Slow start for program to reduce vets' waits at Veterans Affairs facilities, offer private medical care

Far fewer veterans than expected are taking advantage of a new law aimed at making it easier for them to get private health care and avoid the long waits that have plagued Department of Veterans Affairs facilities nationwide.
Only 27,000 veterans have made appointments for private medical care since the VA started mailing out "Choice Cards" in November, the VA said in a report to Congress this month. The number is so small, compared to the 8.6 million cards that have been mailed out, that VA Secretary Robert McDonald wants authority to redirect some of the $10 billion Congress allocated for the program to boost care for veterans at the VA's 970 hospitals and clinics.
Republicans and Democrats insist the problem is the department and that it needs to do a better job promoting the choice program. They also want to change a quirk in the law that makes it hard for some veterans in rural areas to prove they live at least 40 miles from a VA health site.
The government measures the distance as the crow flies, rather than by driving miles, leaving thousands of veterans ineligible.
"Veterans put their lives on the line to defend this country. The very least we can do is ensure they don't have to jump through hoops to receive the care they need and have earned," said Sen. Jon Tester, D-Mont., whose vast state has just one VA hospital.
The choice program was a key component of last year's sweeping law approved in response to reports that dozens of veterans died while waiting for appointments at a VA hospital in Phoenix, and that appointment records were manipulated to hide the delays. A series of government reports said workers throughout the country falsified wait lists while supervisors looked the other way, resulting in chronic delays for veterans seeking care and bonuses for managers who falsely appeared to meet on-time goals.
The law, signed by President Barack Obama in August, allows veterans who have waited more than 30 days for an appointment to get VA-paid care from a local doctor. It also allows veterans who live at least 40 miles from a VA hospital or clinic to get private care and makes it easier to fire VA employees accused of wrongdoing.
The choice program expands an existing program that allows veterans to get outside care for emergencies or procedures not available at the VA. Veterans have long complained about waiting months or even years to be reimbursed for private care, and many are skeptical the choice card will alleviate those problems, despite promises by the VA.
"I don't believe any of us thought that there would be a wholesale rush to leave the VA system at all, but we are still early in the program," Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, told reporters during a recent tour of the VA.
McDonald's bid to shift the money has met a bipartisan wall of opposition in Congress, where leaders said the landmark law they adopted last summer to overhaul VA has not been fully implemented. Taking money away from the choice program just three months after it was launched is premature, even irresponsible, lawmakers and veterans advocates said.
Miller called the plan a complete nonstarter. His Senate counterpart, Johnny Isakson, R-Ga., called it unacceptable. And Sen. John McCain, R-Ariz., one of the law's chief authors, said Congress not only would reject the idea "but refuse to even consider" it.
Connecticut Sen. Richard Blumenthal, the senior Democrat on the Senate veterans panel, said in an interview he would oppose any reallocation of funds "so long as there are delays and issues with quality of care" at VA.
McDonald counters that the proposal, which has not been formally submitted to Congress, would help ensure that "every veteran receives the care they have earned and deserve regardless of where they choose to get it from."
McDonald, who took over as VA secretary in July, said he never intended to "gut the choice program or somehow eliminate" it. Instead, he said, he simply seeks the kind of budget flexibility he enjoyed as Procter & Gamble CEO.
"Imagine your household. You are hungry, but you can't move the money from the gasoline account to the food account. Well, that is the situation I face," he said at a Feb. 11 budget hearing before the House Veterans Affairs Committee.
Louis Celli, director of veterans affairs and rehabilitation at The American Legion, the largest veterans service organization, called McDonald's explanation disingenuous.
"Draining funds from the bill short-circuits the program and ultimately hurts vets," Celli said, noting that VA officials had pushed for the choice program as a short-term way to expand patient access to care.
Rep. Tim Huelskamp, R-Kan., said a veteran in his rural district drives 340 miles one-way for cardiology treatment at a VA hospital in Kansas City.
"If the VA choice program can't provide something closer for him, then we need to relook at how we are implementing that," Huelskamp told McDonald at the Feb. 11 hearing.
McDonald said VA officials are willing to look at the 40-mile rule to see if it needs to be changed. The VA is committed to doing all it can to "make sure the program is robust," he said.

