President Obama is set to address the nation’s largest veterans group Tuesday in hopes of bolstering support for his administration’s efforts to crack down on deadly lapses in medical care at Department of Veterans Affairs hospitals nationwide.
But the commander in chief has a tough sell.
Though the president will tout a $16.3 billion bill passed recently by Congress, his speech to the American Legion in Charlotte, N.C., is likely to raise questions about pressing issues not resolved by the fix on Capitol Hill.
Even before the president’s trip to her home state, vulnerable Democratic Sen. Kay Hagan, said the administration “has not yet done enough to earn the lasting trust of our veterans and implement real and permanent reforms at the VA.”
Many veterans agree.
“There’s been some good changes, a new secretary, but that’s just a start,” said Jeff Brown, executive director of the American Legion. “We don’t want them to see this as a solution. We’d like to hear a long-term plan, a long-term commitment from the president.”
Here are the most pressing issues the Obama administration — and Congress — will have to solve to truly overhaul an agency that has become the poster child for ineffective bureaucracy.
Moving past short-term fixes
Obama signed legislation expected to reduce the backlog of veterans waiting for appointments. But structural problems persist, analysts said, ensuring that members of the military will struggle to get the medical care they need without substantial improvements.
Thanks to legislation co-sponsored by Sen. Bernie Sanders, I-Vt., and Jeff Miller, R-Fla., veterans on wait lists for 30 days or more can receive private health care treatment. However, such options are generally limited in duration, meaning patients would eventually get thrown back into the government system.
“Why does it have to be temporary?” asked Joseph Antos, a scholar in health care and retirement policy at the American Enterprise Institute. “Once that problem is solved, you have to get back in line. The VA health system is mostly providing care you can find in the civilian health system just fine.”
Obama and lawmakers have to decide how much to increase access to the private system long term, particularly if veterans say they prefer the coverage they receive in those facilities.
How much money is enough?
Obama is unlikely to get into specific budgetary details Tuesday. And that’s because nobody can agree on a fiscal framework for the agency beyond the next few years.
The agency’s budget has more than tripled since 2000, proving that money isn't the lone problem, analysts said.
“We tried that. Obama can’t just give a speech talking about how much money they spent,” said Pete Hegseth, CEO of Concerned Veterans for America. “It’s not a funding issue. It’s a culture issue.”
Still, at some point, the administration will need to define how much money it needs and why.
Prove real accountability exists
One of the major provisions of the Sanders-Miller deal was giving Veterans Affairs leaders the ability to fire people.
VA Secretary Bob McDonald, the former chief at Procter & Gamble, has been judicious in his use of such powers. The agency has declined to reveal how many people have been fired or are on the chopping block.
Many in the audience Tuesday would certainly like Obama to announce a new round of pink slips.
“You don’t have to fire hundreds of people, just demonstrate that the power is there,” Hegseth said. "You’ve got to wake people up. Clearly, there are bad apples and you have to fire those people immediately.”
McDonald has insisted that employees facing termination are entitled to due process.
Delivering quality care, not just slashing wait lists
Much of the attention surrounding the Veterans Affairs scandal focused on phony wait lists and excessive delays in care at VA hospitals.
But the solution can’t just be about churning veterans through the system as quickly as possible, advocates said. In fact, administrators' focus on meeting quotas was one of the causes of the crisis.
“I’d like the president to put a major focus on the people involved here,” said one Democratic strategist who is also a veteran. “It can’t just be about checking a box. Sure, we want to get people in and out — but it doesn’t make a helluva difference if they aren’t getting the care they deserve.”
Better record sharing
It sounds simple enough: get VA hospitals the documents they need.
But both Pentagon and VA officials have complained about difficulties in sharing information electronically. Communication improvements would help reduce waiting times, they say.
As the Obamacare rollout proved, however, the federal government hasn’t always done a stellar job with basic records verification.
It’s not the sexiest topic, but a roomful of veterans in Charlotte Tuesday would welcome the president’s attention to the matter.
“This is a major opportunity [for Obama],” the American Legion’s Brown said. “We want to send him a clear message.”