[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING
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HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
THURSDAY, JUNE 12, 2025
__________
Serial No. 119-26
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Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
61-124 WASHINGTON : 2025
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COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa SHEILA CHERFILUS-MCCORMICK,
GREGORY F. MURPHY, North Carolina Florida
DERRICK VAN ORDEN, Wisconsin MORGAN MCGARVEY, Kentucky
MORGAN LUTTRELL, Texas DELIA RAMIREZ, Illinois
JUAN CISCOMANI, Arizona NIKKI BUDZINSKI, Illinois
KEITH SELF, Texas TIMOTHY M. KENNEDY, New York
JEN KIGGANS, Virginia MAXINE DEXTER, Oregon
ABE HAMADEH, Arizona HERB CONAWAY, New Jersey
KIMBERLYN KING-HINDS, Northern KELLY MORRISON, Minnesota
Mariana Islands
TOM BARRETT, Michigan
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
SUBCOMMITTEE ON HEALTH
MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman
JACK BERGMAN, Michigan JULIA BROWNLEY, California,
GREGORY F. MURPHY, North Carolina Ranking Member
DERRICK VAN ORDEN, Wisconsin SHEILA CHERFILUS-MCCORMICK,
JEN KIGGANS, Virginia Florida
ABE HAMADEH, Arizona MAXINE DEXTER, Oregon
KIMBERLYN KING-HINDS, Northern HERB CONAWAY, New Jersey
Mariana Islands KELLY MORRISON, Minnesota
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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THURSDAY, JUNE 12, 2025
Page
OPENING STATEMENTS
The Honorable Mariannette Miller-Meeks, Chairwoman............... 1
The Honorable Julia Brownley, Ranking Member..................... 3
SPEAKING FROM THE DAIS
The Honorable Greg Murphy, U.S. House of Representatives, (NC-3). 4
The Honorable Nikki Budzinski, U.S. House of Representatives,
(IL-13)........................................................ 5
The Honorable Kimberlyn King-Hinds, U.S. House of
Representatives, Northern Mariana Island's at-large
Congressional District......................................... 6
The Honorable Morgan Luttrell, U.S. House of Representatives,
(TX-8)......................................................... 6
The Honorable John McGuire, U.S. House of Representatives, (VA-5) 7
WITNESSES
Panel I
Dr. Antoinette V. Shappell, M.D., Deputy Assistant Under
Secretary for Health for Patient Care Services, Veterans Health
Administration, U.S. Department of Veterans Affairs............ 8
Accompanied by:
Dr. Ilse Wiechers, Deputy Executive Director, Office of
Mental Health, Veterans Health Administration, U.S.
Department of Veterans Affairs
Panel II
Mr. David Coker, President, Fisher House Foundation.............. 17
Mr. Randy Johnson, Constituent, Rep. King-Hinds of the
Commonwealth of the Northern Mariana Islands................... 18
Mr. Cole Lyle, Director, Veterans Affairs and Rehabilitation
Division, The American Legion.................................. 20
Mr. John Schmitt, Chief Executive Officer, iXpressGenes, Inc..... 22
Ms. Caira Benson, Caregiver Fellow, Elizabeth Dole Foundation.... 23
APPENDIX
Prepared Statements Of Witnesses
Dr. Antoinette V. Shappell, M.D. Prepared Statement.............. 33
Mr. David Coker Prepared Statement............................... 50
Mr. Randy Johnson Prepared Statement............................. 51
Mr. Cole Lyle Prepared Statement................................. 53
Mr. John Schmitt Prepared Statement.............................. 71
Ms. Caira Benson Prepared Statement.............................. 78
APPENDIX--continued
Statements For The Record
The Honorable Joseph Morelle, U.S. House of Representatives, (NY-
25) Prepared Statement......................................... 83
Paralyzed Veterans of America Prepared Statement................. 83
Gold Star Spouses of America, Inc. Prepared Statement............ 87
National Association of Veterans' Research and Education
Foundations Prepared Statement................................. 88
National Association of State Veterans Homes Prepared Statement.. 88
Quality of Life Foundation Prepared Statement.................... 90
United Services Automobile Association Prepared Statement........ 92
The Veterans of Foreign Wars of the United States Prepared
Statement...................................................... 93
American Academy of Physician Associates Prepared Statement...... 95
Concerned Veterans of America Prepared Statement................. 97
Military Officers Association of America Prepared Statement...... 101
Student Veterans of America Prepared Statement................... 105
K9s For Warriors Prepared Statement.............................. 108
LEGISLATIVE HEARING
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THURSDAY, JUNE 12, 2025
Subcommittee on Health,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:15 p.m., in
room 360, Cannon House Office Building, Hon. Mariannette
Miller-Meek [chairwoman of the subcommittee] presiding.
Present: Representatives Miller-Meek, Bergman, Murphy, Van
Orden, Kiggans, Hamadah, King-Hinds, Brownley, Cherfilus-
McCormick, Dexter, Conaway, and Morrison.
OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN
Ms. Miller-Meeks. This legislative hearing of the
Subcommittee on Health will now come to order. Without
objection, the Chair may declare a recess at any time. Given
that votes have been moved to 3 o'clock, we will, in all
likelihood, declare a recess. I would like to welcome all
members and witnesses to today's hearing. We have 12 important
legislative proposals to consider here today. It is important
to note that not all of the proposals will move forward in the
legislative process, but many will. Congress is responsible for
ensuring U.S. Department of Veterans Affairs (VA) stewards its
resources effectively. Many of my colleague's bills would
optimize the VA's funding, talent, and capital. Other bills
reinforce VA's mission to care for veterans in mental and
physical health.
I am grateful to Representative Hamadeh for introducing the
Health Professional Scholarship Program (HPSP) Improvement Act.
One of the greatest resource drains at the VA is the broken
student-to-employee pipeline. The VA loses untold investments
in student clinicians by offering scholarships in exchange for
employment commitments only for the VA not to keep its end of
the deal. Students are consistently unemployed for months
before the VA gives them a position. These students have been
driven to the point where they cut their losses with the VA and
seek jobs elsewhere at great financial cost to them and an
opportunity cost to the VA. Representative Hamadeh's bill would
help end this unacceptable dilemma.
The Representing Our Seniors at VA Act by Representative
Kiggins would improve the Geriatric and Gerontology Advisory
Committee. Under current law, there is no requirement for input
from State veterans homes, even though these homes are key
partners in serving aging veterans. Representative Kiggins's
bill would fix this oversight by making sure these homes have a
seat at the committee table.
The Veterans Patient Advocacy Act by Representative
Moolenaar would increase the rural footprint for VA patient
advocates. I know all too well how veterans in rural areas
struggle to obtain care from the VA. I firmly support the
bill's goal to have patient advocates accessible to rural
veterans. I think we can all agree that we can always do more
to ensure that VA's resources must keep evolving to reach
veterans where they live.
The Territorial Response and Access to Veterans Essential
Life Care (TRAVEL) Act by Representative King-Hinds would also
help our veterans living in remote areas. This bill would
require a 1-year billet for VA physicians at U.S. territories
like the Northern Mariana Islands. Health care is not easy to
come by in these remote parts of the world. This bill would
place VA practitioners in the right places at the right times.
Representative McGuire's bill, the VA Data Transparency and
Trust Act, tackles the unending reporting requirements at the
VA and replaces them with a comprehensive and unified report on
outcomes and metrics to improve VA programs. The laws today
incentivize a system where consultants can create a cottage
industry to broker reports, which diverts precious time and
money away from VA's mission and only makes oversight more
difficult. Congress has gained little from the manner in which
it has received information from the numerous current VA
reporting requirements. Representative McGuire's bill would
pull in the reins and improve outcomes for veterans.
My bill, the Fisher House Availability Act, would make
lodging in Fisher Houses more accessible for service members
and their families. Fisher House Foundation is a nonprofit
dedicated to providing lodging for veterans and service members
in need. The VA owns most Fisher Houses. We know that service
members and their families can stay at Fisher Houses whenever
they get care from the VA. However, a recent agency
interpretation prohibits them from using VA-owned Fisher House
when receiving non-VA care, even though we all know there is
more than enough room to house them. This bill does not
displace veterans or veterans' families. It is important to
know it would simply ensure that service members have access to
available lodging. I am thankful to the Fisher House Foundation
for supporting this bill, and I am proud to sponsor it.
Representative Luttrell's bill, the Service Dogs Assisting
Veterans (SAVES) Act, picks up where the popular Puppies
Assisting Wounded Servicemembers for Veterans Therapy (PAWS)
Act left off. This bill covers the cost for service dogs that
provide veterans with mental and physical assistance. The
therapeutic benefits of service dogs are well established. I
thank Representative Luttrell for his efforts to improve the
availability of service dogs for veterans in need.
Representative Dunn's bill would align nonsmoking policies
at Veterans Health Administration (VHA) with most medical
facilities in America. Currently, there is no protection in law
against smoking at VHA facilities. As a physician, I know how
important it is to make sure that patients breathe clean air
when they receive care at the VHA facility. This bill would
ensure that.
Finally, a bill introduced by Dr. Murphy would create a
pilot program to build on existing research into Post-Traumatic
Stress Disorder (PTSD)-related inflammation and cellular
stress. The continued prevalence of PTSD in our veteran
population requires us to continue finding new and innovative
ways of screening and diagnosing PTSD. The research from this
pilot program could help equip VA with the tools for preventive
rather than reactive care for PTSD.
Again, these bills optimize VA and reinforce its mission to
care for veterans' mental and physical health in exchange for
their service in uniform. I now yield to Ranking Member
Brownley for any opening remarks you may have.
OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER
Ms. Brownley. Thank you, Madam Chair, and thank you to our
witnesses for making the time to be here. I understand we will
have votes, as the Chairwoman said, that could interrupt us
this afternoon. I will keep my remarks brief to allow us to get
to everyone's testimony. While Committee Democrats appreciate
and are not opposed to the intent of many of the Republican
bills on today's agenda, we would like to see some changes and
improvements on some of these bills. I hope we will be able to
work together collaboratively with our majority colleagues to
make these improvements through the committee markup process
and put forth the best possible legislation to support our
veterans.
I am pleased we are considering three Democratic bills
today, including my bill, the Civilian Health and Medical
Program of the Department of Veterans Affairs (CHAMPVA)
Children's Care Protection Act. I first introduced this bill in
2019, and it has long been a priority for numerous veteran
service organizations and organizations serving caregivers and
survivors. CHAMPVA provides health care coverage for spouses
and dependent children of veterans with permanent and total
service-connected disabilities and for the surviving spouses
and children of veterans who have died from service-connected
disabilities.
When the Affordable Care Act (ACA) was signed into law in
2010, it required private-sector health plans to allow children
to stay on their parent's insurance until they are 26 years
old. However, this ACA mandate was not extended to military or
veteran health coverage. This inequity was addressed for
TRICARE in 2011, but to date, we have not extended parity to
the CHAMPVA program. It is long past time to right this wrong.
I am glad we will have a chance to hear directly from a
caregiver, Ms. Caira Benson, about what this legislation would
mean for her and her family. I look forward to working with the
VA to learn how we can address the department's concerns and
ensure that caregivers and their families have the support that
they deserve.
To that end, I also appreciate that we are considering
Representative Morelle's bill, H.R. 2148, The Veteran Caregiver
Reeducation, Reemployment, and Retirement Act. This legislation
will provide VA and other agencies additional authorities to
support veteran caregivers as they transition out of VA's
program of comprehensive assistance for family caregivers. The
sacrifices caregivers make, including for their own earning
potential and financial security, are immense, and we must
support them by ensuring they have the tools and the resources
they need. I know Ms. Benson will also provide powerful
testimony in support of Representative Morelle's bill.
Finally, I know Congresswoman Budzinski will be here to
discuss her own legislation, the VA Mental Health Outreach and
Engagement Act, so I will briefly just say that I also support
her bill. This legislation will ensure that VA conducts regular
outreach and offers consultations to assess the needs of
veterans with service-connected disability ratings for mental
health conditions. We know that veterans who are connected with
VA care have better health outcomes and lower risk of suicide
than veterans who are not connected. I am glad Congresswoman
Budzinski's bill will allow more eligible veterans to engage
with VA care.
I look forward to hearing from all of our witnesses today.
With that, Madam Chair, I will yield back.
Ms. Miller-Meeks. Thank you, Ranking Member Brownley. We
have a full agenda today, so I will be holding everyone to 3
minutes per bill to ensure we can move in a timely manner. In
accordance with Committee Rule 5(e), I ask unanimous consent
that Representative Luttrell from Texas be permitted to
participate in today's subcommittee hearing. Without objection,
so ordered.
I now recognize Representative Murphy for 3 minutes to
speak on his bill.
STATEMENT GREG MURPHY
Mr. Murphy. Thank you, Chairwoman Miller-Meeks and Ranking
Member Brownley, for holding this meeting today. My bill, H.R.
3886, the Veterans PTSD Screening Act, is being discussed at
today's hearing. You know, we talk a lot about mental health
with our veterans, especially with PTSD and Traumatic Brain
Injury (TBI), and anything that we can do to move the needle. I
have been obviously a big fan of hyperbaric oxygen therapy, but
any other thing that we can do to move the needle is critical
in how we are trying to help the veterans who have kept us
free.
I am going to talk a little bit about something called
Ribonucleic Acid (RNA), RNA sequencing. Deoxyribonucleic Acid
(DNA) is in our body, and DNA is a constant thing in our body.
RNA rather changes with different experiences, with different
memories, et cetera, in our brain. What we have found and has
been well documented is the ability to measure RNA sequencing,
either microRNA or something called long digital RNA, in
different assays. These have become a predicting point to
determine levels of stress within the body. Where compared to
controls, those who have experienced PTSD have a markedly
different pattern of RNA. What this bill is going to do is
going to direct the VA to study this RNA sequencing in five
separate veterans' VINs. I think it is going to be critical as
we put our armamentarium, as our toolbox gets bigger and bigger
as technology advances, that this will be a great tool.
Now, caveats. We do not want to ever deny care based upon
what is found with RNA sequencing. We also do not want to make
this as a single modality. We have to have a holistic approach
to PTSD. Being able to monitor just this one single variable
really helps us, but it is not going to be the sole object for
doing this.
The science is growing. We are actually using this in some
VAs right now, as been modeled in some VAs right now and is
being modeled in other places, trauma centers, et cetera. I
think we are seeing as technology increases, especially with
AI, that we are going to be able to use all these new different
tools to help our veterans, those who have experienced PTSD,
and hopefully come up with a cure 1 day. If not, be able to
monitor, to diagnose, and to monitor treatment as we treat our
veterans.
I will ask for appreciation and I would love us to bring
the vote to committee. Thank you, Madam Chairwoman. I yield
back.
Ms. Miller-Meeks. Thank you, Representative Murphy. The
Chair now recognizes Representative Budzinski for 3 minutes to
speak on her bill.
STATEMENT OF NIKKI BUDZINSKI
Ms. Budzinski. Thank you, Chairwoman Miller-Meeks, and
thank you to Ranking Member Brownley. I appreciate this for
giving me the opportunity to speak on my bill, H.R. 3863, the
VA Mental Health Outreach and Engagement Act, which would
expand VA's outreach to veterans about mental health services.
I also want to thank my Republican colleague, Mr. Edwards, for
co-leading this bipartisan bill.
As a member of the Veterans Affairs Committee, I have heard
from veterans unaware of where to turn for support and care for
the invisible wounds of war. We must support our veterans and
provide them with the knowledge and resources to prosper
following their service to our Nation. My bill would ensure we
are proactively reaching out to veterans with mental health-
related service-connected disabilities and connecting them with
the care that they need. Navigating the VA should never be a
burden, and this bipartisan legislation would help to make it
easier for veterans to get the mental health care that they
have earned.
I am also here today to speak in support of H.R. 3767, the
Health Professional Scholarship Program Improvement Act. I want
to thank my colleague on the committee, Congressman Hamadeh,
for his leadership and bipartisan collaboration on this bill.
VA's Health Professional Scholarship Program supports the
students pursuing healthcare careers while connecting VA with
talented staff. When program participants graduate, they are
often met with delays in receiving a contract. Amid Veteran
Health Administration staffing shortages, we need solutions to
address this inefficiency. This legislation would streamline
the path for HPSP participants to start working full-time,
making it easier for veterans to get the care that they need.
For both of these bipartisan bills, I am committed to
working with my colleagues on both sides of the aisle, the VA
and Veterans Service Organizations (VSO), to ensure we are
continuing to improve healthcare for our Nation's veterans.
Thank you very much for the time, and I yield back.
Ms. Miller-Meeks. Thank you, Representative Budzinski. The
Chair now recognizes Representative King-Hinds for 3 minutes to
address her bill.
STATEMENT OF KIMBERLYN KING-HINDS
Ms. King-Hinds. Thank you, Chairwoman Miller-Meeks and
Ranking Member Brownley, for the opportunity to speak on my
bill, H.R. 3400, The Territorial Response and Access to
Veterans Essential Life Care Act, or the TRAVEL Act of 2025 for
short, which aims to provide much-needed medical care to the
United States territories.
My home, the Northern Mariana Islands, has one contracted
part-time doctors who sees and cares for hundreds of veterans
who are spread across three islands. Which means if a veteran
needs specialized medical care, he or she must travel to Guam,
Hawaii, or the continental United States for health care. This
is not only acceptable, it is offensive to the people who have
served our country. Veterans should not have to pay upfront for
air travel, book appointments across the globe, or forego
medical care entirely because there are no nearby accessible
doctors.
Our Nation's heroes have worked hard and sacrificed so much
to provide for us. We owe medical care to our veterans. We are
indebted for their service. The very least we can do is to
ensure they can go to a cardiologist or a neurologist when they
need it. It is my hope that the TRAVEL Act will begin to
address the medical desert that veterans face every day in the
Northern Mariana Islands and all across the territories.
This bill, once passed, will create a program similar to
Doctors Without Borders. Veterans' Affairs, who supports this
bill, will send doctors to the territories for periods of up to
1 year so they can practice specialized medical care on Island.
It will not bring the status of medical care for veterans in my
district up to par with care available in the continental
United States, but every little bit, any sort of improvement
will help, and this bill does that.
I ask and urge all of my colleagues in the House of
Representatives to stand behind me as I advocate for our heroes
across our territories. Thank you, Madam Chair. I yield my time
back.
Ms. Miller-Meeks. Thank you very much, Representative King-
Hinds. The Chair now recognizes Representative Luttrell for 3
minutes to speak on his bill.
STATEMENT OF MORGAN LUTTRELL
Mr. Luttrell. Thank you, Madam Chairwoman and Ranking
Member Brownley, for inviting me to speak on the Service Dogs
Assisting Veterans Act. This legislation is an important step
forward toward improving access to service dogs for our
veterans. This pilot program gives the Secretary the authority
to award competitive grants to nonprofits that provide service
dogs to assist veterans who need them most.
