NTF issue paper: president46.doc. 8-17.

BACKGROUND. President Obama and his regime cared little for the plight of veterans who require health care. That administration relegated veterans affairs to a low priority and ignored a series of scandals and the increasing necessity for quality physical and mental health care services for our brave veterans. Inefficiency in treating patients and dangerously long backlogs of patients persisted. The VA, the second largest federal agency with more than 300,000 employees and 1,500 hospitals and clinics across the nation, has endured constant criticism to provide better care and services to veterans since at least 2014, when news broadcast that veterans had died while waiting for appointments at the Phoenix VA. Schedulers there had kept secret waiting lists hiding how long vets were waiting. The Senate in August approved a $3.9 billion emergency spending bill to help the department whittle down its monstrous backlog. President Trump has reversed a disgraceful situation and promoted veteran care to the highest priority, including appointing Dr. David Shulkin as VA Secretary.

CONGRESS HELPS. Members of Congress are trying to address geography and licensing barriers to telehealth services, most recently with the introduction of the Veterans E-Health and Telemedicine Support Act of 2017 (VETS Act), which proposes to allow qualified VA health professionals to operate across state lines and conduct telehealth services. A patient in northwest Iowa now cannot see a doctor in Omaha because of arcane VA licensing rules. Senators Joni Ernst (R-IA) and Mazie Hirono (D-HI), both members of the Senate Armed Services Committee, promoted the expansion of telehealth services for veterans by introducing a bill. Other groups pushing for expansion of telehealth services and licensing, including the National Council of State Boards of Nursing, applauded the new effort.

TRUMP INITIATIVE. President Trump is removing stifling federal regulations and geographic barriers. He announced that the VA, together with the American Office of Innovation, which his son-in-law Jared Kushner manages, are working to improve care transitions between the Defense Department and VA, enabling patients and families to compare quality and wait times and heightening their ability to choose doctors. The VA requested the advice of the Justice Department to make sure this initiative was constitutional. The executive order extends license portability for VA-employed providers who deliver care via telehealth, if they maintain a valid state license. Trump and Sec. Shulkin announced 3 initiatives to expand access to health care by American veterans. Telehealth technology and mobile applications will connect the VA to additional vets with services closer to home, especially in rural areas far away from VA hospitals. An emphasis placed on mental health and suicide prevention services. The plan will expand VA services into patient homes and the offices of private medical practice doctors around the country. The VA already boasts a large telehealth program nationwide, 700,000 vets receiving telehealth services in 2016. New regulations authorize VA providers, using telehealth technologies, to serve vets no matter the location of patient, even if traveling, or provider, regardless of state licensing laws. This novel initiative will allow the VA to hire medical providers in major metro areas and connect them to vets in rural and isolated communities that lack sufficient medical services. VA Video Connect will offer secure Internet video services that simplifies for vets connection with their VA providers by video on their mobile phones or personal computers. Technology now enables the private transfer of medical records and test results. This growth is particularly pronounced in the field of mental health and in rural areas. This VA video tool will allow doctors working in hospitals with ample capacity to treat patients in places with few medical providers. Presently, over 300 providers at 67 hospitals and clinics are using this diagnostic system, with a Trump pledge to offer it nationwide over the next year. The VA handles many geriatric patients, so the less disturbance in their day, the better. The American Telemedicine Association voiced its strong support for the VA expansion of telehealth services and eliminating state licensure requirements for its healthcare professionals. The President and Secretary also announced a nationwide system simplifying scheduling or changing an appointment. The Veteran Appointment Request app (VAR) allows vets to use cell phones, tablets, or computers to schedule or alter appointments at VA facilities. The system can track appointment details and the status of requests, send messages about requested appointments, receive notifications, and cancel appointments. As it began, VAR allowed vets to book over 4,000 appointments with VA and private medical providers and cut wait times that now range from 8 to 87 days. Vets will have access to doctors from over 50 specialties, from dermatology to dentistry, with a special focus on mental health services. To accomplish these changes, the Administration eliminated Obama Regime regulations that hindered medical access for vets. To learn more about this telehealth program, access https://www.telehealth.va.gov/.

ACCOUNTABILITY. A series of VA scandals occurred in sequence under the Obama Regime. In response, the Trump Administration is furthering transparency and accountability with its VA Accountability & Whistleblower Protection Act, publicly listing rogue employees and their offenses. The list updates weekly. Trump created an office at the VA charged with holding more VA employees accountable for wrongdoing. The office will investigate allegations of misconduct, including retaliation against whistle-blowing employees who report abuses, and identify systemic barriers that have previously hindered agency top leaders from more adequately addressing these problems in the past by administering disciplinary action. The new office will report directly to Shulkin. Creation of the office by executive order demonstrates how committed the President is to the issue. Trump also created a White House hotline for VA complaints and a task force to investigate allegations of fraud and abuse at the VA, initiatives Shulkin has implemented. The VA also launched a new Access & Quality Tool that allows vets an easy way to access patient wait time and quality of care data. This tool offers vets more information about VA services and ensures through feedback that this department maintains a higher standard. Shulkin, the only holdover from the Obama Regime in the Trump Cabinet, has instituted more transparency at the agency since becoming secretary. He unveiled a new web site that reveals for the first time exactly how care at some VA hospitals compares with nearby private sector hospitals and national averages. The site, accesstocare.va.gov, also shows if veterans are satisfied with wait times at each hospital and clinic across the country and how long they actually wait.

TAKE ACTION NOW. Encourage President Trump to issue an Executive Order to eliminate the state licensure requirement for all federal and private sector health professional employees servicing federal government programs, health benefit programs like Medicare and TRICARE, federally-funded health sites such as community health centers and rural clinics, and during federally-declared emergencies or disasters. Contact your congressman and senators to support this effort.

Research, documentation, and analysis for this issue paper done by Nebraska Taxpayers for Freedom. This material copyrighted by Nebraska Taxpayers for Freedom, with express prior permission granted for its use by other groups in the NE Conservative Coalition Network. 8-17 C.

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