    [House Hearing, 115 Congress]
    [From the U.S. Government Publishing Office]

          MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
                            APPROPRIATIONS FOR 2019
    _______________________________________________________________________
    _______________________________________________________________________

                                     HEARINGS

                                     BEFORE A

                               SUBCOMMITTEE OF THE

                           COMMITTEE ON APPROPRIATIONS

                             HOUSE OF REPRESENTATIVES

                          ONE HUNDRED FIFTEENTH CONGRESS

                                  SECOND SESSION

                                    _________

      SUBCOMMITTEE ON MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED
                                    AGENCIES

                     CHARLES W. DENT, Pennsylvania, Chairman

      JEFF FORTENBERRY, Nebraska             DEBBIE WASSERMAN SCHULTZ, Florida
      THOMAS J. ROONEY, Florida              SANFORD D. BISHOP, Jr., Georgia
      DAVID G. VALADAO, California           BARBARA LEE, California
      STEVE WOMACK, Arkansas                 TIM RYAN, Ohio
      EVAN H. JENKINS, West Virginia
      SCOTT TAYLOR, Virginia

    NOTE: Under committee rules, Mr. Frelinghuysen, as chairman of the
    full committee, and Mrs. Lowey, as ranking minority member of the full
    committee, are authorized to sit as members of all subcommittees.

       Sue Quantius, Sarah Young, Kiya Batmanglidj, and Tracey E. Russell,
                                Subcommittee Staff

                                    _________

                                      PART 4

                                                                       Page
    U.S. Department of Veterans Affairs..........................         1
    Fiscal Year 2019 Budget Oversight Hearing on Energy,
      Installations, and Environment.............................        95
    Members' Day.................................................        97

      [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                    _________

                         U.S. GOVERNMENT PUBLISHING OFFICE

    31-445                    WASHINGTON : 2018

                          COMMITTEE ON APPROPRIATIONS

                                    ----------

                 RODNEY P. FRELINGHUYSEN, New Jersey, Chairman

      HAROLD ROGERS, Kentucky \1\             NITA M. LOWEY, New York
      ROBERT B. ADERHOLT, Alabama             MARCY KAPTUR, Ohio
      KAY GRANGER, Texas                      PETER J. VISCLOSKY, Indiana
      MICHAEL K. SIMPSON, Idaho               JOSE E. SERRANO, New York
      JOHN ABNEY CULBERSON, Texas             ROSA L. DeLAURO, Connecticut
      JOHN R. CARTER, Texas                   DAVID E. PRICE, North Carolina
      KEN CALVERT, California                 LUCILLE ROYBAL-ALLARD, California
      TOM COLE, Oklahoma                      SANFORD D. BISHOP, Jr., Georgia
      MARIO DIAZ-BALART, Florida              BARBARA LEE, California
      CHARLES W. DENT, Pennsylvania           BETTY McCOLLUM, Minnesota
      TOM GRAVES, Georgia                     TIM RYAN, Ohio
      KEVIN YODER, Kansas                     C.A. DUTCH RUPPERSBERGER, Maryland
      STEVE WOMACK, Arkansas                  DEBBIE WASSERMAN SCHULTZ, Florida
      JEFF FORTENBERRY, Nebraska              HENRY CUELLAR, Texas
      THOMAS J. ROONEY, Florida               CHELLIE PINGREE, Maine
      CHARLES J. FLEISCHMANN, Tennessee       MIKE QUIGLEY, Illinois
      JAIME HERRERA BEUTLER, Washington       DEREK KILMER, Washington
      DAVID P. JOYCE, Ohio                    MATT CARTWRIGHT, Pennsylvania
      DAVID G. VALADAO, California            GRACE MENG, New York
      ANDY HARRIS, Maryland                   MARK POCAN, Wisconsin
      MARTHA ROBY, Alabama                    KATHERINE M. CLARK, Massachusetts
      MARK E. AMODEI, Nevada                  PETE AGUILAR, California
      CHRIS STEWART, Utah
      DAVID YOUNG, Iowa
      EVAN H. JENKINS, West Virginia
      STEVEN M. PALAZZO, Mississippi
      DAN NEWHOUSE, Washington
      JOHN R. MOOLENAAR, Michigan
      SCOTT TAYLOR, Virginia
      ----------
      \1\ Chairman Emeritus

                       Nancy Fox, Clerk and Staff Director

                                       (ii)

         MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES
                            APPROPRIATIONS FOR 2019

                                  ----------

                                              Thursday, March 15, 2018.

                      U.S. DEPARTMENT OF VETERANS AFFAIRS

                                    WITNESS

    HON. DAVID J. SHULKIN, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

                       Opening Statement of Chairman Dent

        Mr. Dent. I am pleased to gavel the subcommittee to order
    for our first hearing on the fiscal year 2019 budget, and
    before the 2018 budget is even finished, so we are here to talk
    about 2019. So welcome, Secretary Shulkin.
        We weren't sure if we were going to be able to pull this
    hearing off because of the plans to bring the omnibus to the
    floor this week, but we managed it, thanks to the leadership of
    Chairman Frelinghuysen, so we are grateful for this
    opportunity.
        And so we are delighted, once again, to welcome back Dr.
    David Shulkin, the Secretary of the Department of Veterans
    Affairs, and discuss his agency's 2019 budget and the issues
    that need to be addressed over the coming year.
        As we all know, there is a lot going on at the VA these
    days, and that may be an understatement. And there are many
    challenges that need to be addressed. Those challenges require
    focused leadership, and we look forward to hearing from you and
    how you intend to address them.
        As always, we certainly appreciate your hard work, your
    dedication to our veterans, and the positive changes that you
    have been able to make for veterans' lives.
        Now we are operating under several constraints today. As
    you know, we are knee deep in negotiations on the omnibus bill
    to get 2018 funding resolved, so we haven't had much of a
    chance to delve into the 2019 budget request.
        Additionally, your budget had late-breaking changes after
    it was printed, reflecting suggestions for more funding because
    of the budget caps agreement. As a result, your budget
    documents haven't been updated at this time, complicating our
    ability to assess your funding needs.
        Our second constraint is that, like us, our fellow
    subcommittees are trying to jump-start their 2019 hearings, so
    there are five hearings with cabinet secretaries this morning.
    I am afraid you are going to see more than the usual bouncing
    around in and out of hearings as they try to also participate
    in those important hearings and briefings this morning.
        In any event, let's get started. And before you give your
    opening statement, Mr. Secretary, I would like to ask our
    ranking member, the distinguished gentlelady from Florida,
    Debbie Wasserman Schultz, for her opening statement.

               Opening Statement Ranking Member Wasserman Schultz

        Ms. Wasserman Schultz. Thank you, Mr. Chairman.
        And thank you for joining us, Mr. Secretary. And to your
    colleagues as well, we appreciate you being here with us.
        Mr. Chairman, the VA continues to receive tremendous and
    much-needed increases in its budget. For example, the VA
    medical care accounts have grown from $36.7 billion in fiscal
    year 2003 to $64.6 billion in fiscal year 2017. And the overall
    discretionary accounts have increased from $43.6 billion to a
    more robust $74.4 billion in the current budget.
        Fiscal year 2019 is no different. The President's budget
    requests $85.3 billion in VA discretionary funding, a $10.9
    billion, or 15 percent increase, over the 2017-enacted level.
        Other than defense, I am pretty sure that there is no other
    Federal agency that has fared better than the VA while we
    functioned under the budget caps. And that is good news.
    Certainly not complaining. We want to see a great number for VA
    medical care in fiscal year 2019.
        But I am concerned that the budget is seeking to merge a
    congressionally mandated account, as I have mentioned to you,
    that was meant to provide greater accountability and
    transparency of how much care was being sent outside of the VA.
        Merging these accounts is going to hinder our oversight of
    non-VA care. And it looks like, honestly, a backdoor
    privatization effort, especially when you factor in that
    between fiscal year 2017 and fiscal year 2019 requests,
    community care spending will have increased by 49 percent, and
    that is without taking into account the $4.2 billion in
    emergency funding that Congress provided.
        This is compared to the 9 percent spending increase in VA-
    provided care during this same period. What has been
    emphasized, I am sure, to many of us from our veterans all over
    the country, is that the best care they get is from the VA. It
    might be hard to get it. They might have to wait a while, but
    they get excellent care at the VA. And so moving in the
    direction of privatization is not something that veterans
    across this country support, nor would it be in their best
    interest.
        So I am glad to see an increased number for the VA in
    fiscal year 2019, but I am concerned that the 2019 budget folds
    that community care account back into the medical services
    account. And I want to hear--I am interested to hear the
    rationale behind this move, because it is my understanding that
    the law dictates that there be a separate account.
        The fiscal year 2019 budget request uses the additional
    funds provided by the budget agreement to provide $1.9 billion
    in discretionary funding for the Veterans Choice Fund.
        Now, my understanding on that is that the budget agreement
    didn't include specifics, but the spirit of the deal, the very
    clear understanding that we had is that these funds were to be
    used for infrastructure needs. I am confident that you will
    find across the Congress that Members would attest to their VA
    infrastructure needs in their own districts. It is critical
    that our understanding from the budget agreement be upheld.
        Turning to the electronic healthcare record modernization,
    the fiscal year 2019 budget requests $1.2 billion to continue
    the massive implementation, preparation, development,
    interface, management, rollout, and maintenance of a veterans
    electronic healthcare records system, which is excruciatingly
    long overdue.
        But despite having assurance during our closed hearing to
    discuss this issue, we need to be very careful to establish
    accountability, which is something I know you share,
    accountability measures through the whole implementation
    process that could fundamentally change the Nation's use of
    electronic records.
        I mean, we are talking about a $16 billion project that
    will take a very long time, probably longer than many of us
    will be here to see it completed. And I can understand this
    degree of complexity will have its growing pains, but it is
    crucial that we understand how its procurement will work.
        I believe that the goal of everyone on this subcommittee is
    to make sure the VA provides the best care to our veterans at
    the best possible cost. And with that in mind, Mr. Chairman, it
    is imperative that we discuss some critical issues, including
    the Choice Program, and the state of the VA's electronic health
    records.
        From our discussions, Mr. Secretary, I believe that you
    earnestly want to reform and improve the VA. But I believe we
    must ensure that you have adequate resources to do that--you
    can't squeeze blood from a turnip--and that proper oversight is
    in place to guard against abuses and mismanagement, which can
    and do occur in projects of this magnitude.
        We have a lot to discuss today. Mr. Chairman, thank you for
    the opportunity to share my concerns and my observations. But
    before I yield back, as we begin your final appropriations
    season, as a Member of Congress, I really think it is important
    that we acknowledge the remarkable contributions that you have
    made.
        You are a classmate of mine. We were both elected together
    in 2004. You have been a voice of reason. You have been a
    trusted colleague. You have the respect of many, far beyond the
    boundaries of your district.
        Really, in short, they just don't make them like Charlie
    Dent that much anymore, and you are going to be missed. And I
    am sure we are going to have an opportunity to celebrate you as
    you close out your service, but as we begin your final
    appropriation seasons, I wanted to start the celebration.
        So thank you, Mr. Chairman, and I yield back.
        Mr. Dent. Thank you for the very generous remarks of my
    friend, Debbie Wasserman Schultz. And I also want to say what a
    pleasure it has been to work with you and every member of this
    subcommittee, you as ranking member, and, of course, Mr.
    Bishop, who has also been a great partner too when he was
    ranking member. It has just been a thrill.
        And I appreciate the spirit and the bipartisan cooperation
    you have always demonstrated here. When there are differences,
    we always figured out ways to work through them, and I want to
    thank you all for that. It is very kind.
        So with that, Mr. Secretary, I would just like you to
    please identify the people at the table with you and then
    proceed with your oral remarks. Your written statement will be
    entered into the record, of course. We would appreciate if you
    could keep your remarks to about 5 minutes so members will have
    more time to ask questions.
        So with that, Mr. Secretary.