We are talking about men and women who have borne the
weight of war, many of them returning from a theater of combat
with invisible wounds. Nearly one in five veterans from those
conflicts live with post-traumatic stress, post-traumatic
stress disorder, or other cognitive issues. Over 450,000
veterans have suffered at least one traumatic brain injury over
the past two decades. These are not just numbers. These are
warriors now battling depression, anxiety, addiction,
joblessness, and homelessness. Right now, we are losing an
estimated 17 to 22 veterans a day to suicide. This is
absolutely a national crisis.
Service dogs are more than companions. They are a life
changing--they are life changing. They assist veterans. They
assist veterans in regaining a sense of normalcy and control.
They support those living with post-traumatic stress and
traumatic brain injury and also assist vets dealing with
mobility issues, vision loss, and hearing impairments. These
dogs help our veterans live independently and stay active and
re-engage with their families and their communities. This
program is about giving back to those who never hesitated to
serve. It is a step toward healing and toward honoring the
promise we made to our veterans.
Cost is one of the biggest hurdles veterans must jump over
when it comes to service dogs. I am pleased that this
legislation would enable veterans to gain access to highly
trained service dogs at no cost. Ensuring our veterans have
access to the biggest resources is a team sport. The SAVES Act
team is comprised of dedicated members from across the
political spectrum working to make this bill a reality. We also
count numerous veterans organizations who are ready to execute
and provide our veterans with highly trained service dogs who
will make their life better.
I would like to thank this committee and Ranking Member
McGarvey for their assistance. Thank you, and I yield back.
Ms. Miller-Meeks. Thank you, Representative Luttrell. The
Chair asked--in accordance with Committee Rule 5(e), I asked
unanimous consent that Representative McGuire from Virginia be
permitted to participate in today's committee subcommittee
hearing. Without objection, so ordered. The Chair now
recognizes Representative McGuire for 3 minutes to speak on his
bill.
STATEMENT OF JOHN MCGUIRE
Mr. McGuire. I need a little teammate teamwork for my SEAL
brother. Thank you, Madam Chair. We would not have a country
without our men and women who risk their life or give their
life. For all of our men and women, our veterans, thank you.
Ranking Member Brownley, thank you as well. For the opportunity
to speak on my bill, H.R. 3643, the Virginia Data Transparency
and Trust Act, which I was proud to introduce with my good
friend, the chairman of the full committee, Chairman Mike Bost
of Illinois. Information and access to reliable and accurate
data are necessary to all industries and government agencies.
Nowhere is this need more apparent or more important than the
Department of Veterans Affairs.
Over the past 10 years, the VA's budget has increased by
nearly 220 percent while the daily suicide rate has remained
flat, with 18 veterans committing suicide each day, with some
experts believing that number might be higher. We also cannot
forget that last November, the Department of Veterans Affairs
made egregious mistakes and its accountant and budgeting
practices, and they came to Congress last summer asking for
additional funds or else veterans would lose their benefits.
This resulted in a $3 billion stopgap spending bill that was
rushed through Congress to ensure veteran benefits could
continue, only for us to learn months later that there was no
shortfall at all. Clearly, Congress needs to have better
oversight of how the VA spends taxpayer funds and where they
spend it.
Currently, the department provides Congress with a wide
range of reports but falls short of providing timely and
accurate reports conducted by other agencies, such as the
Department of Defense (DOD), with regard to TRICARE and the
Center for Medicare and Medicaid Services. My bill would
require that the VA provide an annual comprehensive report that
would provide Congress and congressional support agencies with
the necessary information to provide proper and clear oversight
while allowing for greater visibility of veterans needs and the
usage of certain programs. Without comprehensive and useful
data, Congress cannot make informed decisions about veterans'
healthcare, disability compensation or program funding. This
bill modernizes the way the VA handles data, bringing it in
line with other major Federal agencies' best practices.
I would like to thank Chairwoman Miller-Meeks for allowing
me the time to speak and be impart on this important
legislation today. I will yield back the balance of my time.
Ms. Miller-Meeks. Thank you, Representative McGuire. Seeing
no other members here to speak on their bills, as is our
practice, we will forego a round of questioning for the
members. For those off committee members who are here, you may
remain to ask questions of our witnesses if you have time.
I now invite our first panel to the table. Thank you.
Joining us today is Dr. Antoinette Shappell with support from
Dr. Ilse Wiechers. Dr. Shappell is Deputy Assistant
Undersecretary for Health and Patient Care Services at VHA. Dr.
Wiechers is Deputy Executive Director of the Office of Mental
Health and Suicide Prevention at VHA.
Dr. Shappell, you are now recognized for 5 minutes to
prevent the department's testimony.
STATEMENT OF ANTOINETTE SHAPPELL
Dr. Shappell. Thank you. Chairwoman Miller-Meeks, Ranking
Member Brownley, and members of the subcommittee thank you for
inviting us to discuss several bills affecting Veterans Affairs
programs and services. My name is Dr. Antoinette Shappell, and
I currently serve as the Deputy Assistant Undersecretary for
Health for Patient Care Services. I am joined today by Dr. Ilsa
Wiechers, Deputy Executive Director for the Office of Mental
Health.
While VA's detailed views on each of the bills are included
in my written statement, I will briefly highlight some of the
bills. First, H.R. 785, the Representing Our Seniors at VA Act.
VA supports the intent and has already appointed a member of
the National Association for State Veteran Homes to the
Gerontology Advisory Committee in 2024. We have some concerns
with the legislation as written.
Next is H.R. 1404, the CHAMPVA Children's Care Protection
Act of 2025, which would extend CHAMPVA benefits for children
until age 26. CHAMPVA is a medical care benefit for dependents
of certain veterans similar to DoD's TRICARE. However, VA does
not support this bill because we believe this coverage up to
age 23 is sufficient for our beneficiary population. VA is
concerned that the bill would require resources that could
otherwise be used to support patient care.
VA agrees with the intent of H.R. 2068, the Veterans
Patient Advocacy Act. The bill aims to ensure rural veterans
can access patient advocates. VA has expanded advocacy options
for veterans, such as local advocates, online platforms, and
the VA Hotline to meet veterans' needs. VA has concerns with
some of the bill's provisions.
The Veteran Caregiver Reeducation, Reemployment, and
Retirement Act, H.R. 2148, proposes several changes. It extends
CHAMPVA benefits for 180 days for primary family caregivers
after their designation ends, offering a necessary transition
time for seeking alternative health care coverage. The bill
also suggests employment assistance and compensation, including
training for caregivers. VA supports Section II of the bill,
subject to appropriations. We generally support Section III of
the bill, subject to appropriations. However, we do have some
concerns with the certain provisions and would appreciate the
opportunity to discuss these concerns with the committee.
The Service Dogs Assisting Veterans ACT, or the SAVES Act,
H.R. 2605, requires the VA to establish a pilot program to
provide service dogs to eligible veterans. VA supports this but
recommends clarifying the bill's language for effective use of
funds. We also propose aligning terminology with existing VA
definitions. We do have concerns about including traumatic
brain injury and post-traumatic stress disorder in the
criteria, given insufficient evidence of service dogs'
effectiveness for PTSD.
Additionally, H.R. 3400, the TRAVEL Act, proposes assigning
traveling VA physicians to territories and possessions in the
U.S. VA supports this with amendments to clarify the bonus
eligibility and coordination of care, ensuring physicians
provide care where it is needed. We agree with the intent to
expedite the employment process for healthcare professions.
However, we do not support the bill seeking to expedite VA
employment for health professional scholarship program
participants within 90 days.
VA supports the VA Data Transparency and Trust Act, which
requires VA to submit detailed reports and create a data-
sharing system for researchers. However, we recommend
amendments to focus on desired topic areas to avoid complex and
resource intensive implementation.
The Fisher House Availability Act of 2025 aims to extend
lodging benefits at Fisher Houses. VA supports this, provided
amendments to clarify eligibility for service members and
dependents, ensuring the bill's language aligns with current
practices.
We strongly support the bill banning smoking in all VHA
facilities.
VA supports the intent of the draft bill, directing VA to
conduct a study on RNA sequencing to diagnose PTSD. We do have
concerns with several of the bill's provisions and would
appreciate the opportunity to discuss our concerns with the
committee.
VA supports the VA Mental Health Outreach and Engagement
Act. Support is subject to amendments and the availability of
appropriations. We would appreciate the opportunity to discuss
amendments with the committee and provide technical assistance.
This concludes my statement. We are happy to answer any
questions you or other members of the subcommittee may have.
Thank you.
[The Prepared Statement Of Antoinette Shappell Appears In
The Appendix]
Ms. Miller-Meeks. Thank you for your testimony, Dr.
Shappell. Your full written statement will be entered into the
record.
As is my typical practice, I will reserve my time until all
of the members have had a chance to ask their questions,
especially with pending votes coming. I now recognize Ranking
Member Brownley for 5 minutes for any questions she may have.
Ms. Brownley. Thank you, Madam Chair. Dr. Shappell, thank
you for being here. In your testimony, your written testimony,
anyway, you say that the--that VA opposes the CHAMPVA because
it is not an insurance plan. Is that correct?
Dr. Shappell. Yes.
Ms. Brownley. If you could answer just a couple of
questions for me, just yes--yes or no. The first one, does
CHAMPVA have cost-sharing requirements like deductibles and co-
pays?
Dr. Shappell. I would need to that for the record.
Ms. Brownley. Well, I can say that it does for the record.
Are there any limitations to the services and supplies covered
by CHAMPVA?
Dr. Shappell. I would also take that one for the record.
Ms. Brownley. It does. Does CHAMPVA use a formulary?
Dr. Shappell. I believe so, but I can get specifics for the
record.
Ms. Brownley. Well, I can tell you that it does. Does
CHAMPVA have any prior authorization requirements for services
like mental health and substance use treatment?
Dr. Shappell. I believe so, but I can--I can----
Ms. Brownley. I can tell you--say that it does. Is CHAMPVA
considered credible coverage for the purposes of the ACA's
mandate that individuals have health insurance coverage?
Dr. Shappell. CHAMPVA is a benefit, but it is not an
insurance policy per se.
Ms. Brownley. Well, the point that I am trying to make here
is that all the questions that I just asked you, the answers
are yes. Then, of course, you say that it is not a health
insurance policy, but it certainly sounds like one. It has, you
know, the questions that I just asked you were sort of almost
like a checklist for insurance policies. It just seems to me
that CHAMPVA--you say it is not a health insurance policy. I
say it certainly appears to be one. As the old saying goes, if
it walks like a duck and swims like a duck and quacks like a
duck, it is probably a duck.
DoD's TRICARE program was not affected by the ACA either.
However, Congress created the TRICARE Young Adult program in
2011 to provide health care for qualified young adults ages 21
to 26 who are unmarried and not eligible for an employer-
sponsored health plan. Why is VA advocating for the dependents
and survivors of service-disabled veterans to be treated
differently and less than TRICARE beneficiaries? This
legislation would create that long-standing inequity.
In her testimony on behalf of the Elizabeth Dole
Foundation, Mrs. Benson suggests that our committee should use
its oversight authority to improve the administration of the
CHAMPVA program. I certainly agree. She recounts the incredible
number of hurdles she has to overcome in getting services
covered, getting claims paid, and even simply getting VA to
process the paperwork to recertify her child's status as a
college student. Yes, I mean paperwork because CHAMPVA is still
operating, in my most humble opinion, in the dark ages with
paper-based forms and a month's long backlog in processing the
mail.
Dr. Shappell, 7 weeks ago today, committee staff submitted
a few simple questions to VHA regarding academic enrollment
recertification requirements for CHAMPVA beneficiaries. We have
yet to receive a response despite our attempts to follow up.
Can I have your assurance that we will receive answers to these
questions within the next week, which will make it more than 2
months since we requested the information?
Dr. Shappell. Thank you. I do not have a timeline right
now, but I can assure you that I will work with my colleagues
in our Office of congressional Legislative Affairs to ensure
you have a response.
Ms. Brownley. You cannot state at a timeline? Not a week,
not 2 weeks, not a month, not 3 months?
Dr. Shappell. Not at this time.
Ms. Brownley. I yield back.
Dr. Shappell. Thank you.
Ms. Miller-Meeks. Thank you, Representative Brownley. The
Chair now recognizes representative Dr. Murphy for 5 minutes
for any questions he may have.
Mr. Murphy. I am going to hold off and pass on questions. I
will come back later. Thank you.
Ms. Miller-Meeks. The Chair now recognizes Representative
King-Hinds for any questions she may have.
Ms. King-Hinds. just have a couple of questions. I was
reading over your comments on the proposed TRAVEL Act, and
first of all, thank you for the support. Section, the proposed
section 7415B proposes to require traveling physicians to
coordinate with non-departmental medical providers to the
extent necessary to ensure high-quality and coordinated care.
How do you foresee the VHA implementing this program?
Dr. Shappell. Thank you. I am going to pass that to Dr.
Wiechers.
Dr. Wiechers. We would actually like to work with the
committee to better understand what the intent is in that
section so that we can have some clarity on what care
coordination entails.
Ms. King-Hinds. Okay, great.
Dr. Wiechers. That we could make a plan together.
Ms. King-Hinds. I would love to have that conversation with
you. Just one other quick question. There was some objections
with regards to, I think I want to say, section--the pay,
section 7415. I know that there are some concerns about the
budget and the language with regards to the retention bonus,
which is included in the legislation. I just wanted to bring
this up for situational awareness.
Right now, the Commonwealth of the Northern Mariana Islands
(CNMI), in general, is having a hard time recruiting healthcare
professionals just for regular care. I think that is a direct
result of, you know, just the difference in the quality of life
that is here on the mainland as it relates to back in the
territories. I will give you an example. I am really excited
that he is introducing the SAVES Act, which would, you know,
allow for the VA to provide service care or service animals. We
do not have a vet. That is one of the biggest challenges is
that you do have these professionals who want to relocate
there. Transporting your pets to the CNMI right row costs
around $10,000. You know, it is cost-prohibitive, right? We do
not have a mall, we do not have a shopping center, any type of
major shopping center. Our only movie theater has just recently
closed down. I would like to have a conversation with you with
regards to the challenges as it relates to recruitment and
retention for people coming out to the territories.
Dr. Wiechers. Absolutely. We would be happy to engage in a
conversation with you about that. I think the technical
amendment suggestion is just to ensure that the language and
the authorities that we have related to bonus eligibility line
up appropriately. Absolutely understand the importance of being
able to recruit high quality providers to be able to come to
the islands and to help with the health care for our veterans
there.
Ms. King-Hinds. All right, thank you. I yield my time.
Ms. Miller-Meeks. Thank you. If I can, I will remind our
witnesses to speak a little louder. The Chair now recognizes
Representative Bergman, General Bergman, for any questions he
may have.
Mr. Bergman. Thank you, Madam Chair, and thank you to
everybody who is here because we are all trying to do the right
thing for the right reasons. The question is, how do we figure
out what the right reasons really are and what the priorities
are? We are in an oversight position here. You are the, you
know, we are the higher headquarters that send you money and
resources to do the mission. We want to know how the mission is
going, okay? I appreciate the honesty in your testimony.
One specific question here as it relates to H.R. 3767, as
it relates to the Health Professional Scholarship program. I am
not going to go into details of what each--whether you are a
psychiatrist, a nurse practitioner, pharmacist, how many of
those scholarships, so the Health Professional Scholarship
program, are providing scholarships for certain specialties. I
will just say if you do not have the answer, you can take it
for the record. Why is the VHA plan for Fiscal Year 2026
eliminating the PA, Physician's Assistance, Health Professional
Scholarship Program for returning veteran medics and corpsmen?
Do we have any detail of that? I do not want--I do not want to
play gotcha here, but I want to give you the opportunity to
answer the question based upon what you know.
Dr. Shappell. Thank you. I will pass that to Dr. Wiechers.
Dr. Wiechers. I am going to have to take that for the
record, sir. I do not have an answer for you today, but I will
get an answer for you.
Mr. Bergman. Well, the reality is here we need all
different medical special, you know, proficiencies,
specialties. It would seem to me that when we have veteran
medics and corpsmen that are already, for lack of a better
term, in most cases, battle-tested, we would want to make sure
that we continue to develop their expertise and their ability
to serve other veterans. This is a medical specialty that we
need to continue to move forward. This cannot be, you know,
the--not that I would get specific, but there is an ongoing
discussion between nurse anesthetists and anesthesiologists.
That is--we have been dealing with that for a very, very long
time, and there is room for both. The question is, who
supervises who, who has charge of patient care, et cetera, et
cetera. As we continue to look at the healthcare system of the
future and physician's assistance, as they might migrate into
the VA system, and maybe they go out into community care, which
the vast majority of veterans are looking for care in the
community. Physician assistant in the world in which we live is
a great step forward.
With that, Madam Chair, I yield back.
Ms. Miller-Meeks. Thank you, General Bergman. The Chair now
recognizes Dr. Conaway for any questions he may have for 5
minutes.
Mr. Conaway. Hi. Thank you, Madam Chair, for recognizing me
for a few moments to make a statement and answer some
questions. We are, I am assuming I just walked in, we are on
3643, right? No. Oh. What is that? Okay. I just wanted to take
a moment to discuss H.R. 3643, the VA Data Transparency and
Trust Act. It aims to reauthorize a congressionally mandated
report that expired in 2022 and significantly expands the
number of elements that the VA is required to report. Dr.
Shappell, does the VA have the personnel and resources
necessary to compile, calculate, and report this data?
Dr. Shappell. Thank you. VA does support this bill, subject
to amendments. Right now, as written, the report is very broad
and would require a significant amount of time and resources to
fully understand what is desired. We would appreciate the
opportunity to meet with the committee to narrow the focus of
the specific topics.
Mr. Conaway. I agree with the importance of transparency in
this bill and strongly believe data points from the VA are
essential for Congress to effectively conduct its oversight
responsibilities. I would. You have just said that you have
some concern about the breadth of the report, but I must say
that I am concerned about what is lacking, specifically how
many staff are retiring, resigning or leaving the VA, along
with their specific job titles. I am also concerned about what
is going on with new hires and what their titles are. It sounds
like you would not be able to provide--you do not believe the
VA, excuse me, is in a position to provide this data. We think,
I think, and I think, I hope, I am joined by everyone here,
believes it is important to understand what is going on with
the staffing levels in the VA and that it has the appropriate
personnel and adequate numbers of personnel to complete its
very important mission. Certainly, what is going on with hiring
and staffing, et cetera, would be important to our oversight
function. What are your thoughts on--on the things I suggest
needed to go into the bill?
Dr. Shappell. Thank you. Thank you for the question. That
the resources that would be needed to collect and report on
this data could potentially divert from health care and
benefits delivery, but we do not have a cost estimate at this
time. We would really appreciate the opportunity to meet with
the committee to fully understand what is really desired and
needed so that we can come up with a better plan to move
forward.
