Tuesday, November 10, 2015

Fact Sheet: Hillary Clinton's Plan to Overhaul the VA

International troops listen to a speech by U.S. State Secretary Hillary Clinton during a meeting at Kabul airport before her departure from Afghanistan November 19, 2009. REUTERS/Jerry Lampen (AFGHANISTAN POLITICS CONFLICT MILITARY)
International troops listen to a speech by U.S. State Secretary Hillary Clinton during a meeting at Kabul airport before her departure from Afghanistan November 19, 2009. REUTERS/Jerry Lampen (AFGHANISTAN POLITICS CONFLICT MILITARY)
U.S. State Secretary Hillary Clinton speaks during a meeting with International troops at Kabul airport before her departure from Afghanistan November 19, 2009. REUTERS/Jerry Lampen (AFGHANISTAN MILITARY POLITICS CONFLICT)
U.S. State Secretary Hillary Clinton speaks during a meeting with International troops at Kabul airport before her departure from Afghanistan November 19, 2009. REUTERS/Jerry Lampen (AFGHANISTAN MILITARY POLITICS CONFLICT)
U.S. State Secretary Hillary Clinton meets with International troops at Kabul airport before leaving Afghanistan November 19, 2009. REUTERS/Jerry Lampen (AFGHANISTAN)
U.S. State Secretary Hillary Clinton meets with International troops at Kabul airport before leaving Afghanistan November 19, 2009. REUTERS/Jerry Lampen (AFGHANISTAN)



Factsheets

Supporting Our Veterans, Troops, And Their Families

Hillary Clinton believes that supporting our veterans is a sacred responsibility. By fulfilling that responsibility, we not only ensure that veterans receive the opportunity, care, and support they earned by serving our country.  Prioritizing their reintegration also ensures that they bring their unique skills and experience to the success of their communities and our nation after their service is over.  Yet too often, we as a nation failed to uphold our end of the bargain.  As Commander-in-Chief, she will personally commit to fulfilling America’s promise to our veterans, our troops, and their families – a commitment driven by her recognition not just of the extraordinary sacrifices they make, but also of how essential that promise is to our long-term national security and our vitality and prosperity at home.
Secretary Clinton has fought for our veterans throughout her career.  This issue is deeply personal for her, and her approach is rooted in her upbringing as the daughter of a World War II veteran and decades of experience working with military members and their families.  As First Lady, she fought to have Gulf War Syndrome recognized.  As Senator on the Armed Services Committee, she fought to establish new services for military members and veterans suffering from post-traumatic stress (PTS) and traumatic brain injuries (TBI).  She regularly worked across the aisle to expand military benefits, including to ensure that all members of the Reserves and National Guard and their families had access to health benefits; to expand benefits afforded to surviving spouses; and to broaden protections afforded by the Family and Medical Leave Act to the family members of wounded service members.  And as Secretary of State, she was at the table in the Situation Room, providing advice to the President on the most grave decision a Commander-in-Chief makes: whether and how to send our military personnel in to harm’s way.
Secretary Clinton is committed to a strong and resilient military, built by the extraordinary men and women who volunteer to serve and the families who serve alongside them.  And she believes that issues affecting current service members and veterans are inseparable.  As President, she’ll continue to support the needs and talents of all who have served and who serve us still, whether Soldiers, Sailors, Marines, Airmen and Coast Guardsmen, including active duty, reserve, and National Guard, and every race, creed, gender, and sexual orientation.  And she will have no tolerance for failure to put veterans first.
Secretary Clinton’s comprehensive plan will:
  • Fundamentally reform veterans’ health care to ensure veterans’ access to timely and high quality health care and block efforts to privatize the VHA
  • Modernize and refocus the full spectrum of veterans’ benefits across the federal government
  • Overhaul VA governance to create a new veteran-centric model of excellence
  • Empower veterans and strengthen our economy and communities by connecting their unique skills to the jobs of the future
  • Sustain and strengthen the all-volunteer force
  • Strengthen services and support for military families

Veterans Agenda

The systemic failures of the VA to uphold its core mission underscore the need for fundamental reforms and focused leadership.  Long wait times for health care, crippling claims backlogs, and lack of coordination among agencies represent government at its worst.  Secretary Clinton recognizes the gravity of these challenges, and as President will pursue a veteran-centric reform agenda that tackles problems head-on and revitalizes the VA.  She will end the excuses and ensure our veterans receive the timely health care they deserve. She will oppose the privatization of the VA system, which would undermine our veterans’ ability to get the unique care that only the VA can provide while leaving them vulnerable to a health care market poorly suited to their needs.  And she will lead a national effort to invest in and empower veterans to apply their considerable skills in their communities.

