https://betoorourke.com/veterans/

Beto's H.R. 6445, Veterans Health Care Trust Fund Act, which Beto introduced in December 2016, includes a War Tax, see the section titled "Part VII -- War Tax".
https://www.congress.gov/bill/114th-congress/house-bill/6445
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For O'Rourke, the plan for veterans recalls some of his biggest legislative victories while serving in Congress from 2012 to 2018. Possibly his hallmark legislative accomplishment was a bill expanding mental health care for military veterans even if they received a less-than-honorable discharge, an idea that was an outgrowth of El Paso having one of the highest suicide rates for veterans in the nation.
https://www.houstonchronicle.com/news/politics/texas/article/Beto-O-Rourke-proposes-new-war-tax-to-14036019.php
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https://betoorourke.com/veterans/

Honoring Our Commitment

Caring For Our Nation's Veterans

Beto's plan for honoring our veterans by investing in them at home, and ending wars abroad.

very year, young women and men leave Fort Bliss in El Paso, Texas to serve our country overseas, some sent to fight in "forever wars" that started before they were born.  And every year, many others return home to an El Paso VA where they must seek care for the mental and physical trauma they have sustained. 

A lifelong El Pasoan, Beto has always understood that we must pay any price, and bear any burden, to support all those who have worn the uniform and keep America safe.  That is why, as soon as he became a member of the House of Representatives in 2013, he brought El Paso's voice and values to the Veterans' Affairs Committee. 

Over his three terms in Congress, Beto did not spend a single day in the majority. And yet, he distinguished himself as a leading advocate for veterans—successfully expediting the veterans' disability claims process, extending emergency mental health care to veterans with Other-Than-Honorable discharges, and improving the staffing and functioning at the El Paso VA facility. 

These laws are already saving lives, but Beto recognizes that our work is far from done. An average of  20 veterans and servicemembers die by suicide every day.  And countless veterans have come home from generations of wars, only to struggle with PTS, find themselves in the grips of addiction, or end up living on the streets.

https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf

Our country can do better.  And we must.

That is why Beto is unveiling a new, comprehensive plan to improve the services we provide to veterans all across America, which he will push on Day One and beyond, with the same tenacity he did as a Member of Congress. Beto's plan is built around a four-part framework:

1 End the Wars in Iraq and Afghanistan, and Reinvest the Savings in Veterans

2 Invest in Building a State-of-the-Art Veterans Affairs Health Care System

3 Provide All Veterans with Equal Treatment

4 Ensure Veterans Can Succeed When They Come Home


Part 1

End "Forever Wars" and Establish a new Veterans Health Care Trust Fund

There is perhaps no greater way to honor the sacrifice of our veterans than to take gravely seriously the awesome responsibility of declaring war.  Eighteen years into the war in Afghanistan, and nearly three decades after our first engagement in Iraq, the time has come to cancel the blank check for endless war and to ensure that any future engagements are the result of a national conversation about our security interests and duly authorized by Congress.

And when we do make the solemn decision to send our troops to war, we must take steps to honor their service.  In part, this means recognizing that our service members make sacrifices not only during their time of deployment but also once they return home.  Although advances in medical care are ensuring that more and more of our service members are surviving the wounds of war—many of these injuries will require treatment for the rest of their lives. Honoring the service of our troops means standing with them each step on the way through treatment, recovery, and a full life.

Over the next few decades, the costs related to health care and disability compensation for the "forever wars" in Iraq and Afghanistan alone are projected to be nearly a trillion dollars. Today, these services — ones which we have promised to veterans and ones which they are owed — are subject to fiscal battles in Washington.  They should not be.

Building on bipartisan proposals he advanced as a Member of Congress, as President, Beto would:

Bring a responsible end to the wars in Afghanistan and Iraq.

These conflicts have yielded both tremendous human and fiscal costs. By ending these wars, we can reinvest the resources saved in those who have served. 

- Beto would propose that Congress invest $1 out of every $2 dollars saved—estimated at nearly $200 billion to vets, and at least $400 billion in total savings—in programs that benefit those who served. 

Establish a new Veterans Health Care Trust Fund.

To ensure the care needed by veterans of our wars will always be funded, Beto would work with Congress to pass a law that creates a Veterans Health Care Trust Fund (VHCTF) for each war we fight.

- At the start of any newly authorized war, a new trust fund will be established within the General Fund of the Treasury for future veterans of that war.