Mr. Conaway. Well, then I would ask then, do you know why--
and of course, you are supposed to know the answer to these
questions before we ask them. You know, it is, my notes say, of
course, this report ceased a couple of years ago. Do you have
an explanation for why that happened?
Dr. Shappell. I do not know. I was not in my current
position at that time. I would be happy to take that for the
record and provide a response for you.
Mr. Conaway. Well, I would just say that we know that
staffing and the ability to fully staff the various departments
within the VA plays an enormous role in the quality of care
that is delivered to our veterans. Gathering these data points
would allow us to better understand how we can support the VA
and ensuring they provide the high-quality care that veterans
deserve. Do you agree? Or that staffing levels have an
important impact on the. On the outcomes that we expect from
the VA and that our veterans need the VA to produce for them
and their care?
Dr. Shappell. Yes, I do believe that the veterans need the
VA. However, I can assure you that the VA has worked with the
White House and the Office of Personnel Management to exempt
more than 300,000 positions from the hiring freeze and early
retirement incentives or deferred resignation program. We, the
Department, is committed to ensuring that we have the best
employees in place to serve our veterans and the services that
they need.
Mr. Conaway. Thank you, Doctor. Madam Chair, I yield back.
Ms. Miller-Meeks. Thank you, Dr. Coleman. The Chair now
recognizes Representative Luttrell for 5 minutes for any
questions you may have.
Mr. Luttrell. Thank you, Madam Chairwoman. Dr. Shappell,
H.R. 2605, the SAVE Act, I think I heard you say that the
Department of Veterans Affairs does not support a portion of
that because of the given service--it says that the service
dogs do not provide effectiveness for post-traumatic stress
disorder?
Dr. Shappell. Yes.
Mr. Luttrell. I want you to read that statement out of your
notes. Make sure that I heard it right.
Dr. Shappell. The Service Dogs Assisting Veterans Act, or
the SAVES Act, H.R. 2605, requires the VA to establish a pilot
program to provide service dogs for eligible veterans. VA
supports this but recommends clarifying the bill's language for
effective use of funds. We also propose aligning terminology
with existing VA definitions. We do have concerns about
including traumatic brain injury and post-traumatic stress
disorder criteria in the--in the criteria given insufficient
evidence of service dogs' effectiveness.
Mr. Luttrell. Insufficient evidence that service animals
assist veterans with post-traumatic stress disorder. That is
the opinion of the Department of Veterans Affairs?
Dr. Shappell. Yes, and I am going to pass this over to Dr.
Wiechers.
Mr. Luttrell. Have at it.
Dr. Wiechers. All right. Thank you, sir, for the question.
The evidence does not support any----
Mr. Luttrell. What evidence?
Dr. Wiechers. There is a study that was conducted.
Mr. Luttrell. One study. One study.
Dr. Wiechers. That is----
Mr. Luttrell. The VA is basing that claim that you just
threw at me off of one study.
Dr. Wiechers. I would like----
Mr. Luttrell. I would be very careful in the waters that
you are going to swim in with me right now----
Dr. Wiechers. I am, sir.
Mr. Luttrell [continuing]. because I have been studying
this for an extremely long period of time. One thing that I do
know, and I talked to hundreds of veterans that have post-
traumatic stress disorder and post-traumatic stress and
traumatic brain injury with service animals, and they say this
is a life-changing event for them. It is the opinion off of one
study in the Department of Veterans Affairs to say that that is
ineffective?
Dr. Wiechers. We have a method in the existing regulations
that we have around access to service dogs for mental health
mobility dogs for veterans with PTSD and TBI. That is what we
are speaking to.
Mr. Luttrell. You are differentiating between a service
animal and a therapy animal?
Dr. Wiechers. I am speaking to a mental health mobility
dog. Mental health mobility service dog, which can be provided
for patients with PTSD and TBI. It is a--sir, I agree with you.
Mr. Luttrell. In the language----
Dr. Wiechers. I agree with you.
Mr. Luttrell [continuing]. in front of you, I need to add
that subtext in there to make this thing?
Dr. Wiechers. I would like to work with you to make sure we
have language that aligns with the definitions we have that
allow for the access when it is appropriate clinically for
veterans with PTSD or TBI who have a mental health mobility
disability. We have a method we need to align language, sir.
Mr. Luttrell. Well, I can assure you, if it does not happen
today, within the next couple of days, you need to be in my
office and make sure that it is absolutely the way that it
needs to be because this is something I am not walking away
from because I adamantly disagree with what you are saying.
Since you are speaking for the VA, you do not want to go to war
with me over this.
Dr. Wiechers. I do not.
Mr. Luttrell. There is a room full of veterans sitting
behind you that I am sure going to be on my side.
Dr. Wiechers. I understand. I am committed to working with
you and making sure we get the language that works so that we
can ensure access to the service dogs through this pilot
program.
Mr. Luttrell. This is the conversation that most likely
should have happened before you are sitting in front of the
committee in an open hearing.
The VA has expressed concerns that the Fisher House
Availability Act will create an adverse interference that
providing lodging to some service members is prohibited by law.
On what legal authority does VA base its concern? If these
concerns were alleviated, would VA support allowing DoD use of
excess capacity in VA Fisher House residences?
Dr. Shappell. Thank you. Yes, so VA does support this
proposed bill. We would like to work with the committee on some
technical assistance. We do want to support service members and
their beneficiaries.
Mr. Luttrell. Madam Chairwoman, I yield back.
Ms. Miller-Meeks. Thank you, Representative Luttrell. The
Chair now recognizes, again, Dr. Murphy for any questions you
may have. Okay. The chair now recognizes herself for any
questions she may have. They are calling for votes, so I am
going to be very, very brief so we can try to complete this
panel before we recess and then come back for the next panel.
Dr. Shappell, in your testimony, you state that due to the
ambiguity of current law, active-duty service members, and I
think this is getting to the point Mr. Luttrell was making, and
their beneficiaries are being turned away even though the
Fisher House Foundation is willing and able to support them if
there is availability. Can you explain why my bill is necessary
to clarify congressional intent and correct this error?
Dr. Shappell. Currently, the current law does not allow for
TRICARE beneficiaries to stay in the Fisher home. VA does
support this and does want to provide equitable access for our
military families, but we do need to have it codified in law.
Ms. Miller-Meeks. Dr. Shappell, Congress often encounters
difficulty getting timely information on performance outcomes
and spending. I know that the VA spends countless hours
preparing numerous and disparate reports for Congress. Would
the VA support a centralized, publicly accessible data
platform, as Congressman McGuire's bill proposes, to streamline
oversight and increase public trust?
Dr. Shappell. Thank you for your question. I would have to
take that back for the record, ma'am.
Ms. Miller-Meeks. Thank you very much. The other questions
I will have, I will submit for the record in order for time.
There is still 421 votes, so I think we have a few minutes. On
behalf of this subcommittee, I want to thank you for your
testimony and for joining us here today. You are now excused.
We are going to wait a moment for the second panel to come to
the witness table.
Thank you very much. Welcome, everyone, and thank you for
your participation today. The staff and I are watching votes
very carefully. I am hoping to push through to get through at
least one of our testimoneys, and we can at least introduce the
panel.
On our second panel today, we have Dave Coker, President of
the Fisher House Foundation, Randy Johnson, Marine Corps
veteran, member of The Veterans of Foreign Wars of the U.S.
(VFW) Post 3457, and constituent of Representative King-Hinds.
Cole Lyle, Director of the Veterans Affairs and Rehabilitation
Division at the American Legion. John Schmitt, Chief Executive
Officer (CEO) of iExpressGenes. Caira Benson, a caregiver
fellow, testifying on behalf of the Elizabeth Dole Foundation.
Mr. Coker, you are now recognized for 5 minutes.
STATEMENT OF DAVID COKER
Mr. Coker. Thank you, Chairwoman Miller-Meeks, and good
afternoon to the members of the committee. My name is David
Coker, and I have the privilege of serving as President of
Fisher House Foundation.
The Fisher House Program was founded in 1990 by Zachary
Fisher, a private citizen and patriotic philanthropist who
believed that no military family should ever struggle to be by
their loved one's side during a medical crisis. He built the
first Fisher Houses at the National Naval Medical Center and
Walter Reed Army Medical Center. The vision was simple but
powerful: to create a home away from home for families
traveling to be with a loved one receiving care.
The Fisher House program has now grown into a network of
100 Fisher Houses located at Department of Defense hospitals
and VA medical centers across the country and overseas. Because
of the special mission of supporting both military and veteran
families, it is fitting that the 100th Fisher House, to be
dedicated next month, is located at the James A. Lovell Federal
Health Care Center, the only fully integrated DoD and VA
Medical center in the country.
Each home is now built through the generous support of the
American public and donated to the Veterans Affairs or the
military service it serves. To date, Fisher Houses have offered
more than 12 million nights of lodging and saved families more
than $650 million in out-of-pocket costs. When we gift a Fisher
House to the Army, Navy, Air Force, or Veterans Affairs, our
goal is to support these families in their time of greatest
need. We know that having a loved one present improves
recovery. Family members serve as caregivers and advocates and
are a tremendous source of strength. We believe they are
essential to the healing process and that every veteran and
service member deserves to have their loved one by their side.
Of the 100 Fisher Houses, more than half support VA medical
centers. In 2024, the VA Fisher Houses served more than 24,000
veteran families spanning all eras and generations.
Last fall, guidance was published which changed the way VA
Houses operate. It directed that only families of veterans
receiving VA-directed care were eligible for the support Fisher
Houses provide. Even when rooms are available, families that
have historically been welcomed must now be turned away. Last
year, the occupancy rate at the VA Fisher Houses across the
country was 53 percent. We would ask that if a room was
available, consideration should be given to support the family
of an eligible DoD beneficiary.
The Fisher House supporting the Washington DC VA Medical
Center is on the same campus as the Children's National
Hospital, the National Rehabilitation Hospital, and the
Washington Hospital Center. Last year, occupancy at that house
was 22 percent and could have easily accommodated families
receiving care at one of those facilities.
The world-renowned Paley Orthopedic and Spine Institute is
located near the Fisher House, supporting the Thomas H. Corey
VA Medical Center in West Palm Beach, Florida. 27 military
children were referred to them for life-changing care last
year. Today, their families are no longer eligible to stay in
the Fisher House.
There are three Fisher Houses at the DeBakey VA Medical
Center in Houston, adjacent to the Texas Medical Center and MD
Anderson. Last year, the occupancy rate was 63 percent. Again,
because of this guidance, military families will be turned
away.
The bipartisan Fisher House Availability Act of 2025 would
restore the flexibility that the VA Fisher House Managers once
had, allowing the families of active-duty service members and
other eligible beneficiaries to stay on a space-available basis
while preserving the priority access for veterans. This change
will not reduce access for veterans. It simply allows these
homes already built, already staffed, and already serving, to
do what they were intended to do: keep families of our Nation's
heroes together in the hardest moments of their lives.
This bill is consistent with the Memorandum of
Understanding between the Secretary of Defense and Secretary of
Veterans Affairs titled, Strengthening Our Partnership and
Service to Those Who We Serve, and it will provide one more way
for the two departments to work together to support both the
military and veterans' communities.
On behalf of the Fisher House Foundation and the tens of
thousands of families we have the privilege of serving each
year, I want to thank the sponsors of this bill and all of you
for your support of our Nation's service members, veterans, and
their loved ones. Thank you for the opportunity to speak today.
I welcome any questions.
[The Prepared Statement Of David Coker Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Mr. Coker. Mr. Johnson, you
are now recognized for 5 minutes.
STATEMENT OF RANDY JOHNSON
Mr. Johnson. Thank you. Chairwoman Miller-Meeks, Ranking
Member Brownley, and members of this committee. My name is
Randy Johnson. I am a resident of the Northern Mariana Islands,
a veteran of the United States Marine Corps. For the past
decade, I have had the privilege of assisting fellow veterans
in the Northern Marianas, helping them navigate the VA system
and access the benefits they earn through their service. I have
traveled nearly 8,000 miles to be here today to speak in
support of H.R. 3400, The Territorial Response and Access to
Veterans' Essential Lifecare, known as the TRAVEL Act,
introduced by our delegate, Congresswoman Kimberlyn King-Hinds.
This is a good bill.
In the Northern Marianas, we do not have a VA medical
center. We do not have consistent access to specialty care or
mental health services. When veterans need more than basic
care, we are often told to leave the island, traveling
thousands of miles, paying out of pocket, and spending weeks
away from our families. The TRAVEL Act helps to change that. It
allows the Department of Veterans Affairs to send traveling VA
physicians into remote communities like ours. Instead of
forcing the veteran to chase care across oceans, this bill
brings care to the veteran. That is the right direction.
I am here to voice my support for the TRAVEL Act, but I
also came this distance to give voice to the hundreds of
veterans who could not be here. Veterans who serve this country
with honor, who, like me, are not asking for special treatment.
We are asking for what we would have received if we lived
anywhere else in the United States.
We are the only place in the Nation where a veteran can
call home but have no access to community-based outpatient
clinicians (CBOC). No CBOC at all. Veterans from every
conflict, past and present, have been told that if they want
the full range of care they have earned, they cannot live at
home. Veterans seeking care at home see one doctor on Tuesdays
and Thursdays. Dr. Ada has done a great job, but only--but
there is only one such--only so much one person can do. Her
office has one VA registered nurse, a veteran herself, but if
she needs care or takes a much-needed vacation, there is no one
left to keep pace.
Decisions on care, travel, and benefits happen in Guam or
Hawaii. Resources come from Guam or Hawaii. When those places
are struggling or overloaded, we cannot reasonably expect them
to prioritize our needs.
What we want, and what I believe we have earned, is the
right to live in the country that we fought for, in the
community we fought for, and to have our services speak for
itself. We should not have to choose between access to care and
being with home with our families. We stood the watch. We
answered the call. That should be enough.
I served in Iraq. I saw combat. I received a Purple Heart
for it. I traveled here by choice. Many veterans are forced to
travel simply to receive the care they need. That should not be
the case.
In the Northern Marianas, I have served alongside and
advocated for generations of veterans, those who fought in
Vietnam, Panama, Iraq, and Afghanistan. All of them returned
home to a system still not built to meet their needs.
As I made my way here, I thought the--thought of the
Vietnam veterans in their 70's and 80's who served our Nation
even before our islands were formally part of this country.
They have spent a lifetime fighting for benefits that only
trickled in slowly over decades. Now, even in their later
years, they are still being asked to travel off island for
basic, sometimes life-sustaining care. I think of how difficult
this travel is for them. I thought of the Gulf War veterans who
opened a new chapter in America's military history but returned
to the same old gaps in care and support. I thought of my
generation, those who served in Operation Iraqi Freedom and
Enduring Freedom. We served with commitment. We returned home
with hope. We still face the same cycle of delay, denial, and
distance.
Of this generation of new veterans, I am proud to be part
of a group that is organizing to support one another directly.
Project Buddy Check 670 is an example of that effort. It
reflects our belief that care for veterans does not always come
in the form of a pill or prescription, but sometimes it comes
from another veteran picking up the phone, checking in, and
listening. Project Buddy Check is a reminder that veterans
seeking care that treats us as people, not just patients. When
even ordinary care is far to reach, how can we expect a system
to provide the mental health and holistic support for our
veterans who truly need?
Generations of veterans have answered the call from our
islands. I know the challenges we face are difficult to
address, but again, we stood the watch. We bore the burden.
That should be enough. It is time the system answered back.
H.R. 3400 is a strong start. I respectfully ask this
committee to support it and continue advancing policies that
bring real access, real dignity to every veteran, no matter
where they live. Thank you for your time and for your
unwavering commitment to those who serve.
[The Prepared Statement Of Randy Johnson Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Mr. Johnson, and thank you for
your long duration of travel to get here. Mr. Lyle, you are now
recognized for 5 minutes.
Mr. Luttrell. Madam Chairwoman, they called votes. I do not
know if you, just----
Ms. Miller-Meeks. Yes, sir. There is 327 people left to
vote.
Mr. Luttrell. I have never missed a vote time.
Ms. Miller-Meeks. Sir, you may be excused if you want to be
excused. I am sorry. Mr. Lyle.
STATEMENT OF COLE LYLE
Mr. Lyle. Well, thank you, Chairwoman Miller-Meeks, Ranking
Member Brownley, distinguished members of the subcommittee, on
behalf of National Commander James A. LaCoursiere Jr., and the
1.5 million dues-paying members of the American Legion, thank
you for the opportunity to testify today discussing pending
legislation that directly impacts the lives and well-being of
American veterans.
Today, the American Legion supports nearly all the bills
under consideration because they reflect a bipartisan
commitment to improving mental health outcomes, suicide
prevention, addressing provider shortages, and safeguarding the
dignity of those who have worn the uniform.
First, H.R. 785, the Representing Our Seniors at VA Act.
This bill appropriately recognizes the vital role that State
veterans homes play in long-term care. As the average age of
our veteran population reaches 75 this year, this legislation
would add a representative from the National Association of
State Veterans Homes (NASVH) to the Geriatrics and Gerontology
Advisory Committee. With over 169 homes now operating under
NASVH, this change is both timely and necessary.
Second, the VA Data and Transparency and Trust Act is a
good step toward improving VA reporting on health care and
benefits. By expanding access to underlying data and requiring
disaggregation by gender, age, geography, and condition, this
legislation enhances oversight, fosters collaboration, and
enables evidence-based improvements in care delivery. We
support the bill with amendments to clarify definitions like
``reliance'' on VA care and minimize administrative burden
while urging the inclusion of data on caregivers, survivors,
and emerging chronic conditions.
We also offer strong support for H.R. 3400, the TRAVEL Act,
which would authorize temporary VA physician assignments to
U.S. territories like Puerto Rico and Guam. With physician
shortages reaching crisis levels in these areas, this
legislation brings us closer to healthcare equity for veterans,
no matter where they live.
Further, we commend the draft legislation directing VA to
study RNA sequencing as a diagnostic tool for post-traumatic
stress. While this technology should never be used as the sole
basis for compensation decisions, it holds promise for
advancing diagnostic precision and developing targeted
therapies. We must embrace science without losing sight of the
holistic nature of invisible wounds.
Workforce development also remains a priority. That is why
we support the bill establishing employment timeframes for
Health Professional Scholarship Program participants, a
commonsense measure to address critical shortages and ensure VA
retains its pipeline of trained professionals.
On caregiver support, H.R. 2148 expands transitional health
care and provides stipends for career re-licensure, recognizing
the sacrifices caregivers make. These steps help veterans
remain in-home settings at a fraction of the cost of
institutional care and ensure caregivers can reenter the
workforce with dignity and purpose.
Finally, H.R. 2605, the SAVES Act, would establish a grant
program to expand access to service dogs through accredited
nonprofits. VA's own research continues to confirm that
veterans paired with service dogs experience reduced post-
traumatic stress symptoms, decreased suicidal ideation, and
improved quality of life. The VA itself offered a FOX Grant to
a service dog organization.