ENSURE VETERANS’ ACCESS TO TIMELY AND HIGH QUALITY HEALTH CARE
Veterans must have access to a system that puts their needs first. But in order to build such a system, prepared for the unique and growing needs of the twenty-first century, we cannot simply throw more money at the problem or tell veterans to go get private care, as the VA’s implementation of the Veterans’ Choice Act has shown.  We also cannot throw our veterans at the mercy of the private insurance system without any care coordination, or leave them to fend for themselves with health care providers who have no expertise in the unique challenges facing veterans. The Veterans Health Administration (VHA) must embrace comprehensive process and systems integration across its health care enterprise to ensure a fully-networked and financially-sustainable organization that is dedicated to best practices and continual improvement in everything it does. Specifically, Secretary Clinton will:
Create a new framework for VHA health care deliveryby refocusing, reorganizing, and streamlining the VHA to best serve veterans in the 21st century.  The VHA must be transformed from primarily a provider of services into an integrated health care system that responsibly balances its role as health care provider, partner, and payer for veteran-directed care.  And it must have the health care providers necessary to ensure it is able to provide quality and timely care.  At the same time, the VA must maintain the ultimate responsibility of coordinating and ensuring comprehensive and quality health care for every veteran and the specialized services that they deserve – critical functions that would disappear if the VA were privatized.  The VHA must:
  • Refocus as a veteran-centric provider of service-connected care. The VHA should focus its resources on what it can do best, particularly health care for service-connected conditions. This is especially important in areas where veterans lack access to the necessary care outside of the VHA, such as prosthetics and traumatic brain injury.
  • Synchronize and coordinate VHA care with other available programs, including coverage already provided to veterans, such as private or employer-provided insurance, TRICARE, Medicare, federally-qualified health centers, Indian Health Service, and the Affordable Care Act, to ensure the most responsible use of taxpayer dollars;
  • Strategically purchase private-sector care when it makes sense to do so, such as for some specialty inpatient or surgical procedures, expanded access to mental health and substance abuse treatment, or when the VA cannot provide timely access to necessary care.  Secretary Clinton would present and advocate for legislation that allows the VA to pursue provider agreements to do this in the most effective and efficient manner;
  • Establish a VHA Strategic Oversight and Governance Board of health care and management leaders. In line with the best practices of modern hospital systems across the country, the board will be empowered to provide oversight of VHA management processes, monitor accountability, promulgate best practices, and ensure the VHA remains true to its mission of putting veterans first.  This Board would include strong veterans representation.
Personally convene the Secretaries of Veterans Affairs and Defenseregularly in the Oval Office and direct them to develop, execute, and report on an effort that integrates their health care operations to create a more efficient and a sustainable system. She will direct them to:
  • Streamline the DoD-VA health care footprint by identifying opportunities to co-locate and better coordinate inpatient services across federal health delivery programs, while stripping out costly and redundant bureaucratic functions, and developing a plan to ensure the VA has the facilities needed to provide 21st century care;
  • Synchronize procurement to find cost savings by negotiating and procuring a single formulary of pharmaceuticals along with medical and office supplies and information systems to ensure compatibility and eliminate waste and redundancy;
  • Streamline VA and DoD IT, ending the years of delay in developing an electronic health record (EHR) system that is fully interoperable. The VA has over 100 different versions of its own EHR system, making it difficult enough to communicate between different VA clinics, let alone with DoD.  DoD and VA must also eliminate bureaucratic barriers to seamless coordination and information-sharing.  And the new system must also link to private sector providers to enable full information sharing, care coordination, and integrated billing and payments.
Improve health care for women at the VHA to ensure all veterans are fully and equally supported after serving our nation. Women veterans are the fastest growing population served by the VA, highlighting the importance of proactively addressing the VHA’s ability to meet their needs. Secretary Clinton would work to pass bipartisan legislation that requires VA medical facilities to meet the health care needs of women veterans. In addition, Secretary Clinton calls for:
  • New funding to ensure women equal and respectful access to health care, going beyond simply modifying facilities and increasing the number of OBGYNs employed by the VHA, to include expanding provider training, ensuring culturally-competent VHA staff and policies, and providing other gender-specific health services – including mental health services;
  • Requiring the provision of reproductive services across the VHA to ensure women have access to the full spectrum of medical services they need;
  • Broadening initiatives to provide childcare at VA medical facilities so that parents, particularly single mothers, don’t have to choose between taking care of their child and taking care of their health.
End the veteran suicide epidemic andensure that every veteran has access to world-class medical and counseling services whenever and wherever they are needed. To do this, Secretary Clinton will:
  • Increase funding for mental health providers and training to ensure timely and ongoing identification and triage of mental health issues, and ongoing access to quality mental health care and substance abuse treatment, particularly for alcohol and opiate abuse, including private-sector care when necessary.
  • Expand programs targeted at providing effective mental health treatment for veterans that have participated in classified or sensitive missions without compromising non-disclosure requirements,working with Congress to pass needed legislation;
  • Promote better prescriber and treatment practices by promulgating guidelines that recommend treatments for pain management other than opioids, so that prescribers can consider those alternatives, particularly for patients without chronic physical pain;
  • Ensure that Military Sexual Trauma (MST) is acknowledged as a valid form of PTS, setting a burden of proof for MST that is no higher than for any form of trauma, and that men and women who suffer from it are uniformly eligible for disability compensation and treatment;
  • Educate and encourage state veterans affairs departments to include veteran mental health programs in state requests for federal grants as part of Secretary Clinton’s initiative to combat drug and alcohol addiction;
  • Provide proper legal assistance to review and upgrade other-than-honorable discharge categorizations for service members who were improperly separated from service due to service-connected mental health and cognitive issues, such as TBI, PTS, and addiction.
Continue efforts to identify and treat invisible, latent, and toxic wounds of warthat continue to affect veterans, family members, and caregivers long after their service.  This includes Agent Orange, Gulf War syndrome, burn pits, and – two issues that Secretary Clinton has long worked to better address – PTS and TBI. Secretary Clinton will:**
  • Maintain presumptions of service-connection for latent and invisible wounds from the Vietnam War, Gulf War, Iraq war, and Afghanistan war while directing the VA to consider additional presumptions of service connection for disabilities arising from toxic exposure;
  • Expand the current VA burn pit registry to become a comprehensive registry for all post-9/11 deployment veterans exposed to environmental dangers, toxic hazards, and other conditions.
  • Dedicate research funding and provide mechanisms for collaborative efforts to facilitate the development and expansion of evidence-based diagnostic tools and treatments for veteran-centric conditions, including mental health issues and other invisible, latent, and toxic wounds of war, and direct the VA, HHS, and DoD to collaborate and integrate portfolios when it makes sense to do so.

