The first major bill to privatize veterans’ mental healthcare is headed to the president’s desk.
In mid-August, former Veterans Affairs (VA) Secretary Anthony Principi (2001-2005) worked to get a number of fellow former VA chiefs to sign on to a draft Op-Ed encouraging the House to take up a Senate-passed suicide prevention bill —S. 785: The Commander John Scott Hannon Veterans Mental Health Care Improvement Act.
The seemingly innocuous legislation actually represents a major step towards privatizing veterans’ mental health care.
It will give the VA Secretary broad authority to award $174 million in grants up to $750,000 in size to private sector programs that ostensibly enhance veterans’ mental health and reduce veteran suicide. Its passage was a top priority for the White House, which is eager to accelerate VA privatization efforts and also notch a policy win with the all-important veteran voting bloc ahead of Election Day.
Principi made clear to the former VA secretaries that this legislation was being pushed by Trump’s VA, and said he’d be happy to change the Op-Ed should anyone feel the need to do so. In the end, no other Secretary jumped onboard, so Principi went solo with it in the Military Times earlier this month. It reads, in part:
Additional VA resources are always important, but the legislation recognizes a deep truth that America needs to take onboard if it is going to end veteran suicide: VA can’t do this job alone and American communities want to help their veterans.
Early on in the Trump administration, Principi — a Vietnam veteran who competently ran the VA under President George W. Bush — suggested that Trump’s stewardship of the department had put it “in turmoil.” He further blasted the president’s outsourcing of VA policy to a trio of buddies at Mar-a-Lago. “I don’t think that’s good governance,” he toldStars and Stripes in the summer of 2018.
But then, something changed. Principi embraced the president. In February 2019, he and three former VA secretaries wrote a Fox News op-ed hailing Trump for his “historic and welcome transformation” of the department. Later that year, Principi penned another op-ed in The Hill hailing Trump’s reforms of the department, including his massive privatization law, the VA Mission Act. Most recently, Principi’s become an official Trump campaign surrogate, Zooming in for a “Veterans for Trump” video conference earlier this year.
In an interview with Battle Borne, Principi depicted his relationship with the Trump administration as tangential, saying he’d only visited the White House once over the last four years. In his meeting there, Principi said he gave advice on a provision in the Mission Act that will next year establish a commission to review VA’ infrastructure footprint, and potentially close facilities.
Principi’s public statements on the VA have often included a vigorous defense of its strengths. But they’ve also lent credence to Trump’s outsourcing efforts. His seemingly contradictory positions make sense in the context of his swampy, Washington career. The former VA Secretary, after all, was a federal contractor first, and a public servant second.
Before joining the Bush administration, Principi ran the medical services company QTC Management Inc., which conducts veterans’ disability exams. During Principi’s time in government, QTC secured as much as $1 billion in federal contracts. According to a 2006 report in theLos Angeles Times those figures raised eyebrows among veteran advocates and government officials.
After he exited the department, Principi returned to QTC as chairman, then moved into a plum lobbying role for Pfizer pharmaceuticals. After Trump was elected, Principi’s small lobbying shop took on a new client, TriWest Healthcare Alliance, which went on to score multi-billion dollar contracts to administer the Mission Act. QTC has also netted billions in VA contracts in the Trump era, despite a documented history of over-billing.
In an interview, Principi said he no longer has any financial or professional relationship with QTC, and described his work for TriWest as “strategic advising.”
“I’ll talk to old friends at the VA and other people I know, but I don’t lobby,” Principi said. He added that he was unsure if TriWest would seek work stemming from S. 785. “It might be a question to circle back on once the bill becomes law and the regulations go out,” he said. Hours after we got off the phone, the House passed the bill, and sent it to the president’s desk to be ratified.
Principi is far from the only high-ranking former VA official to jump into lobbying work. In fact, his successor at the VA, Jim Nicholson, has been a far more prolific lobbyist, and includes recent work for Verdant Holdings, a real estate company transforming an old Pennsylvania prison into a “health and wellness campus for veterans.”
When pushed, Principi acknowledged “risks” with pushing veterans into community mental health care. “It is a balancing act,” he said. “These outside treatments should be carefully monitored, VA should make sure there’s some data behind them. You don’t want to throw this money away.”
Like other VA privatization bills of late, S.785 attracted strong interest from a string of non-profits who could benefit from its passage.
These entities offer all sorts of novel PTSD and mental health treatments, some of which lack solid evidence. In a recent post, Battle Borne went deep on one of these entities —Mission Roll Call — a shadowy new veterans group nestled inside America’s Warrior Partnership (AWP), a non-profit consortium of private veteran mental health care groups.
AWP’s leader, Jim Lorraine, has been instrumental behind the scenes in shaping S.785, and he recently gave public remarks at a House hearing in support of its passage.
