Wonkbook: How to the fix the VA

May 23, 2014

Welcome to Wonkbook, Wonkblog’s morning policy news primer by Puneet Kollipara. To subscribe by e-mail, click here. Send comments, criticism or ideas to Wonkbook at Washpost dot com. To read more by the Wonkblog team, click here.


(Photo by Christian Petersen/Getty Images)

Wonkbook’s Number of the Day: 47 percent to 46 percent. That's the divide between Americans who back abortion rights versus those who oppose abortion, a new poll says.

Wonkbook’s Chart of the Day: This interactive chart shows how health care hiring has slowed in recent years.

Wonkbook's Top 5 Stories: (1) What can be done to fix the VA?; (2) weakened NSA reforms advance; (3) the tea party wins even when it loses; (4) promising housing signs; and (5) Dems lay down the immigration hammer.

1. Top story: As Shinseki loses support, what can be done to fix the VA?

VA’s Shinseki vows to stay on the job as calls for his ouster continue. "Veterans’ Affairs Secretary Eric K. Shinseki vowed Thursday to stay in office and pledged to address the allegations of health care mismanagement that have besieged his agency and the Obama administration. In a brief interview with reporters on Capitol Hill, Shinseki initially demurred when asked why he thought he should keep his job. When a reporter noted that he’s been 'under the gun' all week, Shinseki quickly shot back: 'This is not the first time.' Shinseki is a former Army general who served two tours of duty in Vietnam and earned a Purple Heart after losing part of his right foot in battle." Ed O’Keefe in The Washington Post.

Primary source: Shinseki's open message to veterans.

Explainers:

Obama and the broken veterans medical system: 4 blunt points. Paul M. Barrett in Bloomberg Businessweek.

The VA scandal explained. German Lopez in Vox.

About that secret waiting list: Shinseki letter reveals early efforts to explain it. "An exchange of letters between Veterans Affairs Secretary Eric Shinseki and a top Republican this month reveal the VA’s early efforts to explain a secret waiting list that one of its hospitals allegedly used to hide treatment delays. Shinseki said the secret list may refer to a spreadsheet of 'interim notes' that a Phoenix VA clinic developed 'for reference purposes' while entering new patients into an electronic scheduling database....Shinseki acknowledged that the VA eliminated the notes, saying federal law and department policy require such action when the information is 'no longer needed for reference purposes.'" Josh Hicks in The Washington Post.

Explainer: 4 things Washington could do right now. "1. Congress could ask doctors — not veterans — to handle the paperwork....2. Congress could require the VA to give more veterans the benefit of the doubt....3. The VA could start rewarding its employees for quality, not quantity....4. Congress can pressure the Pentagon and the VA to share electronic files." Jordain Carney and Stacy Kaper in National Journal.

What will it take to fix VA health care? Probably not more money. "The solution that most members of Congress and veterans groups are turning to is a major management overhaul, one that some believe should include the departure of VA Secretary Eric Shinseki....there are indications that a shortage of money is not the VA's problem. While reports of long wait times for care and a huge backlog of disability claims goes back more than a decade, the VA saw its budget increase more than $20 billion during Mr. Obama's first two years in office, yet the problem persists." Rebecca Kaplan in CBS News.

As expected, Congress got busy on management overhauls and subpoenas. "Lawmakers Thursday moved to boost funding for a nationwide investigation into whether VA employees covered up long waits for medical care and authorize subpoenas of VA officials....A resolution also has been introduced seeking a House vote calling for Shinseki’s resignation. The Senate Appropriations Committee, meanwhile, approved a VA spending bill that would provide an additional $5 million for a VA inspector general's investigation, give the VA secretary give new authority to fire or demote employees, and freezes bonuses to senior VA employees until the review is complete and reforms have been implemented." Richard Simon in the Los Angeles Times.

Why the White House doesn't back the House VA bill. "The White House on Thursday provided a little — but only a little — clarity on the administration's objections to a House Veterans Affairs reform bill, saying provisions of it could result in litigation against the government....The White House spokesman also reiterated that the administration shared and supported the goals of the bill, and that the president was determined to punish those responsible for misconduct." Justin Sink in The Hill.

Lawmakers also want the FBI to investigate. "House Minority Leader Nancy Pelosi (D-Calif.) suggested Thursday that allegations of cooked books at the Veterans Affairs Department could rise to the level of criminal misconduct....She's not alone in suggesting the alleged misconduct might be criminal. Sen. Richard Blumenthal (D-Conn.) has urged VA Secretary Eric Shinseki to call in the FBI to investigate." Mike Lillis in The Hill.

