President Obama’s final assessment of the Commission on Care

President Obama’s final assessment of the Commission on Care

WASHINGTON — Consistent with the Veterans Access, Choice, and Accountability Act of 2014, the President’s formal response to the Commission on Care was transmitted to Congress. As the President has said, “a sacred covenant exists between Veterans and this nation: servicemen and servicewomen take an oath to protect our country, and in turn, our nation pledges to take care of them when they leave the service. The Commission’s work to evaluate the Veterans Affairs health care system is important in ensuring we keep our promise to our Veterans.”

Secretary of Veterans Affairs Robert A. McDonald released the following statement on the report:

VA stands firmly behind the President’s final assessment of the Commission on Care report, and we thank the Commission for their hard work. 

With input from Congress, Veterans Service Organizations (VSOs), and government partners, VA has thoroughly reviewed each and every recommendation to determine whether they were feasible and advisable within the scope of the law.  The President and VA find 15 of the 18 recommendations in the Commission’s report feasible and advisable, and we have already accomplished or have been working on 12 out of the 18 through our ongoing MyVA transformation. The Department has already started implementing the Commission’s recommendations that the President and VA found feasible and advisable. 

Transforming VA into a Veteran-Centric Department

Two years ago, the President charged me with transforming VA into the high-performing, Veteran-centric organization our Veterans deserve. I am thrilled to see that through our MyVA transformation initiative. Though there is certainly much more work to be done, VA has already made irrefutable progress in increasing Veterans’ access to quality health care and the benefits they have earned.

Progress Made

This past March, VA set a new record for completed appointments: 5.3 million inside VA, 730,000 more than in March 2014. VA increased access to Veterans through an integrated system of care. VHA staff and Choice contractors created over 3 million authorizations for Veterans to receive care in the private sector from October 2015 through July 2016. This is a 42 percent increase in authorizations when compared to the same time period last year. From FY 2014 to FY 2015, Community Care appointments increased about 20 percent from 17.7 million in FY14 to 21.3 Million. Clinical workload is up 11 percent in the past two years. Nearly 97 percent of appointments are now completed within 30 days of the Veteran’s preferred date; 22 percent are same-day appointments; average wait times are five days for primary care, six days for specialty care, and two days for mental health care. Nearly 90 percent of Veterans now say they are “satisfied or completely satisfied” with the timeliness of their appointments.

On Commission’s Recommendation to Establish VHA Board of Directors

Overall, we found 15 of the 18 recommendations feasible and advisable, and are working to implement them.  However, VA strongly disagrees with the Commission on its proposed “board of directors” to oversee the Veterans Health Administration (VHA). Such a board is neither feasible nor advisable for both constitutional and practical reasons. Most problematically, this proposal would seem to establish VHA as an independent agency, which would frustrate ongoing efforts to improve the Veteran’s experience by integrating Veterans health care and services across VA, making it more difficult for Veterans to receive the quality care where, when, and how they need it.

Increasing Access to Health Care is a Shared Goal

We do, however, strongly agree with the idea of external advice and counsel to ensure the VA operating with the greatest degree of efficiency and effectiveness for Veterans.  VA is already advised by our new MyVA Advisory Committee, which has been hard at work since March 2015 applying the members’ extensive experience in customer service and organizational change to our transformational challenge. They are leaders in business, medicine, government, and in Veteran advocacy. Among them are eight Veterans like: Major General Joe Robles who after spending 30 years in the Army became President and CEO for USAA; Dr. Richard Carmona, a Special Forces Vietnam Veteran and the 17th Surgeon General of the United States; and Navy Veteran Dr. Connie Mariano, who was the first military woman to serve as White House Physician to the President, the first woman Director of the White House Medical Unit, and the first Filipino American in US History to become a Navy Rear Admiral. These are innovative, resourceful, respected leaders who are advising us on transformation. They know business.  They know customer service.  And, they know Veterans.

I strongly support the Commission’s intent that creating a high-performing, integrated health care system that encompasses both VA and private care is critical to serving the needs of Veterans. In fact, VA has outlined our approach to achieve this same goal in our Plan to Consolidate Community Care, submitted to Congress in October 2015. This plan would provide Veterans with the full spectrum of healthcare services and more choice without sacrificing VA’s foundational health services on which many Veterans depend.

At the same time, it is critical that we preserve and continue to improve the VA health care system and ensure that VA fulfills its mission. Veteran Service Organizations, having decades of experience advocating for generations of our Nation’s Veterans, have made it crystal clear that they believe VA is the best place for Veterans to receive care. Many VSOs fear that the Commission’s vision would compromise VA’s ability to provide specialized care for spinal cord injury, prosthetics, traumatic brain injury, post-traumatic stress disorder, and other mental health needs, which the private sector is not as equipped to provide. We share their concern and therefore do not support any policies or legislation that will lead to privatization, which I am pleased the Commission did not recommend outright. Privatization is not transformational. It’s more along the lines of dereliction of duty.

VA is well on its way towards realizing the integrated health care network envisioned by the Commission, but we cannot get there alone. Congress is our board of directors. If Veterans are to receive the care and services they deserve, Congress must do its job as our board. Abdicating leadership and constitutional responsibilities by creating more bureaucracy hurts Veterans and slows the progress of our MyVA transformation. Congress must act on key pieces of legislation like our Plan to Consolidate Community Care, our plan to reform the claims appeals process, and the President’s budget request for VA.

We, along with VSOs, have worked hard with Republicans and Democrats in Congress to develop these critical pieces of legislation. We know that the vast majority in Congress understand how critical these issues are and are ready to take action. I call on leadership from both parties to put political expediency aside and do what is best for our Veterans and for taxpayers. Only then will we be able to truly transform VA into the 21st century organization Veterans deserve.

Links to the President’s statement and letter may be found at

Information on the Commission on Care and its Charter may be found at

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