WASHINGTON — Next month, President-elect Joe Biden will take office and begin implementing his plans to redirect the energies of federal agencies, including VA and DoD.
Those plans, as defined prior to his election, include reversing some decisions made during the Donald Trump presidency, continuing others and finding a balance between providing new options for care and strengthening existing healthcare infrastructure.
One of the more controversial changes at VA over the last four years was the implementation of the Mission Act, which consolidated and expanded community care access guidelines and created new networks of non-VA providers to whom veterans could be referred. Prior to its implementation, skeptics argued that the legislation came at the expense of existing VA medical care and was a step toward privatization of veteran healthcare. Since then, concern among veterans’ advocates has shifted to the quality of community providers and the continuance of long wait times.
Biden has said his administration will refine and update the community care guidelines, ensuring that, if a veteran is referred to a community care provider, that provider meets VA’s standards. If they don’t, he said, the veteran will be referred back to VA.
“Private sector points of care were designed to provide care to veterans when it was faster, closer, or offered superior services for a particular veteran’s needs,” Biden outlines on his website. “We must ensure that healthcare purchased in the community actually improves access and convenience and does not compromise the health of our veterans.”
At the same time, Biden plans to invest in VA’s existing infrastructure, including retrofitting VA facilities where patient volume has outgrown existing space and repurposing older facilities to meet new needs, such as creating new assisted-living facilities and long-term care alternatives.
The plan includes conducting a staffing assessment, examining VA’s needs and requirements across the system, with the goal of finding better ways to recruit and retain staff.
Biden has put an emphasis on finding ways to support home care providers, including military families. VA’s Caregiver Support Program provides home caregivers with access to education, training, respite care and other support structures. An expansion of program eligibility—one that would include caregivers of Vietnam era and older veterans—was supposed to happen in 2019. That was delayed until October 2020. Another expansion, this one opening eligibility to caregivers of veterans injured between 1975 and 2001, has been pushed back to 2022.
Biden has said he intends to meet, if not exceed that timeline, and to make sure the program meets its goal of actually supporting caregivers by long-term tracking of the program.
Mental Health Options
A Biden administration will continue Trump’s focus on expanding mental healthcare options for veterans and preventing veteran suicide. According to Biden, he intends to expand that focus to better include the military and military families.
“Children and spouses in military families are resilient, but they do experience high levels of stress, whether due to frequent moves, deployment and training schedules of the servicemember, or weak social/emotional support networks,” the president-elect’s site states. “About 25% of high school freshman and juniors in a military family have reported suicidal thoughts during the previous year, and the stresses of military life can exacerbate health issues, among them depression, anxiety, and substance use disorders.”
With that in mind, Biden says he is committing to expanding behavioral healthcare in the military and doing what is necessary to remove stigma around seeking mental healthcare. Specifics include increasing funding for mental telehealth care for military families; investing in recruiting and retaining behavioral health professionals in military treatment facilities; and redefining the federal Health Professional Shortage Areas (HPSAs) to specifically include military-impacted geographies.
Biden also has expressed a desire to expand and prioritize the Substance Abuse and Mental Health Services Administration (SAMHSA) Interagency Task Force on Military and Veterans Mental Health, which was created in 2012 to implement mental health solutions across departments. Biden said he intends to include a seat on his Domestic Policy Council to drive a whole-of-government approach to military and veteran mental health issues.
Some of Biden’s proposed changes can be implemented relatively swiftly through executive orders. That includes reversing the ban on transgender individuals serving openly in the military. Biden helped overturn the ban in 2016 when he served as vice president, but Trump reinstituted the ban in 2019. Biden also has said he intends to reverse DoD policy, which essentially forcibly discharges servicemembers diagnosed with HIV because they are considered nondeployable.
As for the men or women who will lead VA and DoD, Biden had not made his picks at the time of this writing. However, many of the front-runners are veterans of the wars in Iraq and Afghanistan.
Sen. Tammy Duckworth (D-IL), a former Army pilot who lost both her legs when her Blackhawk was shot down in Iraq in 2004, is considered a contender for both DoD and VA Secretary. Rep. Patrick Murphy (D-PA), a former acting Army secretary, also is high on the list of possibilities for VA.
Also under consideration for DoD secretary has been Michele Flournoy, who served as under secretary of Defense for policy under President Barack Obama. Rep. Jim Langevin (D-RI) and Rep. Jackie Speier (D-CA), Democratic leaders in the House Armed Services Committee, issued a joint statement shortly before the Thanksgiving holiday urging Biden to choose Flournoy.
“We are keenly aware of the critical need for a leader with Flournoy’s expertise on complex national security issues,” the legislators stated. “[Her] sound policy experience will be vital in ensuring strong civilian oversight of the military, professionalism and ethics in our special operations forces, workforce diversity, and activities to strengthen our technological edge through science and innovation.”