Campaign Promises

Cabinet/Departments -> Veterans Affairs -> Health Care

ItemVeterans Affairs
Health CareGrade
The Promise: "Obama will expand "Vet Centers in rural areas so that veterans and their families can get the care they need where they live."
When/Where: Obama-Biden Plan: "Fulfilling a Sacred Trust With Our Veterans", dated 09/09/08.
Status:The Veterans Health Care Budget Reform and Transparency Act signed into law on 10/22/09 included funds for investing in mobile clinics to reach veterans in rural areas.

Further, the FY2010 appropriation for the Department of Veterans Affairs (VA) included $250M to continue rural health initiatives and an additional $30M to increase the number of Community Based Outpatient Clinics in rural areas, benefitting approximately 41% of eligible veterans.

President Obama's FY2012 budget proposal included an additional $250M to improve access to care in rural and highly isolated areas by veterans and their families. His FY2013 proposal included continuation of the $250M historical funding level to "improve access and quality of care for enrolled veterans residing in rural areas."

Promise fulfilled.
The Promise: "...requiring individual, face-to-face post-deployment mental health screenings."
When/Where: Obama-Biden Plan: "Fulfilling a Sacred Trust With Our Veterans", dated 09/09/08.
Status:The original requirement to reassess the mental health of all service personnel at 90 and 180 days post-deployment was ordered by the Assistant Secretary of Defense for Health Affairs (ASD(HA)) as a matter of policy on 03/10/05.

On 03/25/09, a bill entitled "Post-Deployment Health Assessment Act of 2009" (S.711) was introduced by Senator Max Baucus (D-MT). On 04/23/09, a similar bill (H.R. 2058) was introduced by Congressman Dennis Rehberg (D-MT). Neither of these bills were signed into law.

However, the National Defense Authorization Act for Fiscal Year 2010 (H.R. 2647) signed into law by President Obama on 10/28/09 was successfully amended to provide "person-to-person mental health assessment for each member of the Armed Forces who is deployed in connection with a contingency operation...At a time during the period beginning 90 days after the date of redeployment from the contingency operation and ending 180 days after the date of redeployment..."

The VA's 2010 budget appropriation provided $4.6B ($300M over the 2009 appropriation) for mental health care to treat psychological wounds of returning combat veterans, including post-traumatic stress disorder.

For FY2011, the President's budget proposal for the VA included $5.2B to provide Veterans "the best possible care for Post-Traumatic Stress, Traumatic Brain Injury, and other mental health conditions..." This amount went up to $5.8B in FY2012 and the President requests $6.2B for this purpose in FY2013.

Face-to-face screenings, designed to help members of the armed forces deal better with stress, also make it easier for them to seek substance abuse treatment, obtain marriage/family counseling, and help prevent suicides.

This promise to our Veterans has been fulfilled.
The Promise: "...will establish standards of care for TBI treatment, require pre- and post-deployment screenings and improve case management so that servicemembers get the best possible care."
When/Where: Obama-Biden Plan: "Fulfilling a Sacred Trust With Our Veterans", dated 09/09/08.
Status:According to Pentagon statistics, more than 244,000 troops have been diagnosed with some form of brain injury since CY2001.

On 05/28/08, the standards for pre-deployment TBI screenings were established by the Assistant Secretary of Defense for Health Affairs (ASD(HA)), directing the armed services to conduct "pre-deployment neurocognitive assessments" on all outgoing service members. The resulting Neurocognitive Assessment Tool (NCAT) program is administered by the Defense and Veterans Brain Injury Center (DVBIC).

In FY2010, the Brain Injury Association of America (BIAA) reported significant funding initiatives from which the VA will likely benefit such as (a) $11M for the Centers for Disease Control TBI registries, surveillance, prevention and national public education and awareness, (b) $20M for the Health Resources and Services Administration (HRSA) Federal TBI State Grant Program, (c) $6M for the HRSA Federal TBI Protection and Advocacy Systems Grant Program, and (d) $13.3M for the NIDRR's TBI Model Systems of Care Program.

On its side, the VA budget request for TBI for FY2010 was $298M, an increase of 16% over FY2009. The final budget appropriation for FY2010 was $281M, $71M above FY2009, for research in a number of areas including mental health, TBI, spinal cord injury, burn injury, polytrauma injuries, and sensory loss.

For FY2011, the VA's request for screening and treatment of TBI and polytrauma was $260.9M, a decrease from the FY2010 budget request attributed to the reduction of combat troops in Iraq during FY2010.

On 03/08/10, the VA issued Directive 2010-012 that sets the standards for the screening and evaluation of possible TBI in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans. This satisfied the post-deployment screening aspect of this promise.

In seeking the "best possible care," the Tricare Management System for Veterans does not yet recognize Cognitive Rehabilitation Therapy (CRT) as a form of treatment for TBI patients despite widespread support from doctors and lawmakers. The effectiveness of CRT was validated by the National Academy of Sciences' Institute of Medicine (IOM) in a 10/11/11 report entitled "Cognitive Rehabilitation Therapy for Traumatic Brain Injury.

