CNAS Briefing: Key Questions for VA Secretary Confirmation Hearing

Washington, January 30– In advance of the confirmation hearing for Dr. David Shulkin to be the next Secretary of Veterans Affairs, Center for a New American Security Military, Veterans, and Society Program experts Phillip Carter, Katherine Kidder, Amy Schafer, and Moira Fagan have prepared a series of questions addressing key issues facing the VA and the nation’s veteran community. The full list of questions is available below:   

Veterans Healthcare  

• Internal and external estimates of VA health care funding suggest that the system faces a shortfall next year of somewhere between $2 billion to $14 billion. This gap is likely so large that it cannot be bridged through efficiency measures alone, and may have an effect on access, quality, and patient satisfaction. What is your estimate of the funding gap facing the VA health care system, and what is your plan to either secure more resources or make the system more efficient in order to bridge this gap? – CNAS Senior Fellow Phillip Carter

• Quality is one of the most important measures for a health care system. Recent reports indicate that the quality of VA care is often better than that of comparable private sector health care systems. However, recent reports suggest that VA health care quality is also uneven, with significant variation across clinics and hospitals, especially those with declining patient headcounts. What is your plan to improve quality across the VA health care system? – CNAS Research Associate Amy Schafer

• Most of the VA health care system’s struggles during the past decade relate to access. The VA faces enormous pressure from an aging veteran population, a new cohort of combat veterans, and increased demand for VA health care (driven, partly and ironically, by the Phoenix scandal and the new VA Choice Act program). Access has not improved significantly across the VA, and in some places has worsened, suggesting the VA still cannot keep up with veteran demand for health care. You worked as under secretary to improve this, including a plan to provide “same day” access for veterans in certain cases. What is your plan to improve access across the VA? If you don’t get additional resources from Congress, can you maintain or improve access? – CNAS Senior Fellow Phillip Carter

• Alongside quality and access, patient satisfaction is another important dimension of health care system performance. The VA has suffered for decades – but especially since the 2014 Phoenix scandal – with perceptions among veterans of its performance. However, surveys of veterans indicate the “MyVA” initiatives of the past two years have improved these perceptions greatly, and that patient satisfaction is on the rise too.  What is your plan to continue or improve VA efforts to boost patient satisfaction and perceptions? Will you continue the “MyVA” initiatives now underway in whole or in part? – CNAS Research Associate Amy Schafer

• President Donald Trump talked during the campaign about the need to create more choice for veterans and to more fully use the private sector to provide health care to veterans. As Under Secretary, you presided over a large increase in the use of the private sector to serve veterans, with nearly one-third of all veteran health appointments now taking place in the private sector. Do you believe the VA should privatize or outsource more of its capability or capacity? If so, do you believe that private sector medical facilities are appropriately equipped to handle veteran-specific medical needs? And how will you mitigate the risks to the VA from a loss of patients, ensuring the VA has a critical mass to do such things as research and training of clinical personnel?  – CNAS Senior Fellow Phillip Carter

 
Veteran Homelessness
 

• During the Obama administration, veteran homelessness was reduced from 65,455 to 39,471 largely due to the massive investments by the federal government in programs led by the VA, Department of Housing and Urban Development, and others. Some have suggested that the VA can begin pulling back from these programs in light of their success; others believe much remains to be done, and that homelessness will rapidly increase if the VA shrinks its spending in this space. What is your assessment of veteran homelessness and what will the Trump administration do to address veteran homelessness under your tenure? Will the Trump administration decrease, maintain, or increase the current level of spending on this initiative? –CNAS Senior Fellow Phillip Carter

 
The GI Bill
 

• The VA has supported more than 1.5 million veterans and family members with the Post-9/11 GI Bill, spending tens of billions of dollars on higher education. And yet, educational and economic outcomes for this population have not been uniformly positive, for a broad variety of reasons. Some have argued the benefit should change and that VA should more aggressively police its use by veterans; others have argued the VA should more aggressively police colleges and universities that receive GI Bill funds. What is your assessment of the VA’s GI Bill program and how will you ensure this program better serves veterans? –CNAS Senior Fellow Phillip Carter

 
Disability Benefits
 

• The majority of the VA’s spending goes to benefits, including disability compensation and educational benefits. The disability compensation system has existed for decades but is beginning to show its wear, most readily apparent in its outdated schedule of disabilities and its creaking system for disability evaluation and appeals. What is your assessment of the VA disability system, and what do you see as the most important or promising areas of reform? –CNAS Senior Fellow Phillip Carter

 
Transitioning from the Military to the VA
 

• Connectivity with the Defense Department has frustrated the VA in many domains, from health records sharing to benefits adjudication. As the VA seeks to improve current care for veterans and deal with immediate crises, it must also contend with preparing to treat the veterans of the future.  One example that has repeatedly caused issues and delayed care is the difficulty with sharing electronic health records between the Department of Defense and the VA. What is your assessment of the current health records sharing between the DoD and VA, and how will you ensure there is a smooth transition between the DoD and VA so there are no gaps in care for veterans? – CNAS Research Associate Amy Schafer

 
Strategic Partnerships
 

• A signature effort of the McDonald tenure over the past two years has been the focus on strategic partnerships. These have included partnerships in the health care sphere, like with Walgreens to provide flu shots, as well as partnerships in the economic sphere, such as those with LinkedIn and Coursera to support veterans’ employment pursuits. What do you see as the value proposition for strategic partnerships, and which partnerships will you continue or pursue? –CNAS Senior Fellow Phillip Carter

 
Previous Experience
 

• The Department of Veterans Affairs (and its predecessor agencies) has historically been led by a veteran.  If confirmed, how will your previous private sector experience shape your leadership of the VA? – CNAS Research Intern Moira Fagan

Carter, Kidder, and Schafer are available for briefings and interviews on the confirmation hearing. To arrange an interview or briefing, please contact Neal Urwitz at nurwitz@cnas.org, or call 202-457-9409.