Providing care for those who ‘have borne the battle’

For more than a decade, less than 1 percent of America’s brave men and women have borne the burden of the wars in Iraq and Afghanistan. To date, more than 2.8 million service members are now part of this growing cohort of men and women who have deployed in support of Operations Iraqi and Enduring Freedom. It is these veterans who have overcome challenges — seen and unseen — that demonstrate the promise of this next generation of leaders.

The support and services these men and women require evolve over time, and the medical expertise and research data our nation needs to possess in order to furnish them top-quality care must keep pace.


Over the next decade, Congress must provide the vision and resources the Department of Defense (DOD) and Department of Veterans Affairs (VA) require to modernize and sustain our healthcare infrastructure to support veterans reintegrating into their communities. My top two recommendations for Congress include continuing to provide advanced healthcare funding for the VA to ensure future budget fights don’t put veteran care at risk and, secondly, providing a clear vision for the future of the Veterans Health Administration (VHA) — specifically the size and scope of the VA healthcare workforce as it relates to the veteran population it serves — and the extent to which non-VA private care should be made available to veterans who cannot access care in a timely manner through VA medical facilities.

In 2009, after strong insistence from many veterans’ service and advocacy organizations, such as the Iraq and Afghanistan Veterans of America and Disabled American Veterans, Congress and the president succeeded in passing legislation that approved healthcare funding in advance for the VA. This provided a safety blanket for veterans who seek care from the VA and ensured there was not a reduction in care or gradual weakening of their support based on shortsighted budget decisions.

The benefit of this advanced funding accomplishment was illuminated in the fall of 2013, when a partial government shutdown occurred during a congressional budget fight. While stress and frustrations were running high across the federal government with many functions of government shuttered, the one area where stability and predictability was guaranteed was inside the walls of VA hospitals. These facilities operated without interruption and veterans continued to receive their healthcare benefits. The advanced funding mechanism was a smart and honorable decision. Despite a congressional budget fight putting a hold on the operations of the federal government in the short term while final priorities were set, the veterans who fought for our country were not denied the care and benefits they earned. Congress must continue to provide advanced funding for VA medical centers.

Congress must also stand and embrace comprehensive reform at the VHA with an eye to the next decade. There is collective agreement across the country that top quality healthcare should be provided to our veterans, so it is not a question of whether veterans should be provided top quality care but how to best deliver that care. Medical care, research, and advances in military medicine are better than at any other time since the beginning of military conflict; however, accessing care in a predictable and timely manner has continued to be a problem for too many veterans. There are many reasons for this, ranging from poor management in some VA medical facilities to geographic demand for care being higher in some regions of the country.

The problems were exemplified by the 2014 scandal at the Phoenix VA medical center. For now, the Veterans Access, Choice and Accountability Act (VACAA), created to respond to and fix those issues involving manipulation of veterans’ wait-time data, is the intermediate solution we have hung our hats on. That law expanded access to care through workforce enhancements and established criteria veterans can meet in order to seek care from a private provider outside of the VA network, in the event they can’t be seen within 30 days, or reside farther than 40 miles from a VA facility. VACAA has provided a short-term solution to provide the VA with more resources and expanded flexibility to hire private caretakers in order to get veterans off of waiting lists and into the doctor’s office.

Congress, in consultation with the VA secretary, must identify the appropriate organizational modifications to maintain adequate VA service for veterans who utilize its care and for those in rural areas or those who cannot be seen within current standards, and identify more clearly pathways to private care. The best starting point when beginning this conversation about the future is to focus on the views of veterans’ groups and available post-9/11 veterans survey research data and not allow the VHA to be the only entity making decisions about planning, funding and medical care.

Naturally these recommendations focus heavily on the VA, which in President Lincoln’s words is the entity charged to “care for him who shall have borne the battle.” The DOD’s mission continues to be defending the nation and carrying out operational requirements.

For Congress to keep the armed forces strong, it should take care of servicemen and servicewomen when they transition to civilian life. Continuing to pass advanced healthcare funding for the VHA will maintain the delivery of high quality care for veterans — both today and tomorrow. Engaging veteran stakeholder groups and healthcare experts will also be paramount to identifying the scope and shape of the VA healthcare system for the next 50 years and beyond.

Neiweem is the legislative associate for Iraq and Afghanistan Veterans of America, a leading post-9/11 veterans empowerment organization. He was honorably discharged in 2007, having served as an enlisted military police sergeant, which included a 2003 deployment to Camp Bucca, Iraq, guarding enemy prisoners of war in support of Operation Iraqi Freedom.