                     Opening Statement of Secretary Shulkin

        Secretary Shulkin. Great. Thank you. I appreciate both your
    comments in terms of the complexity of this budget and how fast
    it has been moving, so I am going to need a lot of help during
    this hearing to give accurate answers to all your questions. So
    I brought with me a lot of people.
        This is John Rychalski, who is sitting to my right, who is
    the Assistant Secretary for Management and our chief financial
    officer, who has been on board about 6 weeks?
        Mr. Rychalski. Correct.
        Secretary Shulkin. Okay. And we have an empty chair that
    hopefully people will join when we need their help. We have
    Mark Yow, who is our chief financial officer of the Veterans
    Health Administration; we have Jamie Manker, who is the Acting
    Principal Deputy Under Secretary for the Veterans Benefits
    Administration; Richard Chandler, who is the Deputy Assistant
    Secretary for Resource Management for OIT; and then, finally,
    Matt Sullivan, who is the Deputy Under Secretary for Finance
    for the National Cemetery Administration.
        Mr. Chairman, I can't imagine a nicer introduction of you
    than the ranking member gave. We believe that we have the best
    committees in all of Congress who work on veterans affairs
    issues because we work together in a bipartisan way, put
    differences aside to do the right thing for veterans. And we
    all want to thank you for your tremendous leadership, and thank
    the committee for their continued focus on what is important.
        I think that--I just wanted to take a moment to say that
    with all of the distractions that are happening in Washington
    and all the distractions in VA, the events of the last week
    that have happened should remind us all about why it is so
    important that we are doing what we are doing today and getting
    this budget right and getting VA on track.
        This past week, we had a very troubled veteran who took the
    lives of three heroic women, all dedicated to helping veterans
    who were troubled: Dr. Jennifer Gonzales, who was our employee,
    a tremendous woman who had trained in the VA, just amazingly
    dedicated, lost her life; Christine Loeber, who was the Pathway
    Home director at the state home, who had worked for VA, also
    tragically lost her life; and then Jennifer Golick, the
    clinical director of the Pathway Home.
        And Dr. Gonzales' memorial service is going to be on March
    19. We are all saddened by this and just have to recommit
    ourselves to understanding how important this work is that we
    are doing here today.
        President Trump's 2019 budget and the 2020 advanced
    appropriations is a very strong budget, and it reflects the
    President's commitment to veterans and their families. I do
    believe it provides the resources necessary so that we can
    continue the modernization work that we are doing at VA.
        It focuses on increasing the foundational services, better
    access to care, effective management practices, and modernizing
    our infrastructure and legacy systems, as the ranking member
    has pointed out, is so important. In my written statement, I
    have given a detailed plan about how we are going to use these
    funds to target innovation and improvement.
        The 2019 budget that the President proposed is $198.6
    billion for the Department, $88.9 billion in discretionary, and
    $109.7 billion in mandatory. The discretionary budget reflects
    an increase of $6.8 billion, or an 8.3 percent increase over
    the 2018 request. And it also reflects an additional $2.4
    billion in discretionary funding that is now available because
    of the work that you did to raise the caps.
        We want to thank Congress for this additional funding that
    is made available through--in 2019 through the budget caps
    deal. The additional resources are going to help us address, as
    the ranking member said, our outstanding infrastructure needs,
    but also, helping us in funding veterans healthcare, including
    care from the community under the new legislative proposals
    that we are working on for reforming the Choice Program.
        Our capital request of $3.4 billion is a 20 percent
    increase over 2018 to help us fix those highest priority
    infrastructure needs. By requesting all of the necessary
    resources for our community care program and our discretionary
    budget, we think we can help prevent the funding crises and
    lapses in veterans care because we funded it from the wrong
    checking account. Simplifying all of this into a single
    program, we think, is going to help us run it better and make
    it work better for veterans.
        Although we are talking about the 2019 budget today, I
    would ask for your support in securing a full appropriation for
    VA in 2018. I know, Mr. Chairman, you have talked about that.
        As you know, VA relies on a second bite to tailor our total
    requirements. The budget also seizes an opportunity to expand
    access to benefits and services, and focuses on the five
    priorities I have laid out for the Department: greater choice,
    modernizing our systems, focusing our resources on what is most
    important to veterans, improving the timeliness in our
    services, and preventing veteran suicides.
        Suicide prevention is my top priority, and this budget
    includes $8.6 billion for mental health, an increase of $468
    million or 5.8 percent increase above the 2018 estimate. It is
    going to enable us to see about 162,000 more outpatient visits
    in mental health and that directs $190 million for suicide
    prevention outreach.
        It provides emergency mental health services for those that
    were discharged with an other than honorable condition, and it,
    finally, helps support the President's executive order that he
    signed on July 9 that allows every transitioning military
    member to have mental health services during that first
    critical year after they leave service.
        Additionally, we are targeting women's health, one of our
    fastest growing populations in VA, by adding $29 million more
    in fiscal year 2019, an increase of 6 percent over 2018. The
    budget provides $1.1 billion in major construction funding, as
    well as $707 million in minor construction.
        I am proud that our 2019 request for infrastructure is the
    largest in the last 5 years, and it is going to allow us to
    address many of VA's modernization, renovation, and aging
    infrastructure concerns.
        In information technology, we have asked for an increase--
    the President has asked for an increase of $129 million above
    the budget to improve the veteran experience.
        Another major project made possible by this budget is a new
    financial management system. As you know, our last--our current
    financial management system is programmed in Cobalt. We can't
    find people who even know how to program Cobalt, so we are
    transitioning this to a modern management system.
        The budget also supports implementation of an electronic
    health record that has already been mentioned so that we can
    interoperably manage records between the Department of Defense
    and the community. We have asked for $1.2 billion to advance
    the implementation of a single accurate lifetime electronic
    health record.
        The 2019 budget also makes important investments in
    benefits. We have asked to hire an additional 605 personnel for
    the appeals modernization office--that is a 40 percent
    increase--to implement the reforms that we have made in appeals
    modernization, and also hire an additional 225 fiduciary field
    examiners, which will protect our most vulnerable population.
        The budget reflects an effort to reform business practices
    intended for us to be able to continue the transformation of
    VA. But our responsibility doesn't end with just asking for
    more resources. Along with requesting more resources comes an
    obligation to promote financial fiscal responsibility.
        It is my belief that by focusing on the well-being and the
    enhanced functioning of veterans, conducting administrative
    reviews to disability payment rates and focusing on fraud,
    waste, and abuse prevention initiatives for benefits, we are
    going to make benefits more equitable for all veterans and
    wisely use taxpayer resources.
        Advances in treatment and medical technologies have
    significantly reduced the impact of certain disabilities in the
    lives of veterans. And our goal is to get veterans better,
    decrease their need for compensation, and to do that, we have
    to modernize our rating system.
        Caring for veterans is personal. The quality of the
    healthcare and services is the highest priority that I have.
    More importantly, veterans and their families deserve better
    access, choice, and control over their healthcare.
        We know that the work that we are doing to improve the
    Choice Program can help clarify and simplify eligibility
    requirements and streamline the administrative processes, build
    a high-performing network, and implement new care coordination
    for veterans.
        Simply put, improving the Choice Program will have a full
    spectrum of care for veterans that capitalizes on our
    foundational services and delivers on the promise for world
    care services.
        Finally, Mr. Chairman, as Secretary of VA, my job is to
    build a modern, adaptable, and sustainable VA for a changing
    world. My job is also to ensure the VA's care, benefits, and
    systems, and policies are stronger in the future.
        The President's budget supports our mission at VA, and in
    the coming years, these priorities will help us maintain our
    commitment to our Nation's veterans. I look forward to working
    with all of you on the committee, and for doing what is right
    for veterans, and I look forward to any questions.
        [The information follows:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Dent. Thank you, Mr. Secretary.
        I thought I would start the hearing off just by saying I
    very much enjoyed working with you when you were in the
    previous administration, and now in this administration. Your
    expertise and your experience in healthcare systems management
    is extraordinary, and I am glad you are in the job that you are
    in.
        Secretary Shulkin. Thank you.