- The trust fund will support veterans' hospital care and medical services; disability compensation; and any other programs directly related to the care of veterans.

- Management of the trust fund would be subject to robust transparency and accountability, including regular reporting to Congress.

Deposit proceeds from a "War Tax" into new VHCTFs.

Under Beto's plan, every new VHCTF would be paired with enactment of new war tax.  This new tax would serve as a reminder of the incredible sacrifice made by those who serve and their families.

- This modest tax would be implemented on a progressive basis, with taxpayers who make over $200,000 per year (adjusted gross income) paying $1,000 in a new tax for each war.

- The tax would be levied on households without current members of the Armed Forces or veterans of the Armed Forces.

Part 2

Invest in Building a State-of-the-Art Veterans Affairs Health Care System

As President, Beto will advance a modern VA that not only delivers high-quality care with transparency and accountability, but also work to serve as a model for the rest of the country.  Already, many veterans prefer the care they get at VA medical facilities over other options.  At the VA, providers are held to high standards of professional training, used to working in an integrated health environment focused on veterans holistically, experienced in treating common service-connected conditions, and well-versed in military and veteran culture, making culturally competent care the norm.

Building on his record of delivering for veterans while in Congress, Beto will work to modernize the VA by increasing transparency and accountability, addressing staffing shortages—prioritizing closing the human capital gap of the over 45,000 vacant positions at the VA, including the 40,000 at the Veterans Health Administration, with a focus on the severe shortages in positions dealing with mental health, and instituting changes to decrease the appeals backlog.  He will also ensure that community providers are measuring up to the high standards that all of our veterans deserve.  As President, Beto would work to:

Attract more talent to the VA

A strong VA starts with a deep bench of talent.  For over 70 years, the VA has partnered with American medical schools, resulting in over 70 percent of US physicians having received training at a VA facility with veterans and residents benefitting. Beto recognizes we can expand on these partnerships.  Beto would invest in making VA a magnet for innovators in health care. Beto would:

- Provide new authority for VA leaders to make contingent offers to future medical providers to get them committed and in the pipeline earlier;

- Spur new partnerships between the VA and top research universities to launch innovative residency programs housed at the VA; and

- Fully fund and grow the Education Debt Reduction Program.

Make the VA a leader in the digital health care revolution.

The VA is already embarking on the largest modern electronic health record installation in the United States,  and leads the nation in interoperability and secure, electronic transfer of veterans' health information across silos of care. Importantly, the VA Blue Button initiative has also empowered veterans to truly own their own health information with electronic access vis-à-vis their own personal devices  As President, Beto would lean into that advantage—supporting the transfer of information from the Department of Defense, recognizing that as a priority, and positioning the VA to drive an industry-wide digital health care revolution. Specifically, under Beto's leadership, the VA would:

https://www.va.gov/bluebutton/

- Drive industry-wide standardization of electronic health care data, using its market power to develop uniform rules of the road around how electronic data is structured, transferred, and displayed to clinicians, no matter where veterans are receiving care. This is especially useful for physicians, nurses, and other front-line caregivers, who can make better clinical decisions with a complete set of a patient's information—especially during an emergency;

- Use electronic health care data as a tool to stitch together silos of care with a single, secure, and up-to-date record of veterans' health information, across specialists, systems, and facilities; and

- Support the expansion of telehealth, and leverage data to drive down costs across the system, enable better care coordination, and improve care quality and value.

Develop evidence-based standards to promote quality, timeliness, and cost-effectiveness of care and deploy those standards across the VA and community providers.

Health care for veterans extends beyond the VA system; and, despite the recent expansion of the Choice Program, efforts are still needed to bolster transparency and accountability, and improve the quality of care. Care must be standardized as an expectation extended not only at the VA but for all community providers involved in providing care to veterans. Beto would:

- Improve transparency at the VA by implementing strict reporting requirements for how funding is being used and investing in data-based performance assessments;

- Require VA providers, and any outside providers receiving VA funds, to publicly report and display: staffing ratios, a comparison between facility and national wait times, disability compensation processing times, and appeals processing times;

- Include veterans in performance assessments of VA and community care through nationwide surveys, and use the resulting data to improve care; and

- Assign a care advocate to veterans who seek care in the community to ensure that veterans' care remains coordinated by VA.

Establish the VA as a leader on mental health and opioid treatment.