“Empowering communities is a proven approach,” he contended. “And I have seen for myself what coordinated networks of veteran-serving organizations can accomplish and how our approach of developing a relationship with veterans before the crisis occurs has paid dividends on improving the quality of life for veterans, their families and their communities.”
A number of other mental health non-profits were invited to submit testimony for this hearing. Assuming these groups will soon be given grants to prevent veteran suicide, it’s worth zeroing in on each for a moment:
First there is Hope for the Warriors, a non-profit out of northern Virginia that offers direct financial grants, Make-a-Wish style trips, and emergency clinical care to veterans. This group has previously received money from the now defunct (and under federal investigation) Donald J. Trump foundation. Its leadership was recently invited to participate in the President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS) Task Force.
A quick aside: PREVENTS endorsed the idea of community mental health care. Before that, another VA Acronym Task Force (ATF), endorsed a number of sketchy, often expensive PTSD treatments available in the private sector. We previously investigated the work of this commission — called Creating Options for Veterans’ Expedited Recovery (COVER) — for Reveal (not an acronym.) This is only worth mentioning now because, tucked into S. 785, is a mandate that VA conduct a three-year pilot program offering COVER-endorsed treatments like equine therapy, which hasn’t been established to help veterans’ mental health. (Don’t try telling that, however, to Kentucky House member Andy Barr.)
Anyways, back to the Hope for the Warriors. Their corporate backers include beer behemoth Anheuser-Busch, tobacco giant Altria, and candy king Jelly Belly. In recent years, salary and other compensation inside the non-profit has generally outpaced spending on services. The group’s President and CEO, an entrepreneur named Robin Kelleher, earned more than $190,000 in 2018, the last year for which 990 data is publicly available.
Then there’s Combined Arms, a Texas-based non-profit that offers a broad series of support programs to transitioning veterans, including career services and social opportunities. In 2018, the executive director of Combined Arms earned $117,126, which is roughly 10 percent of all the contributions that came in that year.
The Lone Survivor foundation offers a diverse treatment regime that includes Alpha-Stim, described on the website as a “Cranial Electrotherapy Stimulation device (CES) that is FDA approved to treat anxiety, depression, insomnia, and pain.” In reality, this device has only been cleared by the FDA — which is significantly different. An exhaustive 2018 study of available research into this and other CES devices found “insufficient” evidence to “support conclusions that CES has clinically important effects on headache, fibromyalgia, neuromuscular pain, depression, PTSD, or insomnia.” (If you want a visual of how Alpha-Stim works, look no further than the image at the top of this story.)
A third private group invited to testify on S. 785 was Boulder Crest, which promotes a treatment called “Post-Traumatic Growth.” Some scientists are skeptical of the theory that trauma can in and of itself spur positive changes, and a 2018 study into related treatments described any benefits as “illusory.” Boulder Crest’s own 18-month longitudinal study has netted largely positive results. Still, as we’ve previously reported, this study was not peer-reviewed, had no control group, and is far from conclusive.
The overarching goal behind S. 785 is a positive one: to improve access to mental health care for veterans. The bill’s namesake, Commander John Scott Hannon, was a platoon leader for various Navy SEAL Teams with a track-record of meritorious service that earned him numerous awards, including the Bronze Star.
Once he came home, Hannon was diagnosed with Post-Traumatic Stress Disorder, a Traumatic Brain Injury, severe depression and bipolar disorder. He sought and received help from the VA in his home state of Montana, and also found healing in nature, where, among other activities, he rescued and rehabilitated injured wild animals and worked with a local land trust to get veterans onto hiking trails. Despite this mix of therapies, Hannon couldn’t overcome the invisible wounds he’d suffered. On February 25, 2018, he died by suicide.
“John Scott spent his final years advocating for easier access and a broader approach to mental health care,” his sister, Kim Parrott, said when the S.785 was first introduced last year. “This bill is in complete alignment with his beliefs and efforts.”
The legislation was introduced by Hannon’s home-state senator, Senator Jon Tester, who serves as the Democratic ranking member of the Senate Committee on Veterans Affairs (SVAC). Tester quickly found an ally for the bill in SVAC’s chairman, Jerry Moran, a Kansas Republican with close ties to the Koch-backed, pro-privatization group Concerned Veterans for America.
In promising to improve veterans’ access to mental health treatment and reduce veteran suicide, S. 785 sets up pilot programs and grant opportunities to private sector providers that purport to improve veterans on a series of metrics, including well-being, financial health, and suicide risk. And it’s likely that much of the nearly $200 million in grants will go to providing veterans the same sort of in intangible relief that Hannon found in nature.
Yet the VA will have no real role in coordinating or supervising this care. There are no competency, training, or qualification standards for these providers, which are offering critical services. Even worse, although many will treat veterans with PTSD or who are suicidal, none are required to have any specialized training in PTSD or suicide prevention.
