[House Document 114-161]
[From the U.S. Government Publishing Office]
114th Congress, 2d Session - - - - - - - - - House Document 114-161
THE FINAL REPORT OF THE COMMISSION ON CARE
__________
COMMUNICATION
from
THE PRESIDENT OF THE UNITED STATES
transmitting
A STATEMENT SUPPORTING MANY OF THE RECOMMENDATIONS AND THE UNDERLYING
OBJECTIVES OFFERED BY THE COMMISSION ON CARE IN THE FINAL REPORT
TRANSMITTED ON JULY 6, 2016, PURSUANT TO 38 U.S.C. 1701 NOTE; PUBLIC
LAW 113-146, SEC. 202(g)(2); (128 STAT. 1776)
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
September 6, 2016.--Referred to the Committee on Veterans' Affairs and
ordered to be printed
______
U.S. GOVERNMENT PUBLISHING OFFICE
59-011 WASHINGTON : 2016
The White House,
Washington, September 1, 2016.
Hon. Paul D. Ryan,
Speaker of the House of Representatives,
Washington, DC.
Dear Mr. Speaker: My Administration is committed to the
ongoing transformation of the Department of Veterans Affairs
(VA) and I strongly support many of the recommendations and the
underlying objectives offered by the Commission on Care
(Commission) in its final report transmitted on July 6, 2016.
These recommendations underscore the fundamental challenges
that face the VA health care system, and the reforms needed to
provide America's veterans with the high quality health care
they need and deserve--both now and in the future. We have made
great strides in delivering improved care to our veterans over
the past 8 years, and we will continue to work tirelessly to
uphold the solemn responsibility to ensure all our veterans are
getting the care and benefits they have earned.
I concur with 15 of the 18 Commission recommendations, many
of which are already being implemented as part of the ongoing
MyVA transformation that the Secretary of Veterans Affairs
(Secretary) has put in place. These include areas such as
enhancing clinical operations, establishing a more consistent
policy for appealing clinical decisions, eliminating
disparities in how health care is delivered to veterans from
different backgrounds, modernizing IT systems, and establishing
new processes for leadership development and performance
management. These reforms are steps in the right direction and
will help put VA on a trajectory to ensure veterans continue to
receive timely and high quality care, while strengthening the
VA health care system that millions of veterans depend on every
day. I appreciate and applaud the Commission for their work.
Of particular note, I strongly support the Commission's
principle 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, my
Administration outlined its approach to achieve this same goal
in VA's Plan to Consolidate Community Care, submitted to the
Congress in October 2015. While this approach must be
implemented in a fiscally sustainable way, it builds on more
than a decade of work with veterans, health care providers, and
community partners, to streamline and enhance VA's capability
to deliver services essential to veterans' health. VA's plan
also recognizes the importance of strengthening VA's
partnerships with other Federal health care providers,
including the Department of Defense and Indian Health Service,
as well as tribal health programs, academic teaching
affiliates, and Federally Qualified Health Centers.
At the same time, it is critical that we preserve and
continue to improve the VA health care system and ensure that
VA has the ability to serve veterans. Research shows that in
many areas, such as mental health, VA delivers care that is
often better than that delivered in the private sector. VA also
provides unique, highly specialized care for many medical
conditions, such as spinal cord and traumatic brain injuries,
which are simply not available to the same extent outside of
VA. In addition, VA provides a comprehensive approach to
wellness that includes the treatment of physical injuries and
mental health. This multidisciplinary approach allows providers
to address the full spectrum of veteran needs beyond medical
care, including other VA benefits and services.
For these reasons, I concur with the Commission's vision
for creating integrated care networks that more tightly
coordinate VA and non-VA care, but urge the Congress to act on
this recommendation by enacting VA's Plan to Consolidate
Community Care. The alternative approach outlined in VA's plan
would achieve the goals of the Commission to create a veteran-
centric approach to care that appropriately balances issues of
access, quality, and cost-effectiveness. It would more clearly
ensure the long-term viability and sustainability of the VA
health care system, preserve VA's role as the primary
coordinator of care for veterans, and safeguard its ability to
carry out its other research, education, and emergency
preparedness missions that are critical to our Nation's well-
being. And it would ensure that veterans have access to the
care they need--whether at the VA or out in the community--
without forcing untenable resource tradeoffs that would limit
the ability of VA to carry out other parts of its mission on
behalf of veterans.
We must also ensure that VA has the ability to operate this
integrated health care system in a rational, efficient, and
dynamic way that best serves the interests of both veterans and
taxpayers. For that reason, I have concerns with the
Commission's proposed governance structure for the VA health
care system. The proposal would undermine the authority of the
Secretary and the Under Secretary for Health, weaken the
integration of the VA health care system with the other
services and programs provided by the VA, and make it harder--
not easier--for VA to implement transformative change.
Moreover, the Department of Justice has advised that the
proposed recommendation would violate the Appointments Clause
of the Constitution. I do, however, support portions of the
recommendation that would establish a term appointment for the
Under Secretary for Health, to ensure that position is removed
from the turmoil and turnover of the political cycle.
For those recommendations I agree with and whose objectives
are not yet achieved, I am directing the VA to develop plans to
complete their implementation. Additionally, in recognition of
the role of the MyVA initiative in transforming the VA as
military service evolves, I have directed the Secretary of
Veterans Affairs to incorporate the principles of the MyVA
initiative into VA strategic planning, leadership training, and
performance monitoring. In those areas where legislation is
required, my Administration will work closely with the
Secretary to transmit to the Congress the relevant legislative
proposals, which I recommend be enacted without delay.
Improving veterans' health care remains a critical issue of
national importance, and my Administration will work with
veterans and military families, the Congress, Veterans Service
Organizations, and other stakeholders to ensure all our
veterans are getting the care and benefits they need when they
need them.
Sincerely,
Barack Obama.
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