MODERNIZE AND REFOCUS THE FULL SPECTRUM OF VETERANS BENEFITS ACROSS THE FEDERAL GOVERNMENT SYSTEM BY IMPLEMENTING A “NEW BRADLEY PLAN”
In the years following World War II, 16 million returning service members were able to rely on the health care and educational opportunities afforded by an adaptable VA organization, headed at the time by General Omar Bradley. General Bradley worked effectively with Congress and stakeholders to build the system that cared for those returning troops. In a similar spirit, aimed at address the VA’s current limitations, Secretary Clinton will direct a national, multi-sector effort to streamline and modernize the veterans’ benefits system.  The “New Bradley Plan” will address the shortcomings of today, while ensuring the nation can meet the needs of tomorrow’s veterans.  To implement this plan, Secretary Clinton will:
End the disability benefits and appeals backlog through overtime work, productivity improvements, and new initiatives.  Secretary Clinton will:
  • Streamline and simplify the claims process by integrating DoD and VA medical evaluations, using “fully developed claims” from private providers, allowing rules-based automatic adjudication for the simplest of applications, and by ensuring veterans have an effective appeals process to make sure the VA gets it right.
  • Improve the VA’s partnership with DOD to anticipate and prepare for future waves of VA claims across the government, and surge resources to the system before claims backlogs grow out of control.
  • Launch an Innovation Initiative led by a team with diverse backgrounds and expertise to connect the VA with leaders in the nation’s leading businesses, universities, and non-profits to develop innovative solutions for sustainably managing the claims and appeals process and to address unforeseen challenges.**
Bring Sustained and Focused White House Leadership and Attentionto coordinate the programs supporting our veterans across the U.S. government, ensure continued consultation and engagement with the veteran community, and leverage the private sector to ensure the entire nation is mobilized to meet this challenge.  To do so she will:
  • Create a standing President’s Council on Veterans, coordinated by a Senior White House official responsible for Veterans Integration. The council will be an all-of-government approach to supporting veterans, comprised of the heads of all 17 agencies involved in this mission to synchronize and integrate the patchwork of programs and benefits.
  • Conduct an end-to-end evaluation to optimize the full scope of benefits afforded to our veterans and provide recommendations to ensure that greater investments in services and support for veterans are smart, effective, and will best meet the needs of veterans today and for generations to come;
  • Convene a White House Summit on Veterans to personally address progress on veterans’ issues with all stakeholders directly, meet early and regularly with a cross-section of veterans to understand their needs and ensure we meets our promises, and work with state governors to ensure that veterans and National Guard issues are addressed at the state level given their important role;
  • Continue to engage private and philanthropic sectors with this effort by ensuring that companies know the value of hiring veterans and by amending federal ethics and acquisition regulations to allow VA, DoD, and other federal agencies to effectively partner with the private and nonprofit sectors, including better data sharing, more open access to federal facilities, and sharing of resources.
 
