After 30 years, it’s time to rethink VA’s Cabinet department status

By all accounts, 2018 has been an eventful year and it has been especially so for veterans. As noted by the departing chairman and soon to be ranking member of the House Veterans’ Affairs Committee, Phil RoeDavid (Phil) Phillip RoeHouse panel delays vote on surprise medical bills legislation If Trump wants to stay popular among veterans he has to do more Want to solve surprise medical bills? Listen to patients MORE (R-Tenn.), the House passed more than 80 veterans bills, 30 of which were signed into law.

Many of these laws centered around creating a culture of transparency and accountability for the Department of Veterans Affairs (VA).

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To this end, the year 2018 is also significant for veterans because it is the 30th anniversary of VA being elevated to a Cabinet department. In 1988, when the Department of Veterans Affairs Act was being considered before Congress, John Glenn (D-Ohio), the chairman of the Senate Governmental Affairs Committee, stated that he wanted VA’s elevation to Cabinet status to be more about substance than symbolism

At the time, the stated goal of those in favor of elevating VA to a Cabinet department was to bring more accountability to VA, at a time when a House Government Operations Subcommittee investigation found that “[i]nternal VA reports indicate that the VA has covered up serious deficiencies” in its processes.

Skeptics of Cabinet status, including those at the National Academy of Public Administration (NAPA), felt that there was “little evidence that the vitally mission of providing for the present and future needs of our veterans would be materially improved” by the elevation. As stated by GAO in response to their report, “VA urgently needs to address its serious management problems, regardless of its status.”

Similarly, NAPA conveyed further concern that Cabinet status would, in effect, served only to “enhance the status of the agency’s senior officials” and that it would not “significantly improve either access to the president, the adequacy of necessary resources for the organization, management and delivery of high-quality services and benefits.”

Thirty years later, VA’s elevation to a Cabinet department seems to be exactly what Glenn advised against, a symbolic gesture that, unfortunately, ultimately lacked substance.

The concerns highlighted by critics in 1988 could easily be said about today’s VA. Problems surrounding VA management persist, despite Cabinet status, as evidenced by the recent debacle over inaccurate GI bill payments and confusion over how or even whether VA would fix them, as well as the failure to spend millions of dollars earmarked for veterans suicide prevention, despite the seriousness of the epidemic.

Similarly, current VA critics would argue that Cabinet status has indeed enhanced the status of senior officials without increasing access to the president or significantly improving how quality benefits and services were delivered.

If this were not the case, significant pieces of legislation recently passed, such as the Department of Veterans Affairs Accountability and Whistleblower Protection Act, would have been completely unnecessary.

And, despite this law, Congress is still focused on accountability for VA leadership, focusing on issues such as the elimination of reassignments for personal gain and prevention of moving managers around in lieu of disciplining them, showing that the issue is still not completely resolved.

With regard to improving the quality of benefits and services, VA has, overall, fared slightly better. As a recent Annals of Internal Medicine article highlighted, VA hospitals often perform at least as well as non-VA hospitals and in certain markets, performed even better.

Nonetheless, VA’s Cabinet status and increased clout have not been able to solve the agency’s issues surrounding access to care. In response, Congress passed the Mission Act in June 2018 to facilitate veterans’ access to care in the community, but as highlighted by the 115th Congress’s final hearing on veterans’ issues — a joint House and Senate hearing on the Act’s implementation — VA currently lags sorely behind important benchmarks set by the law for implementing the legislation.

As noted by Senate Veterans’ Affairs Committee ranking member, Jon TesterJonathan (Jon) TesterDemocratic senators quietly hope Biden wins over rivals GOP Sen. Johnny Isakson to resign at end of year Native American advocates question 2020 Democrats' commitment MORE (D-Mont.), the Mission Act was “passed ... with the best of intentions, but it could be a train wreck, too.”

Like the Mission Act, the Department of Veterans’ Affairs Act in 1988 was passed by Congress with the best of intentions. However, as we reflect on thirty years of Cabinet status, the elevation of VA, sadly, appears to have been more train wreck than accountability measure.

So what happens next?

De-elevating VA from its current Cabinet status is not practical. The traditional means of ensuring accountability, such as through the passage of legislation and Congressional oversight, has thus far proved to be only mildly effective. And calls from veterans themselves about what they need from VA itself have largely gone unheeded.

One idea that is seldom discussed would be downsizing some parts of the VA by redistributing several business lines to other government agencies, rather than privatizing parts of VA or continuing to increasing its funding.

To this end, the Social Security Administration already has infrastructure in place to adjudicate disability benefits claims and could absorb parts of the Veterans Benefits Administration.

Likewise, the government has laws and regulations in effect for providing healthcare through Medicare, Medicaid and Tricare and parts of thus parts of the Veterans Health Administration could be absorbed by the Department of Health and Human Services or the Department of Defense.

As we have seen with the VA’s ballooning budget over the past 17 years, bigger is not always better. Thus, instead of fighting over politically impractical ideas such as privatization or unrealistic budgets, the time is right to discuss government reorganization, instead.

Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her on Twitter, @RileyTopping.