Fact-check: No, Obamacare isn't 'one big fat VA system.' "We found no health policy expert who agreed with that comparison. The VA is owned and operated by the federal government. Its staff are government employees. In contrast, Obamacare builds upon the existing private sector health industry. The law sets standards for insurance and health care providers and it subsidizes premiums. Washington does run the Medicaid insurance program but even under that program, it is paying private providers. We rate the claim Pants on Fire." Tampa Bay Times.

Et tu, Democrats? Campaigning ones want Shinseki out. "The Veterans Affairs scandal isn't bad just for President Obama. Witness the growing chorus of Democratic congressional candidates desperate to get some distance from the administration. This week, would-be Democratic officeholders from moderate- and conservative-leaning districts started to call on Obama to fire VA Secretary Eric Shinseki after accusations that the department covered up long waits that led to the deaths of former service members." Adam Wollner, Andrea Drusch and Jack Fitzpatrick in National Journal.

Poll: Shinseki gets more blame than Obama for VA scandal. CBS News.

MOORE: How scandals have made the VA better. "If there is any silver lining to our current outrage, it is that in the past, acts of negligence or corruption have led to dramatic improvements in the care veterans receive....Predictions about the agency’s impending death would prove far from the mark — but again, failure led to reforms at the VA. With the adoption of the 1996 Veterans’ Health Care Eligibility Reform Act, the VA transformed itself into an integrated health care system. Not only did these changes make veterans’ care easier to access by opening hundreds of outpatient clinics across America, they also increased the VA’s capacity to care for more veterans and to embrace innovative ways to track and measure health care outcomes." Colin Moore in The Washington Post.

BERNSTEIN: Dismissals should address policy, not the need to placate media. "Presidents need to be able to ignore meaningless hype and scandal-mongering in the media, but they also need to learn to read leaks and investigative reporting for clues to what's really happening. That's one of the reasons why presidenting takes a lot of skill. Good intentions and strong beliefs aren't enough. The focus should always be on long- and medium-term policy and governing, rather than one-day press stories. Cleaning house just to send a message may not always be a mistake, but, generally, better options are available." Jonathan Bernstein in Bloomberg View.

Other health care reads:

New bill spreads abortion limits in the South. Jeremy Alford and Erik Eckholm in The New York Times.

Insurance fee for big businesses help fund Obamacare. Sarah Jane Tribble in NPR.

Top opinion

CASSELMAN: Cutting off emergency jobless benefits hasn't pushed people back to work. "The case against extending unemployment benefits essentially boils down to two arguments. First, the economy has improved, so the unemployed should no longer need extra time to find a new job. Second, extended benefits could lead job seekers either to not search as hard or to become choosier...ultimately delaying their return to the workforce. But the evidence doesn’t support either of those arguments. The economy has indeed improved, but not for the long-term unemployed....And the end of extended benefits hasn’t spurred the unemployed back to work; if anything, it has pushed them out of the labor force altogether." Ben Casselman in FiveThirtyEight.

RAMPELL: The private burden of public colleges. "From the days of Benjamin Franklin...up until quite recently, higher education (just like primary or secondary education) was seen as a sort of public good: a service whose benefits were shared among the entire population and whose costs should therefore be borne by the entire population....Yes, most of the perks of higher ed likely accrue to the individual who gets the degree. But college-going also has huge spillover effects for the rest of the economy....College is also one of the best tools we have for promoting upward economic mobility....Which is exactly why shifting the burden of college costs away from taxpayers and onto students is so shortsighted." Catherine Rampell in The Washington Post.

ROSNER: How to turn homes back into piggy banks. "A bipartisan effort to address one of the biggest issues left over from the financial crisis — what to do with mortgage-finance giants Fannie Mae and Freddie Mac — appears to have died in the Senate. Its demise should be seen as an opportunity to reframe the discussion of housing and the role it can play in the creation of wealth for Americans. Proposed by South Dakota Democrat Tim Johnson and Idaho Republican Mike Crapo, the initiative sought to eliminate Fannie and Freddie and reshuffle the roles of various financial players in the mortgage market. Unfortunately, it largely ignored the reasons the government should focus resources on housing in the first place." Joshua H. Rosner in Bloomberg View.