                               INTERNAL DYNAMICS

        Mr. Dent. But I do feel I have to acknowledge the
    proverbial elephant in the room, as the public and Congress
    have been inundated recently with reports, press reports
    regarding palace intrigue at the VA and the White House. Some
    reports even mentioned that you stationed an armed guard
    outside your office.
        If these reports are true, have the issues been resolved,
    and if not, why not? And the other question, which is more
    important, is this internecine squabbling affecting your
    ability to manage the VA and jeopardize your mission to support
    veterans?
        Secretary Shulkin. Yeah. Let me just say that I have
    publicly acknowledged that the distraction that has happened,
    that you have talked about, is something that I deeply regret.
    I have come here for one reason, and that is to improve the
    lives of veterans, and that is what I am focused solely on
    doing.
        There are a lot of people that, frankly, are more
    interested in politics than I am. I am interested in getting
    this job done. In terms of--and I have made it clear to
    everybody in my Department that I have no tolerance for
    anything other than the business that we have to do for VA.
        I believe that we are getting back on track with that, and
    I am going to do everything I can to keep our focus on the work
    that we have to do, because there is a lot of work to do, as
    you have mentioned, that impacts people's lives.
        In terms of the issues about, you know, how I am running
    things and my security, I will tell you, every cabinet member
    has a security detail that is armed. I am no different. I have
    done nothing different in my security protocol. There is no
    change from what it ever has been.
        But I don't like discussing my security protocol, and I am
    not going to give these details. But there is nothing different
    than what we have been doing. My security detail assesses the
    risk and makes the decisions on how to best protect the cabinet
    member.

                           FUNDING THE CHOICE PROGRAM

        Mr. Dent. Well, I appreciate that answer, Mr. Secretary,
    because my interactions with you have always been very
    substantive and professional and on these very weighty issues,
    so I appreciate that.
        I would like to now focus on the Choice funding shortfall.
    After the original mandatory funding of $10 billion for the
    Choice Program provided by the authorizers was exhausted, the
    program's funding has lurched from one shutdown risk to the
    next, with Congress approving two doses of mandatory funding
    totaling $4 billion.
        There is still no authorizing bill to consolidate choice
    with the other non-VA care programs. And once that is enacted,
    it will take a year to do the implementing regulations. So are
    you looking at another 12 months of Choice with no additional
    mandatory funding?
        I know your budget suggestions released after the budget
    caps deal include $700 million in fiscal year 2018, and $1.9
    billion in 2019 for Choice, but I am not sure there is an
    appetite to provide discretionary money for a program that
    remains a mandatory one for another year.
        So what is your most recent estimate of when the existing
    Choice funds run dry? And are you talking with the authorizing
    committees about providing enough mandatory funding to keep the
    Choice Program going while the new consolidated non-VA care
    program is implemented?
        Secretary Shulkin. Yeah. As of March 6, we had a balance in
    our current Choice budget of $1.1 billion. When you take out
    the reserve that we have to keep, because we have to keep a
    certain amount of money for obligations that are incurred, we
    have, on our current run rate, enough money to get us probably
    through the end of May, maybe into the very first or second
    week of June, so that we will not have enough money in 2018 to
    be able to make it all the way through the end of the fiscal
    year. And we would have to start taking management decisions to
    be able to reduce our spending in the Choice Program and use
    other sources of community funds.
        So we are going to be working with the authorizers to make
    sure that they understand that we do have a 2018 shortfall, and
    that we have to be able to get through the end of the fiscal
    year.
        Mr. Dent. Thank you.

                            ELECTRONIC HEALTH RECORD

        I thought I would quickly ask, before I recognize the
    ranking member, just a quick discussion about the electronic
    health record. And during the past week, there have been press
    reports alleging that DOD's rollout of their electronic health
    record system in the Pacific Northwest was plagued with all
    sorts of problems and difficulties.
        And DOD and its IT contractors responded by noting that the
    rollout to four medical centers was designed to identify and
    fix any issues prior to full implementation. They also note
    that issues are being--are to be expected in any large-scale IT
    project, and that DOD's implementation is going more smoothly
    than the comparable commercial conversions.
        Since VA is planning to use the same system and contractor
    as DOD for electronic health record, how concerned are you
    about the glitches uncovered with DOD's rollout?
        Secretary Shulkin. Well, first of all, let me just say that
    I am confident that we made the right decision here, that
    Congress has been asking us, for now 18 years, to find a way to
    get our systems to work together with the Department of
    Defense. And so that will certainly be achieved with this.
        What I have done is I have asked for a pause until I can
    make sure that we have the interoperability with community
    providers. Since 36 percent of veterans now receive care in the
    community, I think that is essential to do.
        I do believe that working with the Department of Defense as
    closely as we are, very close working relationship, we are
    using their lessons to make sure that our contract reflects the
    issues that we have learned, but also that we are going to have
    a smoother implementation.
        Just this past week, I spent time with Admiral Bono, who
    heads the Defense Health Agency, and we talked about these
    specific concerns. And I am confident that, given what she has
    learned from this and shared with us, that we are going to have
    a much smoother implementation.
        Mr. Dent. And can I just quickly say, it sounded like many
    of the problems were related to resistance from users. And
    given the enormous ability of the VA doctors, the VistA system,
    don't you expect more serious user resistance at the VA?
        Secretary Shulkin. Well, I think--you know, I have done two
    previous electronic health record implementations, never on
    this scale, of course. Nobody has done anything on this scale.
    But if you don't have involvement from your clinicians, you
    might as well not start in the beginning. So that is the
    absolute key.
        And so having this being driven through our clinical
    leadership and our clinicians is going to be the factor that is
    going to be successful. We are doing these one VistA instance
    at a time, and involving our clinicians is going to be
    critical.
        Fortunately, we have clinicians that use electronic medical
    records, have been doing it for a long time. And being able to
    make an effective transition, I believe, is going to be
    something that not only is possible, but that our doctors and
    our nurses and clinicians will be able to be in the leadership
    position to tell us how to do that well.
        Mr. Dent. Thank you, Secretary.
        I would like to recognize the ranking member, Debbie
    Wasserman Schultz.
        Ms. Wasserman Schultz. Thank you, Mr. Chairman.
        First, I would like to associate myself with your remarks
    about the distractions, but also with yours about the
    importance and our singular focus needing to be about making
    sure that we can care for our veterans. So let's all make sure
    that we are growing in the same direction----
        Secretary Shulkin. Yes.
        Ms. Wasserman Schultz [continuing]. And focused on who you
    exist to serve.
        We discussed in my office, I mentioned in my opening
    remarks, my concern about rolling back medical services into
    community care when the statute is in direct conflict with that
    proposal.
        You know, the Veterans Affairs Department has given
    veterans some discretion to pursue care in the community, but I
    am deeply concerned that this is a, you know, snowball rolling
    faster and faster down the hill, and appears to be moving in
    the direction of privatization.
        The first part of my question is, has this administration,
    or is anyone pushing you towards privatization of VA care?

                            PRIVATIZATION OF VA CARE

        Secretary Shulkin. I have been clear that I think this
    would be the wrong decision for our country's veterans to
    privatize VA. I have also been clear that I think that VA can't
    do this alone, that that is what we learned out of the access
    crisis in 2014.
        So we have to have a rational system that allows veterans
    to be able to understand what the choices are that they have
    and be able to get the best care that they can from the VA.
        And I completely agree with you that the men and women in
    the VA that serve are doing an extraordinary job every day. We
    have problems that I acknowledge and that we have to fix, but
    we are doing important work on behalf of veterans.
        And so the right choice here is a system that allows for a
    strong internal VA that is working properly, as well as taking
    advantage of working with the private sector when veterans can
    benefit from those services as well.

                 INTEGRATE COMMUNITY CARE INTO A SINGLE ACCOUNT

        Now, I also believe that running separate systems
    administratively, keeping money in different checking accounts,
    is a very, very tough way and inefficient way to run a system.
    And I do believe appropriate oversight, asking the questions
    that you ask, making sure that this is not a back door to
    privatization, is an appropriate role of Congress. And we are
    going to try to be as transparent about our plans and our use
    of funds as possible. But I do think it is the right decision
    to integrate community care funds into a single pot.
        Ms. Wasserman Schultz. And I can understand what you are
    saying, and I hope you can appreciate that it is important that
    we are able to see----
        Secretary Shulkin. Yes.
        Ms. Wasserman Schultz [continuing]. Even if it becomes one
    account, how much is going into non-VA care. Because then, if
    we are masking that, then you are essentially hiding the move
    towards potentially privatization.