EMPOWER VETERANS BY CONNECTING THEIR UNIQUE SKILLS TO THE JOBS OF THE FUTURE
Secretary Clinton recognizes that America’s veterans are an enormous asset for the future of the country and our economic growth.  Veterans bring unique skills from their time in the military that can move America’s economy forward.  From their commitment to service and teamwork to specific job skills from computer science to welding, investment in our veterans can power a workforce for the future.  Secretary Clinton is committed to the programs and supports that will strengthen pipelines of veterans and service members into higher education and industry.  Specifically, Secretary Clinton will:
Support and broaden initiatives that provide educational benefits, job training, and support for veteran entrepreneurs.  Secretary Clinton will build on First Lady Michelle Obama’s Joining Forces Initiative with a national push to improve the pipeline of our nation’s veterans into the workforce.  To do this, she will:
  • Make the Post-9/11 GI Bill a lasting part of the nation’s social contract with those who serve, working with Congress to pass legislation that solidified existing benefits, preserves and extends family transferability (including to non-traditional families), and expands qualified uses for use in the 21st century economy, such as at approved coding academies, entrepreneurship programs, and apprenticeship programs with America’s leading companies and labor organizations;
  • Expand tax credits for veterans’ employment through reauthorizing and making permanent the Work Opportunity Tax Credit for veterans and expanding it to provide credits to businesses that hire disabled veterans.
  • Improve concurrent certification and credentialing programs by increasing funds available to state and local governments to process military certificates, and by expanding the concurrent credentialing program to all appropriate military career fields, to ensure that our veterans can seamlessly transfer their skills from the military to the community;
  • Strengthen veteran entrepreneurship programs, including expanding the efforts of the Interagency Task Force on Veterans Small Business Development to provide entrepreneurship training and counseling and small business loan guarantees;
  • Create pathways and platforms for service members to enter growing career fields, including jobs in clean energy, cyber, and information technology, and areas of critical need by improving integration between these opportunities and the military’s Transition Assistance Program;
Protect veteransfrom discrimination and predatory companies that unfairly target veterans and their families, in the spirit of Secretary Clinton’s broader efforts to protect consumers and bolster the middle class, she will:
  • Fight back against schools that prey on veterans, including through legislation that closes the 90-10 loophole exploited by for-profit schools, and by banning schools from receiving federal student aid (including DoD tuition assistance and VA GI Bill funding) if they are found guilty of fraudulently recruiting students;
  • Enforce zero tolerance for firms that overcharge service members and veterans by banning bill collectors and loan servicers from contracts to service federal loans, and help defrauded students discharge debt from fraudulent schools;
  • Strengthen non-discrimination laws protecting veterans and military families by expanding the Uniformed Services Reemployment and Readjustment Act (USERRA) and Servicemembers Civil Relief Act (SCRA), adding veteran status to the Fair Housing Act of 1968 to protect veterans from discrimination in the housing market.
Move decisively to end veteran homelessness by building on successful initiatives and expanding programs that help ensure long-term success.
  • Increase funding for reducing homelessness while expanding public-private partnerships, with an emphasis on regions with the greatest need. Leverage federal resources to support community-based organizations, including by reallocating excess and unused federal property for use by veteran-focused non-profit organizations;
  • Expand complementary programs and services including outreach, especially in locations involving high densities of homeless veterans, and programs that prepare veterans for independent living to prevent recidivism, such as counseling, job training, disability benefits, and transportation;
  • Address the needs of homeless women veterans and homeless veteran families by clarifying language in the Fair Housing Act that removes ambiguities in the law regarding gender and family-specific housing, and providing shelter options that account for local demographic conditions.
Support Veterans Treatment Courts nationally using block grants to state and local governments while also directing the VA to expand its current pilot programs for “medical legal partnerships” to offer space to community legal organizations in VHA clinics.  Veterans Treatment Courts provide an alternate to the traditional criminal justice system for veterans with minor offenses aggravated by mental health or substance abuse issues, ensuring these veterans are rehabilitated while getting the treatment they need.
Recognize the honorable service of LGBT veterans by proactively reviewing and upgrading discharge records for veterans who were discharged because of their sexual orientation; and honoring their service by continuing efforts to improve the support and care they receive at the VHA to ensure respectful and responsive health care.

