[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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