U.S. GOVERNMENT PUBLISHING OFFICE

WASHINGTON : 

1 

59–011 2016

114th Congress, 2d Session – – – – – – – – – – – – House Document 114–161 

THE FINAL REPORT OF THE COMMISSION ON CARE 

COMMUNICATION 

FROM

THE PRESIDENT OF THE UNITED STATES 

TRANSMITTING

A STATEMENT SUPPORTING MANY OF THE RECOMMENDATIONS 

AND THE UNDERLYING OBJECTIVES OFFERED BY THE COMMISSION ON CARE IN THE FINAL REPORT TRANSMITTED ON JULY 

6, 2016, PURSUANT TO 38 U.S.C. 1701 NOTE; PUBLIC LAW 113– 

146, SEC. 202(g)(2); (128 STAT. 1776) 

SEPTEMBER 6, 2016.—Referred to the Committee on Veterans’ Affairs and 

ordered to be printed 


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THE WHITE HOUSE, 

Washington, September 1, 2016. 

Hon. PAUL D. RYAN, 

Speaker of the House of Representatives, 

Washington, DC. 

DEAR MR. SPEAKER: My Administration is committed to the ongoing transformation of the Department of Veterans Affairs (VA) and 

I strongly support many of the recommendations and the underlying objectives offered by the Commission on Care (Commission) 

in its final report transmitted on July 6, 2016. These recommendations underscore the fundamental challenges that face the VA 

health care system, and the reforms needed to provide America’s 

veterans with the high quality health care they need and deserve— 

both now and in the future. We have made great strides in delivering improved care to our veterans over the past 8 years, and we 

will continue to work tirelessly to uphold the solemn responsibility 

to ensure all our veterans are getting the care and benefits they 

have earned. 

I concur with 15 of the 18 Commission recommendations, many 

of which are already being implemented as part of the ongoing 

MyVA transformation that the Secretary of Veterans Affairs (Secretary) has put in place. These include areas such as enhancing 

clinical operations, establishing a more consistent policy for appealing clinical decisions, eliminating disparities in how health care is 

delivered to veterans from different backgrounds, modernizing IT 

systems, and establishing new processes for leadership development and performance management. These reforms are steps in 

the right direction and will help put VA on a trajectory to ensure 

veterans continue to receive timely and high quality care, while 

strengthening the VA health care system that millions of veterans 

depend on every day. I appreciate and applaud the Commission for 

their work. 

Of particular note, I strongly support the Commission’s principle 

that creating a high-performing, integrated health care system that 

encompasses both VA and private care is critical to serving the 

needs of veterans. In fact, my Administration outlined its approach 

to achieve this same goal in VA’s Plan to Consolidate Community 

Care, submitted to the Congress in October 2015. While this approach must be implemented in a fiscally sustainable way, it builds 

on more than a decade of work with veterans, health care providers, and community partners, to streamline and enhance VA’s 

capability to deliver services essential to veterans’ health. VA’s 

plan also recognizes the importance of strengthening VA’s partnerships with other Federal health care providers, including the Department of Defense and Indian Health Service, as well as tribal 

health programs, academic teaching affiliates, and Federally Qualified Health Centers. 


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At the same time, it is critical that we preserve and continue to 

improve the VA health care system and ensure that VA has the 

ability to serve veterans. Research shows that in many areas, such 

as mental health, VA delivers care that is often better than that 

delivered in the private sector. VA also provides unique, highly specialized care for many medical conditions, such as spinal cord and 

traumatic brain injuries, which are simply not available to the 

same extent outside of VA. In addition, VA provides a comprehensive approach to wellness that includes the treatment of physical 

injuries and mental health. This multidisciplinary approach allows 

providers to address the full spectrum of veteran needs beyond 

medical care, including other VA benefits and services. 

For these reasons, I concur with the Commission’s vision for creating integrated care networks that more tightly coordinate VA and 

non-VA care, but urge the Congress to act on this recommendation 

by enacting VA’s Plan to Consolidate Community Care. The alternative approach outlined in VA’s plan would achieve the goals of 

the Commission to create a veteran-centric approach to care that 

appropriately balances issues of access, quality, and cost-effectiveness. It would more clearly ensure the long-term viability and sustainability of the VA health care system, preserve VA’s role as the 

primary coordinator of care for veterans, and safeguard its ability 

to carry out its other research, education, and emergency preparedness missions that are critical to our Nation’s well-being. And it 

would ensure that veterans have access to the care they need— 

whether at the VA or out in the community—without forcing untenable resource tradeoffs that would limit the ability of VA to 

carry out other parts of its mission on behalf of veterans. 

We must also ensure that VA has the ability to operate this integrated health care system in a rational, efficient, and dynamic way 

that best serves the interests of both veterans and taxpayers. For 

that reason, I have concerns with the Commission’s proposed governance structure for the VA health care system. The proposal 

would undermine the authority of the Secretary and the Under 

Secretary for Health, weaken the integration of the VA health care 

system with the other services and programs provided by the VA, 

and make it harder—not easier—for VA to implement transformative change. Moreover, the Department of Justice has advised 

that the proposed recommendation would violate the Appointments 

Clause of the Constitution. I do, however, support portions of the 

recommendation that would establish a term appointment for the 

Under Secretary for Health, to ensure that position is removed 

from the turmoil and turnover of the political cycle. 

For those recommendations I agree with and whose objectives 

are not yet achieved, I am directing the VA to develop plans to 

complete their implementation. Additionally, in recognition of the 

role of the MyVA initiative in transforming the VA as military 

service evolves, I have directed the Secretary of Veterans Affairs to 

incorporate the principles of the MyVA initiative into VA strategic 

planning, leadership training, and performance monitoring. In 

those areas where legislation is required, my Administration will 

work closely with the Secretary to transmit to the Congress the relevant legislative proposals, which I recommend be enacted without 

delay. 


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Improving veterans’ health care remains a critical issue of national importance, and my Administration will work with veterans 

and military families, the Congress, Veterans Service Organizations, and other stakeholders to ensure all our veterans are getting 

the care and benefits they need when they need them. 

Sincerely, 

BARACK OBAMA. 

Æ 


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