We need to treat mental health with the same diligence, seriousness, and focus as physical health — especially because the epidemic of PTS and veteran suicide in the United States is both unacceptable and preventable.  The VA must make suicide prevention a top clinical priority.  The VA can be a leader on these health issues, pioneering approaches that can be adopted industry-wide.  In addition, the VA can be a driver in innovation for how our country deals with opioid addiction in particular.  In an O'Rourke Administration, the VA would:

- Implement a comprehensive approach to mental health and suicide prevention in collaboration with the Department of Defense, outside community groups, and Veterans Service Organizations, which promote the well-being of all veterans and improve the  identification of and treatments for subgroups of veterans at high risk;

- Change the norms of mental health care, including by:

-- Mandating VA mental health professionals contact each new veteran within one week following transition from the military, with follow ups as necessary;

-- Upholding our commitment that any veteran who visits a VA medical center with an urgent mental health need receives same day care; 

- Provide mental health services to National Guard and Reserve individuals who were never federally activated. These veterans have exceptionally high suicide rates and deserve mental health care from VA regardless of eligibility for other benefits;

- Transform pain management and fight opioid addiction by:

-- Standing up interdisciplinary pain management teams at every VA medical center. VA is on the cutting edge of the opioid crisis, but needs additional infrastructure in place to ensure that every veteran with pain has a team looking holistically at their needs and pain management options;

-- Supporting the compassionate use of medicinal cannabis in states that have applicable programs, help resolve bureaucratic hurdles, and allow VA physicians prescribe or recommend medical cannabis  under the legal authority of states, until federal legislation and reform allow for nationwide access to medicinal cannabis  as an effective remedy for pain control, PTS, anxiety, and many other conditions;

- Expand successful suicide prevention pilot programs, such as REACH-VET, which use predictive analytics and coaching by VA clinicians to decrease the suicide rates;

- Require the VA to collect information on veteran family member suicides to ensure benefits are reaching family members; and

- Ensure VA providers are talking to veterans about gun safety with a particular focus on safe storage options to put time and distance between veterans in crisis and guns.

Attack bureaucratic backlogs and red tape, creating a model for efficiency within the health-care industry

Under an O'Rourke Administration, the VA would be required to reform the appeals backlog so that decisions can be rendered in less than 100 days—setting an example for rather than lagging behind the rest of the healthcare industry.  Further, Beto will direct the VA to continue timely processing of disability claims. 

Dramatically increase research and investment into diseases that disproportionately impact veterans

We need to better resource the innovators on the cutting edge of new cures for the diseases that disproportionately impact veterans.  That means providing billions in increased funding for research on PTS, traumatic brain injury (TBI), and Alzheimer's and related dementias, and ALS.

- In particular, Beto would call for Congress to double funding of NIH research into Alzheimer's and related dementias, from $2.5 billion to $5 billion annually, to confront risks stemming from their service.  It is estimated that between 2010 and 2020 nearly 420,000 veterans will have developed new cases of Alzheimers, with one-third of new cases directly related to service.  Not only will this research yield tremendous benefits for veterans — it would help bend the cost curve for our nation's spending on caring for those with Alzheimer's and related dementias.  Just last year, nearly $300 billion was spent in caring for the 5 million Americans living with these diseases; and that cost if expected to grow to $1.1 trillion in annual spend in 2050.   

https://www.usagainstalzheimers.org/press/new-analysis-highlights-disproportionate-impact-alzheimer%25E2%2580%2599s-veterans

- Beto will also increase funding for research into Amyotrophic lateral sclerosis (ALS). The Institute of Medicine (IOM) published expert reports which found that veterans of armed conflict, including the Persian Gulf War, Vietnam War, and WWII, were at greater risk of developing ALS.

http://web.alsa.org/site/PageServer?pagename=ALSA_Veterans_Risk

Part 3

Provide All Veterans with Equal Treatment.

Beto recognizes that for too long, too many of our troops have faced discrimination and are denied the benefits they have earned through their service.  As President, Beto will fight to change the culture of our system, including reviewing and revising eligibility standards, so that women veterans receive the care they need without harassment; LGBTQ+ veterans are honored for their service; veterans suffering from post-traumatic stress, traumatic brain injuries, or other service-related injuries are not unjustly punished for the effects of their injuries; and that military service is once again celebrated as a pathway to citizenship.