                     COMMUNITY CARE VERSUS VA-PROVIDED CARE

        And just to make a finer point on it, community care--
    between fiscal year 2017 and fiscal year 2019, community care
    spending will have increased by 49 percent. That is without the
    $4.2 billion in emergency funding.
        In the same period, we have only had a 9 percent spending
    increase in VA-provided care. That is, I assume, not because
    the VA doesn't have the capacity to absorb a greater increase
    and be able to provide more services. I know in my own VA
    medical center, I have talked to them. I know what their
    resource needs are and what they are not getting.
        So can you explain the difference between this uneven
    growth?
        Secretary Shulkin. Our singular purpose, since I came to VA
    in 2015, is to make sure that veterans that have healthcare
    needs are getting access. And, frankly, rather than make
    veterans wait until we built programs inside, or hired enough
    people, we have only focused on getting them the care.
        And that has been easier to get care out in the community
    in many settings. And I think that this is where you have seen
    a rapid growth, because we are focused on meeting the needs of
    the veterans. I will not have veterans who have urgent needs
    waiting until we get enough access in the system.
        Having said that, this flexibility will allow our medical
    centers to make good decisions about what is best for veterans,
    whether they can use this money to better support programs in
    the VA, or whether it is a better decision to continue to buy
    care out in the community.
        And that is what you want an accountable management team to
    do, which is to focus on their customers, in this case,
    veterans, and figure out in their market how do you best supply
    the services?
        Ms. Wasserman Schultz. You do. But when you have 49 percent
    to 9 percent difference in increase in growth, you are clearly
    favoring their ability--which side of the ledger is their
    ability to make that choice?
        And so the more and more resources that go into private
    community care and the less of an increase that we are focused
    on in VA care, the longer it takes us--I mean, government
    wheels turn more slowly anyway--then the longer it takes us to
    ramp up to be able to make sure that people could choose the
    option of getting care at the VA rather than the private
    sector.
        And, frankly, every--almost every veteran I have ever
    spoken to--and I don't know if my colleagues have had the same
    experience--if you ask them, their preference is to go to the
    VA.
        I yield back.
        Mr. Dent. I thank the ranking member.
        At this time, I would like to recognize the gentleman from
    California for 5 minutes, Mr. Valadao.
        Mr. Valadao. Thank you, Chairman.
        Thank you, Secretary, for being here. Appreciate your time.

                        OIG REPORT ON VETERAN WAIT TIME

        Last week, the VA Office of Inspector General released an
    audit of veteran wait time data. As you are well aware, the
    audit revealed that the VA incorrectly reported wait times
    experience by veterans seeking first-time care from VA doctors.
        The report estimated that new patients waited on average
    about 18 days for an appointment. Additionally, 36 percent of
    veterans had to wait longer than a month for an appointment,
    despite the VA scheduling system saying only 10 percent had
    waited that long.
        Due to this inaccuracy, nearly 13,800 qualifying veterans
    were wrongly made ineligible for Veterans Choice Program. Have
    those responsible for misreporting wait times been properly
    dealt with, and what do you plan to do to fix this serious
    ongoing issue?
        Secretary Shulkin. Yeah. The IG report, I think, was well
    done and gave us a lot to be able to start going through. There
    have been some immediate changes that have been made.
        Many of the inaccuracies that were in that report were
    because people were inputting specific dates, our schedulers
    were. That is now automatically taken from the system so that
    there is not the ability for individual variation. It is what
    is put into the system.
        I changed the way that we record wait times to when the
    veteran first calls and requests an appointment. It used to be
    there was this judgment in there about when did the patient
    want the appointment, and that is where I think that you had
    the ability to see data problems. Now it is the day that they
    call and ask for the appointment is the way that we start
    recording things.
        We have also increased now the number of audits that are
    going on throughout the system to be able to make sure that
    these types of data are understandable and accurate.
        In terms of accountability decisions, VHA, the Health
    Administration is going through the IG report and seeing what,
    if any, appropriate actions have to be taken there. But, you
    know, I have the data on the wait times today, and, you know,
    overall, for mental health and VISN 15, it is 11.6 days. But
    for primary care, it is 18 days still, and that is something
    that we are working very hard to get lower than it is, because
    that is still too long to have to wait.
        Mr. Valadao. Well, and that is an issue I have even heard
    in my own district. My constituents who have approached me
    throughout the district have always said the same thing. We
    love the care that we get once we are in the door; the struggle
    is getting in the door. And so I appreciate the changes are
    being made.
        Secretary Shulkin. Yes.

                            BLUE WATER NAVY VETERANS

        Mr. Valadao. One more question, Mr. Secretary, as we
    discussed in previous hearings, since 2002, the VA has
    continued to deny claims from Blue Water Navy veterans, despite
    studies showing higher rates of cancer and non-Hodgkin's
    lymphoma among shipboard veterans than those who fought on the
    ground in the country.
        I brought this up in a prior meeting and hearings with you,
    and you replied that you are requesting additional
    recommendations from the VA on this issue. Additionally, I
    wrote a letter to you in August to address this issue.
        In September of 2017, you responded to my letter, and said
    that you were going to be receiving additional subject matter
    expert recommendations on the matter, and would update me and
    my fellow signers and the letter in my coming months.
        So my question is, is nearly 6 months later, have you come
    to a decision on the Blue Water Navy veterans? If not, what is
    the status update, and when exactly can we expect a response as
    to whether your Department plans to afford these brave
    Americans the benefits they have fought for and deserve?
        Secretary Shulkin. Yeah. Well, first of all, I thank you
    and others in Congress that continue to not let this issue go
    unanswered. I am aligned with you that these veterans have
    waited too long, and that this is a responsibility that this
    country has, and as our veterans get older, it is unfair.
        I do want to make clear that any veteran who has a
    disability claim, such as some of the cancers that you talked
    about, is absolutely able to file that claim, and an individual
    decision will be made about whether there is evidence to
    suggest that that disability is related to their service. And
    we are dealing with these claims every single day.
        Mr. Valadao. But----
        Secretary Shulkin. What we are talking about is a
    presumption. What we are talking about is a class of veterans
    who served that wouldn't have to go through that type of
    disability process. And so, I believe that it is imperative
    upon us to resolve this issue.
        I also believe that there will not be strong scientific
    data to help resolve this. This is going to be an obligation
    that we feel as a country that these veterans shouldn't be
    waiting any longer.
        And I am on the side of trying to find a way to resolve
    this for the Blue Water Navy veterans, and we are working hard
    to look at offsets and other ways to be able to do that, and it
    is a high priority for us.
        Mr. Valadao. And I appreciate that. But with these types of
    cancers, time is of the essence.
        Secretary Shulkin. Absolutely.
        Mr. Valadao. And so having that extra step that they have
    to take to be able to get treatment is a huge issue in their,
    hopefully, healing process.
        Secretary Shulkin. I agree.
        Mr. Valadao. So thanks again for your time.
        Secretary Shulkin. Thank you.
        Mr. Dent. At this time, I would like to recognize the
    gentleman from Georgia, Mr. Bishop.
        Mr. Bishop. Thank you very much, Mr. Chairman.
        Mr. Secretary, thank you for appearing today and your
    continued partnership with members of this committee on
    ensuring that we support our Nation's veterans. I want to also
    thank you for your leadership of the Department, both as the
    Medical Director and as Secretary. I, along with the VSOs and
    veterans all across the country, appreciate your hard work and
    your commitment to veterans.

                             PROSTHETICS TECHNOLOGY

        I am going to ask you two questions very quickly to try to
    try to respect your time. The first has to do with prosthetics.
    Dr. Shulkin, the fiscal year 2019 budget includes $727 million
    for research, which is a plus $87 million above the 2018
    budget, coupled with an additional $1.1 billion in other
    Federal and private grants and other support total funding in
    support of veteran research is $1.9 billion.
        My understanding that the technology surrounding the
    prosthetic process for our servicemen and women has grown
    exponentially over the past few years, and that the VA's
    prosthetic program may be somewhat outdated.
        What steps is the administration taking to ensure that
    veterans have access to the latest prosthetics technology that
    is available on the market, and that the VA stays competitive
    with the private sector in this regard?

                          MODERNIZATION AND TELEHEALTH

        And my second question has to do with modernization and
    telehealth. I represent a predominantly rural district, and I
    am concerned with my veteran constituents receiving the highest
    quality of care from the VA.
        The VA is modernizing a program ``Anywhere and Everywhere''
    VA telehealth program. What cost is associated with expanding
    this program, and is it included in your fiscal year 2019
    request? And will the VA be providing the equipment required
    for telehealth and medical appointments?
        I know 45 percent of the telehealth services are for rural
    veterans. Tell me what steps are being taken to grow that
    percentage in rural areas with their limited access to
    broadband?
        And tell me whether or not you are coordinating your
    efforts with the Department of Agriculture that has primary
    responsibility for rural communities, and in particular,
    broadband access, and whether or not you are participating in
    the Rural America Task Force that is made up of cabinet
    secretaries and is convened by Secretary Perdue over at USDA.
        Secretary Shulkin. Yeah. Okay. So thank you for both those
    questions.
        It is essential that VA maintain the most contemporary
    approach to prosthetics and orthotics. This needs to be a
    foundational service for us. And I do believe that our research
    funds, as you suggest, need to be moving us towards those
    contemporary technologies.
        I was, this past week, at the Las Vegas VA, and I went
    specifically to orthotics and prosthetics after our
    conversation to ask about this. I met with their team. They are
    using the laser fittings the way that you and I talked about,
    and that is a best practice. And we are making sure that we are
    learning about what new therapies and diagnostic approaches are
    out there.
        As I mentioned, we are working in several of our sites with
    3D printing. We have recently developed a new prosthetic arm
    with DARPA, and so, it is exactly this type of focus that we
    need to be doing. And I will make sure that we are using the
    very best technologies. But we do work with private
    prosthetists who are constantly telling us about new ways to
    learn, and we are committed to doing that. So thank you for
    that.
        On the telehealth services, as you know, in fiscal year
    2017, we had about 727,000 veterans using telehealth. In the
    rural areas, it is about 300,000. Just this past quarter, we
    had 110,000 rural veterans in one quarter using telehealth, and
    so you can see it is increasing. That will be around 450,000 on
    this type of run rate.
        It is essential, and especially with this Anywhere to
    Anywhere, now that we can provide services across State lines,
    for us to reach more rural veterans and provide that type of
    expertise.
        In terms of the budget, we are seeing an increase,
    particularly for rural health in telehealth. It is a 12 percent
    growth in our budget for rural telehealth activity in 2019.

