine in their desires to help, exactly how best to help has come into greater question.
While the federal government has primary responsibility for the provision of veterans’ health care services, Texas has a proud history of honoring our veterans by helping them get the care and services they need. As such, the Texas Veterans’ Commission (TVC) plays a crucial role in supporting Texas veterans and working in coordination with the federal Veterans’ Administration (VA).
Part of the challenge with how best to assist veterans at the state level is that the federal government is solely responsible for the provision of health services. However, when the federal system fails to deliver needed care, as was the case with the VA system in 2014 and 2015, states are left with trying to determine how best to “wrap around” those gaps in federal services and help their veterans in need. After the issues with the VA came to light, the Texas Legislature and TVC took action by directing TVC to work with veterans in troubleshooting VA-related health care issues and setting up a grant program to train mental health providers and peer support workers on veteran mental health issues.
TCCRI fully supports the Sunset initiative in SB 601 (86R) to introduce annual priorities and evaluation measures for each of TVC’s programs and would encourage this committee to continually monitor the implementation of this bill to ensure that these measures are being put into place. TCCRI is also supportive of the Committee’s Interim Report recommendation to the 86th Legislature to pass a nonbinding resolution urging Congress and the VA to be fully transparent with veterans on the health care options available to them while continuing to expand freedom of choice for veterans,[1] as well as its work to determine how to best connect individuals transitioning from active duty to veteran status with suicide prevention services.
Overview of Veterans’ Health Care Services
Part of the challenge with addressing veteran physical and mental health issues, especially at the state level, is due to the fact that such benefits are administered at the federal level by the U.S. Department of Veterans Affairs, or VA, as it is more informally known, or are covered through the TRICARE program for eligible armed services retirees and their dependents. For the purposes of this testimony, we will focus on services provided by the VA at the federal level, as those services have come under fire due to backlogs and an inability to get care in some areas of the country.[2]
Individuals who served on active military duty for at least 24 continuous months and are honorably discharged from their service are eligible for VA health benefits through the Veterans Health Administration (VHA).[3] Unlike TRICARE, which is a health care coverage product for eligible members, the VA has historically provided direct care services to veterans, including primary care, specialist visits, mental health providers, long-term services and supports, and prescription drugs.[4] Described as “the country’s largest, most comprehensive integrated health care network,”[5] the VA’s system boasts more than 1200 health care facilities and 168 medical centers, serving almost 9 million veterans per year nationwide.[6]
Federal Initiatives
The largest veteran health-related federal initiatives over the past several years have revolved around a veteran’s ability to seek direct care outside of the VA system from private providers. The VA direct care model first began to change in 2014 with the passage of the Veterans’ Access, Choice and Accountability Act of 2014 (“Choice Act”) after media coverage of backlogs in access to care made national headlines.[7] Among other initiatives, the Choice Act also began allowing eligible individuals (i.e. recently discharged combat veterans, those with a Veterans Choice Card) who were unable to access care due to wait times or geographic restrictions to go outside of the VA system to designated eligible providers.[8] This model was expanded more recently under the MISSION Act, discussed in greater detail below.
MISSION Act
Due to the popularity of the Choice Act and ongoing problems in accessing VA care, Congress replaced the Choice Act with the Maintaining Internal Systems and Strengthening Integrated Outside Networks, or MISSION, Act. Launched just last June, this law provides veterans with expanded options to seek high quality access to care outside of the VA system. The MISSION Act decreases wait times from 30 days to 20 days before a veteran may seek private care, with the goal of ultimately lowering the wait time to 14 days sometime later this year.[9] It also provides a wider array of provider options, including a network of more than 8,000 urgent care clinics, combines the various community care programs into a streamlined system,[10] and expands the Program of Comprehensive Assistance for Family Caregivers, which supports family members caring for veterans with disabilities.[11]
In federal fiscal year (FFY) 2018 about 1.7 million veterans across the country used some form of private care and eligibility projections estimate that those numbers could increase by as much as 30 percent under the MISSION Act.[12] Though TCCRI was unable to find any official statistics from the United States government, military.com reports that, as of September 2019, more than one million veterans had consulted with the VA on seeking private care after the rollout of the MISSION Act.[13] Because the program is less than a year old it will likely be several months before official statistics or outcomes measures are available to govern the program’s success. TCCRI supports providing additional private care options to veterans unable to access care through the VA, as well as the Senate Committee on Veterans Affairs & Border Security’s Interim Report recommendation to urge Congress and the VA to be more transparent with veterans on their available healthcare options.
