*Administration of Barack Obama, 2016 *

**Letter to Congressional Leaders on the Final Report of the Commission on Care **

*September 1, 2016 *

*Dear Mr. Speaker: (Dear Mr. President:) *

My Administration is committed to the ongoing transformation of the Department of Veterans Affairs (VA) and I strongly support many of the recommendations and the underlying objectives offered by the Commission on Care (Commission) in its final report transmitted on July 6, 2016. These recommendations underscore the fundamental challenges that face the VA health care system, and the reforms needed to provide America's veterans with the high quality health care they need and deserve—both now and in the future. We have made great strides in delivering improved care to our veterans over the past 8 years, and we will continue to work tirelessly to uphold the solemn responsibility to ensure all our veterans are getting the care and benefits they have earned.

I concur with 15 of the 18 Commission recommendations, many of which are already being implemented as part of the ongoing MyVA transformation that the Secretary of Veterans Affairs (Secretary) has put in place. These include areas such as enhancing clinical operations, establishing a more consistent policy for appealing clinical decisions, eliminating disparities in how health care is delivered to veterans from different backgrounds, modernizing IT systems, and establishing new processes for leadership development and performance management. These reforms are steps in the right direction and will help put VA on a trajectory to ensure veterans continue to receive timely and high quality care, while strengthening the VA health care system that millions of veterans depend on every day. I appreciate and applaud the Commission for their work.

Of particular note, I strongly support the Commission's principle that creating a high-performing, integrated health care system that encompasses both VA and private care is critical to serving the needs of veterans. In fact, my Administration outlined its approach to achieve this same goal in VA's *Plan to Consolidate Community Care*, submitted to the Congress in October 2015. While this approach must be implemented in a fiscally sustainable way, it builds on more than a decade of work with veterans, health care providers, and community partners, to streamline and enhance VA's capability to deliver services essential to veterans' health. VA's plan also recognizes the importance of strengthening VA's partnerships with other Federal health care providers, including the Department of Defense and Indian Health Service, as well as tribal health programs, academic teaching affiliates, and Federally Qualified Health Centers.

At the same time, it is critical that we preserve and continue to improve the VA health care system and ensure that VA has the ability to serve veterans. Research shows that in many areas, such as mental health, VA delivers care that is often better than that delivered in the private sector. VA also provides unique, highly specialized care for many medical conditions, such as spinal cord and traumatic brain injuries, which are simply not available to the same extent outside of VA. In addition, VA provides a comprehensive approach to wellness that includes the treatment of physical injuries and mental health. This multidisciplinary approach allows providers to address the full spectrum of veteran needs beyond medical care, including other VA benefits and services. For these reasons, I concur with the Commission's vision for creating integrated care networks that more tightly coordinate VA and non-VA care, but urge the Congress to act on this recommendation by enacting VA's *Plan to Consolidate Community Care*. The alternative approach outlined in VA's plan would achieve the goals of the Commission to create a veteran-centric approach to care that appropriately balances issues of access, quality, and cost-effectiveness. It would more clearly ensure the long-term viability and sustainability of the VA health care system, preserve VA's role as the primary coordinator of care for veterans, and safeguard its ability to carry out its other research, education, and emergency preparedness missions that are critical to our Nation's well-being. And it would ensure that veterans have access to the care they need—whether at the VA or out in the community—without forcing untenable resource tradeoffs that would limit the ability of VA to carry out other parts of its mission on behalf of veterans.

We must also ensure that VA has the ability to operate this integrated health care system in a rational, efficient, and dynamic way that best serves the interests of both veterans and taxpayers. For that reason, I have concerns with the Commission's proposed governance structure for the VA health care system. The proposal would undermine the authority of the Secretary and the Under Secretary for Health, weaken the integration of the VA health care system with the other services and programs provided by the VA, and make it harder—not easier—for VA to implement transformative change. Moreover, the Department of Justice has advised that the proposed recommendation would violate the Appointments Clause of the Constitution. I do, however, support portions of the recommendation that would establish a term appointment for the Under Secretary for Health, to ensure that position is removed from the turmoil and turnover of the political cycle.

For those recommendations I agree with and whose objectives are not yet achieved, I am directing the VA to develop plans to complete their implementation. Additionally, in recognition of the role of the MyVA initiative in transforming the VA as military service evolves, I have directed the Secretary of Veterans Affairs to incorporate the principles of the MyVA initiative into VA strategic planning, leadership training, and performance monitoring. In those areas where legislation is required, my Administration will work closely with the Secretary to transmit to the Congress the relevant legislative proposals, which I recommend be enacted without delay.

Improving veterans' health care remains a critical issue of national importance, and my Administration will work with veterans and military families, the Congress, Veterans Service Organizations, and other stakeholders to ensure all our veterans are getting the care and benefits they need when they need them.

Sincerely,

BARACK OBAMA

NOTE: Identical letters were sent to Paul D. Ryan, Speaker of the House of Representatives, and Joseph R. Biden, Jr., President of the Senate.

*Categories:* Communications to Congress : Care, Commission on, final report, letter*.*

*Names:* McDonald, Robert A. *Subjects:* Care, Commission on; Veterans : Health and medical care; Veterans : Veterans service organizations; Veterans Affairs, Department of : Secretary; Veterans Affairs, Department of : Veterans Health Administration.

*DCPD Number:* DCPD201600552.