Anyone who owns a dog will tell you they can be
therapeutic. You do not need research. When fingers meet fur,
magic happens. I know from personal experience, having
previously benefited from a service dog named Kaya (phonetic),
the profound power a specially trained dog can have in a
veteran's life. This is why I helped author the original PAWS
Act of 2016, and Kaya and I spent years advocating for its
passage before she passed. The compromised version passed in
2021. The SAVES Act builds on this effort and more closely
aligns to the text of the original PAWS Act than the
compromised version that ultimately passed.
I cannot overstate the power passage and implementation of
this bill would have on veteran suicide prevention and improved
mental health outcomes. Because of Kaya, I earned a bachelor's
and a master's degree. I have a beautiful 2-year-old son. I sit
here today, as a veteran advocate in the largest division for
the largest veterans service organization in the country
because of my service dog.
Chairwoman Miller-Meeks, Ranking Member Brownley, thank you
for the opportunity to testify, and I stand ready to answer
your questions.
[The Prepared Statement Of Cole Lyle Appears In The
Appendix]
Ms. Miller-Meeks. Thank you very much, Mr. Lyle. My
apologies to the witnesses and those who are here. Due to the
vote that has already been called in the House, the
subcommittee will stand in recess subject to the call of the
chair. I expect to reconvene 10 minutes after the start of the
last vote. There are 5 votes.
[Recess]
Ms. Miller-Meeks. Welcome back. I am sorry. Mr. Schmitt.
STATEMENT OF JOHN SCHMITT
Mr. Schmitt. Good afternoon, Chairwoman Miller-Meeks and
Ranking Member Brownley and members of the subcommittee. Thank
you for the opportunity to testify today.
I want to begin not with the science, but with the
intention behind the science. Because when it comes to the
lives of veterans, as one myself, I believe that intention
matters.
In 2010, the founder of iXpressGenes, Dr. Joe Ng, molecular
biologist and professor at the University of Alabama,
Huntsville, was at a routine faculty meeting. Tragedy struck
when a colleague pulled a handgun out of her purse and murdered
three people in front of him. Joe fortunately survived, but in
the aftermath, he watched this spectrum of resilience occur
among his peers. Joe asked the question that would change
everything, could trauma have an immunological component? That
question set us on a path to transform trauma care forever.
I met Dr. Ng in 2018. I am John Schmitt. I am a CEO of
iXpressGenes and a two tour Iraq combat veteran, having served
over 20 years in the Army. When Joe and I crossed paths, I was
still in uniform. I was trapped in a culture of silence. Like
many of my peers and contemporaries, because of the risk to my
career, I could not admit I was unraveling, depressed, anxious,
and increasingly suicidal. That journey for me has turned into
a mission. Today I testify not just as a veteran and a CEO, but
as a survivor advocating for the science to help me heal, and I
hope will help millions of others.
While in uniform, I earned a degree in microbiology and
immunology from Vanderbilt University School of Medicine. It
was a fateful step, one that quietly equipped me to understand
the science and the application of the technology that I stand
before you advocating for.
Together, our team at iXpressGenes has developed
groundbreaking blood tests using the power of RNA transcriptome
analysis, the Trauma Autoimmune Indicator, or TAI as we call
it. It identifies inflammation caused by trauma, detectable
before symptoms even surface, to empower prevention, enable
early intervention, and inform effective treatments for best
possible outcomes.
The TAI test reads RNA transcription, how the body's genes
are responding right now in real time, creating potential for
limitless therapeutic strategies never before possible. Unlike
genetics, which only tell us what might happen, RNA tells us
what is happening and this matters. This matters because it is
the kind of inflammation that we detect, is the root cause for
the oxidative stress and the neuroinflammation that crosses the
blood-brain barrier and contributes to the anxiety, depression,
and other hallmarks of PTSD. This lab developed test is already
available commercially through our lab in Huntsville, Alabama.
It is low cost, it is scalable, and it is incredibly precise.
With the VA, we are not starting from scratch. With our
partnerships at VA Birmingham over the last 2 years, we have
already demonstrated powerful results. In fact, as our key
clinical research collaborators put it, ``Its high sensitivity,
specificity, and translational relevance position it as an
exceptional tool for clinical use. Given the clarity and
consistency of the data it provides, I strongly advocate for
its broader adoption and urge that it be rapidly prioritized
for clinical validation to support improved patient outcomes.''
PTSD and trauma-related illness have long been treated
based on symptoms and subjective reporting. Now with RNA
transcriptome analysis, we can assess it objectively for the
first time, offering a novel approach for diagnosing, treating,
and even preventing trauma-induced disease.
Today there is a promising patchwork of powerful therapies:
mindfulness, contrast therapy, Eye Movement Desensitization and
Reprocessing (EMDR), neurofeedback, ketamine-assisted
psychotherapy, and even psychedelics. It is a choose-your-own
adventure landscape for our veterans because we have lacked an
objective compass. TAI is that objective compass and we can use
it to validate the effectiveness of all of these modalities and
track clinical progress in real time. We are not starting from
scratch here either. We have already partnered with
groundbreaking technology companies using hyperbaric oxygen to
virtual reality with exceptionally promising early results.
The VA has long pioneered technologies that went on to
change the world. Let this be the next chapter, ushering in a
new standard of precision mental health that is proactive, data
driven, and lifesaving. iXpressGenes is a company born out of
tragedy, led by those who have lived the realities of trauma
and built for a world finally ready to confront it. Let us lead
the transformation of trauma care. Our veterans deserve it, and
so does every other American still waiting for their suffering
to be seen, understood, and treated with precision. The
opportunity is massive and, as you know, the need is urgent and
only growing. Now the science is ready. Let us transform trauma
care together forever.
Thank you for your time and I welcome your questions.
[The Prepared Statement Of John Schmitt Appears In The
Appendix]
Ms. KING-HINDS. [Presiding.] Thank you, Mr. Schmitt. I now
recognize Ms. Benson for 5 minutes.
STATEMENT OF CAIRA BENSON
Ms. Benson. Members of the committee, thank you for
inviting me to testify today. As the wife and caregiver of a
severely injured and ill combat veteran, it is my honor to
speak to some proposed legislation that could lessen the burden
of each of our caregiving families face every day. I care for
my husband Eric, who deployed twice to Iraq as a combat
engineer. My husband suffered multiple traumatic brain injuries
during his years in service and is considered by VA to be
permanently and totally disabled and unable to work. He is
wheelchair-dependent, struggles cognitively, suffers from
migraines and blackouts, and is visually impaired.
I am also mom to five amazing kids, three of whom have
needed specialized care over the years. The day my husband was
awarded permanent and total status, my children and I became
eligible for CHAMPVA. I breathed a sigh of relief knowing that
we, too, would have appropriate healthcare.
In 2021, one of my children began attending college and
needed monthly medications. We mailed the required
certification paperwork, but when we went to fill the
prescriptions, we found CHAMPVA was inactive. I called, sat on
hold for 4 hours, and learned CHAMPVA's central mail facility
was 6 months behind on opening mail. Horrifyingly, CHAMPVA
began requiring semester certifications in 2023 with no option
to expedite activation for medical best interest.
Since 2023, my child has suffered from lapsed coverage
between semesters due to the certification process in CHAMPVA's
archaic mail system. Winter and summer break became a mix of
timing medication pickups prior to coverage loss, and paying
out of pocket for any therapies or doctors' visits. This
outdated system ensured my child was without insurance from
November 2024 to May 2025. Caregivers need CHAMPVA fixed
beginning with ensuring our children who have already given up
so much do not have to worry over the loss of coverage upon
their 18th birthday or due to an archaic certification process.
H.R. 1404, the CHAMPVA Children's Care Protection Act,
would allow coverage until age 26, eliminating these egregious
situations. It would align coverage with civilian insurers and
the age at which dependents must begin to use their VA Chapter
35 education benefits. It also recognizes the true nature and
sacrifice of youth caregivers by allowing them to support the
need--or support their needs as they transition from caregiving
into adulthood.
I understand at VA's recent testimony VA indicated they
oppose this bill due to the nature of CHAMPVA, arguing that it
is a medical service and not an insurance product. CHAMPVA
provides explanation of benefits, approves or denies diagnostic
and medical treatment codes, and remits payment for enrollees
to providers for services. CHAMPVA even has out-of-pocket
maximums, deductibles, co-pays, and a medication formulary with
tiered pricing.
Every year, enrollees receive a 1095B attesting to the fact
that CHAMPVA counts as minimum essential coverage under the
Affordable Care Act. I admit I am a layperson, but this feels
like every other insurance product I have ever received through
an employer. While I am here to support extending CHAMPVA
coverage to age 26, I implore this committee to use its
oversight authority to improve the system itself so our
families can use it to find appropriate care. To help you
understand the challenges, let me explain what using CHAMPVA is
like.
In 2019, one of our children was hospitalized and needed a
residential facility. I was told to find a facility that would
take CHAMPVA without the guidance of a provider network. I
called over 20 facilities that were TRICARE approved to see if
they had a bed available or could add my child to their wait
list. All but one turned me down immediately. The reason? Prior
authorization under CHAMPVA since January of that year was
taking upward of 6 to 9 months. The one residential facility
that did agree to treat our child had a stipulation. We were to
sign $110,000 promissory note upon admission and the chance
CHAMPVA refused authorization and payment.
Another of my children needed specialized therapy which was
completed in 2021. In 2023, the provider called me to let me
know they had finally received payment from CHAMPVA, almost 27
months later. Unlike its TRICARE counterpart, CHAMPVA has no
contracted network of providers and no published fee schedule.
CHAMPVA processes the majority of provider and enrollee claims
using a single traditional mail center, lengthening the time
between claim submission, processing, and reimbursement.
Filing and retaining providers willing to file it in my
area--I am sorry, filing and retaining pay for services has
become so cumbersome that the number of providers willing to
file it in my area dropped to two practices, neither containing
a pediatrician.
Once again, I am paying out of pocket for basic routine and
pediatric care. I have stopped filing for reimbursement myself
due to the burden of the process. It is one more bureaucratic
fight caregivers like me do not need. Yet I know another fight
looms on the horizon.
Not long ago, I firmly realized, like so many other
caregivers, I would likely become a survivor. Having given over
a decade to being a caregiver, I was situated to outlive my
veteran with no retirement, no active work credits, and almost
no life insurance for my family's financial security. I am not
alone. Mozella Richardson Kamara, a 2025 Dole caregiver fellow
from Delaware, studied for many years to become a civil
engineer, but left her job to care for her veteran husband.
Like myself, Mozella made this choice to ensure immediate well-
being of her husband and sacrifice their own long-term
professional goals and retirement potential for the benefit of
the veteran.
According to a recent Research and Development (RAND)
report, military connected caregivers saved this Nation in
healthcare costs by providing a minimum of $119 billion in
unpaid care. In exchange, we face this harsh reality: when our
caregiving ends, many of us will be financially destitute.
Caregivers like Mozella and me, we need you to pass H.R. 2148,
the Veteran Caregiver Reeducation, Reemployment, and Retirement
Act. This bill will not fix the entirety of the problem, but it
is a valuable first step in ensuring caregivers can begin to
plan for retirement and establish safety nets of their own.
More immediately, it will provide caregivers financial security
by allowing for reentry--work reentry programs and paying for
relicensure in careers like teaching and engineering.
Again, I am honored to be here at the request of the
Committee and the Elizabeth Dole Foundation. To truly support
the veteran, we must support the caregivers, survivors, and
families who bear the burden of the war that continues to rage
at home.
I thank you for your time and attention and I look forward
to your questions.
[The Prepared Statement Of Caira Benson Appears In The
Appendix]
Ms. King-Hinds. Thank you very much, Ms. Benson. Thank you
to all of you for your very insightful testimony.
I now recognize Ranking Member Brownley for 5 minutes.
Ms. Brownley. Thank you, Madam Chair.
Ms. Benson, thank you for being here. I think you and I
think alike when it comes to the CHAMPVA bill and you certainly
have my commitment to continue to work hard on this. You know,
I introduced this back in 2019, so it has been something that I
have been trying to work on for a long time. I can tell you
before I even got to Congress there were a couple of members
who have carried this bill. For a very long time we have been
trying to fight for some kind of parity and healthcare. We will
continue that fight.
I agree with you that we need more committee oversight of
the program. Again, I commit to you to make sure that that
happens. Hopefully, you can join us again in another hearing
and I certainly would encourage Dr. Miller-Meeks to help me in
that process. I think we should try very hard to encourage the
VA Office of Inspector General and the Government
Accountability Office to assist us in this effort to drill
down.
About 18 months ago, VA's Office of Integrated Veteran Care
began an initiative to modernize what it calls the Family
Member Programs, which included CHAMPVA. You are smiling. They
planned to implement additional Information Technology (IT)
systems to administer the program and move away from a paper-
based process. Have you noticed any improvements in the last 18
months as far as hold times when you call the CHAMPVA call
center or processing times when you submit paperwork?
Ms. Benson. I want to thank you for your commitment and the
question. I actually called this morning and when I called at
opening, the hold time was an hour and a half, which is not
bad. They did now offer----
Ms. Brownley. Which is not bad?
Ms. Benson. I am used to 4 to 6 hours with CHAMPVA. They
did offer callback service now, which was new. I called May 21.
I was here in town and spoke with another caregiver who was
having similar recertification issues and she was able to get
through. They told her they were opening mail from January.
Ms. Brownley. Tell me about the paper process.
Ms. Benson. The paper process, I understand that there is--
I actually just spoke with another caregiver whose wife is
pregnant and diabetic. They are trying--well, I am sorry, the
veteran, his wife is pregnant, diabetic. They are trying to get
her CHAMPVA turned on. They went to go submit through the
online portal, which is down. There is a fax number which has
been disconnected.
Ms. Brownley. A fax number?
Ms. Benson. Yes, ma'am, a fax number. That was the
expedition process that we had always used in the past.
Ms. Brownley. I have not seen a fax machine in a long time.
I guess I should go over to the VA perhaps to see one.
Ms. Benson. Yes. I can tell you that the way we were able
to turn on my daughter's insurance was that I called, I
instituted a VHA executive inquiry. That executive inquiry
allowed us to upload the documentation and bypass the mail
system. The ability to turn it on once that is uploaded is
instantaneous.
Ms. Brownley. Is what?
Ms. Benson. Instantaneous.
Ms. Brownley. Instantaneous.
Ms. Benson. I do not understand why we are on a mail paper
system when no other provider, including other government
medical benefits are. That is the best answer I have is that,
no, I have not seen an improvement at all.
Ms. Brownley. I had a feeling that that was going to be
your answer, but I wanted it for the record, so thank you for
that. You know, in addition to the Children's Care Protection
Act, what should we prioritize in terms of oversight or
legislation to improve the CHAMPVA program for your family and
for other families?
Ms. Benson. My belief is, again, wonderful question, my
belief is the statute is outdated.
Ms. Brownley. Yes.
Ms. Benson. The statute is very outdated. We have been a
very small constituency, 737,000, of those only about 408,000,
according to the congressional Report that was done in October
of last year, are actually users. We have to at least bring it
up to the standard that is TRICARE, who has a contract, who has
providers. It is impossible for me to go to a provider and say,
you may or may not be paid Medicaid rates. Would you please
accept this? The only mandated acceptors are hospitals and
urgent cares.
Ms. Brownley. Hospitals and what?
Ms. Benson. Urgent cares.
Ms. Brownley. Oh, and urgent cares.
Ms. Benson. To the VA's point today that they are worried
that the money that this would cost would take away from
healthcare of the veteran, I argue we are healthcare. Every
caregiver, every youth caregiver, we provide billions in
healthcare for our veterans. We save lives every day. We are
the front lines. We are providing that. In exchange, we are
left without our own care for ourselves because caregiving is
stressful and destroys our own health. Our children, who are
higher special needs rates, are left without coverage and it is
impossible to find coverage. We are, as you said earlier, we
are so behind even TRICARE, and it is egregious.
Ms. Brownley. It is egregious. I agree with you.
My time is up. I also hope that the VA begins the process
of instituting the Elizabeth Dole Bill, because that, too--
well, I should not say that, too, but that will be helpful and
supportive of you as a caregiver to your husband and certainly
to your children as well. I really enjoyed working with the
Elizabeth Dole Foundation to have that section in the bill that
takes care of our caregivers.
Thank you for your husband's service. Thank you for your
service and helping him.
With that, I yield back.
Ms. Miller-Meeks. [Presiding.] Thank you, Ranking Member
Brown.
The chair now recognizes Representative King-Hinds for any
questions you may have.
Ms. King-Hinds. First of all, I want to say thank you to
each and every one of you for coming here and providing your
testimony and sharing your insights with regards to different
legislations that are before us. Time is money and traveling is
very costly, so I definitely appreciate it.
I want to start off first by saying thank you to TSL
Foundation for supporting my very own constituent, Mr. Randy
Johnson, who has made the 8,000-mile trek here to Washington,
DC, to amplify the voices of the veterans across the territory,
specifically the Commonwealth of the Northern Mariana Islands.
I want to focus my questions today to further flesh out some of
the challenges that the veterans in the CNMI face by asking a
couple of questions to Mr. Johnson.
Just for the record, prior to a few--up to about 3 months
ago, you were employed by the district office by my predecessor
and then the first couple months during my tenure serving as a
community caseworker, basically serving our veterans. In your
experience there, what are the three areas of concerns that are
frequently raised by the vets who come and seek help at the
office?
Mr. Johnson. Thank you for your questions. The veterans
seek travel. They have difficulty with travel, mainly, to their
appointments. A lot of times the veterans have to pay out of
pocket. The veteran from Tinian and Rota traveling to Saipan
have to pay out of pocket to travel to go see the VA doctor on
Saipan. If they have to get further care, they have to go
through BeniTravel, which is on Guam, and a lot of times
BeniTravel will not issue the tickets immediately for them and
sometimes it may take up to a couple of days, right, even
before their appointment schedule. At that point, sometimes the
veteran is stressed and was worried if they have to cancel or
postpone their appointments and seek alternative care or
alternative means by either fundraising for the necessary funds
to travel or taking up personal loans. A lot of veterans on
those islands are on fixed incomes and so filing for
reimbursement with the VA sometimes can be difficult.
I know a lot of our veterans are old school, so they would
rather talk to somebody in person. Communicating with the VA is
difficult on Guam because they are also working with their VA
veterans on Guam. Our veterans are stuck with having to wait on
calls sometimes or not get through and that poses a difficult
challenge for them as well.
Ms. King-Hinds. All right. Tell us just a little bit, just
so that the committee has an idea, what the cost of travel is
for vets, for example, from Rota or Tinian----
Mr. Johnson. Yes. The travel----
Ms. King-Hinds [continuing]. and what all that entails.
