Linda Bilmes Testifies Before House Committee on Veterans’ Health Care Costs

Hearing on Veterans' Health Care Costs
Testimony before US House of Representatives Committee on Veterans Affairs
May 23, 2007

Linda Bilmes
Lecturer in Public Policy
John F. Kennedy School of Government
Harvard University

Watch Linda Bilmes on "The Newshour with Jim Lehrer"
Mr. Chairman, and Members of the Subcommittee, thank you for inviting me to speak to you today on this important topic. I am professor Linda Bilmes, a faculty member at the Kennedy School of Government at Harvard University, where I teach management, budgeting and public finance.
Chairman Filner, Members of the Committee, and Colleagues:
Thank you for inviting me to join this important discussion. As you know, I testified to this committee on March 13th, so I have not prepared new testimony. What follows are some key points from my previous statement.
I believe we are all well familiar with the problems facing our veterans and the Veterans Benefits Administration. These include:

  1. A backlog of more than 400,000 pending claims now in the queue, with 200,000 others “in process”
  2. An expected influx of at least 1.6 million additional claims within the next two years, including some 200-400,000 from OIF/OEF soldiers;
  3. A system that incentivizes veterans to apply for disability compensation so they can obtain access to VA medical care;
  4. An average waiting time to process a claim of 6 -24 months;
  5. Thousands of experienced claims adjudicators who are eligible to retire, thus an urgent need to retain high performing employees and to recruit and train new ones;
  6. Increasingly complex claims – with an average of 5 separate conditions per claim;
  7. A complicated system for ascertaining whether a veteran is disabled, using a non-monotonic rating scale for each of thousands of conditions;
  8. A high rate of errors, discrepancies and inconsistencies in how these scales are applied to individual veterans cases;
  9. A convoluted disability claims form that is 23 pages long; and
  10. Difficulty in implementing the Benefits Delivery at Discharge program due to lack of coordination and data-sharing with the Defense Department.
  11. A lack of state-of-the-art IT systems to expedite the process for veterans and to capture information.

To fix these problems – and I want to stress that unlike some of the more intractable problems we face in the war, these problems can actually be solved, to a large extent – I urge you to enact sweeping bipartisan legislation that would, at minimum, do the following:

  1. Change the presumption for eligibility to favor the veteran. The current system places the full burden of collecting evidence and medical records on the veteran. The solution is to reverse the paradigm and have VBA grant presumption of eligibility. There are several ways to implement this concept. A veteran presenting with a disability could be guaranteed a minimum disability stipend for at least two years – in the same way that we offer free health care for two years – during which time the claim can be fully processed. A sample of claims can be audited to deter fraud.
  2. Require that all servicemen have a complete physical examination at the time they separate from the military, which would form the basis for presumption. DOD must be required to provide complete medical records for all soldiers to the VA immediately on discharge.
  3. The BDD process should be expanded and extended to members of the Guards and Reserves. All veterans should have the right to a medical examination prior to discharge conducted by the VA, and the VA should be readily available to do this.
  4. Streamline and simplify the disability process to a 4-step rating (not disabled, low, moderate and severe disability); and simplify the form by creating a “short-form” like the IRS does for taxes. Veterans applying for known presumptions using the short form should be able to waive the 60-day notification period and receive benefits in 30-45 days.
  5. Extend free VHA health care to 3 years or longer in order to relieve the pressure on veterans to file disability claims. Ideally, this should be extended to 5 years, but we must provide higher funding for VHA and give it much greater flexibilities to hire personnel quickly and to re-allocates money in its facilities depending on local needs.
  6. Develop a “fast-track” claims adjudication process for all older claims, with the objective that 75% of claims already in the system be resolved within the next fiscal year. This could be done giving VBA hiring flexibilities to temporarily hire more retirees, to increase pay for VA claims officers,, to bring on civil servants from other government agencies who want to help (for example, loans of other civil servants, postal workers, and teachers) as well as by increasing the use of temporary contractors.
  7. Place one or two claims specialists in each neighborhood Veterans Center and in mobile vet centers to assist veterans and their families in filling out claims forms.
  8. Finally, and this is a longer-term solution – overhaul the technology used in the VA using the Pega system (or similar medical claims IT data system) to enable VA to respond to veterans, capture data, and be responsive to trends.

Thank you for your consideration.

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