                       RURAL AMERICA AND BROADBAND ACCESS

        Mr. Bishop. Are you working with the Task Force for Rural
    America with regard to veterans health, particularly with the
    broadband access?
        Secretary Shulkin. Yeah. Yeah. Yeah. I have attended a
    number of the meetings with the telecommunications leaders in
    the rural areas through the White House conveners. This is a
    really important problem to solve, and I think you have
    identified the reason why: Without the broadband technology, it
    is hard for us to get into veterans homes and even into some of
    our own facilities.
        But we need to do everything we can to partner with those
    companies to be able to find solutions, and so, yes, we will
    continue to work with our rural counterparts throughout the
    administration.
        Mr. Bishop. Thank you, Mr. Chairman.
        Mr. Dent. Thank you, Mr. Bishop.
        At this time, I would like to recognize the gentleman from
    West Virginia for 5 minutes, Mr. Jenkins.
        Mr. Jenkins. Thank you, Mr. Chairman.
        Mr. Secretary, thank you for being here and thank you for
    the opportunity to meet last week.

                            A NATIONAL OPIOID CRISIS

        A couple of quick things: Number one, we have an opioid
    crisis nationally. We certainly have it in my State of West
    Virginia, and tragically, many veterans are impacted by the
    disease of addiction.
        With regard to the VA, the VA was siloed in sharing
    prescription data with State PDMPs. What I am interested in is,
    have we broken down those barriers? And two things: One, do all
    prescribers, dispensers at the VA have full, unfettered access
    to the State PDMP programs; and number two, is all prescribing
    data relating to prescribing behaviors, dispensing of VA folks
    put into the State PDMPs two-way communication?
        Secretary Shulkin. Yeah. Yeah. First of all, you know that
    VA has focused on the opioid safety initiative since 2012. We
    have seen a 41 percent reduction to opioid use. What I am most
    proud of is it is a 90-percent reduction on initial starts now,
    so we are looking in finding alternatives besides having to
    reach first for opioids.
        In terms of the State prescription data monitoring program,
    it is a requirement for us across the country that all VA
    prescribers participate in the State monitoring program for the
    reasons why they exist, so that is a requirement.
        And as far as I am aware--but I am going to come back and
    confirm this, because I think your question is one that, for
    some reason, I wish I had asked and I didn't, to make sure that
    it is this bidirectional, and that is so important, because if
    we are not getting that into the State databases, then how do
    outside prescribers know? So I believe that is the case, but I
    am going to confirm that and get back to you.
        [The information follows:]

     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                            ACCOUNTABILITY WITHIN VA

        Mr. Jenkins. The second--and the gentleman, I think, from
    California raised the IG report, and I would like to talk about
    the issues. This Congress, over the last couple of years, has
    taken great strides, at the administration and the Secretary's
    request, to give broader authority to hold people within the VA
    accountable.
        Our goal is clear: We want the very best care possible for
    our veterans. And if there are people who aren't committed to
    providing that care at the level we expect the veterans
    deserve, we want to hold them accountable.
        And as I raised with you previously, and I heard your
    comments just a moment ago talking about appropriate actions
    and change, and I know you weren't referring specifically--I
    hope not--to the situation in West Virginia. But I simply want
    to say, it is not appropriate action, and it is not the change
    we are talking about where a VA employee in Oregon accused of
    gaming quality-of-care statistics to refusing to treat certain
    veterans was proposed to be transferred to my State of West
    Virginia. And simply because of probably outcry from me and
    others, the decision was not to do that transfer.

                           POOR PERFORMING EMPLOYEES

        Can you reassure us that the way in which you are dealing
    with and handling those employees of the VA that are not
    committed to the mission of the best possible care aren't being
    swept under the rug, shifted to another State? I don't want
    Oregon's hand-me-downs.
        Secretary Shulkin. Well, first of all, Congressman, we
    appreciated the feedback, and as you know, we took that into
    account, right. But this was a decision made by the Health
    Administration, and the decision was made to demote the
    individual to a lower level of responsibility so that they
    could get the appropriate supervision and mentorship
    potentially to be able to contribute back at a higher level.
        This was not just a simple lateral transfer. But because of
    the feedback, as you know, that didn't happen, and I think that
    is the way it should work. We have to come up with mutual
    decisions about what is best.
        But there was not a decision made by the Health
    Administration that this person should be terminated. The
    decision was made that they were probably operating above their
    appropriate level of responsibility, and so a demotion was
    made.
        Mr. Jenkins. Well, maybe demotion is appropriate. I don't
    know the facts.
        Secretary Shulkin. Yeah.
        Mr. Jenkins. It is the demotion and the transfer to send a
    problem from Oregon to the veterans in West Virginia.
        Secretary Shulkin. Yeah.
        Mr. Jenkins. That is unacceptable to me.
        Secretary Shulkin. I appreciate that, yeah.
        Mr. Jenkins. There needs to be transparency. And while you
    acknowledge it was a factor, it did not become a factor until
    there was awareness. And I think those in Oregon probably let
    the folks in West Virginia know, you got a problem on your way.
    We need better transparency and not kind of that----
        Secretary Shulkin. I understand.
        Mr. Jenkins [continuing]. Mode of communication.
        Finally, with regard to the infrastructure, I have visited
    all of our medical centers--I am out of time, I understand. I
    will save it for the next round.
        Secretary Shulkin. Okay. Thanks.
        Mr. Dent. At this time, I would like to recognize the
    gentleman from Virginia, Mr. Taylor, for 5 minutes.
        Mr. Taylor. Thank you, Mr. Chairman.
        Mr. Secretary, thank you for being here today. We
    appreciate it.

                                 INFRASTRUCTURE

        One quick thing. As you know, my district has the fastest-
    growing veteran population, OIF, OEF, women veterans, and
    obviously our care. And according to the VA, 40 percent more
    folks in the next decade will fall into the system, and 60
    percent more care will be needed.
        And on that infrastructure note, you know, our outpatient
    center on the south side in our area is one of 28 major VA
    medical facilities that were approved by Congress last year.
        Secretary Shulkin. Yes.
        Mr. Taylor. My question is, how can we expedite these needs
    to get them built? Because it is going to be, I think, another
    2 years before there is any ground break or anything like that.
    And are we using the correct contract vehicles to be able to
    make that happen?
        Secretary Shulkin. It takes way too long to get this stuff
    done. We are following the Federal contracting rules and
    regulations, and we are trying to do this as quickly as we can
    to get through the process.
        I do believe that the answer that probably you and I are
    both looking for to get this done faster is going to be new
    models to work with the private sector, and allowing public/
    private partnerships to help us achieve this.
        We have asked for legislative authority to use greater
    enhanced-use leases. You have given us authority to do that
    with the homeless population. That is where we are limited to
    being able to do this.
        If we had greater authority to be able to build your
    facilities with enhanced-use leases, the private sector could
    do it and we would lease it back. And I think that is an
    approach that we should look hard at doing, because with
    Federal contracting rules, it does take years.
        Mr. Taylor. Any note on OTAs or SBIRs or the usage of those
    to expedite contracting?
        Secretary Shulkin. It is something that I just don't know
    enough about to answer. I would be glad to get back to you. I
    don't know if any of my colleagues know enough about that. So
    we will be glad to have a discussion with you about that. Any
    ideas--I mean, we need to get this done faster. The money has
    been authorized. Veterans are waiting. It drives me crazy to
    see years go by and not do this.
        [The information follows:]

        Non-Traditional Contracting (NTC) such as Other Transaction
    Authority (OTA) and Small Business Innovation Research (SBIR)
    Phase III programs are streamlined procedures that federal
    agencies use to support scientific excellence and technological
    innovation through the investment of federal research funds.
    The VA routinely evaluates and revises its leasing process to
    ensure it is grounded in private-sector real estate best
    practices for health care delivery and responsive to the
    emerging demands of the Veteran population. We work closely
    with the General Services Administration (GSA) to ensure our
    lease acquisition strategy aligns with the latest government-
    wide guidance, tools, and procedures. Additionally, VA has
    developed a partnership with the General Services
    Administration (GSA) to procure seven of the recently
    authorized leases leveraging GSA's expertise in lease
    procurement. Hampton Roads is one of the seven projects GSA
    will procure. GSA will follow competitive lease procurement
    procedures in its regulations. The NTCs referenced do not apply
    to the proposed leasing action for the South Hampton Roads
    Outpatient Clinic in Hampton, Virginia.

        Mr. Taylor. Thank you, Mr. Secretary. We will get with you
    on that after that.
        Secretary Shulkin. Okay. Thank you.

                      PRIVATE CARE VERSUS VA-PROVIDED CARE

        Mr. Taylor. Another note, I think it is important for me to
    say, as a post-9/11 service-disabled veteran myself, there is a
    generational divide in terms of the desire to use the VA or
    desire to use care. And my generation tends to, in general,
    want to have private care, because it is easier access. The
    older generations tend to like the VA better. So there is
    definitely a generational divide.
        I will say, you know, we had the IG in my office who talked
    about our own facilities, and they talked about the care being
    great, but, of course, the perception still amongst veterans of
    wait times, of not being called back, is still very poor. In my
    area, it is a one star, out of your rating. And that is a big--
    that is obviously a big problem.
        My question is, as the ranking member pointed out, where 9
    percent has increased in the VA care, but 36 percent in
    private, what are the numbers--because I didn't see that--but
    for the folks, the veterans who were using the private care?
        And let me also say on the record that I agree with you and
    the ranking member that it is the government's responsibility
    and our duty to take care of our veterans and to oversee that,
    to not just be privatized.
        At the same time, as one who is of that generation, I think
    it is--to get better, faster access, and not have to wait,
    which is what you said, we should be able to use those
    facilities, but--private care, excuse me.
        What are the numbers and what are the veterans saying in
    terms of wait times, in terms of being called back that are
    using private services, because I haven't seen that?
        Secretary Shulkin. Right. So, look, when you are talking
    about 9 million veterans who use the VA system, this is never
    going to be an ``everybody feels this way or everybody feels
    that way.''
        Mr. Taylor. Of course. Not a monolith.
        Secretary Shulkin. Right. Exactly. That is why we are
    working towards giving people more choice in how they want
    their care.
        Many in your generation, many in my generation increasingly
    want their care on their mobile phones and convenient access
    when you need it. That is where we really need to be moving, no
    doubt about it.
        But the difference between community care and VA care in
    terms of access is geographically variable. But in general, as
    I am going to talk about across the country--and I have a
    publication I am submitting on this--VA access, compared to the
    private sector is 11.3 days less across the country. Now,
    depending upon what region you are in, that can vary.
        The satisfaction of veterans with access to care is
    actually improving from where it was in 2014. We are getting
    better, but there are parts of the country--and I think you
    come from one--where we need the private sector in order to
    meet the needs.
        And so that is what we are doing. That is why you are
    seeing us prioritizing access, community care growing. We are
    trying to build capability, hire more people within the VA to
    address access. That will hopefully give veterans more choice
    about where they want to get their care, in the VA or outside
    the VA.
        Mr. Taylor. Thank you, Mr. Chairman.
        Mr. Dent. I would now like to recognize the gentlelady from
    California, Ms. Lee, for 5 minutes.
        Ms. Lee. Thank you very much.
        Thank you, Mr. Secretary, for being here.
        Secretary Shulkin. Sure.
        Ms. Lee. Once again, as the daughter of a World War II and
    Korean War veteran, I am really pleased to know that we have a
    Secretary dedicated to ensuring that veterans receive quality
    healthcare. I know the VA intimately as a result of my dad, so
    thank you very much.

