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Senate Committee Examines Health Legislation for Women Veterans

On May 21, the Senate Veterans Affairs Committee held a hearing on several health-related bills, including the Women Veterans Health Care Improvement Act (S. 2799).

Sponsored by Sen. Patty Murray (D-WA), S. 2799 would authorize “such sums as necessary” for the Department of Veterans’ Affairs (VA) to conduct a long-term epidemiological study on the health of women veterans who served on active duty in Iraq or Afghanistan. The study would include “information on general health, mental health, reproductive health, and mortality of such women veterans, and shall include physical examinations and diagnostic testing of a representative sample of such women veterans.”

The bill also would authorize “such sums as necessary” for “a comprehensive assessment of the barriers to the receipt of comprehensive health care through the Department of Veterans’ Affairs that are encountered by women veterans,” including the availability of child care, transportation, the stigma associated with seeking mental health care, and the “perception of personal safety and comfort of women veterans in inpatient, outpatient, and behavioral health facilities of the Department.” The measure would authorize “such sums as necessary” for a “comprehensive assessment” of VA services and programs to address the health care needs of women veterans and an Institute of Medicine study on “health consequences of women veterans” deployed in Iraq and Afghanistan.

S. 2799 would authorize up to 30 days of care for the newborn child of a woman receiving maternity care provided by VA if the child was born in a VA facility, as well as a program to provide training and certification for mental health professionals who treat veterans suffering from sexual trauma and post-traumatic stress disorder (PTSD).

The legislation would authorize $1.5 million for a pilot program to pay for the costs of child care incurred so that the veteran may receive health care services, and $2 million for a pilot program to provide reintegration and readjustment services to women veterans newly separated from service. The services would include information and counseling on stress reduction, conflict resolution, financial counseling, and occupational counseling.

Gerald Cross, principal deputy undersecretary for Health at the Department of Veterans’ Affairs, outlined the Department’s concerns with the studies required under S. 2799, saying, “[W]e do not support section 101 [the epidemiological study]. It is not needed. A longitudinal study is already underway. In 2007, VA initiated its own ten-year study, the ‘Longitudinal Epidemiological Surveillance on Mortality and Morbidity of OIF/OEF [Operation Iraqi Freedom/Operation Enduring Freedom] Veterans Including Women Veterans’…The study has already been approved to include 12,000 women veterans. However, section 101 would require us to expand our study to include women active duty servicemembers. We estimate the additional cost of including these individuals in the study sample to be $1 million each year and [up to] $3 million over a ten-year period.” Dr. Cross added, “Neither do we support section 102 [the assessment of barriers to women veterans to health care from the VA]. It is not necessary because a similar comprehensive study is already underway. [The] VA contracted for a ‘National Survey of Women Veterans in FY2007-2008’…This study is examining barriers to care (including access) and includes women veterans of all eras of service. Additionally, it includes women veterans who never used VA for their health care needs. We estimate no additional costs for section 102 because VA’s own comparable study is underway, with $975,000 in funding committed for FY2007 and FY2008.”

“Section 103 [comprehensive assessment of women’s health care programs at the VA] would require a very complex and costly study,” added Dr. Cross. “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 of Health. Furthermore, we lack current resources to carry out such a comprehensive study within the 18-month time frame…This is not to say that further assessment is not needed. We recognize there may well be gaps in services for women veterans, especially given that VA designed its clinics and services based on data when women comprised a much smaller percentage of those serving in the armed forces. However, the study required by section 103 would unacceptably divert significant funding from direct medical care. Section 103 would have a cost of $4,354,000 in FY2008.” Dr. Cross continued, “We do not object to section 104 [the Institute of Medicine study]. We suggest the language be modified to allow VA to decide which organization is best situated to carry out this study (taking into account the best contract bid).”

With regard to the provision that would provide health care for newborn children of a woman veteran, Dr. Cross, said, “We can support this provision with modification. As drafted, the provision is too broadly worded. We believe this section should be modified so that it applies only to cases where a covered newborn requires neonatal care services immediately after delivery. The bill language should also make clear that this authority would not extend to routine well-baby services.”

“Women veterans are a dramatically growing segment of the veteran population,” said Joy Ilem, assistant national legislative director for Disabled American Veterans. She continued, “The current number of women serving in active military service and its reserve and Guard components have 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 grown 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…VA must prepare to receive a significant new population of women veterans in future years, who will present needs that VA has likely not seen before in this population. The 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, the Independent Budget, and DAV [Disabled American Veterans]. DAV was proud to work with Senator Murray and the original cosponsors of the bill in crafting this proposal. A similar bill was introduced in the House (H.R. 4107) on a bipartisan basis by Representatives [Stephanie] Herseth Sandlin [(D-SD] and [Ginny] Brown-Waite [(R-FL)]. DAV strongly supports this measure and urges the committee to approve it and move it toward enactment.”

Thomas Berger, chair of the National PTSD and Substance Abuse Committee, on behalf of the Vietnam Veterans of America, said, “Women’s health care is not evenly distributed throughout the VA system. Although women veterans are the fastest growing subset, there remains a need for increased focus on health care and its delivery to women, particularly the young women coming home today. What is needed are real women’s medical clinics that are separate places within each hospital, and ensure that the women get the privacy and the ‘comfort level’ needed for them to seek assistance for the full range of maladies from which they may suffer, including Military Sexual Trauma (MST). Dr. Berger continued, “Although VA Central Office may interpret women’s health services as preventive, primary, and gender-specific care, this comprehensive concept remains ambiguous and splintered in its delivery throughout all the VA medical centers. Many at the VA appear (unfortunately and wrongly) to view women’s health as only a GYN clinic. It certainly involves more than gynecological care. In reality, women’s health is viewed as a specialty unto itself, as demonstrated in every university medical school in the country. Furthermore, some women continue to report a less than ‘accepting,’ ‘friendly,’ or ‘knowledgeable’ attitude or environment both within the VA and/or by third party vendors. This may be the result, at least in part, of a system that has evolved principally (or exclusively) to address the medical needs of male veterans. But reports also indicate that in mixed gender residential programs, women remain fearful and unsafe.”

Carl Blake, national legislative director for the Paralyzed Veterans of America; Joseph Wilson, deputy director of the Veterans Affairs and Rehabilitation Commission for the American Legion; Christopher Needham, senior legislative associate of the National Legislative Service for the Veterans of Foreign Wars of the United States; Stan Luke, vice president for programs at Helping Hands Hawaii; J. David Cox, national secretary-treasurer of the American Federation of Government Employees, AFL-CIO; Cecelia McVey, former president of the Nurses Organization of Veterans Affairs; Donna McCartney, chair of the National Association of Veterans’ Research and Education Foundations and executive director of the Palo Alto Institute of Research and Education; and Sally Satel, resident scholar for the American Enterprise Institute and a lecturer at the Yale University School of Medicine, also testified.

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