VINIK: Reform conservatives' smart safety-net idea — simply give the poor money. "While the right often overstates the inefficiencies in government, a universal credit, if structured properly, would make the U.S.’s social safety net more effective. A growing body of research finds that the best way to help low-income people is to give them money. They know how they can use it best to improve their living standards....A straight cash transfer, such as a universal credit, would eliminate the need for these transactions and deploy the government’s resources more effectively....The biggest hurdle for a universal credit is funding: To fill the holes in the safety net, the government will have to spend more money." Danny Vinik in The New Republic.

DICKERSON: How GOP Senate control could reduce the gridlock. "For the moment, partisanship provides an excuse and impediment to action. House Republicans pass legislation, but their views never have to be sharpened or reconciled with those of their Senate colleagues. Control of both houses could force clarity in the GOP on issues like immigration, which leaders have ducked so far, claiming they didn’t have a trusted partner in the president. That is a dodge to keep from starting a fight in the party over a contentious issue. When you control both houses, this kind of inaction can’t be allowed if the goal is to be taken seriously as a governing party....Republican strategists know the GOP has to shake the 'Party of No' label." John Dickerson in Slate.

ORNSTEIN: Term limits would mean better Supreme Court. "For more than a decade, I have strongly advocated moving toward term limits for appellate judges and Supreme Court justices....Doing so would open opportunities for men and women in their 60s, given modern life expectancies, and not just those in their 40s. It would to some degree lower the temperature on confirmation battles by making the stakes a bit lower. And it would mean a Court that more accurately reflects the changes and judgments of the society. If we could combine term limits for justices with a sensitivity by presidents to find some judges who actually understand the real world of politics and life, and not just the cloistered one of the bench, we might get somewhere." Norm Ornstein in The Atlantic.

Baby interlude: Baby feeds a kitten.

2. These aren't the NSA reforms privacy advocates are looking for

House passes bill ending NSA's bulk collection of phone records. "The House on Thursday approved by a wide margin a bill that would end the National Security Agency’s mass collection of Americans’ phone call records, a counterterrorism program that stoked privacy concerns after its existence was leaked last year. The USA Freedom Act, which began as a broad package of surveillance reforms embraced by civil libertarians and tea party Republicans, was revised this week to meet the concerns of intelligence and law enforcement officials." Ellen Nakashima and Andrea Peterson in The Washington Post.

Not a joke: Half the original bill's cosponsors voted against it. "The new version from the House Rules Committee, privacy advocates say, significantly weakened the reform and included loopholes that could potentially allow bulk data collection on U.S. citizens to continue. Privacy advocates weren't the only ones upset about the changes. Many co-sponsors of the original version were also concerned. In fact, a Washington Post analysis of the votes shows that 76 of the 152 co-sponsors of the earlier version voted against passage of the altered version on the House floor Thursday. So, half of the co-sponsors ended up voting against what was supposed to be their own NSA reform bill." Andrea Peterson in The Washington Post.

Explainer: How far did the House go to rein in the NSA? Francine Kiefer in the Christian Science Monitor.

NSA reformers hope they can restore lost provisions in the Senate's version. "After the House's passage of a compromise version of the USA Freedom Act, some of the biggest critics of government surveillance are hoping the Senate will come through with a stronger bill. The 303-121 vote in the House was a step forward towards ending some of the National Security Agency’s (NSA) most controversial operations, but could amount to little unless the Senate strengthens a number of the legislation’s provisions, critics said." Julian Hattem and Kate Tummarello in The Hill.

House lawmakers to Snowden: Don't take this the wrong way, but... "House lawmakers on Thursday had a message for NSA leaker Edward Snowden: No mercy. The surveillance reform that passed the House would not have been introduced without Snowden’s revelations last June. But the measure’s key sponsors said the National Security Agency contractor should not get a free pass and be admitted back into the country with immunity. House Judiciary Chairman Bob Goodlatte (R-Va.) and ranking member John Conyers (D-Mich.) made it clear that the reforms don’t justify Snowden’s actions." Alex Byers in Politico.

On patent trolls, a familiar theme: Congress isn't doing anything, so the states are instead. "Efforts to rework federal patent law to prevent questionable patent ownership claims were dealt another setback Wednesday when the Senate Judiciary Committee cancelled a legislative markup scheduled for Thursday. State lawmakers, meanwhile, have been moving more quickly. Louisiana Gov. Bobby Jindal says he plans to sign recently passed legislation aimed at reining in so-called patent trolls, which buy up patents and seek to profit from them. That would make Louisiana the thirteenth state to enact such legislation, twelve of which have acted this year." Ruth Simon and Angus Loten in The Wall Street Journal.