                                 ALAMEDA POINT

        I have a couple of things I want to mention to you. First
    of all, I have a letter that I am going to give to you
    regarding Alameda Point. We are now--this is the new outpatient
    clinic in my district. Now it appears it will be 2 years now
    off track in terms of timing.
        So I would like, and I am asking you in this letter, to
    give me monthly updates on the status of this, because I am
    quite concerned about what is taking place.
        Secretary Shulkin. Okay.
        Ms. Lee. So that is for the record, and I will give that to
    you.
        [The information follows:]

        VA will continue to work with Congresswoman Lee's office to
    provide regular updates on the Alameda Point construction.

        Secretary Shulkin. Thank you.

                               MEDICAL MARIJUANA

        Ms. Lee. And then, secondly, okay, now, coming from
    California, of course, you know we have a variety of
    dispensaries which make marijuana available to patients and
    veterans who use it for PTSD or chronic pain and it works.
        Okay. Now, you have said that the VA can't recommend
    medical cannabis in accordance with State laws until the
    Federal law changes. But marijuana schedule 1 status does block
    formal prescriptions. It does not block the ability of doctors
    to fill out questionnaire forms in those States.
        So what is the problem? What is the Federal statute that
    blocks the VA from doing this and not letting physicians simply
    recommend cannabis to veterans who need it and has proven that
    it works?
        Secretary Shulkin. Congresswoman, so would filling out a
    questionnaire, isn't that the step towards prescribing?
    Somebody has to write the prescription.
        Ms. Lee. It is not a formal prescription, no. It is just a
    recommendation form. That is all the State requires, not a
    prescription.
        Secretary Shulkin. So who writes the prescription for the
    medical marijuana?
        Ms. Lee. The physician would write--would just recommend
    cannabis.
        Secretary Shulkin. My understanding is, VA Federal law
    would not allow the physician to write the prescription, but--
    so I have to understand what the questionnaire would be in
    order to make a recommendation, but not write a prescription.
        Ms. Lee. Okay. Well, could we show you that questionnaire,
    Mr. Secretary?
        Secretary Shulkin. Absolutely.
        Ms. Lee. Because veterans need this, it works, and it is a
    shame and disgrace that the VA is preventing this type of
    treatment that works. So--and we know the Federal statutes and
    what all, but this is a merely questionnaire. So I would like
    for you to review that.
        Secretary Shulkin. I would be glad to review that, yes.

                             THE PATHWAY HOME MODEL

        Ms. Lee. Okay. Yountville, California, the tragedy that
    occurred in Yountville, it just shows one, of course, the
    access to guns; but secondly, veterans who need more mental
    healthcare.
        And the pathway model, where it leverages benefits from the
    private sector as well as the public sector and the VA, is
    really a nationwide model. And so, I hope you look at what took
    place there, and look at how we can expand the model, first of
    all, but also how we can prevent these tragedies from
    happening.
        Secretary Shulkin. Yeah.
        Ms. Lee. I don't know. Are you conducting an investigation
    now?
        Secretary Shulkin. We are. As you know, this is a State
    home, so that we weren't providing the security. That is up to
    the State to be able to do that, but we are looking at every
    aspect of this.
        Before you came in, I mentioned that three heroic women
    lost their lives, as I know you know, but one of them was a VA
    employee. We are absolutely torn up that this happens to people
    serving veterans. We are looking at every aspect of this to see
    what we can do.
        We don't want our employees ever to have to go through
    this, but also the fear that when they are serving veterans
    that they have to worry about this. So we are working very hard
    to look at what we can do in order to protect our staff and to
    protect our veterans, quite frankly.
        The Pathway Home model is a remarkable model. They were
    dealing with the toughest of the tough, you know, in terms of
    people who failed other treatments. We are not going to give up
    on this. That would be a failure of our acceptance of this
    mission, so we are going to continue to do that.
        And we are working closely with our California
    counterparts. We--you know, I spoke to Governor Brown, and we
    have worked with the State Department head of Veterans Affairs
    there, and we will continue to work to make sure that we are
    going to see this model continue.
        Ms. Lee. Thank you very much.

                                MILITARY PARADE

        Mr. Secretary, let me ask you one more question about this
    military parade that the President is proposing. Now, will any
    part of the VA budget be directed toward this parade? Mr.
    Mulvaney said $10 million to $30 million. Right now, 1.5
    million veterans live in households that receive SNAP benefits.
    We have an increase in homelessness among veterans. Are you all
    going to pay for part of this parade, rather than put the money
    into veterans healthcare and mental health and housing and
    where it should go?
        Secretary Shulkin. As you know, Veterans Day is a very
    important day to us. We put our resources and our efforts into
    the recognition at Arlington National Cemetery that day. We
    have no plans to change that. We have not had any discussions
    with the White House about participating in the parade.
        Ms. Lee. Thank you very much.
        Mr. Dent. At this time, I would like to recognize the
    retiring gentleman from Florida, our good friend, Mr. Rooney,
    for 10 minutes.
        Mr. Rooney. I forgot. Thank you to the retiring chairman.
        Dr. Shulkin, welcome. Thank you.
        I don't know if you are aware or not, but over the last
    several years, Congressman Tim Ryan and myself have both served
    as cochairs of the Military Mental Health Caucus. It has had a
    few variations of different names.
        But essentially, you know, we have tried to hold hearings
    and have meetings to discuss things that would help returning
    warfighters and veterans deal with any mental health issues or
    stigmas that have arrived since, quite frankly, the last war on
    terror, and to try to do something to address the suicide issue
    that has obviously been a big problem.
        I wanted to say that we appreciate everything that you have
    tried to do and your willingness to send someone to participate
    in a lot of those briefings that we have had for our members
    and for our staff. And I recently read a report about the VA
    that raised some concerns about our ability to meet the mental
    health needs of those post-9/11 veterans.
        Of the post-9/11 veterans who haven't gone to the VA for
    help, many reported that they don't know how to apply for
    benefits. They don't know if they are eligible, or they are not
    aware that the VA offers mental healthcare benefits altogether.

                         TRANSITION ASSISTANCE PROGRAMS

        How are you working with the Department of Defense to
    improve transition assistance programs and reduce this lack of
    knowledge amongst veterans? How are you working to target
    veterans who have left the military before these type of
    transition programs were actually in place?
        And then, I am going to ask this other question--I will
    just ask all my questions and then let you answer, if you don't
    mind.
        The report also suggests that transportation issues pose
    challenges for many of these post-9/11 veterans, and I know
    this is especially true in rural districts like mine. But I
    also think that it might be true in anybody's district. You
    know, if you just don't want to go talk to somebody face to
    face, maybe that is part of an issue.
        Maybe it would just be easier to be able to discuss these
    things over a telephone or something like that. But when asked,
    45 percent of veterans answered that they would be in favor of
    using the internet or telephone to receive mental healthcare.