GOP governors in Maryland, Tennessee offer voluntary employee buyouts to reduce government

Republican governors in two states -- Maryland and Tennessee -- are offering voluntary employee-buyout programs as a way to reduce government beyond furloughs and cutting programs.
In Maryland, newly elected Gov. Larry Hogan is offering state employees in agencies in the executive branch a lump sum payment of $15,000, according to a letter dated Wednesday. They also would receive an additional $200 for each year of service.
The program is part of Hogan's balanced budget plan that was released last month and closed a budget shortfall of about $750 million.
"The goal of the program is to reduce the size of the state workforce by allowing employees to elect to voluntarily leave state service," David Brinkley, Hogan's budget secretary, wrote in the letter.
He also said that closing the shortfall “required some very tough decisions” but that the budget still managed to be structurally balanced without eliminating agencies and programs, imposing furloughs or eliminating filled state positions.
In Tennessee, Gov. Bill Haslam mentioned a voluntary buyout program during a budget presentation earlier this week. And the administration’s Department of Human Resources provided more details in a follow-up email to state employees.
According to the email, only those employees determined eligible for the buyout will be invited to participate in the program. Each department and agency is working to determine what classifications will be considered eligible.
A website, telephone line and email address have been established to update and inform people about the program, as well as give them an opportunity to ask questions.
Town hall meetings are also planned across the state to provide assistance to those interested.
In the Maryland program, the deadline to apply is March 13. People who apply and are selected by the state would have to leave no later than April 28.
The plan aims to save about $30 million.
Former Gov. Martin O'Malley included voluntary early separation in a package of budget cuts approved by the state’s Board of Public Works last month.
A Hogan spokesman said the governor is “simply following through with it."
O'Malley also offered voluntary separation in 2010 to help address a budget shortfall. More than 600 people accepted it in 2010.

Obama policy to bring Syrian refugees into US raises concern among Republicans, intelligence community

An Obama administration plan to allow Syrian refuges into the United States is raising concerns within the intelligence community and on Capitol Hill -- with one GOP House leader calling it a “federally sanctioned welcome party” to potential terrorists.
The State Department has defended the plan to welcome refugees from the war-ravaged western Asia country, saying the U.S. was founded on the principles of helping such people.
However, House Republicans are concern about members of The Islamic State, whose de facto headquarters is in Syria, infiltrating the refugee system and getting on American soil.
Mike McCaul, chairman of the House Committee on Homeland Security, said Friday night on Fox News’ “Hannity” show that the policy is “dangerous and reckless.”
The Texas lawmaker said he also recently wrote National Security Adviser Susan Rice about the policy, which includes brining in refugees from neighboring Turkey, where millions of Syrians have fled because of their civil war.
In the letter, he and fellow Republicans raised concerns about the U.S.’s screening process, which is hindered by the intelligence-gathering challenges in Syria.
"You have to have information to vet,” FBI Assistant Director Michael Steinbach, said in a Feb. 11 House homeland security hearing. “Databases don't [have] the information on those individuals, and that's the concern.”
McCaul suggested at the hearing that allowing Syrian refugees into the U.S. would be a “huge mistake.”
“Most of (the refugees) are women and children, but there are male actors that concern me,” he said. “This would be a federally sanctioned welcome party, if you will, to potential terrorists in the United States.”
An estimated 7 million Syrians are seeking refugee status, and 500 have reportedly already been allowed into the U.S.
"It's clearly a population of concern," Nicholas Rasmussen, the director of the National Counterterrorism Center, said at the hearing.
Said Steinbach: "I'm concerned. We'll have to take a look at those (terror watch) lists and go through all of the intelligence holdings and be very careful to try and identify connections to foreign terrorist groups."
Steinbach and Rasmussen were joined at the hearing by Francis Taylor, who runs the Department of Homeland Security’s intelligence office.
Taylor acknowledged his agency was concerned about any group that might be coming to the U.S. for “nefarious purposes.” However, he said he was “not in a position” to agree or disagree with the refugee policy because it was under the offices of the secretary of State.
The State Department did not send a witness to the hearing. But Larry Bartlett, an agency director for refugee admission, told ABC News that the vetting process is "intensive," deliberate and includes information and guidance from the Defense Department and other U.S. intelligence agencies.
"We have a very slow process of moving refugees through our pipeline, and part of it is because of the security vetting component," he said.
Despite the concerns of Rasmussen and the others who testified, they vowed that the screen process would be as rigorous as possible.
"Any tasking we're given ... will be as thorough as we can make it," Taylor said.
Rasmussen said the U.S. intelligence community would put its “full weight” behind vetting refugee candidates.

