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House Subcommittee Holds Hearing on Women Veterans’ Health Bill

On January 17, the House Veterans Affairs Subcommittee on Health held a hearing on several bills aimed at improving veterans’ health care, including the Women Veterans Healthcare Improvement Act (H.R. 4107).

H.R. 4107 would require the secretary of Veterans Affairs (VA) to conduct a 10-year “epidemiologic study on the health of women veterans who served on active duty in the combat theatres of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF).” The study would be required to include information on women veterans’ general health, mental health, reproductive health, and mortality. The secretary would be required to conduct a comprehensive assessment of the barriers women veterans face in accessing physical and mental health care, including perceived stigma, the effect of driving distance or availability of other forms of transportation, availability of child care, comprehension of eligibility, quality of service providers, perception of personal safety and comfort while receiving services, and providers’ cultural sensitivity. The assessment would be required to report on the availability of specialized programs for post-traumatic stress disorder (PTSD), homelessness, substance abuse, mental illness, and pregnancy care.

The secretary would be required to provide training for mental health professionals who provide care to victims of “sexual trauma.” The bill would mandate that the secretary annually report to Congress on the counseling and care services provided to veterans, including the number of women veterans served, the number of mental health professionals who had received training, and the number of training programs.

The bill would authorize $1.5 million for FY2008 and FY2009 to carry out a two-year pilot program to provide child care for women veterans receiving regular or intensive mental health care services. Child care assistance would include stipends for the payment of child care offered by child care centers, the development of partnerships with private agencies, collaboration with facilities, or the arrangement of after school care. The bill also would authorize $2 million for FY2008 and FY2009 to begin a two-year pilot program for women transitioning from active duty to reserve duty or civilian life. The program would provide marital and family counseling, as well as counseling for substance abuse-related disorders.

Rep. Stephanie Herseth Sandlin (D-SD), the sponsor of H.R. 4107, said, “As you know, more women are answering the call to serve, and more women veterans need access to services that they are entitled to when they return. With increasing numbers of women now serving in uniform, the challenge of providing adequate health care services for women veterans is overwhelming. In the future, these needs will likely be significantly greater with more women seeking access to care and a more diverse range of medical conditions.” She continued, “[A]ccording to the VA, the prevalence of potential PTSD among new OEF/OIF women veterans treated at the VA from FY2002-2006 has grown dramatically from approximately one percent in 2002 to nearly 19 percent in 2006. The VA must ensure adequate attention is given to women veterans’ programs so quality health care and specialized services are available equally for both women and men. I believe my bill will help the VA better meet the specialized needs and develop new systems to better provide for the health care of women veterans especially those who return from combat, who were sexually assaulted, or who need child care services.

Gerald M. Cross, principal deputy undersecretary for health at the Veterans Health Administration, voiced several objections to H.R. 4107. He noted that a long-term study of women veterans’ health was already underway: “For several years, veterans, VA, and Congress have been concerned with identifying possible war-related illnesses among returning women veterans, including adverse effects on reproductive health. To that end, in 2007, VA initiated its own 10-year study, the ‘Longitudinal Epidemiologic Surveillance on the Mortality and Morbidity of OIF/OEF Veterans including Women Veterans.’” Dr. Cross objected to the bill’s requirement that the VA conduct a comprehensive assessment of the barriers women face in accessing care. Dr. Cross said, “[The assessment] would require a very complex and costly study. While we maintain data on veteran populations receiving VA health care services that account for the types of clinical services offered by gender, we lack current resources to carry out such a comprehensive study within a one-year time-frame. We would therefore have to contract for such a study with an entity having, among other things, significant expertise in evaluating large health care systems. This is not to say that such a comprehensive assessment is not needed and we recognize there may well be gaps in services for women veterans, especially given that the VA designed its clinics and services based on data when women comprised a much smaller percentage of those serving in the Armed Forces…VA’s Strategic Health Care Group for Women Veterans already studies and uses available data and analyses to assess and project the needs of women veterans for the undersecretary for health. The study required by section 103 would unacceptably divert significant funding from direct medical care.”

Joy J. Ilem, assistant national legislative director for Disabled American Veterans (DAV), said, “[W]omen veterans are a small but dramatically growing segment of the veteran population. The current number of women serving in active military service and its reserve and guard components has never been larger and this phenomenon predicts that the percentage of future women veterans who will enroll in VA health care and use other VA benefits will continue to grow proportionately. Also, women are serving today in military occupational specialties that take them into combat theaters and expose them to some of the harshest environments imaginable, including service in the military police, artillery, medic and corpsman, truck driver, fixed and rotary wing aircraft pilots and crew, and other hazardous duty assignments. The VA must prepare to receive a significant new population of women veterans in future years, who will present needs that the VA has likely not seen before in this population…Mr. Chairman, this comprehensive legislative proposal is fully consistent with a series of recommendations that have been made in recent years by VA researchers, experts in women’s health, VA’s Advisory Committee on Women Veterans, and DAV. Therefore, we support this measure and urge the subcommittee to recommend its enactment.”

Joseph L. Wilson, assistant director of the Veterans Affairs and Rehabilitation Commission, American Legion; Christopher Needham, senior legislative associate, Veterans of Foreign Wars; and Richard F. Weidman, executive director for policy and government affairs, Vietnam Veterans of America, also testified.

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