                               TELEHEALTH PROGRAM

        You recently announced the launch of a new pilot telehealth
    program for rural veterans with PTSD that will provide veterans
    with remote access to psychotherapy and related services. Can
    you provide an overall--an overview of how this program works
    and any plans you have to expand that program to include other
    areas?
        Secretary Shulkin. Yeah. Yeah. Well, first of all, thank
    you for your leadership in this area. As you know, this is
    critical to us and our top priority to reduce veterans'
    suicide. And you are correct that of the 20 veterans a day who
    take their life through suicide, 14 are not getting care in the
    VA. They are out in the community.
        And so we have focused extensive efforts on working with
    community organizations, churches, synagogues, mosques, as well
    as not-for-profit organizations, and veteran service
    organizations to get the message out that people need to get
    resources, whether in the VA or outside the VA.
        Our veterans crisis line, we have expanded to now a third
    center, and we are responding to well over 1,000 calls a day.
    But you can also text into that as well, so we are using
    alternative means to be able to do that.
        Telemental health is a huge area, an opportunity--we use it
    extensively, close to 400,000 episodes of care delivered
    through telemental health. And we think it is important to
    expand that. We now have 11 telemental health hubs where we can
    hire professionals in usually metropolitan areas that can now
    serve in more rural areas where the shortages are more
    significant.
        Mr. Rooney. With regard to my first question--and I
    appreciate that. I don't think it just has to be rural. I was
    just driving around Washington, D.C., and it is maddening just
    to try to get anywhere here, too. So like a lot of, I think, I
    am sure it is just sort of the feeling of easy access,
    especially at critical times when people might need it right
    now--access to somebody that can talk to them--rather than
    trying to figure out how they are going to navigate, you know,
    whether it is a rural district or a city.
        With regard to my first question, when I PCSed in 2004,
    there was no transitional advice or whatever for myself and, I
    assume, for the other people that were PCSing that day or
    around that time. And since I have been out--and some might say
    I probably could use some help as well--but I have gotten
    nothing from the VA or anything to show, ``Hey, by the way, if
    you PCS from the Army or the Navy or any of the branches before
    we started doing some kind of an awareness separation briefing
    and you feel like you might need some of this kind of help,
    this is some of the things that you should do.'' I have never
    gotten that kind of phone call or letter or anything like that.
        So what do you do for people that may have PCSed before
    those types of efforts were put in place?
        Secretary Shulkin. Well, first of all, we have worked hard
    on our TAP program, our Transition Assistance Program, to make
    sure that, before everybody gets out, that they undergo a
    seminar on understanding how to use their benefits. But, too
    often, and I think this is what you were referring to, when I
    talk to veterans that find themselves transitioned out of the
    military, they now find themselves somewhat either depressed or
    in an emotional issue, the last thing that they want to do is
    start figuring out how you start applying for benefits.
        So the President's executive order that he signed on
    January 9 of this year asks for essentially what I call auto
    enrollment. Now, my staff doesn't like when I say that because
    it is complex. But I believe before everybody leaves, that
    paperwork should be done and they should be automatically
    eligible to have access to mental health services.
        And that is what we have presented now to the President on
    March 9, a report that suggests how we are doing that with the
    Department of Defense. We are implementing that as we speak so
    that that is essentially automatic that every servicemember
    will have that mental health benefit when they transition out.
        Mr. Rooney. Thank you, Dr. Shulkin.
        I yield back.
        Mr. Dent. The gentleman from Ohio, Mr. Ryan, is recognized
    for 5 minutes.
        Mr. Ryan. Thank you, Mr. Chairman.
        Just to continue along the line of Mr. Rooney, so I think
    that is a great way to approach the Transitional Assistance
    Program, is to get people in. To me, it doesn't sound complex
    at all; it sounds very straightforward. And I think that is the
    way we need to go. We appreciate your leadership on this.
        In my estimation, we have a couple major issues, some of
    which have been brought up here, on the issues of opiates and
    on the issues of post-traumatic stress. We still have 20, 21,
    22 suicides a day. We have, clearly, some budget issues that we
    need to deal with in the long term, and we have to figure out
    how we can provide care to these veterans who are coming back
    or have been back for 30 or 40 years. We talked about this a
    little bit at our breakfast last week.

                               COMPLEMENTARY CARE

        I have seen, personally, over the last 15 years of my
    career here, complementary programs that are having
    unbelievable effects and improving the health and well-being of
    veterans who have been suffering for a long, long time. I have
    sat at the Washington, D.C., VA in a mindfulness-based stress
    reduction session for 30 minutes of mindfulness-based
    meditation techniques. And then, afterwards, had conversations
    with Vietnam veterans who were in tears talking about how they
    wish they would have found this 40 years ago because they have
    been on so many medications, they have been divorced two or
    three times, they have lost touch with their kids, just
    emotionally disconnected because of what they did.
        And it is the David Lynch Foundation, what they are doing
    with transcendental meditation. It is acupuncture. It is yoga.
    We have had sessions here on Capitol Hill with the veteran yoga
    teacher, double amputee, who is now going out and helping to
    heal these vets. I was just in a session last week with a group
    called Project Welcome Home Troops. They had a Vietnam vet who
    was on 20 prescription drugs--20--which is not common, but it
    is not unusual, either, for people to be on 10, 12, 13 drugs.
    After one session, 5 days of this complementary approach, this
    guy is off all his meds. And I am just saying: We have got to
    wake up. There are things out there, that we don't need to come
    up with any grand new solutions.
        And so I just want to plant the seed with you to say, as
    you are doing the TAP program, that I think it would be in the
    interest of the taxpayer, the veteran, and all of their family
    members to start figuring out how to have these as options. So
    get the people through the TAP program aware of what is going
    on. Let's start studying these.
        I don't know why this stuff works. I have no clue. It has
    something to do with your nervous system and your biochemistry
    and the mind-body connection that we are learning more and more
    about. But when we have vets that are going from 20
    prescription drugs and we do the math on that for the next 30
    years--we do, on the Appropriations Committee and the Budget
    Committee--and then we do the math of that person maybe getting
    a treatment for 500 bucks for 5 or 6 days and it transforms
    their lives, that is something that we need to look into. And I
    don't care what it is. I don't care how it works.
        But what I would just recommend is that--and I know Tracy
    Gaudet is doing an amazing job with the patient-centered care--
    is that when these young men and women come back, that they are
    at least made aware of these programs and where they may be in
    their community and that if we can begin to set up some pilot
    programs where, whether through the Choice Program or something
    else, we give them 500 bucks. Because I would much rather--and
    the people I represent and the veterans and everyone else--
    let's give them the 500 bucks to go try this thing out and see
    if it works, instead of immediately start doling out
    prescriptions.
        I would love to work with you on that. I think it is
    critically important. Time is of the essence. There is a real
    sense of urgency here.
        Secretary Shulkin. Congressman Ryan, I am all in. I think
    you are absolutely correct. It is why we have had a 90-percent
    reduction on new starts in opioids because we are using a
    different approach.
        Ninety-three percent of our VA medical centers offer
    complimentary care. The Choice Program does pay for
    complimentary care. We had 47,000 authorizations this past year
    for acupuncture and 70,000 authorizations for chiropractic
    care. We need to be doing more of this in alternatives. We have
    also talked about pet therapy as another strategy that we have
    seen having an almost similar effect. So we have to continue to
    reach forward on this. Tracy Gaudet, with the Whole Health
    Program, is rolling this out across the country.
        Mr. Ryan. And there is science behind a lot of this now.
    The literature on this stuff has grown exponentially in the
    last 10 or 15 years. I appreciate that.
        I yield back.
        Mr. Dent. At this time, I would like to recognize the vice
    chairman of the subcommittee, Mr. Fortenberry from Nebraska.
        Mr. Fortenberry. Thank you, Mr. Chairman.
        Mr. Secretary, it is nice to see you. Thanks so much for
    joining us today. We appreciate it.
        Look, we have had some great news in Nebraska and some
    harder news. I think you are well aware of it, but I think it
    would be important to discuss publicly.

                          PUBLIC-PRIVATE PARTNERSHIPS

        The slogan ``private, public, public-private partnerships''
    has been used exhaustively, and, yet, at the same time,
    actually making this a reality can sometimes be harder, but we
    are doing it back home.
        In Omaha, we are getting ready to break ground, based upon
    the new piece of legislation that was passed just fairly
    recently on a new ambulatory care center. Taking the money,
    which was set aside for years and years and years, struggling
    to become big enough to actually rehabilitate or rebuild a new
    hospital just was never going to happen, given all of the
    difficulties here. So the community has stepped forward and, in
    partnership with those public dollars and your leadership, are
    now putting up $30 million to build out this care center. It is
    a huge first step, I think, in terms of a new way of thinking
    for the VA.
        Secretary Shulkin. Absolutely.
        Mr. Fortenberry. And we are very proud of that.
        Back to modeling and using this as a scalable template for
    the rest of the country, I would like to hear your perspective
    on that.
        But, secondly, the harder news is the Lincoln VA clinic,
    where we have a historic structure, beautifully, wonderfully
    integrated into a campus that is in the center of our city. A
    redevelopment agreement reached with the city, all things ready
    to go, and then the process collapses.
        Now, you have been very generous in trying to shepherd and
    watch this. But I think it would be helpful, as well, if you
    could give commentary on the new timeline by which we are going
    to receive realbids for the buildout of the new clinic there,
    particularly given that it was just some type of internal
    technical bureaucratic snafu that has delayed us.
        And then the opportunity cost of delays are huge, another
    year or two gone by, in which we are not providing the best
    type of progressive leading-edge care.
        Secretary Shulkin. Well, first of all, I guess it is better
    to focus on the good news.
        The private-public partnership in Omaha, we hope to have a
    groundbreaking ceremony in May. And, frankly, thank you for
    your leadership in this, because I know that you were
    instrumental in helping us with this.
        That model, which Congress has authorized us to do five
    times across the country--Omaha will be the first called the
    CHIP IN Act--is a model that we hope to replicate. And we are
    out actively now in communities looking for the other four
    partners. This is a major priority for us to replicate what you
    are doing in Omaha.
        Mr. Fortenberry. Is this a vision that you anticipate
    catching on throughout the country?
        Secretary Shulkin. We have interests from at least 18
    communities. The great thing about the American public is that
    we ask for their help when it comes to helping veterans and
    they step up.
        Mr. Fortenberry. Exactly.
        Secretary Shulkin. So thanks, again, to Omaha for leading
    this, but we believe that we are going to have all five soon,
    and then we are going to look at this as a model to come back
    to you with.
        In terms of Lincoln, this is a contractor that was awarded
    that, unfortunately, was not able to be able to complete the
    work. That starts us back in the process. I think, as
    Congressman Taylor said, we know this stuff takes too long.
    This was a re-award in 2019, with construction starting in
    2020, and it is not the fault of the veterans that this
    contractor and the contracting process didn't work for them.
        So I have asked our team to go back. I have told them that
    that is unacceptable. They are looking at being able to carve
    about 8 months off that process. But we are still probably 18
    months away from being able to do the work that needs to be
    done.
        That is why I think these public-private partnerships are a
    better way to go than VA being directly involved in this
    contract in the construction process.
        Mr. Fortenberry. Well, we are where we are in Lincoln, but
    anything that--and I know you are doing this, and you have
    communicated that to me--you can do to expedite this is really
    necessary. Meanwhile, people at home, putting plans on hold,
    veterans eager for this new unfolding dynamic, have to be told
    that there were some internal mistakes. So anything that you
    can do to expedite this would be helpful. Again, not having
    this in place is a huge opportunity cost, a loss for us. But I
    know you are on it. I just thought it was important to have the
    conversation publicly.
        Secretary Shulkin. Thank you.
        Mr. Fortenberry. I yield back, Mr. Chairman.
        Mr. Dent. Before we go on to the second round of
    questioning, I would like to recognize the distinguished
    ranking member of the full committee, Mrs. Lowey, for 5
    minutes.
        Mrs. Lowey. Thank you, Mr. Chairman. It has been a busy
    morning, but I am delighted to be here, and I know you are
    proceeding.
        A pleasure to see you, Mr. Secretary.
        Secretary Shulkin. Nice to see you.
        Mrs. Lowey. And I do want to apologize to you, as well. We
    have multiple hearings this morning, and I didn't bring my
    roller skates, so I am moving along.
        I know that important questions on investments and
    oversight on veterans health and benefits have been discussed.
    I would like to raise a few specific items.