Mother Jones' Trash Spout

ISIS Cartoon

State lawmakers weigh ending ‘unnecessary’ car inspections

Broken taillight? Soon, it might not be a problem. 
State lawmakers are revving up efforts to abolish or roll back car inspections -- arguing that the government-mandated check-ups amount to little more than a hassle and a tax. 
The Mississippi state Senate recently passed a bill that would eliminate vehicle inspections completely. 
State Sen. John Polk, a Republican and supporter of the bill, said states are going this way because they've found the inspections "unnecessary." 
"Cars have become much more reliable today," Polk said. The measure heads next to the Mississippi House for a vote. 
While safety advocates argue the inspections are still important, the proposal follows other efforts at the state level to roll back inspections. New Jersey, for example, eliminated their safety inspections back in 2010. And some Pennsylvania lawmakers are pushing anew to get rid of inspections for cars less than two years old. 
There are two types of regulated inspections: safety and emissions. A handful of states -- including Florida, Alabama and Hawaii -- don't require any. Today, at least 18 states require periodic safety inspections, and roughly three-dozen states require emissions inspections. 
Those considering moving away from inspections argue they're antiquated. 
In Mississippi, the inspections cost drivers $5 per year. The penalty for not having a valid inspection sticker is $50. 
Mississippi Lt. Gov. Tate Reeves believes the stickers are used to essentially collect a "$5 tax." 
"Many states are eliminating the inspection sticker as vehicles are manufactured with improved safety features, and I think we should join them," Reeves said in a written statement. He also complained that state troopers have to spend time inspecting inspection stations, when they are trained to "protect Mississippians' safety on the road." 
But some drivers think the inspections are worth it. "I think they're a good thing. They keep broken-down cars off the road, for safety reasons. It's not expensive either," said Long Beach, Miss., resident Cameron Hatch. 
According to the U.S. Department of Transportation, Mississippi had more than 2 million registered vehicles -- which puts the state's annual revenue from safety inspections at more than $6 million. That's a tiny fraction of the state's budget, expected to be more than $6 billion for 2016. 
"This is not about money," state Sen. Billy Hudson told The Clarion Ledger. "I don't care if we are losing money on it or making money. It's a public safety issue." 
But AAA Public Affairs Vice President Mike Wright said some safety inspections are not worth it. 
"Nobody can prove with any degree of certainty that spending the money, suffering the inconvenience of getting your vehicle inspected, actually produces desired results," said Wright, who added only the smallest portion of car accidents are caused by motor vehicle defects. Driver error is the biggest cause, Wright said, while stressing that drivers should still get their vehicles inspected periodically. 
The Department of Transportation created a vehicle inspection program after Congress passed the Highway Safety Act in 1966. But in 1976, Congress allowed states to abandon their inspection programs. 
The safety inspection typically involves a driver bringing a car to an authorized shop for testing on the brakes, steering, suspension and headlights, among other factors. Drivers get a sticker on the windshield to show their car has passed. 
In Pennsylvania, state Sen. John Wozniak, a Democrat, is leading an effort to eliminate safety inspections for cars less than two years old. 
"When you look at accidents and crashes of states that have inspections to those that do not, their accident rates are not much different," said Wozniak, who plans to introduce a bill.   
Wozniak also wants to toss out emissions inspections in his state; he said there is a 99 percent passing rate for emission tests. "If you had your kids in school and that's the kind of grades they were bringing home, you'd say well done ... we don't need these inspections anymore," he said. 
An EPA spokesperson disagreed, saying: "The Clean Air Act's inspection programs are important tools for protecting public health by reducing smog pollution. Although newer vehicles have better emissions control technologies, a significant number of vehicles do not pass their emissions test -- up to 10 percent or more of the tested fleet." 
Some car maintenance shop owners say the inspections are just good for business. 
"A lot of [auto shops] don't do it because they think it's a nuisance, but I like them," said Hal Mardis, owner of the Goodyear Auto Service Center in Ridgeland, Miss. "It brings in a lot of traffic for me. We do 1,600 a month." 
But if Mississippi gets rid of the safety inspections, Mardis thinks his business won't be affected: "We are well-established enough that I don't think we're going to drop a lot of business because of it."

Biden Cartoon

CDC discovers new virus in Kansas

The Centers for Disease Control and Prevention (CDC) announced Friday the discovery of a new virus that may be spread through tick or insect bites. The virus may have contributed to the 2014 death of a Kansas man who was otherwise healthy.