OVERHAUL VA GOVERNANCE TO CREATE NEW VETERAN-CENTRIC MODEL OF EXCELLENCE
Fulfilling the nation’s duty of taking care of our veterans requires effective performance by the VA and other federal agencies that support veterans. As part of a broader effort to promote good governance, Secretary Clinton will reform management within the Department of Veterans Affairs, ensure fair and transparent accountability, and set us on a path to excellence for our nation’s veterans for generations to come. Secretary Clinton will:
Create a culture of accountability, service, and excellence at the VA.Secretary McDonald has done a commendable job of refocusing the VA on its core mission: putting veterans first. But Secretary Clinton believes more must be done to reform and improve the VA from the top-down, and from the bottom-up. Secretary Clinton supports legislation that will:**
  • Hold every employee accountable for their performance and conduct. From the top leadership to mid-level managers to entry-level employees, everyone at the VA must embody the highest workplace standards. Supervisors must be empowered to suspend or remove underperforming employees in accordance with due process not only for the good of the organization, but in service of our nation’s veterans.
  • Revamp the performance evaluation system to recognize and advance high-performing employees to create a thriving, effective, and sustainable organizational culture, while also establishing processes to ensure managers are held accountable for taking action to deal with poorly performing employees.
  • Bolster critical whistleblower protections. Individuals who sound the alarm over wasteful programs or question inefficient practices embody the spirit of reform and management excellence that the VA must champion. Whistleblower protections are key to ensuring these employees are empowered and their voices heard, not silenced.
Provide budgetary certainty to facilitate reforms and enable long-term planning. The recent budget deal reached between the Congress and the White House is a promising first step in providing government agencies with much needed fiscal stability. But we must go further by ending the sequester for both defense and non-defense spending in a balanced way, and prioritizing full-funding and advance appropriations for the entire Department of Veterans Affairs.
Ensure our veterans are buried with the honor, distinction, and integrity they deserve, directing the VA to clean up problems that have led to unacceptable indignities for our veterans and their families.