But prior to all of these developments, the U.S. Army conducted intensive pre-deployment screenings of three brigades of the 3rd Infantry Division (10K+ personnel). Three control brigades did not receive similar screenings to determine mental fitness for combat in the Iraqi theater. The result: in the screened group, one of 35 developed psychiatric disorders; in the unscreened group, the ratio was one of 8 soldiers. For reference purposes, this study was initiated in CY2007, during the Bush Administration.

The "Traumatic Brain Injury Clinical Standards of Care Directorate" of the Defense Centers of Excellence (DCoE) has the mission to "develop state of the science clinical standards to maximize recovery and functioning and to provide guidance and support in the implementation of clinical tools for the benefit of all those who sustain traumatic brain injuries In the service of our country." While the promised standards are under development, the DCoE operates a 24/7 Outreach Center that provides a source of information to everyone (not only wounded warriors) on psychological health and TBI issues and resources.

The DoD's Instruction #1300.24, Subject: "Recovery Coordination Program" dated 12/01/09 and other directives issued since the start of the Obama Administration go a long toward improving TBI victims' case management.

While definitive standards are still unavailable for TBI treatment, the availability of pre- and post-deployment screenings, coupled with improved case management practices indicates that tangible progress has been made on promise fulfillment as of mid-CY2015.
The Promise: "As the nation's largest integrated health system, the Veterans Health Administration has already been a national leader in reform, particularly with electronic health records and prevention initiatives...will continue this trend to make the VA a leader of national health care reform so that veterans get the best care possible. This includes efforts to improve electronic records interoperability, expand effectiveness research, promote wellness programs, and instill more accountability for performance and quality improvement initiatives."
When/Where: Obama-Biden Plan: "Fulfilling a Sacred Trust With Our Veterans", dated 09/09/08.
Status:Cross Reference to Promise Number VA-15, similar in intent but made in a different venue.

On 04/09/09, President Obama announced the creation of a Joint Virtual Lifetime Electronic Record (VLER) that will improve care and services to transitioning veterans by facilitating the flow of medical records the Department of Defense (DoD) and the Department of Veterans Affairs (VA). Once fully developed, VLER will include both administrative and medical information from the day a new recruit enters military service, throughout that servicemember's career, and after that servicemember retires or separates from active or reserve duty.

A proof of concept VLER prototype and production pilot was executed in the San Diego area during CY2009. On 01/30/10, the DoD and VA joined the Nationwide Health Information Network (NHIN). They announced on 03/08/10 that they had progressed to testing capabilities to complete data integration implementation, and were building adaptors to communicate through the NHIN with each other and with private providers.

The above capability is helping to drive and establish standards for health information exchange on a national basis.

In so doing, the promise to maintain the VA (with the DoD) as a leader in health care reform has been fulfilled.
The Promise: "...increasing the VA budget to recruit and retain more mental health professionals..."
When/Where: Obama-Biden Plan: "Fulfilling a Sacred Trust With Our Veterans", dated 09/09/08.
Status:The Department of Veterans Affairs (VA) FY2010 appropriation included an increase of $300M over the FY2009 appropriation of $4.3B for "programs addressing the wounded, ill and injured, traumatic brain injury, and psychological health. This includes includes "$1 million to provide education debt relief as a hiring incentive for mental health professionals." The DoD budget for FY2010 included $800M for improving the hiring and retention of psychiatrists and mental health professionals.

For FY2011, the President's budget proposal for the Department of Defense included $669M "to provide care for traumatic brain injury and psychological health" and $250M "for continued support of mental health and traumatic brain injury research". Also in the VA FY2011 budget proposal, the President proposed to invest $5.2B in "specialized care" for post-traumatic stress, traumatic brain injury and other mental health conditions. This number went up to $5.8B in FY2012 and the proposal for FY2013 is $6.2B.

Given the steady increase in the VA's budget since the Obama Administration started in early-CY2009, an action that has permitted the increased hiring of mental health professionals, this promise has been fulfilled.
The Promise: "There will be a longterm need for strengthened specialty care within the VA, including additional polytrauma centers as well as centers of excellence for Traumatic Brain Injury (TBI), PTSD, vision impairment, prosthetics, spinal cord injury, aging, women's health and other specialized rehabilitative care...he will expand the number of these centers of excellence and invest in specialty care."
When/Where: Obama-Biden Plan: "Fulfilling a Sacred Trust With Our Veterans", dated 09/09/08.
Status:When President Obama assumed his office, the VA administered four (4) Polytrauma Rehabilitation Centers (PRC), one each in Richmond, VA; Tampa, FL; Minneapolis, MN; and Palo Alto, CA, supplemented by 21 Polytrauma Network Sites. These are further supplemented by about 80 Polytrauma Support Clinics at the nation's VA hospitals.

On 09/08/10, the VA awarded a $1.3M pre-construction contract for an $800M facility to replace the Denver VA Medical Center in Aurora, CO. When completed in CY2014, this new hospital will include a 120-bed in-patient facility with a 30-bed spinal cord injury unit. Enhanced telehealth, polytrauma and traumatic brain injury programs will also be included.

A fifth PRC was dedicated on 10/25/11 in San Antonio, TX at a cost of $66M. For FY2013, a $55M mental health building is planned for Seattle, WA and a $33.5M spinal cord injury facility is planned for Dallas, TX.

This promise is being fulfilled.