Final Political Actions for H.R 1544

This past week our nation celebrated Veteran’s Day. A day to honor all those who have served and are currently serving in the armed forces, and to thank them for protecting the liberties that we as Americans hold dear to us. I can’t think of a better way to honor them, than to ensure that they are well provided and cared for.  H.R. 1544 will do just that by ensuring that any veteran who requires mental health services receives it, regardless of previous approval that their illness is “attributable” to the services. If passed, this bill will extend mental health care to thousands of veterans across the country. 

In our previous blog posting, "Our Stance on H.R 1544" we stated the various elements that we intended to carry out in our political action plan. Among, those actions we have successfully fulfilled the majority of them. 

We have spread information about the Veterans Mental Health Accessibility Act to fellow veterans and their families and have even received direct feedback from those citizens, through phone calls and comments on our blog. We have contacted our nursing peers through this blog, word of mouth, as well as major political figures in Virginia like Susan Motley, the CEO of the Virginia Nurses Association (VNA) and Thelma Roach-Serry, the vice president of the VNA. Our group also wrote multiple letters to James Madison University's newspaper The Breeze this past week, in hopes that it would raise awareness about H.R 1544 especially since Veterans Day has just passed. Our most success was met by contacting our local legislators and key stakeholders. We contacted the Department of Veterans Affairs by sending a message to Congressman Jerry Moran, senior member of the House Veterans Affairs Committee. Also, we contacted different representatives on Subcommittee on Health in hopes to persuade them, more specifically, Congressman  Tom Periello and Representative Michael H. Michaud as well as other representatives for the state of Virginia like Delegate Tony O'Wilt and Senator Mark Obenshain. We received feedback from Aaron Wasserman the representative who covers veterans issues for Congressman Driehaus. 

As well as actions for H.R. 1544 Congressmen Driehaus is a part of a few other bills concerning veterans affairs.  Bill H.R.6230 is meant to exclude bonuses given to military personnel from being used in determining eligibility for assistance or benefits.  The Representative is also part of H.R.303, the Retired Pay Restoration Act, H.R.333, the Disabled Veterans Tax Termination Act, and H.R.2698, the Veterans and Survivors Behavioral Health Awareness Act, among several other bills.  All of these bills, cosponsored by Representative Driehaus, will help to improve the lives of our veterans in thanks and appreciation of their service to our country.

Contacting our key stakeholders/legislators

We felt that it was necessary to try and contact the following people for a variety of reasons. 

Susan Motley and Thelma Roach-Serry:  Susan Motley is the CEO of the Virginia Nurses Association (VNA) and Thelma Roach-Serry is the vice president of the VNA.  We decided to contact these two women because they are important members and officers of this particular organization.  The VNA plays a large role in driving policy formation behind our health care system.  Vice President Thelma Roach-Serry is also affiliated with the Richmond Veterans Affairs Medical Center, so we thought that she would find our blog interesting as well as possibly being able to show it to some of her colleagues at the Veterans Affairs Center.

Betty Sutton: she is a cosponsor for our bill, and therefore firmly believes in the bill at hand.  She believes that it is vital to get veterans seen by a professional if they believe they are having problems from active duty combat, whether a physician thinks so or not.  So many of our soldiers need help when they come back from serving our country, and it is vital to make sure we facilitate their transition back to American society after all they have done to serve our country in combat.  We believe this woman will push to have this bill passed and therefore should know we are helping to promote this bill and spread the knowledge of its benefits to others.  

Congressman Tom Periello: Periello is a very important key stakeholder because he is a local representative, representing the 5th district of Virginia, who is in the Veteran's Affairs Committee as well as the subcommittee of Health. Since he is a local representative, there is a better chance of receiving a response from him.  He is most likely already well informed about H.R 1544 and veterans health due to the committees he is assigned.  Also since he has a seat in both the Veteran's Affairs Committee and the subcommittee of Health he has the potential to be very influential on others throughout both relative committees help pass this bill.  

Rep. Michael H. Michaud (ME): As Chairman of the Subcommittee on Health, Rep. Michael H. Michaud has been a key player in passing initiatives that benefit veterans, including passing a provision that increased funding to the Department of Veterans Affairs. His influence in the Subcommittee on Health is vital in passing H.R. 1544. Through email, we have invited Rep. Michaud to visit this blog. 

Group member John Fox: “I have emailed my mother, Maria Fox.  As a child in a military family, with both my mother and father serving in separate branches, I have first hand seen the mental health and psychological effects of service.  If greater access to care was available I believe my upbringing and the family would have been affected for the better, creating a happier, more stable family.  There still may be time for such a bill to have a positive effect on my family, but more importantly, the sooner we act the more it will help other families and the greater military community.  This bill may prevent mental health and psychological problems associated with the burden of service to ones country, or at least help to mitigate its effect on the service person and family.  I believe the continuation and growth of services for our men and women in service is critical to the future as it will ensure a stable foundation for generations to come."