Why the FCC is being so vague on net neutrality. "The Federal Communications Commission is moving ahead with a net-neutrality proposal, but no one knows exactly what business practices it would ban. And for the FCC, that's all part of the strategy. The commission wants a vague standard to allow Internet companies to experiment with new business models, while giving the agency authority to step in when it sees abuses." Brendan Sasso in National Journal.

Explainer: The FCC's options on net neutrality. Robert Litan in The Wall Street Journal.

Other tech reads:

House votes to delay administration's Internet shift. Kate Tummarello in The Hill.

Animals interlude: The 18 cutest cat forts.

3. Are the GOP and the Tea Party becoming more similar on policy? 

The tea party makes its last stand in Mississippi. "After a string of humbling defeats in Republican primaries this spring, the tea party’s last best hope to oust a lawmaker is in Mississippi. But things are not going well for the movement’s Chris McDaniel, who is challenging longtime senator Thad Cochran....Conservative groups — hoping for their first victory in knocking off an entrenched incumbent this year — are doubling down to prop up McDaniel in the run-up to the June 3 primary." Philip Rucker and Robert Costa in The Washington Post.

Background reading: Republicans receive boost in Senate primaries. Philip Rucker and Robert Costa in The Washington Post.

How the tea party is still hurting the GOP. "Make no mistake, the right is still drawing blood. The fight between the mainstream and the right wing remains a bloody and draining battle for the GOP, one that saps party resources at a potential cost to the party's chances in November." Molly Ball in The Atlantic.

The tea party wins, even if it loses. "The lesson is not that the Establishment beat the Tea Party or vice versa but that the two are becoming increasingly similar. There aren’t primaries as there were two or four years ago with moderate mandarins like Mike Castle or Dick Lugar. Instead, the candidates from each wing of the Republican Party are starting to look more alike....This isn’t to say that there has been a convergence and, of course, with social issues and the press and pull of pork barrel politics there never will be one. But, the gap between the two is narrowing and it is entirely because the Tea Party is successfully dragging the rest of the GOP to the right." Ben Jacobs in The Daily Beast.

Is a shift toward middle-class concerns in order? "As Republicans seek to take control of the U.S. Congress in November’s election, party leaders are shifting the focus of their message from job creators to wage earners. Senate Minority Leader Mitch McConnell and House Majority Leader Eric Cantor helped unveil a 121-page policy document today that repackages Republican positions from health care to taxes for middle class voters whom the economic recovery has done little to help. The change comes two years after Republican presidential nominee Mitt Romney’s unsuccessful campaign centered its economic message on entrepreneurship." Michael C. Bender in Bloomberg.

Primary source: Room to Grow.

Other political reads:

IRS postpones hearing on rules for tax-exempt groups. Josh Hicks in The Washington Post.

Science interlude: The strange scourge of light pollution.

4. There's no (market)place like home

Housing sector turning the corner; jobs market firming. "U.S. home resales rose in April and the supply of properties on the market hit its highest level in nearly two years, hopeful signs for the stalled housing market recovery....Housing is one of the main channels through which the Federal Reserve is seeking to boost growth via its monthly bond purchases. The housing slump has prompted Fed Chair Janet Yellen to caution it could undermine the economy....Labor Department data showed initial claims for state unemployment benefits rose 28,000 to 326,000 last week. The four-week average, which irons out week-to-week volatility, rose by only 10,500, indicating the underlying jobs market trend remains strong." Lucia Mutikani in Reuters.

Another encouraging economic sign: Manufacturing keeps expanding. "The Markit Economics preliminary index of U.S. manufacturing increased to 56.2 in May from 55.4 a month earlier as output accelerated, the London-based group said today. Readings above 50 for the purchasing managers’ measure indicate expansion and the May figure was the highest in three months." Callie Bost in Bloomberg.

Housing isn't as affordable as you think. "A growing number of economists and policy makers are faulting last summer’s spike in mortgage rates for a broad slowdown in housing activity that began last fall....Wait a minute, you say. Isn’t housing still pretty affordable?...The problem is that this picture of affordability assumes borrowers have down payments of at least 20% and that they’re able to qualify for the lowest mortgage rates. A new analysis from Goldman Sachs shows that for marginal borrowers, including many first-time buyers, the picture of affordability is only so-so." Nick Timiraos in The Wall Street Journal.