Mr. Johnson. Yes. The travel between the interislands can
run up a couple hundred dollars round trip, and that is just
the veteran him-or herself. Oftentimes veterans are
uncomfortable traveling by themselves so they would pay for
their spouse or caregiver and that comes out of pocket, and
then they would have to file for reimbursement. Fortunately, I
have not heard of delay in that reimbursement. I would have to
assume that there has been delays because that was an issue
during my employment during my--the last delegate-under
Delegate Sablan. That was something that we had tried to close
gaps with the reimbursement because a lot of these veterans do
not just have a single appointment on Guam or Hawaii, they have
multiple appointments. While they are waiting for the
reimbursement, they have to push back their next appointment at
times.
Ms. King-Hinds. In terms of specialized care, what are the
areas of needs do you foresee being something that will fulfill
some of the medical requirements that are needed on the ground?
Mr. Johnson. Yes. The one thing that been highlighted
during discussions recently is the chiropractic care. I do know
some veterans that do travel to Guam for chiropractic care,
including myself in the past. Those tickets can, round trip,
run between $300 to $580 through United Airlines and that is
just the airline itself. Then, also, you are considering the
overnight stay because there is only one flight leaving to Guam
daily. Those can add up significantly for a veteran.
Ms. King-Hinds. All right, thank you.
I yield back the balance of my time. Thank you, Chair.
Ms. Miller-Meeks. Thank you, Representative King-Hinds.
I now recognize myself for 5 minutes for questions.
Mr. Lyle, can you share with us how veterans around the
country would benefit from Congressman Luttrell's SAVES Act?
Mr. Lyle. Thank you for the question, Chairwoman Miller-
Meeks. Obviously, in my opening statement, I testified that I
have a large, extensive personal experience with this as an end
user of a service dog.
As somebody who has advocated and heard from other veterans
for years, you know, I think there is a misconception that
service dogs, at least at the VA, service dogs should be viewed
simply as clinical tools. I think they also serve as a powerful
backstop to veteran suicide because when you are in that point,
that critical crisis point, you feel unloved, you feel alone,
and you look down at the dog and you say, I cannot leave the
dog, and the dog would miss me. Right? It provides a sense of
purpose that pills and therapy simply just will not ever do.
I was a little upset to hear the study that the VA cited,
which I am very familiar with. The study, in my mind, was set
up to fail because the control group was emotional support
animals, not somebody that did not have a service dog
altogether. The study, even though I feel it was set up to
fail, still showed positive results for reduced post-traumatic
stress symptoms, depression, anxiety, any number of different
things.
In my long history of advocating for this, the amount of
veterans that have reached out to me and said, you know, I saw
your story and it prompted me to get my own dog, and if I had
not had the dog, I would have killed myself, is just super
powerful testimony to that end.
Ms. Miller-Meeks. Thank you. Mr. Coker, would you mind
sharing firsthand accounts of servicemembers and their
families' inability to access your facilities due to the
current policy and how my legislation would help prevent this
from occurring again?
Mr. Coker. You know, the VA medical centers have such a
tremendous affiliation with academic medical centers, and so
often we believe that both within the DOD health system and VA
health system, you have world-class healthcare. Sometimes the
treatments need to be so specialized, and when you do not have
a safe, comfortable environment for your family to be there,
you worry about do I max out the credit cards? Or you decide I
am going to accept what time I have left, and I will just
forego treatment so that we can be together. That is not a
decision that a military member should have to make.
Ms. Miller-Meeks. Thank you very much. Ranking Member
Brownley, would you like to make any closing remarks?
Ms. Brownley. I have no closing remarks, but I thank you
for bringing the witnesses here today and reviewing all of
these bills and look forward to continuing to mark them up and
move them forward.
Ms. Miller-Meeks. I want to also thank our witnesses and
then again apologize for the 90-minute delay on recess as we
had to go vote.
On behalf of the subcommittee, I want to again thank all of
you, the witnesses and the members, for being here today. I
look forward to working with you and the Ranking Member to
address the issues facing our veterans.
The complete written statements of today's witnesses will
be entered into the hearing record. I ask unanimous consent
that all members have 5 legislative days to revise and extend
their remarks and include extraneous material.
Hearing no objection, so ordered.
This hearing is now adjourned.
[Whereupon, at 4:44 p.m., the subcommittee was adjourned.]
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A P P E N D I X
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Prepared Statements of Witnesses
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Prepared Statement of Antoinette Shappell
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of David Coker
Thank you, Chairwoman Miller-Meeks, and good afternoon to the
members of the Committee.
My name is David Coker, and I have the privilege of serving as
President of Fisher House Foundation.
The Fisher House program was founded in 1990 by Zachary Fisher, a
private citizen and patriotic philanthropist who believed that no
military family should ever struggle to be by their loved one's side
during a medical crisis. He built the first Fisher Houses at the
National Naval Medical Center and Walter Reed Army Medical Center. The
vision was simple but powerful: to create a home away from home for
families traveling to be with a loved one receiving care.
The Fisher House program has now grown into a network of 100 Fisher
Houses located at Department of Defense hospitals and VA medical
centers across the country and overseas. Because of the special mission
of supporting both military and veteran families, it is fitting that
the 100th Fisher House, to be dedicated next month, is located at the
Captain James A. Lovell Federal Health Care Center--the only fully
integrated DoD and VA medical center in the country.
Each home is now built through the generous support of the American
public and donated to the VA or the military service it serves. To
date, Fisher Houses have offered more than 12 million nights of lodging
and saved families more than $650 million in out-of-pocket costs.
When we gift a Fisher House to the Army, Navy, Air Force, or VA,
our goal is to support families in their time of greatest need. We know
that having a loved one present improves recovery. Family members serve
as caregivers, advocates, and a tremendous source of strength. We
believe they are essential to the healing process--and that every
veteran and service member deserves to have their loved one at their
side.
Of the 100 Fisher Houses, more than half support VA medical
centers. In 2024, VA Fisher Houses served more than 24,000 veteran
families--spanning all eras and every generation.
Last fall, guidance was published which changed the way VA houses
operate. It directed that only families of veterans receiving VA-
directed care were eligible for the support Fisher Houses provide. Even
when rooms are available, families that have historically been welcomed
must now be turned away.
Last year, the occupancy rate at VA Fisher Houses across the
country was 53 percent. We would ask if a room was available;
consideration should be given to support the family of an eligible DoD
beneficiary.
The Fisher House supporting the Washington DC VA Medical Center is
on the same campus as the Children's National Hospital, the National
Rehabilitation Hospital, and Washington Hospital Center. Last year,
occupancy at that house was 22 percent and could easily accommodate
families receiving care at one of the other hospitals.
The world-renowned Paley Orthopedic and Spine Institute is located
near the Fisher House supporting the Thomas H. Corey VA Medical Center
in West Palm Beach, Florida. 27 military children were referred to them
for life-changing care last year, but today their families are no
longer eligible to stay in the Fisher House.
There are three Fisher Houses at the DeBakey VA Medical Center in
Houston, Texas adjacent to the Texas Medical Center and MD Anderson.
Last year, the occupancy rate was 63 percent, and again, because of
this guidance, military families will be turned away.
The bipartisan Fisher House Availability Act of 2025 would restore
the flexibility that VA Fisher House managers once had, allowing
families of active-duty service members and other eligible
beneficiaries to stay on a space-available basis, while preserving the
priority access for veterans.
This change will not reduce access for veterans. It simply allows
these homes--already built, already staffed, already serving--to do
what they were intended to do: keep families of our Nation's heroes
together in the hardest moments of their lives.
This bill is consistent with the Memorandum of Understanding
between the Secretary of Defense and the Secretary of the VA--
Strengthening our Partnership in Service to those we Serve, and it will
provide one more way for the two departments to work together to
support both the military and the veteran communities.
On behalf of Fisher House Foundation and the tens of thousands of
families we have the privilege of serving each year, I want to thank
the sponsors of this bill and all of you for your support for our
Nation's service members, veterans, and their loved ones. Thank you for
the opportunity to speak today. I welcome your questions.
Prepared Statement of Randy Johnson
Thank you, Chairman Bost, Ranking Member Takano, and members of
this Committee.
My name is Randy Johnson. I am a resident of the Northern Mariana
Islands, a veteran of the United States Marine Corps, and for the past
decade I have had the privilege of assisting fellow veterans in the
Northern Marianas, helping them navigate the VA system, and access the
benefits they earned through their service.
I have traveled nearly 8,000 miles to be here today to speak in
support of H.R. 3400, the Territorial Response and Access to Veterans'
Essential Lifecare Act, known as the TRAVEL Act, introduced by our
delegate, Congresswoman Kimberlyn King-Hinds.
This is a good bill. In the Northern Marianas, we do not have a VA
medical center. We do not have consistent access to specialty care or
mental health services. When veterans need more than basic care, we are
often told to leave the island, traveling thousands of miles, paying
out of pocket, and spending weeks away from our families.
The TRAVEL Act helps to change that. It allows the Department of
Veterans Affairs to send traveling VA physicians into remote
communities like ours. Instead of forcing the veteran to chase care
across oceans, this bill brings care to the veteran. That is the right
direction.
I am here to voice my support for the TRAVEL Act. But I also came
this distance to give voice to the hundreds of veterans who could not
be here. Veterans who served this country with honor, who, like me, are
not asking for special treatment. We are asking for what we would
receive if we lived anywhere else in the United States.
We are the only place in the Nation where a veteran can call home
but have no access to a Community Based Outpatient Clinic. No CBOC at
all. Veterans from every conflict, past and present, have been told
that if they want the full range of care they have earned, they cannot
live at home.
Veterans seeking care at home see one doctor, on Tuesdays and
Thursdays. Dr. Ada has done a good job, but there is only so much one
person can do. Her office has one VA Registered Nurse, a veteran
herself. But if she needs care, or takes a much-needed vacation, there
is no one left to keep pace.
Decisions on care, travel, and benefits happen in Guam or Hawaii.
Resources come from Guam or Hawaii. And when those places are
struggling or overloaded, we cannot reasonably expect them to
prioritize our needs.
But what we want, and what I believe we have earned, is the right
to live in the country we fought for, in the community we fought for,
and to have our service speak for itself. We should not have to choose
between access to care and being home with our families. We stood the
watch. We answered the call. That should be enough.
I served in Iraq. I saw combat. And I received the Purple Heart for
it. I traveled here by choice, but many veterans are forced to travel
simply to receive the care they need. That should not be the case.
In the Northern Marianas, I have served alongside and advocated for
generations of veterans, those who fought in Vietnam, Panama, Iraq, and
Afghanistan. All of them returned home to a system still not built to
meet their needs.
As I made my way here, I thought of the Vietnam veterans in their
70's and 80's who served our Nation even before our islands were
formally part of this country. They have spent a lifetime fighting for
benefits that only trickled in, slowly, over decades. Now, even in
their later years, they are still being asked to travel off-island for
basic, sometimes life-sustaining care. I think of how difficult this
travel is for them.
I thought of the Gulf War veterans who opened a new chapter in
America's military history, but returned to the same old gaps in care
and support.
And I thought of my own generation, those who served in Operation
Iraqi Freedom and Enduring freedom. We served with commitment. We
returned home with hope. But we still face the same cycle of delay,
denial, and distance.
Of this new generation of veterans, I am proud to be part of a
group that is organizing to support one another directly. Project Buddy
Check 670 is an example of that effort. It reflects our belief that
care for veterans does not always come in the form of a pill or a
prescription. Sometimes, it comes from another veteran picking up the
phone, checking in, and listening.
Project Buddy Check is a reminder that veterans seeking care that
treats us as people, not just patients. But when even ordinary medical
care is so far out of reach, how can we expect the system to provide
the mental health and holistic support our veterans truly need?
Generations of veterans have answered the call from our islands. I
know the challenges we face are difficult to address. But again, we
stood the watch. We bore the burden. That should be enough. It is time
the system answered back.
H.R. 3400 is a strong start. I respectfully ask this committee to
support it and to continue advancing policies that bring real access
and real dignity to every veteran, no matter where they live. Thank you
for your time, and for your unwavering commitment to those who served.
Prepared Statement of Cole Lyle
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of John Schmitt
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Caira Benson
Chairwoman Miller-Meeks, Ranking Member Brownley, Members of the
House Committee on Veterans' Affairs, thank you for inviting me to
testify today. As the wife and caregiver of a severely injured and ill
combat veteran, it is my honor to speak to some proposed legislation
that could lessen the burden each of our caregiving families face every
day.
Veteran family caregivers are a group of people who have been
tempered in the fires of a war many will never see and even fewer will
understand. We are forged stronger every day we fight for appropriate
care for our loved ones.
I care for my husband, Eric, deployed twice to Iraq between 2003-
2006, spending roughly over 20 months in combat zones. I immediately
noticed things were off upon his return home, but I was told not to
worry. It was only ``expected reintegration stress.'' By 2007, my
husband's ``reintegration stress'' would ensure he couldn't feel his
legs when he ran. He was quickly put on a permanent profile, meaning he
was unable to carry out a mission due to medical conditions that had
not stabilized, and, due to deployment readiness policies at the time,
my husband was separated from the Army with no medical board and no
financial security.
We would spend the next decade fighting for understanding of his
injuries as well as proper diagnosis and treatment while often facing
the worst-case scenario. Initial screens for Traumatic Brain Injury
(TBI) were non-existent or misunderstood; the Veterans Health
Administration (VHA) originally told me my husband's IQ was too high to
have suffered TBI, despite all evidence to the contrary. By 2010, my
husband needed full-time care, and I would have to step down from my
position as an executive director at a non-profit. It would take us
until 2018 to formally diagnose my husband's multiple TBIs, despite a
clear record of evidence. It would take another year to figure out his
case was complicated by toxic encephalopathic process, most likely due
to chemical exposures. The two conditions, mingling together, started a
path of neurological degeneration that cannot be stopped.
Today, Eric is considered by the Department of Veteran Affairs (VA)
to be permanently and totally disabled and unable to work. He is
wheelchair dependent, struggles cognitively, suffers from migraines and
blackouts, and is visually impaired. I care for him full-time and am
enrolled in the VA's Program for Comprehensive Assistance for
Caregivers (PCAFC). His TBI care is considered complex enough it is
managed by a university specialty neurological team.
You should know I am also mom to five amazing children, three of
whom have needed specialized care over the years. The day my husband
was awarded permanent and total status, my children and I became
eligible for the Civilian Health and Medical Program of the Department
of Veteran Affairs (CHAMPVA). CHAMPVA is medical coverage offered to
dependents and survivors of eligible veterans, mainly those with 100
percent permanent and total disabilities. CHAMPVA is also offered to
caregivers through PCAFC. I breathed a sigh of relief knowing that we,
too, would have appropriate health care for our needs.
However, in 2021, one of my children began attending college prior
to their 18th birthday and needed monthly medications. We mailed the
certification paperwork, but, when I went to fill prescriptions, I
found out CHAMPVA was inactive. I called CHAMPVA, sat on hold for 4
hours, and was told that CHAMPVA's central mail facility was 6 months
behind opening mail. Because my child was on medications that would
cause permanent damage if terminated without tapering, I was offered an
expedited process to certify and activate the CHAMPVA coverage within 7
days via fax. We used the same method to certify coverage in 2022.
However, in the fall of 2023, coverage lapsed again when certifications
began to be required on a semester basis instead of a yearly basis,
compounding the mail-in timeframe dilemma. Horrifyingly, CHAMPVA agents
relayed to me that CHAMPVA had terminated the ability to expedite
certifications in the fall of 2024.
My child, who is in therapies and on daily medications, suffered
from lapsed coverage between semesters--even over Christmas break--due
to the way certification was completed. CHAMPVA's archaic mail system,
often months behind in opening mail, complicated the ability to
maintain coverage. Winter break and summer break became a mix of timing
medication pickups prior to coverage loss and paying out of pocket for
any therapies or doctor's visits. Indeed, until last month, my child,
who was enrolled in school, had been without insurance since November
2025, had been paying out of pocket for meds and therapies, and had an
unpaid ER bill sent to collections. However, it wasn't a miracle in the
mail room that finally activated the CHAMPVA coverage; it was an
executive inquiry within VHA.
I have another child who graduated high school this past May. With
licenses and certificates in hand, my child desires to work instead of
going to college. However, this child knows that within the next 6
months, their CHAMPVA coverage will disappear unless they enroll in
college or trade school. Can you imagine the pressure on this 17-year-
old who worked day in and day out to finish high school and attain a
drone pilot's license within 3 years to meet their goals? This child
who has given up so much to aid me in the care of their father, who has
suffered the trauma of watching their father's degeneration, and who
has been devastated over the lack of appropriate care for both their
father and their siblings--tell me, how do I tell my child that the
system meant to help us has spectacularly failed once more?
Caregivers like myself and our families need CHAMPVA fixed and that
begins with ensuring our children, who have already given so much,
don't have to worry over loss of coverage upon their 18th birthday or
suffer from lapse of coverage due to an archaic certification process
by passing H.R. 1404, The CHAMPVA Children's Care Protection Act. This
legislation would help alleviate these egregious situations by
authorizing CHAMPVA eligibility automatically through age 26, allowing
us to forgo the constant bureaucracy, which makes using the benefit a
challenge. It also recognizes the true nature and sacrifice of these
young caregivers by allowing them the support they need to transition
from caregiving into adulthood while having their medical and mental
health needs supported during key years. Allowing the younger
dependents coverage until age 26 is crucial and aligns with not only
private, civilian insurers but also the age limit CHAMPVA eligible
dependents CHAMPVA must begin to use their VA Chapter 35 Dependent's
Education Assistance.
I understand in VA's testimony to the Senate Veteran Affairs
Committee on May 21, 2025, VA indicated they opposed this bill due to
the nature of CHAMPVA, arguing that it is a medical service and not an
insurance product.
However, the industry, the Federal Government, and, more often than
not, VA treat CHAMPVA as an insurance product. For instance, like those
covered by Medicaid, Medicare, or TRICARE, my family may not take part
in the drug cost reduction programs offered to patients on fixed or low
incomes due to our eligibility for CHAMPVA. If we choose to shop for
insurance through the Health Care Marketplace, CHAMPVA enrollees are
not eligible for either financial assistance nor advance premium tax
credits. Every year, CHAMPVA enrollees receive a 1095-B attesting to
the fact that CHAMPVA counts as minimum essential coverage under the
Affordable Care Act. Finally, even VHA states that CHAMPVA is only
available to caregivers enrolled in PCAFC when they have no other
health insurance.
CHAMPVA provides explanations of benefits (EOB), approves and
denies diagnostic codes, approves and denies medical treatment codes,
and remits payment for enrollees to providers for approved services
rendered by the medical community. CHAMPVA even has out-of-pocket
maximums, deductibles, copays, and a medication formulary with tiered
pricing. I admit I am a lay person, but this feels like every other
insurance product I have ever received through an employer.