Suicide Prevention
Another critical federal initiative relating to veterans is the issue of suicide prevention, with about 6,000 veterans each year losing their lives to suicide.[14] The Defense Suicide Prevention Office (DSPO) is tasked with suicide prevention policies and programs for the entire military community. Although it administers multiple initiatives, one of its key programs is the Veteran and Military Crisis Line, which active or retired military members can access via phone, text, or online chat.[15] The Texas Veterans Commission (TVC) also features the crisis line prominently at the top of every page of its website. While the crisis line serves as an invaluable resource, TCCRI supports the Committee’s efforts to determine if there are any additional ways in which the state can help connect individuals to such services as they transition from active duty to veteran status.
While the federal government has primary responsibility for the provision of veterans’ health care services, Texas has a proud history of honoring our veterans by helping them get the care and services they need. As such, TVC plays a crucial role in supporting Texas veterans and working in coordination with the VA.
Texas Veterans Commission & State Initiatives
Established in 1927, the mission of TVC is “to advocate for and provide superior service to veterans that will significantly improve the quality of life for all Texas veterans, their families, and survivors.”[16] Texas boasts the second largest veteran population in the nation, with about 1.6 million veterans calling this state home. With a veteran constituency of this size, the work of TVC is vital.
Part of the challenge with how best to assist veterans at the state level is that the federal government is solely responsible for the provision of health services. However, when the federal system fails to deliver needed care, as was the case with the VA system in 2014 and 2015, states are left with trying to determine how best to “wrap around” those gaps in federal services and help their veterans in need. After the issues with the VA came to light, the Texas Legislature and TVC took action.
As it relates to physical and mental health, TVC currently focuses on the following areas:[17]
Providing assistance and advocacy to Texas veterans experiencing issues with the VA health care system- in fiscal year 2017, TVC assisted more than 5,000 veterans with VA-related health care issues.[18]
Training and providing technical assistance to Service Members, Veterans, and their Families (SMVF) peers, mental health providers, community- and faith-based organizations, and state agencies on the impacts of military-related trauma- through an almost $2 million grant from HHSC, the agency supports veteran peer coordinators at local mental health authorities throughout the state. In FY 2017, the agency trained about 6,000 volunteer veterans to mentor other veterans dealing with military-related traumas and coordinated training for about 600 mental health providers on veteran mental health issues.[19]
Providing training and technical assistance to agencies and organizations involved within the criminal justice system to improve diversion and mental health treatment options for veterans who have suffered military-related traumas.
After going through the Sunset process in the 2017-2018 legislative interim, TVC was continued for an additional twelve years via SB 601 (86R, Hall, Sp: Flynn). In addition to continuing the agency and enacting some government efficiency provisions, the bill also established criteria for the agency’s Mental Health Program Director and required the agency to set annual priorities and evaluation measures for each of its programs. TCCRI supports this initiative and believes that all programs funded by taxpayer dollars should be subject to transparent and objective outcomes measures.
The 86th Legislature also passed SB 822 (Nelson, Sp: Flynn) to build upon the success of the aforementioned mental health grant, also known as the Texas Veterans + Family Alliance (TV+FA) grant program. SB 822 expanded the types of providers HHSC may contract with to administer the program and better aligned the grant with similar programs.[20]
In addition, to help raise awareness for the important issue of veteran mental health and suicide prevention, the 86thTexas Legislature passed HCR 148 (Landgraf, Sp: Campbell), which designates June as Veteran Suicide and PTSD Awareness Month in the state of Texas.
Conclusion and Recommendations
This Committee’s work, particularly as it relates to veterans’ health and mental health services, is equal parts vital and challenging. With the second largest veteran population in the country, Texas has a clear need to provide support to our veterans who are struggling with accessing the physical and mental health care they need. However, because this care is exclusively provided for by the federal government, it can be challenging for state leaders to determine how to provide this assistance most efficiently and effectively.
TCCRI fully supports the Sunset initiative in SB 601 (86R) to introduce annual priorities and evaluation measures for each of TVC’s programs and would encourage this committee to continually monitor the implementation of this bill to ensure these measures are being put into place. TCCRI is also supportive of the Committee’s Interim Report recommendation to the 86th Legislature to pass a nonbinding resolution urging Congress and the VA to be fully transparent with veterans on the health care options available to them while continuing to expand freedom of choice for veterans,[21] as well as its work to determine how to best connect individuals transitioning from active duty to veteran status with suicide prevention services.
[1] See Texas Senate Committee on Veteran Affairs & Border Security, “Report and Recommendations to the 86th Texas Legislature,” Interim Charge Three, Recommendation 3, p. 10, September 2018, available at https://senate.texas.gov/cmtes/86/c650/c650.InterimReport2018.pdf.