Why Congress is needed to overhaul Fannie and Freddie. "Legislative efforts to overhaul Fannie Mae and Freddie Mac look unlikely to advance this year, and ideological gridlock doesn’t appear likely to abate during the next session of Congress. That’s leading to more questions from housing-finance insiders and the mortgage giants’ shareholders about whether it’s possible to overhaul the companies through administrative fiat....Can Fannie and Freddie easily exit their government-run conservatorship and be restored as private companies without an act of Congress? Jim Parrott, a former housing adviser in the Obama White House, says that the answer is no." Nick Timiraos in The Wall Street Journal.

Primary source: Parrott's analysis. Urban Institute.

Obama interlude: Footage from his surprise walk through D.C.

5. The Democrats lay down the immigration hammer, but will it hit the nail?

Dems to Republicans: Pass immigration reform, or else. "Senate Democratic leaders say President Obama will act unilaterally to reform the nation’s immigration system if House Republicans fail to pass legislation by the end of July. 'They have about a six-week window, from June 10 after the last Republican primary until the August recess....' said Sen. Charles Schumer (N.Y.), the third-ranking Senate Democratic leader and author of the comprehensive Senate immigration reform proposal....Senate Majority Leader Harry Reid (D-Nev.) said Democrats’ highest priority for reform is to reunify the families of illegal immigrants that have been split by deportations." Alexander Bolton in The Hill.

The clock is ticking, starting now. "The issue for Reid, as it is for other Democrats, is timing. Senate Democrats believe there is a narrow window of about six weeks this summer — from mid-June to the end of July — for the GOP-led House to move immigration bills, and they want the focus during that period to be on Republican lawmakers, not the administration....He endorsed an idea first floated by one of his top deputies, Sen. Chuck Schumer (D-N.Y.): Pass a bill this year, but have it take effect in January 2017 when a new president moves into the White House. That is meant to take aim at a chief criticism from House Republicans: They don’t trust President Barack Obama to implement an immigration bill." Seung Min Kim in Politico.

Why the plan probably won't get Republicans to move. "Schumer has previously brought up the idea of changing the Senate bill so that it doesn't take effect until Obama is out of office. Now, Reid has formalized it and packaged it as a 'compromise.' It's unclear how exactly that would happen. And House Republican leadership immediately shot the plan down....House Republicans haven't ruled out implementing immigration reform this year....But the growing sense on the Hill is that the window for any sort of immigration-related bill is rapidly closing." Elahe Izadi in National Journal.

Obama's relationship with Latinos hinges on the GOP. "By March in the face of increasing pressure from Latino activists, the president asked his director of homeland security to review deportation enforcements. Last week, on PBS, Jay Johnson said the administration has discretion when it comes to deportations....Although the president hasn't been shy about preempting Congress in other areas, on immigration, the strategy is to give John Boehner some space to see if the House Speaker can finally convince his own party to pass immigration reform this summer. In the meantime, the president is trying something else, identity politics." Mara Liasson in NPR.

One way Obama hopes to keep appealing to Latinos: The Julián Castro nomination. "President Obama is scheduled to announce Friday that he will nominate San Antonio Mayor Julian Castro as the next secretary of Housing and Urban Development. Castro will replace Shaun Donovan, who Obama will name as head of the White House Office of Management and Budget, a White House official said. Castro, 39, is serving his third term as mayor of San Antonio. He is considered a rising star in Democratic politics and delivered the keynote speech at the 2012 Democratic National Convention." Katie Zezima in The Washington Post.

Other immigration reads:

Senate Democrats may block military DREAMers measure from defense bill, too. Kate Nocera in BuzzFeed.

Skilled foreign workers seen as a boost to pay. Josh Zumbrun and Matt Stiles in The Wall Street Journal.

Michael Jackson interlude: Dancing performance at a talent show.

Wonkblog roundup

The "1 Percent" isn’t America’s biggest source of inequality. College is. Jim Tankersley.

How many patients should your doctor see each day? Lenny Bernstein.

Will America ever be ready for a Congressional commission to study reparations? Emily Badger.

No, shoes are not the reason why women are saving less for retirement. Jonnelle Marte.

Tim Geithner is wrong about FDR. Matt O'Brien.

Et Cetera

Energy company reaches deal with EPA to clean up coal ash spill. Matt Pearce in the Los Angeles Times.

Nutrition compromises following first lady's calls. David Rogers in Politico.

Signs of a suburban comeback, Census data show. Neil Shah in The Wall Street Journal.

Two Oregon counties ban genetically modified crops. Andrew Martin in Bloomberg Businessweek.

Congress heads toward a showdown over 2015 defense priorities. David Alexander in Reuters.

Got tips, additions, or comments? E-mail us.

Wonkbook is produced with help from Michelle Williams and Ryan McCarthy.

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