While I'm here to support extending CHAMPVA coverage to age 26, I
also ask that this Committee use its oversight authority to improve the
system itself so our families can find appropriate medical care.
To help you understand the challenges, let me explain what using
CHAMPVA is like. In 2019, when one of our children was hospitalized and
needed movement to a residential facility, I was told to find a
facility that would take CHAMPVA, as there was no facility nor provider
network available under CHAMPVA. I called over 20 TRICARE approved
facilities to see if they had a bed available or could add my child to
their waitlist. All but one turned me down immediately. The reason -
prior authorizations under CHAMPVA since January of that year were
taking upwards of 6-9 months. The one residential facility that did
agree to treat our child had a stipulation - we were to sign a $110,000
promissory note upon admission in the chance CHAMPVA refused
authorization and payment. Later during treatment, I would be told that
CHAMPVA had ordered a discharge within 24 hours, even though our child
had not completed their treatments. Only intervention by a VHA
executive, finding the preauthorization form in the mail room, enabled
necessary continued hospitalization approval.
Another of my children needed specialized therapy during 2020 and
2021. The physician didn't routinely take CHAMPVA, but, wanting to help
us, agreed to see us and bill CHAMPVA. Our child completed her therapy
in 2021. In 2023, I received a call from the physician's office. They
had finally received payment from CHAMPVA with the exception of one
therapy session, which I would have to pay for myself. I gladly paid
and asked about the delay; the account manager relayed that she'd had
to mail-in everything and simply wait. Because CHAMPVA has no provider
contracts or a published fee schedule, the provider only had a ballpark
estimate of what their payment would be until the claim was returned.
Due to the mail-in claims system, lack of automation, and lack of
published fee schedule, providers must wait inordinately long periods
of time for payment, and that payment is a relative unknown until it is
received. I can't think of a better scenario to discourage provider
participation.
As I mentioned above, CHAMPVA has no contracted network of
providers or facilities. It has no published fee schedule to share with
potential providers. It processes the majority of claims using paper
sent through a mail-in center, lengthening the time between physician
or enrollee submission, claim processing, and enrollee reimbursement.
CHAMPVA processes certifications, coverage additions, and changes of
information through mail - using a single mail center in Colorado for
all 737,000 enrollees. While an online portal currently exists for
initial applications only, its functionality varies.
Providers who have agreed to take CHAMPVA often have mixed
messaging - hospitals can file electronically, but most providers I've
spoken to must file by mail. Some are told to file with the mail-in
center in Colorado, while others are told to file directly with the
local VAMC Community Care Network (CCN). Filing and retaining pay for
services has become so cumbersome that the number of providers willing
to file it in my area, which is last year's fastest growing county in
the United States, dropped to 2 practices outside hospitals and urgent
cares. Neither practice willing to file CHAMPVA contains a
pediatrician.
Once again, I'm paying out-of-pocket for basic, routine, and
pediatric care. I've stopped filing for reimbursement myself due to the
burden of the process, including diagnostic codes which may or may not
be covered and long pay times.
My understanding is that CHAMPVA falls under VHA's Office for
Integrated Veteran Care (IVC), which also runs VHA's CCN. If that is
true, why could VA not use the existing CCN structure to provide for
network providers, a published fee schedule, and electronic claims
submissions? It seems that it would be far more efficient, reduce the
burden on VA and providers, and better meet the medical best interest
of our veterans' dependents and caregivers.
As a wife and caregiver, I have fought every day for appropriate
care for my husband and for my children. Yet, I know another fight
looms on the horizon.
Not long ago, I firmly realized, like so many other caregivers, I
would eventually become a survivor. Having given over a decade to being
a sandwich caregiver, I am situated to outlive my veteran with almost
no retirement, no active work credits, and almost no life insurance for
my and my family's financial security.
Because we have fought so long for appropriate care and ratings, my
family has financially suffered. I left my growing career in non-profit
administration at the age of 30. What I had saved in retirement until
that point was cashed out to pay for emergent medical care for my
family. We have struggled, but survived, for over a decade on only
disability income. The severity of my husband's injuries, like so many
others, makes him uninsurable for life insurance.
I am not alone. Mozella Richardson Kamara, a 2025 Dole Caregiver
Fellow from Delaware, studied for many years to become a civil
engineer, but left her job to care for her veteran husband who suffers
from many service-connected disabilities, both neurological and
physical. Like myself, Mozella made this choice to ensure the immediate
well-being of her husband, and, out of love, sacrificed her own long-
term professional goals and retirement potential for the benefit of her
family and service-connected veteran husband.
According to a recent RAND report, commissioned by the Elizabeth
Dole Foundation and released in September of last year, military-
connected caregivers save this Nation billions in healthcare costs by
providing a minimum of $119 billion in unpaid care. In exchange, we
face this harsh reality--when our caregiving ends, most of us will be
financially destitute.
As this harsh reality was revealed, I started planning what I
could. I used my Chapter 35 Dependents Educations Assistance to finish
a terminal degree remotely, all while caring for both my husband and
our children. Once I graduated, I overhauled my resume and began
seeking any kind of contract work so that I had some earned income.
That earned income allowed me to finally contribute some small amount
to a retirement plan. It's too little, too late, but it is something
more than 0.
With the growth of remote work, I eventually began searching for
full-time work so that I could once again have work credits to pay
toward Social Security and pay toward student loans. Employers are not
designed to be caregiver friendly, even with their remote employees. I
found an employer willing to be flexible with me, and I excelled at my
job. Unfortunately, I had to resign recently because my salary would
not entirely cover the cost of care for my husband while I worked. I
loved my work, I had stellar performance reviews, but I was working at
a net negative after expenses.
Like Mozella, I have once again put aside my own personal and
professional goals to care for those who need me. But caregivers like
Mozella and me, we need you to pass H.R. 2148, The Veteran Caregiver
Reeducation, Reemployment, and Retirement Act.
This bill won't fix the entirety of the problem, but it is a
valuable first step in ensuring caregivers can begin to establish
safety-nets of their own. It will begin the process and hopefully
eventually allow caregivers like Mozella and me to contribute to a
retirement fund. More immediately, it will provide caregivers financial
security by allowing for returnships, or other possible work-rentry
program, and paying for re-licensure in careers like teaching and
engineering, ensuring caregivers like Mozella experience fewer
obstacles to returning to work.
It is a truth that 1 day, every caregiver will stop caregiving,
either through the veteran's improvement or their passing. As a
thankful nation, we should ensure veteran caregivers do not end up in
poverty simply because they ensured their veteran had appropriate care
due to the wounds, illnesses, and injuries sustained while serving
their nation.
Again, I am honored to be here at the request of the Committee and
the Elizabeth Dole Foundation. I am ever thankful that Senator
Elizabeth Dole led the charge to build a remarkable non-profit that
ensures caregivers like me are seen, accepted, supported, and
encouraged. Senator Dole gave caregivers a voice so we are heard in
places such as this Committee room. Every day, caregivers carry out the
work of caring for, as President Lincoln said, those who have borne the
battle. To support the veteran, we must also support the caregivers,
survivors, and families who bear the burden of the war that continues
to rage at home.
I thank you for your time and attention, and I look forward to your
questions.
Statements for the Record
----------
Prepared Statement of Joseph Morelle
Chairwoman Miller-Meeks, Ranking Member Brownley, thank you for the
opportunity to submit this statement for the record in support of H.R.
2148, the Veteran Caregiver Reeducation, Reemployment, and Retirement
Act. I also want to express my deep appreciation to my colleague and
co-lead, Representative Juan Ciscomani, for his partnership on this
vital bipartisan legislation.
Every day, thousands of family caregivers across the country make
extraordinary sacrifices to care for our Nation's veterans. They put
their careers on hold, deplete savings, and forgo personal goals to
ensure their loved ones receive the care and dignity they deserve. When
those caregiving duties come to an end--whether through recovery,
transition to other care, or the passing of a veteran--these caregivers
are often left to navigate a difficult and uncertain path forward,
without the tools or support they need to rebuild their lives.
H.R. 2148 seeks to change that. This legislation would require the
Department of Veterans Affairs to provide family caregivers with
practical and meaningful support as they transition into the next
chapter of their lives. This includes employment assistance, retirement
planning, bereavement counseling, and reimbursement for professional
certification or re-licensure fees. It would also require VA to study
the barriers caregivers face when reentering the workforce, grant
access to existing employment services, and evaluate the feasibility of
establishing a retirement savings mechanism tailored to their unique
circumstances.
These are not luxuries--they are long overdue acknowledgments of
the economic and emotional toll that caregiving can take. This
legislation will empower caregivers to regain their footing and reclaim
their futures. It is a step toward honoring the quiet service they
provide behind the scenes and recognizing that their well-being is
essential to our broader commitment to veterans and their families.
Finally, I want to extend my heartfelt thanks to the many
caregivers across America whose strength and selflessness make this
bill necessary. Your stories, your sacrifices, and your advocacy have
shaped this legislation. It is my hope that H.R. 2148 is just the
beginning of a broader national effort to support you in the same way
you have supported our veterans.
Thank you.
Prepared Statement of Paralyzed Veterans of America
Chairwoman Miller-Meeks, Ranking Member Brownley, and members of
the subcommittee, Paralyzed Veterans of America (PVA) appreciates this
opportunity to share our views on some of the legislation before the
subcommittee today. PVA members, veterans who have acquired a spinal
cord injury or disorder (SCI/D), experience the breadth of VA care and
benefits in unique ways due to their injuries and illnesses. We welcome
the chance to share how some of these bills might impact our members.
H.R. 1404, the CHAMPVA Children's Care Protection Act
The Civilian Health and Medical Program of the Department of
Veterans Affairs (CHAMPVA) is a comprehensive healthcare program for
the spouse or widow(er) and children of an eligible veteran. Through
CHAMPVA, VA shares the cost of certain healthcare services and supplies
with eligible beneficiaries. It may also provide benefits to the
Primary Family Caregiver through the Program of Comprehensive
Assistance for Family Caregivers (PCAFC). Coverage for children under
CHAMPVA currently expires when they turn 18 unless they are full-time
students. In this case, they continue to receive coverage until they
turn 23, stop attending school full-time, or get married. However, for
most Americans with health insurance, their adult children can remain
on their plan until age 26 with no separate premium, as mandated in the
Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).
CHAMPVA and the military's TRICARE programs were not affected by the
ACA, so they required separate congressional action to extend these
benefits to children up to age 26. This discrepancy was addressed for
TRICARE in 2011 and the CHAMPVA Children's Care Protection Act would
fix this for VA's CHAMPVA program.
The delay in making this change to CHAMPVA has adversely impacted
several of our members. Take PVA member Amy and her husband for
example. She served honorably in the U.S. Marine Corps before an SCI/D
cut her military service short. Her husband served in the Marine Corps
as well, but injuries he sustained in Operation Desert Storm curtailed
his military career, too. Both have 100 percent disability ratings from
the VA. Their two boys have severe immune deficiencies that were caused
by their parents' exposure to hazards during their military service. As
a result, the boys require weekly plasma infusions to keep them alive.
These infusions cost thousands per month, and they cannot afford to pay
for them out of pocket. They rely on CHAMPVA to provide this life-
saving care and suffered tremendous angst when their oldest child
turned 18. Fortunately, he became well enough with the infusions that
they were able to keep him in school and CHAMPVA until he turns 23 in
March 2026. The younger child is currently 17 but he has additional
comorbidities that may not allow him to do the same. The family is
straining under the pressure that the lack of action from Congress has
put on them and unless legislation like this is passed, there is a very
real possibility that both children will age out of the program next
year.
The VA testified in opposition to the companion measure to this
bill at a May 1, 2025, Senate Veterans' Affairs Committee hearing. The
witness correctly stated that CHAMPVA was not affected by the ACA, but
we disagree with VA's assertion that it is not health insurance because
it clearly functions like it. For example, certain types of care and
services require preauthorization. This approval is extremely
important, and the failure to obtain it may result in denial of the
claim. Also, providers must be properly licensed in their State to
receive payment from CHAMPVA, and they cannot be on the Medicare
exclusion list. To be reimbursed, providers must file a claim, using
diagnosis and procedure codes that all other healthcare plans follow.
The Congressional Research Service (CRS) which advises Congress on
programs like this seems to agree. In its October report to Congress on
VA healthcare programs for dependents and survivors, CRS stated,
``CHAMPVA is primarily a health insurance program where certain
eligible dependents and survivors of veterans receive care from private
sector healthcare providers. The program is administered by the
Veterans Health Administration (VHA), Assistant Under Secretary for
Health (AUSH) for Integrated Veteran Care, Office of Integrated Veteran
Care (IVC). The law (38 U.S.C. Sec. of veterans, 1781) requires CHAMPVA
to provide for medical care in the same or similar manner and subject
to the same or similar limitations as medical care is furnished to
certain dependents and survivors of active duty and retired members of
the Armed Forces under [the Department of Defense (DOD) TRICARE
program].'' \1\
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\1\ Health Care for Dependents and Survivors of Veterans, October
16, 2024
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DOD's TRICARE program wasn't affected by the ACA either, but
Congress created the TRICARE Young Adult program in 2011 which provides
health care for qualified young adults aged 21 to 26 who are unmarried
and not eligible for an employer-sponsored health plan. Our government
should not deem veterans' dependents and survivors less worthy than
civilians for support. Those who are eligible for CHAMPVA should be
able to retain their healthcare coverage until their 26th birthday just
like those in private and Federal healthcare plans. We urge Congress to
correct this inequity as soon as possible.
H.R. 2148, the Veteran Caregiver Reeducation, Reemployment, and
Retirement Act
The VA's PCAFC was established by Congress in 2010 to support
family caregivers who play a critical role in caring for and supporting
veterans severely injured in the line of duty following 9/11.
Occasionally, changes have been made to improve the program's support
of veterans. Such changes include those in the VA MISSION Act of 2018,
which authorized VA to offer PCAFC to caregivers for veterans of all
eras.
Still, the program does not consider that many caregivers are
forced to reduce their work hours, take unpaid leave, or leave the
workforce entirely to provide care. They sacrifice wages, retirement
savings, and financial stability to care for those they love. The time
away from their jobs creates gaps in their resumes and many lose the
employment certifications they previously held. When their loved one
either passes away or returns to independent functioning, caregivers
need to return to the workplace and must face these issues. Also, those
who were relying on CHAMPVA for their health care lose this coverage
within 90 days of leaving PCAFC through the death or discharge of the
veteran. Members in other insurance programs have 180 days to
transition their health insurance benefits.
This bill seeks to strengthen the PCAFC by addressing these, and
other common problems that many caregivers face. Provisions in the bill
would provide former caregivers with bereavement counseling, funding to
renew their professional certifications, and the ability to participate
in employment assistance programs like Military OneSource or the
Department of Labor's, Veterans' Employment and Training Service. It
also directs studies on the possibility of allowing caregivers to make
contributions to Social Security and other types of existing retirement
accounts, the feasibility of caregivers being allowed to participate in
a Department of Labor returnship program, and the possibility of the VA
incorporating former caregivers into the VA workforce as personal care
attendants, enabling the VA to lessen staff shortages. Last, it gives
caregivers who are not Medicare eligible the option to keep their
CHAMPVA coverage for 180 days, if they need it.
Caregivers are often the most important component of rehabilitation
and maintenance for veterans with catastrophic disabilities. As a
result, their welfare directly affects the quality-of-care veterans
receive. We strongly support this bill and urge Congress to pass it
quickly.
Discussion Draft, the Fisher House Availability Act of 2025
Beneficiaries of active-duty service members often travel far from
home to receive care through DOD's TRICARE program. Often their
appointments don't end until late in the day which then requires them
to drive extended distances home at night. This bill would allow VA to
provide temporary lodging to a covered beneficiary or a family member
of a covered beneficiary on a space available basis. If VA has
available space and there is no cost to the department, PVA can support
this legislation.
Discussion Draft, to provide for a timeframe for the employment in the
Department of Veterans Affairs of participants in the Health
Professionals Scholarship Program
The Health Professionals Scholarship Program (HPSP) provides
financial assistance to students in various healthcare disciplines,
aiming to meet VA workforce needs. Participants must complete their
education and meet qualification requirements before employment, with
the program requiring an 18-month service obligation for each year of
support. The current law does not have a provision guaranteeing
graduates of the HPSP a job at the VA following completion of their
training. PVA supports this draft bill which requires VA to offer each
participant a contract for full-time employment at the VA facility with
the greatest need for their specialty within 90 days of their course
completion date.
Discussion Draft, the VA Mental Health Outreach and Engagement Act
PVA supports passage of the VA Mental Health Outreach and
Engagement Act. The VA suicide report clearly states that veterans who
are not enrolled and engaged with the VHA are more likely to die by
suicide. As we work to reduce the number of veteran suicides, the most
common sense first step is to conduct proactive outreach to veterans
receiving compensation for a service-connected mental health condition
who are not accessing VA mental health services. By conducting
intentional outreach to a vulnerable population, the department could
not only increase enrollment in VA mental health programs, but
ultimately, it may move the needle on curbing the number of veteran
suicides.
Discussion Draft, the VA Data Transparency and Trust Act
The House and Senate Veterans' Affairs Committees are responsible
for moving legislation expanding, curtailing, or fine-tuning existing
laws relating to health care and benefits for veterans, certain
dependents, and eligible survivors. The committees also have oversight
responsibility of the department, which means monitoring and evaluating
the operations of the VA. So, if the committees find that VA is not
administering laws as Congress intended, or if emerging needs of
veterans are identified, it is addressed through the hearing process
and legislation. To fulfil this role, the committees need timely and
accurate information, but in recent years, VA has been unable to
provide either. We strongly believe that VA should be able to produce
timely and accurate reports to Congress and respective oversight bodies
so the committees can ensure the department is providing the benefits
and services that veterans have earned and deserve.
We support the VA Data Transparency and Trust Act which requires
the department to provide Congress with annual reports detailing how VA
benefits are delivered, who is using them, and how well the system is
performing while still safeguarding veterans' privacy. This would help
the committees ensure VA programs are properly funded, operating
efficiently, and most importantly, meeting the needs of the veterans
they were intended to serve.
H.R. 2605, the Service Dogs Assisting Veterans (``SAVES'') Act
Service dogs provide invaluable assistance to disabled veterans
with the greatest support needs, allowing them to live more independent
lives in their communities. PVA supports the SAVES Act, which requires
the VA to establish a competitive grant program to fund nonprofit
organizations that provide service dogs to veterans with a variety of
disabilities, such as mobility or vision impairments or PTSD. Nonprofit
organizations would be required to submit an application to the
Secretary that includes a description of the training that will be
provided by the organization to eligible veterans; the training of dogs
that will serve as service dogs; the aftercare services that the
organization will provide for the service dog and eligible veteran; the
plan for publicizing the availability of service dogs through a
marketing campaign; and the commitment of the organization to have
humane standards for animals. Passage of this legislation will increase
veterans' access to service dogs and their independence.