[2] New York Times, “V.A. Prepares for Major Shift in Veterans’ Health Care,” by Jennifer Steinhauer, June 5, 2019, available at https://www.nytimes.com/2019/06/05/us/politics/va-health-care-veterans.html.
[3] Huang, Phd., et. al., “2017 Survey of Veteran Enrollees’ Health and Use of Health Care,” Data Findings Report, Prepared by Westat for the Office of Veterans Affairs, April 2018, available at https://www.va.gov/HEALTHPOLICYPLANNING/SOE2017/VA_Enrollees_Report_Data_Findings_Report2.pdf.
[4] See U.S. Department of Veterans Affairs website, “VA health care,” available at https://www.va.gov/health-care/.
[5] Huang, Phd., et. al., “2017 Survey of Veteran Enrollees’ Health and Use of Health Care,” Data Findings Report, Prepared by Westat for the Office of Veterans Affairs, April 2018, available at https://www.va.gov/HEALTHPOLICYPLANNING/SOE2017/VA_Enrollees_Report_Data_Findings_Report2.pdf.
[6] Texas Senate Committee on Veteran Affairs & Border Security, “Report and Recommendations to the 86th Texas Legislature,” September 2018, available at https://senate.texas.gov/cmtes/86/c650/c650.InterimReport2018.pdf.
[7] New York Times, “V.A. Prepares for Major Shift in Veterans’ Health Care,” by Jennifer Steinhauer, June 5, 2019, available at https://www.nytimes.com/2019/06/05/us/politics/va-health-care-veterans.html.
[8] U.S. Department of Veterans Affairs, Fact Sheet on Veterans Access, Choice and Accountability Act of 2014, available at https://www.va.gov/opa/choiceact/documents/choice-act-summary.pdf.
[9] New York Times, “V.A. Prepares for Major Shift in Veterans’ Health Care,” by Jennifer Steinhauer, June 5, 2019, available at https://www.nytimes.com/2019/06/05/us/politics/va-health-care-veterans.html.
[10] See AARP, “Veterans Now Eligible for More Private Health Care Options,” by Aaron Kassraie, June 6, 2019, available at https://www.aarp.org/home-family/voices/veterans/info-2019/mission-act-health-care.html.
[11] U.S. Department of Veterans Affairs, “Mission Act,” available at https://missionact.va.gov/.
[12] New York Times, “V.A. Prepares for Major Shift in Veterans’ Health Care,” by Jennifer Steinhauer, June 5, 2019, available at https://www.nytimes.com/2019/06/05/us/politics/va-health-care-veterans.html.
[13] See Military.com, “A Million Veterans Have Looked Into Private Care Since Mission Act Rollout,” by Richard Sisk, September 25, 2019, available at https://www.military.com/daily-news/2019/09/25/million-veterans-have-looked-private-care-mission-act-rollout.html.
[14] See U.S. Department of Veterans Affairs blog, “VA releases Request for Information, seeks strategies for ways to end Veteran suicide,” June 20, 2019, available at https://www.blogs.va.gov/VAntage/61985/va-releases-request-for-information-as-it-seeks-strategies-for-ways-to-end-veteran-suicide/.
[15] See Military Crisis Line website, available at https://www.veteranscrisisline.net/get-help/military-crisis-line.
[16] See Texas Veterans Commission website, available at https://www.tvc.texas.gov/.
[17] Texas Veterans Commission website, “Health Care Advocacy,” available at https://www.tvc.texas.gov/health-care-advocacy/.
See also See Texas Veterans Commission website, “Veterans Mental Health Services,” available at https://www.tvc.texas.gov/mental-health/.
[18] Texas Sunset Commission, “Texas Veterans Commission Staff Report with Final Results,” June 2019, available at https://www.sunset.texas.gov/public/uploads/files/reports/Texas%20Veterans%20Commission%20Staff%20Report%20with%20Final%20Results.pdf.
[19] Ibid.
[20] See bill analysis for SB 822, 86R, Author’s/ Sponsor’s Statement of Intent, Veteran Affairs & Border Security, Enrolled Version, May 27, 2019, available at https://www.legis.state.tx.us/tlodocs/86R/analysis/pdf/SB00822F.pdf#navpanes=0.
[21] See Texas Senate Committee on Veteran Affairs & Border Security, “Report and Recommendations to the 86th Texas Legislature,” Interim Charge Three, Recommendation 3, p. 10, September 2018, available at https://senate.texas.gov/cmtes/86/c650/c650.InterimReport2018.pdf.