Undergirding this soon-to-be law, which has been hailed by a flurry of powerful veteran groups, is a fundamentally false assumption: that the private sector is better at addressing mental health care than the VA.
In fact, the VA has been found to outperform the private sector in treating a broad swath of mental health conditions, including each and every one that Hannon suffered from. As the most recent data shows, veterans outside the VA are far more likely to die by suicide than those who receive care inside departmental walls. A comprehensive study released last month similarly found that veterans far prefer VA mental health care to what’s being offered in the private sector.
Not only does S. 785 powerfully endorse the inaccurate notion that the private sector can easily care for veteran’s complex conditions, it sets an extraordinary precedent for veterans’ mental healthcare. For the first time, the legislation would mandate that the government pay for care and other social services for veterans, regardless of their eligibility for VA care. Because family problems often influence veterans’ mental health, the bill would also, for the first time, pay for private sector care for veterans’ families.
The sentiments behind these proposed changes are correct. Today, a massive roadblock preventing progress on the veteran suicide crisis is that millions of veterans are simply ineligible for help. That’s because VA eligibility is determined by the nature of a veteran’s military discharge as well as, with some exceptions, whether or not the veteran has a proven service- related disability and/or low income.
More than 1.2 million veterans are permanently excluded from some or all VA benefits and aren’t even defined as veterans for VA purposes. That’s because they’ve been separated from the military with so called “Other Than Honorable” or “General” discharges, a designation known more commonly by its shorthand: “bad paper.”
More than 125,000 of these bad paper discharges have been assigned during the Forever Wars. Most of the veterans who have received these discharges minor infractions — getting drunk, taking drugs, getting into fights, being “insubordinate”, showing up late for formation etc. Much of this “bad behavior” is directly due to military-related mental health conditions. Women who have had the courage to report sexual assaults or harassment have also been retaliated against with these discharges. Because veterans with “Other Than Honorable” discharges have no access to the VHA, they are doubly punished: they are kicked out of the military and then denied care for the problems the military created or exacerbated from the only system that understands and is competent to address these problems.
S. 785 pledges to assist this population, but then limits their options to the private sector — a bizarre policy directly at odds with the rhetoric of “choice” and “competition” surrounding privatization work like the Mission Act.
They also looked to insert language reducing veterans’ access to firearms — which are involved in nearly 70 percent of veteran suicides — and medication, but were rebuffed. The Senate, White House and VSOs refused to discuss specifics on the bill and instead put broad pressure on Takano to pass a clean Senate version.
Last fall, Takano effectively blocked similar legislation — The Improve Wellbeing for Veterans Act — despite vicious political attacks against him from conservative veteran advocates and VA Secretary Robert Wilkie, who, during a hearing, questioned Takano’s commitment to veterans’ issues. (This time around, Wilkie simply declined to show up for a House hearing on S. 785.)
Some House staff were frustrated by the reemergence of this type of legislation. One of them appeared to be Heather Kelly, a psychologist and House veteran policy staffer who recently published a frustrated but diplomatically vague Twitter thread:
If you’re serious about preventing veteran suicide (any suicide), then you’re up for implementing the few things we know actually reduce actual suicide deaths, yes? Even if they’re hard?
— Heather O'Beirne Kelly, PhD (@HeatherKellyPhD) September 13, 2020
I see a lot of groups intent on innovation without evaluation.
— Heather O'Beirne Kelly, PhD (@HeatherKellyPhD) September 13, 2020
Even so, the pressure was hot, Takano capitulated, and the bill passed the House. In exchange, he secured support for a number of other important veteran policies.
Once Trump signs S. 785, Wilkie will hold broad authority over assigning grants and establishing pilots, even though he has no background in clinical care. The millions he’ll give out will have little oversight tied to them, making it hard to tell if struggling veterans are being effectively treated outside VA walls.
In short, the decision to divert VA dollars into the private sector from existing, underfunded VA care makes no clinical sense. As a 2018 paper from the National Academies of Science, Engineering and Medicine, the VA runs the best mental healthcare network in America. This paper also reported that many veterans don’t seek VA mental healthcare because they don’t know how to apply for VA benefits, aren’t sure whether they are eligible for services, or don’t feel deserving of help.
While the Hannon bill pledges to also improve VA mental care, there’s no money to attached to address these efforts by, for instance, increasing PR efforts to make veterans’ aware of their benefits. There’s also no new new funding to bolster internal capacity and provide VA care to all veterans regardless of discharge status. What S. 785 instead feature are empty, unfunded mandates ordering that care is assessed and plans are devised.
Instead of addressing the root causes of the veteran suicide crisis, lawmakers and veterans advocates continue to expend enormous amounts of time, energy, and taxpayer dollars into shiny, novel work-arounds that far-too-often channel veterans into expensive, evidence-free, private sector programs.