Discussion Draft, the Territorial Response and Access to Veterans'
Essential Lifecare Act or the TRAVEL Act of 2025
Thousands of veterans who are residents of U.S. territories or
reside on islands in the Pacific face significant challenges in seeking
medical care. In May 2024, the Government Accountability Office issued
a report that found these veterans often experienced ``unique and
substantial barriers'' that veterans in the United States do not
encounter when seeking medical services from the VA.\2\ PVA supports
this proposed legislation, which authorizes the department to utilize
traveling physicians to provide needed health care to veterans residing
in these areas.
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\2\ GAO-24-106364, VETERANS AFFAIRS: Actions Needed to Improve
Access to Care in the U.S. Territories and Freely Associated States
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Discussion Draft, the Representing our Seniors at VA Act of 2025
State Veterans Homes play a crucial role in providing care and
support for those who have served this Nation in uniform. These
facilities are designed to meet the unique needs of veterans, offering
a range of services tailored to their medical and emotional well-being.
For many veterans and their families, these homes represent a vital
resource for long-term care, rehabilitation, and companionship. They
play an outsized role in VA's ability to provide skilled nursing and
long-term care for veterans. PVA supports including a representative of
the National Association of State Veterans Homes on the VA's Geriatrics
and Gerontology Advisory Committee.
H.R. 2068, the Veterans Patient Advocacy Act
PVA supports the Veterans Patient Advocacy Act, which seeks to
ensure there are an adequate number of patient advocates at VA medical
facilities. Patient advocates are highly trained professionals who can
help resolve veterans' concerns about any aspect of their healthcare
experience, particularly those concerns that cannot be resolved at the
point of care. They help to ensure access to care by listening to any
questions, problems, or special needs that a veteran has and working to
resolve them. PVA supports passage of the Veterans Patient Advocacy Act
with the understanding that VA may need additional resources to assign
patient advocates to rural community-based outpatient clinics.
PVA would once again like to thank the subcommittee for the
opportunity to submit our views on some of the bills being considered
today. We look forward to working with you on this legislation and
would be happy to take any questions for the record.
Information Required by Rule XI 2(g) of the House of Representatives
Pursuant to Rule XI 2(g) of the House of Representatives, the following
information is provided regarding Federal grants and contracts.
Fiscal Year 2025
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events---- Grant to support rehabilitation sports
activities--$502,000.
Fiscal Year 2023
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events----Grant to support rehabilitation sports
activities--$479,000.
Fiscal Year 2022
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events----Grant to support rehabilitation sports
activities--$ 437,745.
Disclosure of Foreign Payments
Paralyzed Veterans of America is largely supported by donations from
the general public. However, in some very rare cases we receive direct
donations from foreign nationals. In addition, we receive funding from
corporations and foundations which in some cases are U.S. subsidiaries
of non-U.S. companies.
Prepared Statement of Gold Star Spouses of America, Inc.
Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished
members of the House Committee on Veterans Affairs, Subcommittee on
Health,
Gold Star Spouses of America, Inc. appreciates the opportunity to
submit this statement for the record as the Committee considers several
important legislative proposals aimed at improving the lives of
veterans and their families. As an organization dedicated to advocating
for the needs, dignity, and recognition of surviving military spouses
and their families, we are encouraged by the Committee's ongoing
commitment to addressing inequities and modernizing policies that
directly affect our community.
We write today to express our strong support for the CHAMPVA
Children's Care Protection Act (H.R. 1404), introduced by Ranking
Member Julia Brownley. This legislation would extend eligibility for
health care coverage under the Civilian Health and Medical Program of
the Department of Veterans Affairs (CHAMPVA) to children of disabled
veterans up to age 26, aligning CHAMPVA with current standards
established by the Affordable Care Act and the Department of Defense's
TRICARE program.
Currently, children enrolled in CHAMPVA lose eligibility at age 18,
or at 23 if enrolled in school. This is in stark contrast to families
covered under private insurance or TRICARE, who benefit from dependent
coverage through age 26. As a result, children of disabled or fallen
veterans are too often forced off health coverage at a critical stage,
while pursuing higher education or beginning their professional lives.
This disparity is not only unjust; it places unnecessary financial and
emotional strain on families who have already endured great sacrifice
in service to our country.
Surviving families deserve the same respect, stability, and support
afforded to others across the Federal health care system. By extending
CHAMPVA eligibility, this legislation honors the full scope of a
veteran's service and ensures their children are not treated as second-
class dependents under Federal policy. We urge the Committee to advance
this bill and address this longstanding inequity.
Gold Star Spouses of America stands ready to work alongside
Congress to strengthen the systems that support surviving families. We
remain committed to ensuring the promise made to those who serve, that
their families will not be forgotten, is fully upheld.
Thank you for your consideration of this statement and for your
steadfast dedication to veterans and their loved ones.
Gold Star Spouses of America, Inc.
Gold Star Spouses of America is a national nonprofit organization
dedicated to supporting the surviving spouses of military service
members and veterans who have made the ultimate sacrifice in defense of
our country. Our mission is to provide meaningful support, advocacy,
education, and a sense of community for Gold Star families. Through our
programs, we work to ensure that the needs of these spouses and their
families are heard, addressed, and prioritized by policymakers at the
Federal, State, and local levels.
GSSA is listed as an approved resource in the National Resource
Directory (NRD.gov) and has been approved by the Department of Defense
as a resource on Military OneSource and in the ``Days Ahead'' binder
for all active-duty losses.
GSSA is also recognized by the Department of Veterans Affairs for
volunteer opportunities within the department's Center for Development
and Civic Engagement.
Prepared Statement of National Association of Veterans' Research and
Education Foundations
The National Association of Veterans' Research and Education
Foundations (NAVREF) is the national nonprofit organization
representing over 75 VA-affiliated nonprofit research and education
corporations (NPCs), established by Congress [38 U.S.C. Sec. Sec. 7361-
7366] to support the VA's medical and scientific research enterprise.
Since 1992, our community has facilitated clinical trials, engaged
private sector and academic partners, and advanced groundbreaking
discoveries that improve the health and lives of veterans.
VA Data Transparency and Trust Act
We commend the intent behind the VA Data Transparency and Trust Act
to improve transparency and trust in VA data. However, we have concerns
about the scope and quality of data that would be accessed and reported
if the legislation were enacted. Specifically, the bill calls for
medical services data as defined by 38 U.S.C. Sec. 1701, which may not
fully capture the complexity of veteran care and research activities at
VA. For example, a veteran receiving medical care for diabetes at VA
could also be enrolled in an industry-sponsored diabetes study at the
same VA medical center, but those treatment protocols are not
traditionally accounted for the same way as a ``medical service'' is.
This segmentation risks incomplete or skewed reporting, limiting the
full picture of veteran care and research. We urge Congress and VA
stakeholders to carefully consider these nuances to ensure transparency
efforts accurately reflect the scope of veteran care and research and
ultimately, keep VA accountable on all aspects of the integrated health
care system.
RNA Sequencing to Diagnose PTSD Bill
NAVREF fully supports the direction of the proposed legislation
directing the VA to study whether RNA sequencing can effectively
diagnose inflammation or cellular stress symptoms related to PTSD in
veterans. This initiative aligns with ongoing VA research efforts to
explore innovative molecular diagnostics and precision medicine
approaches that could improve mental health diagnosis and treatment.
Several VA-affiliated nonprofits are actively engaged in PTSD research,
and NAVREF's membership stands ready to collaborate with the VA and
congressional committees by sharing expertise, supporting study
implementation, and facilitating connections with research programs. We
also encourage the legislation to be inclusive of the VA Million
Veteran Program and direct it to use its resources and data to engage
in this initiative.
NAVREF appreciates the opportunity to provide input on these
important legislative efforts. We look forward to working closely with
Congress and VA leaders to help refine policies and support research
that advances veterans' health and well-being.
Prepared Statement of National Association of State Veterans Homes
Chairwoman Miller-Meeks and Ranking Member Brownley:
As President of the National Association of State Veterans Homes
(NASVH), I'm pleased to offer our strong support for H.R. 785, the
Representing our Seniors at VA Act of 2025, legislation to include a
member of NASVH on VA's Geriatrics and Gerontology Advisory Committee
(GGAC). This legislation is a commonsense effort to ensure that the
experience and expertise of a State Veteran Home (SVH) leader is a part
of VA's long term care planning.
As you may know, NASVH is an all-volunteer organization dedicated
to promoting and enhancing the quality of care and life for the
veterans and families in our Homes through education, networking, and
advocacy. Today there are 172 VA-recognized State Veterans Homes across
the Nation operating 166 skilled nursing care programs, 47 domiciliary
care programs, and 3 adult day health care (ADHC) programs. NASVH is
the only organization representing their collective interests, and our
membership continues to grow as new Homes seek VA recognition.
With over 30,000 authorized State Home beds providing a mix of
skilled nursing and domiciliary care, SVHs provide approximately half
of all federally supported institutional long-term care for veterans
yet consume less than 20 percent of VA's total budget for veterans'
long term nursing home care. Having a permanent seat for a NASVH member
would add a critical voice commensurate with the leading role that
State Veterans Homes play in meeting veterans long term care needs.
The GGAC was first authorized by Public Law 102-40 in 1991 to
advise VA on all matters pertaining to geriatrics and gerontology, and
was charged with three specific tasks:
1. Evaluate the operation and effectiveness of VA's Geriatric
Research Education and Clinical Centers (GRECCs);
2. Assess the demand for long term care by veterans and VA's
capability to provide high quality geriatric and extended care
services; and
3. Assess the current and projected needs for veterans' long
term care services and VA's activities and plans to meet such
needs.
H.R. 785 would require the appointed NASVH member to be a licensed
nursing home administrator, which would provide a different perspective
from the clinicians, researchers, and academics on the GGAC.
Historically, there have been few, if any, GGAC members with direct
experience leading or overseeing nursing homes, and particularly not
ones focused on the care of aging and disabled veterans.
For more than a decade, NASVH had proposed a number of highly
qualified leaders for membership on the GGAC, however none had been
chosen until last year. Among the arguments that some VA officials had
made against a NASVH member was that State Home administrators were not
``experts'' and that the GGAC already had sufficient expertise.
However, the vast majority of GGAC members have never run a nursing
home, nor worked directly on issues related to aging and disabled
military veterans and their unique medical and social challenges.
We were pleased last fall when then-VA Secretary McDonough and
Under Secretary Elnahal agreed to add a NASVH member, however we were
disappointed to learn that the NASVH member would be a ``non-voting''
member of the GGAC. We were told that a NASVH member would have a
conflict of interest, since State Veterans Homes receive funding from
VA, even though many current and past members of the GGAC have worked
for organizations or companies that have an interest in Federal
policies related to long term care.
For example, the GGAC's immediate past Chairman, David Gifford, was
the Chief Medical Officer for the American Health Care Association
(AHCA), which lobbies on behalf of thousands of nursing homes,
overwhelmingly private ones. Most of these nursing homes receive
significant Federal funding through the Center for Medicare and
Medicaid Services (CMS), and many also have contracts with VA for the
care of veterans. Yet, Dr. Gifford was able to successfully lead the
GGAC and manage his dual roles in conformity with Federal ethics rules.
While NASVH receives no funding from VA or any Federal agency, if a
member of NASVH appointed to the GGAC also works for a State Veteran
Home, then that member would certainly recuse themselves appropriately,
in the same manner as other GGAC members whose jobs, organizations, and
companies are impacted by Federal funding, grants, and policies.
Madame Chairwoman, State Veterans Homes can and must play a greater
role in meeting the needs of aging veterans and their caregivers in
partnership with VA and other Federal agencies. One way to strengthen
that partnership is to ensure that NASVH and its members are engaged
when VA is discussing, evaluating and making plans to improve the
access to and quality of long-term care for our Nation's aging and
disabled veterans.
NASVH fully endorses H.R. 785 and looks forward to continuing to
work with Congress and VA to ensure that veterans have greater access
to a full spectrum of long-term care options, whether at home or in
nursing homes. Adding the experience and expertise of a NASVH member
will not only benefit the GGAC but will also improve the lives of
America's heroes.
Prepared Statement of Quality of Life Foundation
Thank you Chairman Miller-Meeks, Ranking Member Brownley, and
distinguished members of the Committee for allowing us to emphasize and
advocate for H.R. 2148, the Veteran Caregiver Re-education, Re-
employment and Retirement Act (Veteran Caregiver 3R Act). This bill is
deeply personal to my organization, Quality of Life Foundation, and to
me personally as a caregiver to a veteran who withdrew from the VA's
Program of Comprehensive Assistance for Family Caregivers (PCAFC). I'd
like to thank Congressmen Ciscomani and Morelle, as well as Senator
Moran, and former Senator Sinema for taking my words in the SVAC
hearing in March 2022 to heart when I said VA's family caregivers,
without the safety nets in this bill, will fall into poverty upon
leaving their caregiving roles. I will leave the facts and statistics
of caregivers' financial contributions and lost income to others.
Today, I want to tell you why this legislation is personal to me and
why I feel it necessary to advocate so strongly for it.
In 2009, Wounded Warrior Project invited myself and 19 other Post
9/11 military veteran caregivers to the Hill, to tell our stories to
lawmakers about why Congress should create the VA's Caregiver Support
Program, a component of which, the Program for Comprehensive Assistance
for Family Caregivers (PCAFC), would provide a stipend for those
caregivers whose role prevented us from maintaining a position in the
workforce. When I arrived in DC in July 2009, my husband was on his
third hospitalization since returning from Iraq in February 2007.
During those years, I had tried to maintain my 13 year teaching career
while raising two young children and caring for him, but it was
impossible to simultaneously teach well and to caregive well. And,
honestly, there is no room in either role, teacher or caregiver, for
anything less than well.
In May 2009, I made the decision to give up my financial
independence and professional identity in order to become ``just a
caregiver.'' At the time, not only did I hold teaching licenses in two
states, but I also held my National Board Of Professional Teaching
Standards certificate. This certificate offered me a substantial salary
boost to my teacher salary and is something only 141,000 teachers
nationwide have achieved. The last day of that school year in June 2009
saw me shifting from providing the majority of my family's income to
providing none of it.
That shift was substantial and provided the reason it was so
important for me to advocate for family caregivers in the summer of
2009. I gave up my job voluntarily to care for my husband, but, in
doing so, I lost my professional identity, my financial independence
which contributed to my family's financial well-being, and my long-term
retirement savings' stability. Additionally, I had no idea how long I
would have to support my veteran through caregiving nor the long-
lasting effects that it would have on my retirement savings.
In 2009, I came to the Hill with high hopes for the creation of a
program that would provide me, a caregiver, an income, allowing me to
make a monetary contribution to my family and relieve the financial
pressure we felt after losing my teaching income. I also had hopes of
having my role as caregiver validated as an important part of my
husband's recovery, not just another role that was expected of me. When
the Caregivers and Veterans Omnibus Health Services Act of 2010 was
signed into law on May 5, 2010, I was excited to see a program that I
had supported through legislation come into fruition.
However, as the years have gone by, PCAFC has become a reality
along with regulations and a few oversights. As a person who worked on
helping PCAFC come into existence, I find it imperative that I, as
Advocacy Director of Quality of Life Foundation's Wounded Veteran
Family Care Program, and a caregiver, lead the efforts in fixing those
oversights, for the caregivers that advocated for that original
legislation and all the caregivers that have come before and will come
after us.
As a teacher, I had to renew my licenses with continuing education
credits, some of which can be earned by teaching in the classroom and
others through taking classes or going to conferences. I held on to my
State licenses for 15 years, but did eventually give them up. It made
little sense to keep them, when there was no end in sight to my
caregiving. In addition to my regular State teaching licenses, The
National Board of Professional Teaching Standards certification that I
had taken such pains to earn in addition to my State licenses was lost
as it could only be renewed by actually being in the classroom.
Had I chosen to return to the classroom, here's what would have
happened: I would have needed to renew my license. Depending on the
State, I would be teaching on daily substitute pay until my full
license was restored by earning enough continuing education credits.
Not only would that path mean teaching days be paid with extremely low
wages on which to support myself, it also meant I would have to bear
the cost of the renewal of my licenses which could add up to thousands
of dollars depending on the State requirements, including any college
classes or seminars. That is not a cost caregivers can support if they
have lost their income from caregiving, nor will that cost be
realistically covered by the 3-months of stipend paid when the
caregiver exits PCAFC.
H.R. 2148, the Veteran Caregiver Re-education, Re-employment, and
Retirement Act would grant $1000 per caregiver for those who wish to
renew licenses or certifications upon leaving the Caregiver Program and
returning to the workplace. H.R. 2148 would institute a program which
is a mirror of a program that already exists in DOD for military
spouses that must relocate due to their spouses receiving orders. In
reality, many of our caregivers will never return to the workplace,
either because their veterans never recover fully enough for them to do
so or because they will end caregiving well past retirement age. But
for those caregivers who must return to the workforce due to the death
of their care recipients during their pre-retirement years, this money
would be essential.
The bill would study expanding returnships to caregivers.
Returnship programs are already supported by the Department of Labor.
Returnships are opportunities for companies to hire Americans returning
to work after being out of the workplace for a period of at least 2
years. The best way to think about returnships are to think of Robert
De Niro's character in the movie The Intern. Technically he wasn't an
intern; he was a return. This type of returnship program would allow
caregivers to become current on workplace skills while using the vast
knowledge they have from their prior careers and leveraging the skills
they have learned from caregiving, such as superb organizational skills
and ability to prioritize multiple tasks. Some companies, i.e. Goldman
Sachs and Wells Fargo, and State governments, such as Utah and Vermont,
have returnship programs already established.
The VA remains in a shortage of workers to meet demand, and the
Veteran Caregiver 3R Act would study whether caregivers discharged from
PCAFC could be used to fill gaps within the VA workforce, either
through roles leveraging prior professional skillsets or as non-medical
attendants. Either way, leveraging the wealth of experience, knowledge,
and skill sets of caregivers exiting PCAFC could be a way to fill
apparent gaps in VA's workforce while also providing economic stability
to caregivers having to return to the workforce.
Another component of this bill offers transition assistance to
caregivers who are either transitioning from caregiving back to the
workforce or into caregiver ``retirement,'' the later stages of life
where it is no longer beneficial for caregivers or their care recipient
to have care from the person designated as the family caregiver.
But what future exists for caregivers without retirement income
options? Truly, this is the most important component of this bill to
me. It solves a crisis that currently keeps me up at night. For many
years, I was not able to contribute to a retirement fund due to lack of
earned income in my home. Any year that I worked part time, I made a
contribution to my personal individual retirement account, though there
were many years it was not funded or underfunded due to limited income
and the inability to contribute. At 51, I have about one-third of the
retirement savings that I should have at this time, and I am running
out of time to catch up on those contributions.