Military Personnel and Families Agenda :

Our obligation to our veterans cannot be separated from our broader commitment to take care of our soldiers, sailors, airmen, marines, coast guardsmen –active duty, reserve, and National Guard – and their families. Our men and women in uniform have volunteered to put their lives on the line to serve our country in operations that keep our people safe and ensure peace and security across the globe.  As President, Secretary Clinton will make sure the United States supports the men and women who make the US military the best-trained, best-equipped, and strongest military the world has ever known.
Secretary Clinton believes that no individual should have to choose between serving their country and taking care of their family, while on active duty or afterward.  She will continue to work with civilian and military national security leaders to ensure that our nation’s armed forces are trained, equipped, and ready for the full spectrum of challenges they will face, including those still over the horizon.
SUSTAIN AND STRENGTHEN THE ALL-VOLUNTEER FORCE
The All-Volunteer Force (AVF) has been stressed by fourteen years of continuous combat and is endeavoring to rebuild and reset, while facing growing instability and complexity around the world, reduced end-strength, and an uncertain fiscal environment.  Secretary Clinton is developing a broad strategy on DOD budget and reform measures grounded in permanently ending the damaging sequester while making smart reforms in both defense and non-defense spending.  Included in that plan will be military personnel policies that support and promote total force readiness by:
Supporting smart compensation and benefits reformthat attracts the best and brightest new recruits to the AVF. Secretary Clinton’s unwavering commitment to our military men and women includes policies that will:**
  • Ensure reforms to military compensation and retirement benefits improve readiness and quality-of-life, and working with Congress and the services to ensure that ongoing improvements to the system, such as plans to modernize the commissary system, are accomplished in a smart and comprehensive manner, guaranteeing the strength and sustainability of the force for generations to come.
  • Modernize the military health system by ensuring service members, military retirees, and their families robust access to health care by changing the incentive structure of the TRICARE contracts to produce better health outcomes with better patient satisfaction, expanding access to mental health care through telemedicine and non-traditional treatments, and ensuring the health needs of military women – including reproductive health care – are fully supported.**
Adopting modern and inclusive personnel policies that serve to bolster and enhance the finest fighting force the world has ever seen. Secretary Clinton’s plan will both take advantage of America’s strengths while embodying its values. This includes:
  • Attracting millennials to military service by building on ‘force of the future’ initiatives, to include emphasizing military opportunities in science and technology and promoting smarter and more flexible DoD policies on tour lengths and assignments, which give military families greater stability and increase retention.
  • Zero-tolerance for Military Sexual Assault and Harassment by strengthening protections to ensure that our women and men in uniform can serve without fear of sexual assault or harassment, and without fear of retaliation for reporting.**
  • Welcoming women to compete for all military positions provided they meet the requisite standards, in line with the ongoing DoD policy review. From piloting fighter jets to serving on submarines to earning respect as an Army Ranger, merit and performance should determine who serves in the military’s combat specialties and units, not gender.
  • Supporting the DoD policy review on transgender service, anticipating that transgender people will soon be allowed to serve openly alongside their comrades in arms in a military where everyone is respected enough to let them serve with dignity.
 
STRENGTHEN MILITARY FAMILY SERVICES AND SUPPORT
Secretary Clinton recognizes that military family readiness is a critical part of total force readiness, and she understands that military families face unique concerns and challenges, especially after fourteen years of continuous deployments. To tackle these challenges, Secretary Clinton will:
Promote family policies that provide military families with additional opportunities and much-needed flexibility in juggling multiple challenges. This includes:
  • Increasing access to child care both on- and off-base, including options for drop-in services, part-time child care, and the provision of extended-hours care, especially at Child Development Centers, while streamlining the process for re-registering children following a permanent change of station (PCS);
  • Creating flexibility around military moves by allowing families to continue receiving their housing allowance for up to six months after a military member’s PCS move under common-sense circumstances; for example, when the service member has a spouse enrolled in a degree-granting program or one or more children enrolled in a local school;
  • Expand military spouse employment initiatives by developing resources and high quality portable or work-from-home positions for spouses while expanding public hiring preferences and credentialing programs to assist military spouses.
Champion efforts to care for our military members and families, and ensure that our nation honors and respects them throughout their service and beyond. Secretary Clinton will:
  • Ensure continued focus on mental health for military members and families by enhancing DoD programs to help remove the stigma of mental health issues and by developing a comprehensive whole-of-life approach with the DoD Suicide Prevention Office that includes education, training, counseling resources, and family outreach;
  • Remain committed to extended leave policies that are critical to military families, whether preparing for a service member’s deployment or caring for a wounded warrior, and expanding paid maternity and paternity policies across all of the services;
  • Continue to support Gold Star Families and recognize their sacrifice through enhanced gratuity payments to surviving spouses and ongoing access to benefits in recognition of their sacrifice.
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