Ensure women veterans receive quality care

Women veterans are the fastest growing group of veterans of the United States armed forces—now representing nearly 10 percent of our total veteran population.  But many of the services offered at our VA facilities are still geared towards our male veterans, leaving women veterans feeling excluded and unappreciated.  What is more, one in four women veterans report experiencing sexual harassment or degradation by male veterans at VA facilities.  We must do better.  As President, Beto will:

https://www.dav.org/veterans/resources/military-sexual-trauma-mst/

- Require that VA medical benefits cover the full spectrum of women's reproductive health care, and include the provision of contraception with no out-of-pocket costs, in vitro fertilization without regard to marital status or sexual orientation, and abortions to the extent they are provided by other federal programs, such as Medicare and TRICARE;

https://www.govinfo.gov/content/pkg/CFR-2014-title38-vol1/pdf/CFR-2014-title38-vol1-part17.pdf

- Instruct VA to publicize their efforts to combat sexual harassment at their facilities and metrics for success to ensure accountability;

- Ensure that every VA Medical Center and Community-Based Outpatient Clinic (CBOC) has a women's health primary care provider, and is equipped to provide gender specific health services, such as mammograms, pap smears, obstetrics, and other gynecological care;

- Hold VA facilities accountable for their performance for women veterans through mandatory public reporting. Service scores will specifically include this performance metric, to ensure we are ending harassment and developing an inclusive environment across the entire VA system;

- Work with Congress to secure legal authority and appropriations to provide free child care at all VA facilities, and commit to making all VA hospitals achieve "baby-friendly" hospital designation status; and

- Increase the number of VA mental health care providers who are specifically trained in treating women veterans and military sexual trauma (MST) survivors.

https://www.babyfriendlyusa.org/about/

Ensure LGBTQ+ troops and veterans are treated with respect for their service

LGBTQ+ troops have served our country since its inception. If elected to serve as Commander in Chief, Beto will celebrate their sacrifice, and make certain LGBTQ+ troops and veterans and their families are granted the dignity of their service. He will do this by:

- Overturning Trump's discriminatory transgender troop ban, including all resulting discharges, ending the "Deploy or Get Out" policy, and banning the practice of discharging HIV+ servicemembers; and 

- Directing the Department of Defense to upgrade the service records of openly LGBTQ+ veterans discharged due to their sexual orientation, gender identity, and sex characteristics who wish to receive an upgrade.

Pardon veterans who have been denied the benefits for conduct stemming from service related-injuries.

Veterans who are discharged with a status of Other-than- Honorable (OTH) discharge— often referred to as having "bad paper" discharges—can be denied their veterans benefits.  Between 2011 and 2015, 12 percent of service members were discharged with a status unable to access benefits, with over 55,000 diagnosed with post-traumatic stress or a related injury. Further, racial disparities are prevalent in the military justice system, with black service members more likely to face disciplinary actions than their fellow soldiers. The Trump Administration has failed to implement the Honor Our Commitment Act, which included provisions Beto championed  in the House extending mental health care to veterans with "bad paper." As President, Beto will direct the VA to fully implement the Honor Our Commitment Act, and pardon post-9/11 veterans who received OTH discharges for conduct related to PTS or service-related injuries or who were discharged without the due process of a court-martial.  Beto will also work to reform our system so that victims of Military Sexual Trauma, many of whom are women, are not discriminatorily denied their PTS claims.

https://rebootcamp.militarytimes.com/opinion/2017/07/12/commentary-restore-gi-bill-benefits-for-veterans-with-career-ending-ptsd/
https://www.protectourdefenders.com/disparity/
https://www.stripes.com/news/senator-va-missed-deadline-to-inform-vets-with-bad-paper-about-access-to-mental-health-care-1.550429
https://www.texastribune.org/2018/11/02/ted-cruz-beto-orourke-congressional-accomplishments-texas/
https://www.nytimes.com/2016/12/30/opinion/a-less-than-honorable-policy.html
https://law.yale.edu/system/files/documents/pdf/Clinics/VLSC_CastingTroopsAside.pdf

Restore military service as a pathway to citizenship

Those willing to serve on behalf of the United States should see a pathway to citizenship through their service. Though there is a long tradition of military service leading to citizenship, naturalization data from the U.S. Citizenship and Immigration Services reflecting the end of 2018 found immigrants serving in the military are being denied citizenship at a higher rate than civilian applicants. 