I am one of the lucky ones. I was old enough to have made some
retirement contributions, and I have been able to return to work in a
job that uses all of my teaching experience and my knowledge of caring
for an injured veteran.
Unfortunately, that is not the case for many of the caregivers I
advocated with on the Hill in 2009. Many of them have been caregivers
since 2005. They are looking at 20 years with no contributions to
Social Security or individual retirement accounts. There is no safety
net for them if they are injured while providing care for their loved
one. If their spouses pass away now, with them in their early 40's to
mid 50's, they will have to go back into the workplace after more than
20 years out of the workforce. They will have no retirement savings,
and they will have to move into jobs that are at a lower pay level than
their peers of the same age due to their lack of work experience. This
severely limits their ability to save for retirement in their personal
retirement accounts and their income from Social Security. In addition,
the Social Security spousal benefit will not be an option for them
because their spouses stopped contributing to Social Security at an
extremely young age; meaning the potential spousal benefit would be
extremely low, if it existed at all. These caregivers should not be
forced into a low retirement income because they chose to care for
their loved one and save the VA and taxpayers money.
As caregivers, we simply want to be able to have a way to
contribute to and fund our own retirement savings and income so that we
do not to fall into poverty because we chose to care for our veterans
at home. Please allow us the pathway to do this. Such a pathway could
be created by creating special caregiver IRA's which would allow
taxation at the withdrawal period and not at the contribution period.
Other options are Thrift Savings Plans like those offered to troops.
While I am extremely grateful that I was able to be a part of the
creation of the VA's PCAFC, I would also like to be a part of the
fixing issues that were not even considered when the legislation
creating the program was drafted. None of us knew this would be a
potential lifelong role. We did not think about returning to the
workforce if our care recipient passed away. None of us thought about
retirement at the ages of 20 or 30, and none of us thought about having
to transition from caregiving for our veteran to possibly needing to
``retire'' from caregiving and ourselves be cared for and how that
would be funded. But today, at 40 and 50 years of age, we are thinking
of that. And what we see is frightening--we don't have easy pathways to
returning to the workforce or retiring. Some of us have no pathway to
return to the workforce or retire.
Veteran Caregiver Re-education, Re-employment, and Retirement Act
is our plea to Congress to help us address these issues. It allows us
to create our own long-term safety nets through re-employment or
funding retirement. As a caregiver for a veteran, and as an advocate
for caregivers of veterans, I would ask you to please pass H.R. 2148,
the Veteran Caregiver Re-education, Re-employment, and Retirement Act.
Prepared Statement of United Services Automobile Association
On behalf of the United Services Automobile Association (USAA) and
our nearly 14 million members of the U.S. military, veterans who have
honorably served, and their families, thank you for convening today's
hearing on legislative proposals to care for our Nation's veterans and
their families. We appreciate the opportunity to provide this statement
of support for H.R. 2148, the Veteran Caregiver Reeducation,
Reemployment, and Retirement Act.
USAA is a membership association that serves members of the
military community, including active duty, Guard, Reserve, veterans,
and their families. Since our founding in 1922 by 25 U.S. Army
officers, USAA has facilitated the financial security of our members,
associates, and their families by providing a full range of highly
competitive financial products and services. In our second century of
service, we remain focused on meeting our members' needs through every
stage of life--from joining the military to buying a home to retiring.
H.R. 2148, the Veteran Caregiver Reeducation, Reemployment, and
Retirement Act
In September 2024, RAND published a report commissioned by the
Elizabeth Dole Foundation titled, ``America's Military and Veteran
Caregivers: Hidden Heroes Emerging from the Shadows.'' There are
approximately 14.3 million military and veteran caregivers today,
representing 5.5 percent of the U.S. adult population. According to
RAND, these caregivers on average incur over $8,500 in annual out of
pocket costs, while forgoing over $4,500 in annual household income.
More than one-third of these caregivers live below 130 percent of the
Federal poverty level. Serving as a caregiver can also compound future
financial challenges. Military and veteran caregivers often have
employment gaps in their resume, which can impact their future
employment and earnings prospects, and many lack retirement savings
vehicles to invest in their own financial security.
This bipartisan bill will expand support available to veteran
caregivers enrolled in the Department of Veterans Affairs (VA) Program
of Comprehensive Assistance for Family Caregivers (PCAFC). It would
provide employment assistance to eligible caregivers, including fee
reimbursement associated with professional certifications or licenses.
Caregivers would also be granted access to existing employment
assistance programs through the VA, the Department of Defense, and the
Department of Labor. In recognition of the fact that caregivers are at
higher risk of depression and suicidality, the bill expands caregiver
access to bereavement counseling and support. The bill also directs the
VA to study the feasibility of establishing a retirement plan or
alternate pathway to retirement savings for veteran caregivers.
USAA thanks Representatives Joseph Morelle (D-NY) and Juan
Ciscomani (R-AZ) for their leadership on this important proposal to
better support the caregivers who selflessly serve our Nation. We urge
the Committee to support the bill when considered during a future
markup.
Prepared Statement of The Veterans of Foreign Wars of the United States
Chairwoman Miller-Meeks, Ranking Member Brownley, and members of
the subcommittee, on behalf of the men and women of the Veterans of
Foreign Wars of the United States (VFW) and its Auxiliary, thank you
for the opportunity to provide our remarks on this pending legislation.
H.R. 785, Representing our Seniors at VA Act of 2025
The VFW supports this legislation to include a representative from
the National Association of State Veterans Homes on the Department of
Veterans Affairs (VA) Geriatrics and Gerontology Advisory Committee.
This inclusion would give state-run veterans homes a voice in Federal
VA policymaking on elder care, and facilitate collaboration between VA
and State Veterans Homes (SVHs) as the veteran population continues to
age.
SVHs originated in the pre-Civil War era and were initially
established to care for injured and aging soldiers. These homes are
operated by State governments and provide nursing, assisted living, or
domiciliary care specifically for veterans. They offer long-term care
services tailored to meet their unique needs.
Living in SVHs offers several benefits, including subsidized care,
VA per diem grants that help reduce out-of-pocket expenses, and a
supportive environment where veterans can connect with one another and
build camaraderie. VA provides general oversight for all 153 SVHs,
which care for approximately 14,500 veterans.
H.R. 2068, Veterans Patient Advocacy Act
The VFW supports this legislation to provide veterans living in
highly rural areas with better access to patient advocate services. For
the past 11 years, the VFW has partnered with Student Veterans of
America (SVA) to select student veterans from across the country to
research and advocate for improvements on issues that matter to
veterans. Past VFW-SVA Fellow and Grand Valley State University
graduate Cameron Zbikowski focused his semester-long research proposal
on enhancing the patient advocate program at VA. He proposed
improvements to ensure that each facility had an adequate number of
patient advocates. In that spirit, the VFW continues to support this
legislation.
H.R. 2605, Service Dogs Assisting Veterans (SAVES) Act
The VFW strongly supports this legislation to create a 5-year pilot
program in which VA would provide up to $2 million in grants to
nonprofit organizations to provide service dogs to eligible veterans.
It would also provide commercially available veterinary insurance for
them. Service dogs assist with various physical, auditory, and trauma-
related disabilities. They help empower veterans to regain their
independence, pride, and hope. While they are typically provided free
of charge, the medical care involved can be costly. This legislation
would enable more veterans to receive support animals with less of a
financial burden.
The VFW thanks Representative Luttrell for introducing this
legislation and for inviting VFW Post 4709 Commander Marcy Phillips
from his Post in Conroe, Texas, to speak at the Congressman's press
conference for this legislation. The VFW was honored to have her talk
about her service dog and how it has had a positive impact on her life.
H.R. 3400, Territorial Response and Access to Veterans' Essential
Lifecare (TRAVEL) Act of 2025
The VFW supports this legislation to authorize VA physicians to
temporarily serve as traveling physicians for up to 1 year in American
Samoa, Northern Mariana Islands, Guam, Puerto Rico, the Virgin Islands,
and other U.S. territories. It would improve support for veterans
living in these areas or medically underserved regions by offering
providers incentives like relocation or retention bonuses. This would
allow VA to address gaps in health care in U.S. territories and provide
a continuity of care through coordinated integration with local
providers.
H.R. 3643, VA Data Transparency and Trust Act
The VFW supports the intent of this legislation, but we have
questions about the scope of the information to be collected. This
proposal would establish certain VA annual reports to Congress from the
Veterans Benefits Administration and the Veterans Health
Administration. The reports would span 5 years, focusing on areas such
as hospital care, medical services, nursing home care, and the
management of these services. It includes a set of metrics designed to
provide insights into veterans' demographic profiles, health
conditions, service utilization, and benefits usage over time. While
the VFW has advocated for improved data reporting by VA, we also want
the intent of these reports to be made clear. The VFW also cautions
against collecting income and other financial information of veterans
that could be used to reduce benefits or prevent veterans from
accessing their earned benefits.
Discussion Draft: To direct the Secretary of Veterans Affairs to
conduct a study to determine whether RNA sequencing can be used to
effectively diagnose PTSD in veterans
As a resolutions-based organization, the VFW does not have a
position on this proposal at this time, however, we do have some
concerns. This legislation would direct the Secretary of Veterans
Affairs to conduct a study on whether ribonucleic acid (RNA) sequencing
can effectively diagnose post-traumatic stress disorder (PTSD) in
veterans. Although this idea is innovative, focusing solely on
biological markers may oversimplify the complexity of the disorder.
Trauma, environment, genetics, and psychology are all factors in PTSD.
While a biomarker-based diagnostic tool could aid in the early
detection of PTSD, it also raises several scientific, practical, and
ethical concerns.
Discussion Draft: Health Professionals Scholarship Program Improvement
Act of 2025
The VFW supports this legislation to improve the hiring of
participants in the VA Health Professional Scholarship Program that
provides scholarships to students pursuing health care degrees in
exchange for service at VA facilities. It enables VA to provide
incentives to qualified health care professionals to work at VA medical
centers, particularly in areas where recruitment and retention are
difficult.
This legislation would create a more efficient process of placing
scholarship recipients into clinical roles, which is particularly
important given VA's critical medical staff shortages. It would do this
by requiring VA to provide employment contracts within 90 days of
students completing their coursework. It would also assign providers to
VA facilities with the highest need, and offer competitive salaries and
benefits aligned with VA standards.
H.R. 3726, Fisher House Availability Act of 2025
The VFW supports this legislation to allow veterans, service
members, and their families to stay at temporary lodging facilities,
such as Fisher Houses, when having to travel significant distances for
medical care. For more than 30 years, Fisher Houses have been available
free of charge. The Fisher House Foundation provided 57 homes to VA and
42 to the Department of Defense. A VA policy change in 2023 restricted
these homes to only those receiving VA-directed care, greatly
restricting service members with TRICARE from using this option. In
2024, Fisher Houses were operating at only 53 percent capacity, mainly
housing the families of hospitalized veterans. This proposal would
codify the previous practice of allowing service members who receive
non-VA care and their families to stay at temporary lodging facilities
on a space-available basis. The priority access would continue to be
for veterans and their families. The VFW sees this as a reasonable
expansion for TRICARE beneficiaries and their families. Broadening
eligibility would help alleviate financial and logistical burdens when
a loved one needs to be hospitalized or receive medical care far from
home.
H.R. 1404, CHAMPVA Children's Care Protection Act of 2025
The VFW supports this legislation that extends the age limit for
children eligible for medical coverage under the Civilian Health and
Medical Program of the Department of Veterans Affairs (CHAMPVA). This
legislation aims to enhance health care access for young adult children
of veterans, ensuring they receive continuous care during a critical
phase of life and minimizing coverage gaps for military families. This
initiative is a key legislative priority for the VFW, and it aligns
with other Federal health care programs such as the Affordable Care Act
that allows dependent coverage until age 26.
H.R. 2148, Veteran Caregiver Reeducation, Reemployment, and Retirement
Act
The VFW supports this legislation to expand medical coverage,
counseling, and employment services to individuals who have
participated in VA's caregiver programs. These dedicated individuals
spend a significant amount of time providing in-home care. When someone
leaves the program, typically because the veteran loved one has passed
away, the caregiver often faces challenges when attempting to reenter
the workforce. Proper training, counseling, and support for
reintegration are essential for those who have left their careers to
become full-time caregivers.
This proposal would provide employment assistance to former
caregivers through reimbursement of certification fees, access to VA
training modules, and support through Military OneSource and the
Veterans' Employment and Training Service. It would also expand
available retirement planning and workforce transition assistance for
these individuals; extend CHAMPVA medical coverage to former caregivers
for 180 days after their designation ends as long as they were not
dismissed for fraud, abuse, or mistreatment; and provide bereavement
counseling following the death of the veteran. The VFW sees all of
these initiatives as beneficial to the dedicated caregivers who provide
long-term care for veterans who need it.
Discussion Draft: VA Mental Health Outreach and Engagement Act
The VFW appreciates the intent of this legislation, but we have
certain recommendations for improvement. Currently, VA is required to
offer a mental health consultation to veterans within 30 days after
submitting a claim for disability compensation for mental health
conditions. Offering veterans mental health consultations every year
may be a deterrent that creates concerns that their benefits could be
reduced, or cause retraumatization when asked to discuss their mental
health needs.
The VFW recommends instead that VA conduct regular outreach to
veterans who have filed VA claims (regardless of the outcome of these
claims) and who do not utilize VA health care services, so they can
receive information about services they may need now or in the future.
Effective outreach to those within the VA health care system and to
those who have not yet enrolled would encourage veterans to consider
these services and utilize them when needed.
Chairwoman Miller-Meeks, Ranking Member Brownley, this concludes my
statement. Again, thank you for the opportunity to offer our comments
on these issues.
Information Required by Rule XI2(g)(4) of the House of Representatives
Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has
not received any Federal grants in Fiscal Year 2025, nor has it
received any Federal grants in the two previous Fiscal Years.
The VFW has not received payments or contracts from any foreign
governments in the current year or preceding two calendar years.
Prepared Statement of American Academy of Physician Associates
Subcommittee Chairman Miller-Meeks, Subcommittee Ranking Member
Brownley, and Members of the Committee on Veterans' Affairs:
On behalf of the approximately 190,000 physician associates/
physician assistants (PAs) throughout the United States, including more
than 2,500 PAs employed by the Veterans' Health Administration to serve
veterans, the American Academy of Physician Associates (AAPA) thanks
the Subcommittee on Health for its continued leadership on veterans'
health issues. We appreciate the opportunity to comment on H.R. 3767,
the Health Professionals Scholarship Program Improvement Act of 2025
(HPSP Improvement Act of 2025), which was introduced by Reps. Abraham
Hamadeh (R-AZ) and Nikki Budzinski (D-IL).
The PA profession proudly maintains a close connection to the VA,
as the founding class of PA students in 1965 were veterans. These first
PA students were former Navy hospital corpsmen and Army combat medics
with considerable medical training from their military service. The VA
was the first employer of PAs in 1967 and today is the largest single
employer of PAs in the Nation. Eleven percent of all practicing PAs and
24 percent of PAs employed by the VA are veterans, active-duty
military, or serve in the National Guard and Reserves. PAs maintain a
strong, personal desire and dedication to serve veterans and AAPA fully
supports efforts, such as the law enacted in 2018 that provided funding
for HPSP scholarships for PAs, to strengthen the workforce at the VA
and expand access to care for veterans.
Last year, AAPA commented on a proposed rule to implement
requirements in the Consolidated Appropriations Act of 2023 for the VA
to ``specifically award scholarships to applicants pursuing degrees or
training in mental health disciplines, including advanced practice
nursing (with a focus on mental health or substance use disorder),
psychology, and social work,'' and to provide no fewer than 50
additional awards to such applicants beginning in academic year 2022.
In its comments, AAPA noted that while it appreciated the VA specifying
that PAs should be eligible for the additional HPSP scholarships, it
also formally requested that the VA specifically list PAs in the Code
of Federal Regulations as well to minimize any future confusion.\1\ In
its final rule, the VA responded that ``PAs are eligible to apply for
and receive HPSP scholarships for mental health disciplines under
proposed Sec. 17.603(b)(2),'' but that it would not be making changes
based on AAPA's comments because, ``the list of mental health
disciplines in proposed Sec. 17.603(b)(2) is not an exhaustive list''
and ``VA determined that it should maintain a non-exhaustive list in
the regulation to permit flexibility so that new mental health
professions can be included without the need to amend the
regulations.'' \2\ AAPA continues to support efforts that encourage and
support PAs to practice in mental or behavioral health and psychiatry
to help address national provider shortages.
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\1\ American Academy of Physician Associates. Comments on Proposed
Rule-VA Health Professional Scholarship Program. October, 2023.
\2\ Federal Register. 38 CFR Part 17, RIN 2900-AR98, VA Health
Professional Scholarship Program. June, 2024.
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AAPA has heard from some PAs working for the VA that even after
completing the HPSP, there are many problems with communication and
administrative delays that have prevented HPSP beneficiary PAs from
being able to treat veterans. Some PAs have faced delays as long as 6
months from the time of their interview until they began work at a VA
facility. These unnecessary delays impose the burden of an income gap
on PAs and other health care providers who would like to care for
veterans, while also compounding the problem of student debt. The HPSP
Improvement Act of 2025 would address this problem by requiring the
Secretary of the VA to ensure that HPSP participants receive a contract
for full-time employment withing 90 days of the completion of their
training.
The HPSP Improvement Act of 2025 is an important step toward
ensuring that the VA is able to hire qualified health care
professionals for which recruitment or retention is difficult. However,
as the VA and Congress work to strengthen the Veterans Health
Administration workforce, it is essential that PAs are included in
these efforts. Despite previous inclusion in VA's HPSP, and despite the
most recent OIG Determination of Veterans Health Administration's
Severe Occupational Staffing Shortages listing numerous severe
shortages of PAs, mental health care providers, and primary care
providers,\3\ the VA has not made PAs eligible for the current round of
HPSP.\4\ It is important for VA recruitment and retention efforts and
for veterans' access to care that PAs be eligible for HPSP, and we
believe it is critical to ensure that PAs and other health care
providers for which there are severe shortages at VA facilities are
included in HPSP.
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\3\ Veterans Health Administration. OIG Determination of Veterans
Health Administration's Severe Occupational Staffing Shortages Fiscal
Year 2024. August, 2024.
\4\ Department of Veterans Affairs. HPSP. Retrieved June 17, 2025.
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With clinical expertise, medical training, the initiative to help,
and unique connection to our veteran population, PAs are on the ground
in local communities and especially positioned to increase access to
care in areas of health care in which VA has acute shortages.
AAPA thanks the Subcommittee for this opportunity to provide
comments on H.R. 3767, the HPSP Improvement Act of 2025, and welcome
any comments or questions you may have for us. Please contact AAPA Vice
President of Federal Advocacy Tate Heuer at [email protected].
Prepared Statement of Concerned Veterans of America
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Military Officers Association of America
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Student Veterans of America
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of K9s For Warriors
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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