Working with experts from the Kansas Department of Health and Environment (KDHE) and University of Kansas Medical Center (UKMC), researchers found that the virus is part of a group of viruses called thogotoviruses. The virus was named Bourbon virus for the county in which the patient lived. The case is the first time a thogotovirus has been shown to cause human illness in the U.S. and the eighth known case of it causing symptoms in people.
According to the report, the patient, who was over 50 years old, was working outside on his property in late spring 2014 when he received several tick bites and
found an engorged tick on his shoulder. Several days later, he fell ill with nausea, weakness and diarrhea. The next day, he developed a fever, anorexia, chills, headache, myalgia, and arthralgia. The patient visited his primary care physician on the third day, at which point he was prescribed an antibiotic for a presumed tickborne illness.  The next morning, his wife found him experiencing reduced consciousness and we was taken to the local hospital.
Test results for many infectious diseases came back negative and a sample of the patient’s blood was sent to the CDC, which found evidence of an unidentified virus. Researchers used Advanced Molecular Detection (AMD) and determined it was a new virus.
According to the news release, the CDC is working with KDHE and UKMC to identify additional cases of Bourbon virus disease, determine who gets sick and with what symptoms, and how people are getting infected. CDC experts are also working to better understand the virus itself to potentially prevent and control Bourbon virus.
CDC researchers believe other undiscovered viruses are likely causing illness, with this finding and recent discoveries of Heartland virus in Missouri and severe fever with thrombocytopenia syndrome viruses in China.

Beagle Cartoon

GOP senators demand answers over disclosure of mission to oust ISIS from Mosul

Top Republican senators Friday demanded answers after a military official revealed “detailed operational information” about a looming Iraqi mission to retake Mosul from the Islamic State, saying the disclosure has put the mission at risk.
“Never in our memory can we recall an instance in which our military has knowingly briefed our own war plans to our enemies,” Sens. John McCain, R-Ariz., and Lindsey Graham, R-S.C., said in a letter to President Obama.
“These disclosures not only risk the success of our mission, but could also cost the lives of U.S., Iraqi, and coalition forces.”
The senators asked who was responsible for the briefing, conducted Thursday by a military official, and whether they had White House approval. “Those responsible have jeopardized our national security interests and must be held accountable,” they wrote.
The letter follows criticism in other corners that the military may have revealed too much detail in previewing the operation.
On Thursday, the U.S. military official outlined plans to retake Mosul and said the “shaping” for the battle is currently underway. He said the Iraqi military hopes to begin operations in the “April, May timeframe” with the goal of retaking Mosul before Ramadan begins on June 17.
The official then went a step further and leaked that five Iraqi Army brigades will be used in the fight, as well as several smaller brigades, composing a total force of up to 25,000 Iraqi troops. Three brigades of Kurdish Peshmerga fighters will participate as well. 
But the details, disclosed at the close of a White House summit on combating violent extremism, raised some concerns. 
"That is pretty amazing that that information's out there," retired Gen. Jack Keane, former Army vice chief of staff and a Fox News military analyst, said Friday.  
A current and former military intelligence officer also told Fox News that the decision to publicly announce the plan was counterintuitive because it "telegraphs" the timing and number of units involved. The officers said it would allow Islamic State, also known as ISIS, or ISIL, to prepare for the battle by laying improvised explosive devices.
Both officers questioned whether political considerations on the part of the Obama administration factored into the decision to announce the offensive. 
The Obama administration wasn't the first to discuss plans to retake Mosul, however. Iraqi government leaders previously had talked about the looming offensive, and Defense officials are pushing back on the notion that anything tactical was revealed on Thursday. 
CENTCOM sources also stressed that the briefing on Thursday came from the military, not the White House. 
Keane suggested there should be nothing surprising about the fact that Iraqi forces are looking to retake Mosul before Ramadan. 
"ISIS is not stupid," he said, adding that their fighters already know that Mosul is the key to any counteroffensive and have likely been preparing for weeks. "This is not something new to ISIS."
However, Keane said the details about the force size and other elements were "surprising" to hear. 
ISIS militants overtook Mosul last June, as the group marched across large sections of Iraq and Syria, sending Iraqi forces fleeing. At this point, officials estimate there are between 1,000 to 2,000 ISIS insurgents in the city of Mosul. Military leaders have been talking about retaking the city for some time, but they have said they won't launch the operation until the Iraqi troops are ready.
Included in the force would be a brigade of Iraqi counterterrorism forces who have been trained by U.S. special operations forces. The brigades include roughly 2,000 troops each.
The CENTCOM official said the U.S. will provide military support for the operation, including training, air support, intelligence and surveillance. The official said there has been no decision made yet on whether to send in some U.S. ground troops to help call in airstrikes.
"But by the same token, if they're not ready, if the conditions are not set, if all the equipment they need is not physically there and they (aren't) trained to a degree in which they will be successful, we have not closed the door on continuing to slide that to the right," he said.
The official also revealed for the first time that Qatar has agreed to host a training site for coalition forces to train moderate Syrian rebels who would return to Syria to fight the Islamic State forces there. Other sites are in Turkey, Jordan and Saudi Arabia.