https://www.mcclatchydc.com/latest-news/article230269884.html

- Beto will reverse Trump Administration policies that have discouraged applicants, and will ensure naturalization offices are open and active at basic training locations; and

https://www.mcclatchydc.com/latest-news/article230269884.html

- Beto will direct the Department of Defense to restart the Military Accessions Vital to the National Interest (MAVNI) program, a critical program that brings the valuable skills of non-citizens to the United States military, which lapsed at the end of FY17, and will allow veterans who have honorably served their country, yet have faced deportation, to return to the United States and be granted the benefits of citizenship. 

https://www.militarytimes.com/news/pentagon-congress/2018/09/30/how-trump-administration-policies-stymie-the-pentagons-immigrant-recruit-program/
https://www.mcclatchydc.com/latest-news/article230269884.html

Part 4

Ensure Veterans Can Succeed When They Come Home

During his time in Congress, Beto worked to improve the transition process by adding a mental health evaluation to the existing physical examination for all departing service members and requiring the process to start a year before separation.  By December 2018, Beto had held 24 veterans' town halls, engaging with the veteran community to ensure his agenda in Congress put their real needs and concerns at the forefront. Recognizing the value of the veterans community, Beto will harness its support to improve a veterans transition from service. As President, Beto will:

https://www.congress.gov/bill/113th-congress/house-bill/3045/cosponsors?q=%257B%2522search%2522%253A%255B%2522HR+3045%2522%255D%257D&r=1&s=3
https://www.facebook.com/BetoORourkeTX16/videos/1812767952184562/

Expand the support offered by the Transition Assistance Program, offering "reverse boot camps" to ensure veterans are prepared for success in their communities prior to discharge.

Beto will direct the Department of Defense to ensure these boot camps include civilian advisors such as career specialists, education counselors, financial advisors, and mental health professionals to determine service members' readiness for separation.

- Civilian advisors will carve out explicit time for one-on-one conversations with transitioning service members about their VA eligibility and benefits, help prepare for transition and connect veterans to Community Veterans Engagement Board (CVEB) in their region, to assist with community integration and transition. 

- Boot camps will further require separating service members to enroll in VA programs before they separate, guaranteeing the benefits are active in case they are needed, ensuring continuity in care, and mandating that mental and physical health evaluations happen at least six months prior to separation.

- If treatment is necessary, Beto will require that a future veteran gets assigned a provider where they will live, and talks to that provider a month before leaving the military. When a veteran's location is known, the VA will assist with their connection to a clinical case manager in the nearest VA facility.

Expand support for families of servicemembers

Beto will ensure families are aware of the support benefits available to them, and instruct the VA to expand services so that family members, who sacrifice alongside their servicemember, get the support they need.

Ensure veterans' economic well-being

Beto will harness government resources to prevent veteran homelessness and to support veterans seeking to improve their employment credentials,  own their own businesses or farms, or avoid crushing student loan debt.  As President, Beto will ensure federal agencies are:

- Increasing access to capital by making veterans a target population for CDFI certification and the Small Business Catalytic Credit Initiative proposed as part of Beto's broader plan to spur small business growth;

- Providing career-readiness and apprenticeship programs and encouraging states to increase reciprocity around credentials and convene public-private partnerships designed to make it easier for private-sector employers to leverage the high-value skills so many veterans possess;

https://www.legion.org/sites/legion.org/files/legion/publications/25VEE0517%2520The%2520State%2520of%2520Credentialing_0.pdf

- Protecting veterans from predatory for-profit providers by re-establishing Obama Administration regulations designed to ensure programs that defraud veterans and other students are shut down and to ensure that the Department of Education grants automatic loan discharges to the 42,000 qualified disabled veterans through the Total and Permanent Disability Discharge (TPD) program;

https://www.politico.com/story/2019/05/24/attorneys-general-devos-cancel-debt-disabled-veterans-1472656

- Increasing funding for transitional housing, rapid re-housing, and homelessness prevention through the Supportive Services for Veteran Families (SSVF) program to $400 million; and investing $250 million in the collaborative Department of Housing and Urban Development (HUD) Veterans Affairs Supportive Housing (HUD-VASH) Program to ensure permanent supportive housing is available to those who have been homeless the longest; and

- Investing in a modern benefits system so that veterans are not denied educational or housing benefits due to a technical error and, standing up an Interagency Council on Veterans to ensure coordination across the federal government.

https://taskandpurpose.com/veterans-gi-bill-benefits-delays