Delegate Tony O'Wilt and Senator Mark Obenshain: are the representatives (legislators) for Harrisonburg in the Virginia State Legislature. Once H.R 1544 has (hopefully) progressed past the Committee Referral Stage, recognition of the act will eventually have to come from these governmental officials as well. Also, the reason it was very hard to contact other key stakeholders on the Veterans Affairs Committee is because a lot of the time one is only allowed to contact legislators from their district. However, making our local delegates and senators aware of this act is just as important in raising it's support.

Steve Driehaus: is the Representative of the 1^st District of Ohio and the main sponsor of our bill.  He is the one that proposed to expand mental health care to our retired veterans.  Therefore, Steve Driehaus has been actively involved in passing H.R. 1544 and we felt that it was of great importance to contact him and politely ask him to view our blog to see the many ideas that we have come up with.

Congressman Jerry Moran:  As a senior member of the House Veterans Affairs Committee, improving the quality of life for our nation's veterans has been one of Jerry Moran’s top priorities.  He has been a strong advocate for improving the benefits and health care that veterans of our nation deserve for protecting our country.  Jerry Moran serves on the Subcommittees on Health and on the Subcommittee on Economic Opportunity. The Subcommittee on Health oversees the health care system for the Department of Veterans' Affairs (VA).  This man could potentially be a very important influence for the passing of this bill along with the other key stakeholders we have mentioned.

Our stance on H.R. 1544...

After reviewing the Veterans Mental Health Accessibility Act and data from various journals, we further understand the importance of this bill becoming a law and are in full support.  With research, we have discovered a repetitive theme of an increase prevalence of mental health disorders, including PTSD and depression, among soldiers returning from Operation Iraqi Freedom and Operation Enduring Freedom.   In one study found here, researchers found a continued linear increase in the cumulative prevalence of new mental health diagnoses in veterans who have been home for at least two years.  This suggests that soldiers are still experiencing symptoms, if not an increase in symptoms, of PTSD and depression months to years after they have finished touring.  This is a huge concern and it is imperative that they have immediate access to screenings and mental health care in order to prevent further debilitating symptoms.   If the Veterans Mental Health Accessibility Act becomes a law, veterans can be seen earlier and more readily with a greater range of services and resources to assist them in returning to wellness.

We will work to see that the Veterans Mental Health Accessibility Act is passed.   As mentioned earlier, since this bill is so young and has not moved from the subcommittee on health and there has been little publicity about it.  It important to spread information to the people, especially current soldiers, veterans and their families, so they can become more informed and involved.  We will raise awareness among nursing peers, through this blog and word of mouth, as this issue is related to nursing and the healthcare practice as previously outlined.  The Virginia Nursing Association will also be contacted in hopes that they will participate in the cause and raise awearness among nursing thoughout the state.  We will start our work locally by contacting local newspapers and media in hopes of gaining the people’s attention and sharing our passion for this legislation.  Also, we will contact Virginia state legislators and key stake holders.  This blog will be used as a tool to spread information about the bill and its importance over the internet to populations throughout the nation.  By spreading information and increasing publicity locally and throughout the web people will recognize the prevalence of mental health issues among veterans and the good that this bill will do if passed.  Once the people are talking, hopefully legislators will start to consider the importance as well. 

Key stakeholders and legislators in passing H.R. 1544 include the following people and groups:

1.    Veterans and families of veterans

2.    Department of Veterans Affairs

3.    Representative Steve Driehaus of the 1^st district of Ohio

4.    Subcommittee on Health including these legislators:
Democrats— Chairman Michael H. Michaud (ME), Corrine Brown (FL), Vic Snyder (AR), Harry Teague (NM), Ciro D. Rodriguez (TX), Joe Donnelly (IN), Jerry McNerney (CA), Glenn C. Nye (VA), Deborah L. Halvorson (IL), Thomas S. P. Perriello (VA)
Republicans—Henry E. Brown. Jr. (SC), Cliff Stearns (FL), Jerry Moran (KS), John Boozman (AR), Gus M. Bilirakis (FL), Vern Buchanan (FL)

5.    Fellow nurses and other health care professionals, including the Virginia Nurses Association. 

H.R 1544 Can Change the Lives of Veterans

As previously discussed in the first posting, the primary governmental objective Steve Driehaus is seeking to fulfill is to ensure that through the Veterans Mental Health Accessibility Act, “any veteran who served on active duty in a theater of combat operations during World War II, the Korean conflict, the Vietnam era, the Persian Gulf War, Operations Iraqi Freedom or Enduring Freedom, or any other period of war after the Persian Gulf War, or in combat against a hostile force during a period of hostilities, is eligible for hospital care, medical services, and nursing home care for any mental illness through the Department of Veterans Affairs (VA), notwithstanding insufficient medical evidence to conclude that the mental illness is attributable to such service,”. 

Currently the only mental health services that are exempt from inpatient and outpatient copays are military sexual trauma cases, and related mental health services to PTSD (Post Traumatic Stress Disorder). However, in addition to those services the Department of Veterans Mental Health services encompasses care for all of the following topics: Homelessness, Veterans at Work, Returning Veterans, Substance Abuse, Depression, Women Veterans, and Mental Health Recovery. To receive these comprehensive services, a veteran must be termed as “eligible” or “referred by a physician” for these services. Driehaus’s goal is for veterans to be eligible and receive the rest of these services if they feel they need or want them.

Veterans who are currently receiving care under TRICARE (the health care program serving Uniformed Service members, retirees and their families worldwide, this includes retired service members i.e veterans) may receive mental health care “if they need it”. Veterans may only seek outpatient mental health services without referral for a limit of eight visits. Veterans are also required to receive physician referrals and pre-authorization screening before receiving such mental health services.

The purpose of the Veterans Mental Health Accessibility Act is to ensure that for whatever need or reason veterans require mental health services, they receive it, regardless of previous approval that their illness is “attributable” to the services. With H.R 1544 veterans will not have to have physician referrals or pre-authorization screenings in order to receive eligibility for mental health care services.

Regarding the publicity surrounding this act, in all actuality, there isn’t much. This bill is still only in the Committee Referral stage, the committees it has been referred to include the House of Veterans’ Affairs and House of Veterans’ Affairs Subcommittee on Health; therefore given its young age, it hasn’t been released over several mediums. Most influences come from online media such as Waiting Room USA Magazine-Online Edition. One particular website states that, “No news coverage is found for this bill at this time. This means that this bill has not yet been mentioned on a publicly-searchable news website.”

Potential political influences include the democratic party, as Steve Driehaus (the bill’s representative sponsor) is listed as a moderate democrat, and both Chair of the House of Veterans’ Affairs, Representative Bob Filner, and Chairman of the Subcommittee on Health, Michael Michaud, are both democrats. However, the bill has not moved from the subcommittee on health, so political influence in terms of voting and political parties, is not fully determined at this time. More people and political need to be involved in this bill so that our veterans can get the care that they indefinitely deserve.

This bill is a necessary, key component and important piece of legislation in creating effective changes in the current standards of mental health services provided to veterans, the following will describe it's potential beneficial impact.

The bill is meant to modify our current code, found here. The current code provides the rules of eligibility for a veteran who has suffered physical ailments but has no mention of mental health within the section (1710). There are provisions for "readjustment counseling and related mental health services" as described in section 1712A of the same subchapter, found here. In section 1712A, a veteran is able to receive screening and treatment in an outpatient setting for readjustment counseling and related mental health services. From these two sections we can learn the following: Mental health issues are not being addressed at in-patient care settings. Screening and care is limited to readjustment counseling and related mental health services screening and care is limited to government employed or appointed staff at government facilities.

How do we fix this?

The text of the bill, found here, states that a veteran is, "eligible for hospital care, medical services, and nursing home care under subsection for any mental illness". This recognizes and corrects the following areas: Mental health issues will be treated in short and long term facilities, both in and out-patient, for greater access to care screening and care will not be limited to government resources, further supporting greater access to care screening and care will not be limited to readjustment counseling and related mental services, appreciating the breadth and depth of psychological/mental health illnesses.

What does this mean for the veteran, nurse, and healthcare system?

A veteran no longer has to wait for an assigned health care provider at an assigned facility. The veteran can be seen more readily and with greater resources than before, having access to greater range of services to assist them in returning to wellness. As a nurse we will have access to more resources, both to treat and refer a client towards. We will also have increased access to clients, as additional avenues of receiving veterans will now be open. The health care system will become more flexible and more efficient. With a greater diversity of resources available, a veteran may be treated with care best suited for his or her needs, allowing for efficient distribution of remaining resources to other patients. Flexibility comes both through the financial management, but also the ability to receive and delegate patients and staff wisely.

Our future depends on what we do now, and if we are to improve the wellness of our veterans HR 1544 will give the healthcare system, nurses, and veterans the tools they need to promote better access and management of care, leading to better outcomes for all of our military, and our nation.

Introduction to H.R. 1544

H.R. 1544 The Veterans Mental Health Accessibility Act, introduced by Representative Steve Driehaus in March of 2009, proposes to expand mental health care to retired United States veterans. The bill stipulates that veterans who served on active duty during World War II, the Korean conflict, the Vietnam Era, as well as those who served during and following the Persian Gulf War are eligible to receive hospital care, medical services, and nursing home care for any mental illness.

Many veterans suffer from varying mental illnesses due to the intense conditions to which they are exposed in hostile combat. Current legislation does not provide enough access to mental health services for our veterans. This bill, if passed, would provide for mental health services in various healthcare settings to our veterans.