                 INPATIENT SUBSTANCE ABUSE TREATMENT WAIT TIMES

        Number one, the waiting time for substance abuse treatment,
    I don't think that has been discussed as yet.
        Last year, I heard from a local veterans healthcare
    provider that veterans facing substance abuse who have the
    courage to seek treatment can face an average wait time of 10
    days before a spot in treatment becomes available. Nationally,
    the average wait time is even worse at 21 days. Delays, as you
    know, can prevent a veteran who may be ready to confront
    addiction from actually seeking treatment, and that doesn't
    honor our end of the bargain to provide care for our veterans.
        This is really shocking to me. What is the cause for these
    delays? Is it the availability of funding, staffing, or other
    structural issues? And, more importantly, what is the VA doing
    to make inpatient treatment for substance abuse available as
    soon as possible?
        Secretary Shulkin. This is critical to the debate that is
    going on right now about opioids and suicide and the
    homelessness problem. I mean, these all intersect.
        Too often--and even our veterans justice issue, that our
    jails are still places where we are putting people with
    substance abuse disorders. The VA has a responsibility to
    increase its capacity for substance abuse, particularly as we
    are learning more about medication-assisted treatments and
    other effective treatments.
        As you know, the substance abuse programs are filled with
    people who have recycled with recidivism. So the more that we
    can find more evidence-based treatments that help people
    essentially get back on track, find jobs, and get back to their
    life the way that they should be living, it is important.
        So we do recognize our responsibility to increase capacity.
    We are looking to hire additional mental health and substance
    abuse experts. There are shortages of them.
        As you recognized--and I appreciate you doing it--the
    private sector is struggling with this as well. And while there
    are longer waits, my concern in the private sector is: If you
    don't have the right type of insurance or enough cash, you
    don't have access to programs at all. So the VA has much easier
    equity and access to these programs, but we need to expand them
    faster.
        Mrs. Lowey. Thank you. And I hope we can work together so
    that you get the resources you need to do just that.
        Secretary Shulkin. Thank you.

                            NATIONAL CENTER FOR PTSD

        Mrs. Lowey. The National Center for Post-Traumatic Stress
    Disorder conducts important research to access and treat PTSD.
    With approximately 11 to 20 of every 100 veterans returning
    from Operation Iraqi Freedom and Enduring Freedom with PTSD,
    the Center's work is not only critical, but, as you know, it
    increases the likelihood of discovering effective treatments
    and even potential cures.
        If you can, share with us the research informing the VA
    about the assessment and treatments of PTSD, and how will the
    VA continue to support the Center in its essential work?
        Secretary Shulkin. When I looked into this, the law that
    requested that VA do a study on the evidence-based treatments
    coming out of the National Center was actually never enacted.
    So that is something that we would like to make sure--because
    we have been asked about when is this study going to be done,
    and I don't believe that law has yet been enacted. But our
    National Center is moving ahead and doing the study anyway. But
    I don't have a specific date when that is going to be done. You
    know, these studies often take a while to do well, so I will
    get back to you when that study will be done. But I think there
    was an expectation that we had already begun that. That is
    going to begin this spring. And then we need to get the
    timeline for you.
        But this is a critical area for our National Center to be
    looking at, and that is why we are moving ahead with this now.
        Mrs. Lowey. Thank you.

                        HEALTH NEEDS OF FEMALE VETERANS

        And, lastly, concerning female veterans' care, I am very
    concerned that the VA is not adequately addressing the health
    needs of female veterans, including obstetrics, gynecological
    care, treatment for gender-specific conditions and diseases.
        According to VA's recent report, suicide rates among female
    veterans increased more than 60 percent from 2001 to 2014
    compared to 29 percent among their male counterparts. The VA
    also found the risk of suicide among female veterans was 250
    percent higher in comparison to U.S. civilian adult women.
        Frankly, these statistics were shocking to me. If you have
    any explanation about the disproportionate rate of suicides
    impacting veterans, I would appreciate it.
        And, secondly, how will the VA ensure that female veterans'
    physical and mental health needs are met?
        Secretary Shulkin. In the President's budget, we have
    requested a 6-percent increase in women veterans dollars
    available to be able to support this.
        Mrs. Lowey. Is that sufficient?
        Secretary Shulkin. I think on top of what we have been
    adding each year, this is what our field has asked for. We have
    just trained an additional 332 women health providers in our
    certification course, so we are very aggressively expanding our
    women's clinics, our women's services, and the dollars I think
    are appropriate to flow with that.
        The issue of women's suicide, these are really disturbing
    statistics, as you have said. There is no doubt that the
    overall incidence among women veterans is higher than the
    general population.
        But what we do know is this, is that, in the last 15 years,
    we have been studying this comprehensive database of suicides.
    If you were a women veteran who got care in the VA over the
    last 15 years, your rate of suicide actually decreased by 2.6
    percent, a decrease. If you were a woman veteran not seeking
    care in the VA during those 15 years, it went up 81.6 percent.
        So I always say to people: If you had a drug where one
    worked by decreasing and the other didn't, everybody would be
    using the drug that worked and not the other one.
        So we have to connect women. And this is why your question
    is so important. We have to have access to services. We have to
    have women feel comfortable in the environment that they seek
    care in a sensitive way. And our culture has not always been
    that in the VA, so we have to continue to change that. But we
    can absolutely save lives by getting women connected with care.
        The reasons why women's suicide among veterans is high is
    something that we don't totally understand. I think that we
    need to do more research into that. But, right now, we are
    focused on getting women the help that they need.
        Mrs. Lowey. Thank you, Mr. Chairman. I appreciate you
    giving me the time.
        I do hope we can follow up on this because, as we know--you
    call it the President's budget, and I call it Mr. Mulvaney's
    budget. This is a really important committee and members that
    do work in a bipartisan way. I was just shocked by these
    statistics, and I hope we can address it as best as we can with
    your recommendations.
        Thank you, Mr. Chairman.
        Mr. Dent. Thank you, Mrs. Lowey, for that line of
    questioning.
        At this time, we are going to move into a second round of
    questions for those who are here. So, with that, I will
    recognize myself for 5 minutes.
        On the same day last week as the release of the unfavorable
    IG report about the D.C. VA hospital, you announced sweeping
    plans to reorganize VHA from top to bottom with a plan for
    Central Office reorganization due by May 1st and a nationwide
    reorganization plan for your regional hospitals due by July
    1st.

                      DC VA HOSPITAL AND RESTRUCTURING VHA

        Could you quickly just touch on the situation up at the
    D.C. VA hospital and then, just as importantly, what led you to
    set in motion such significant changes, and have your market
    assessments of different healthcare markets revealed systemic
    problems, and are you considering delayering the VHA and
    getting rid of the VISN level?
        Secretary Shulkin. First of all, very briefly, just to
    update you on the Washington, D.C., situation, back in April of
    2017, the inspector general called me in an unusual step and
    said: I want to tell you about what we are finding during this
    review.
        The results were so concerning to me, that day, I removed
    the medical center director. We ended up having to remove him
    twice because the court made us bring him back. But we have new
    leadership in place, Mr. Larry Connell.
        Since April of 2017, I think this is a very much better
    environment for our veterans. We have had an increase in
    veteran satisfaction to recommend that hospital by 26 percent
    just since April of 2017, which is a big, big number move.
        In terms of consults, we had 11,000 consults for
    prosthetics greater than 30 days. Today, that number would be
    zero. So we are seeing dramatic improvements in the care there.
        But what we learned from it was, it was a failure at every
    level of our organization. It should have never gotten to that
    point.
        And so when things are failing at the facility level, the
    VISN should know about it. When things are not getting
    addressed at the VISN, the Central Office needs to know about
    it.
        I will tell you that I was not aware of those types of
    problems. So what I did in this restructuring move was, we took
    three VISNs that I think that there was consistent evidence
    that there was not the proper flow of information, we no longer
    have VISN directors there, and we are trying a model where
    there is direct accountability to the VACO Office. That is
    delayering.
        And what I want is a plan submitted to me by July 1st for
    the entire country about how we look at what the role of the
    VISN should be, if there should be a VISN, and how do we get
    more direct accountability over performance.
        I have asked for a quicker plan for the Central Office by
    May 1st--I met with the team this morning to go over what that
    plan needs to look like--where we would delayer at the Central
    Office as well, because too much information is being passed up
    one level. And nothing is being done about it. We need to be
    fixing these problems, and the Washington, D.C., should be a
    wake-up call that these problems, like a 59-percent vacancy
    rate in supply chain people in a hospital, just should never
    exist. You can't run a hospital with a 59-percent vacancy rate.
        So I believe that we are now taking the appropriate actions
    in place to restructure this across the country.
        Mr. Dent. Thank you, Mr. Secretary.

                            ELECTRONIC HEALTH RECORD

        I want to get to the health record interoperability.
        VA's electronic health record is not only intended to be
    interoperable with DOD but also with the private sector. We
    understand that a big challenge to interoperability with the
    private sector is private health networks tend to hoard data
    for a competitive advantage and that incentives would be
    required to change their behavior.
        What incentives can you bring to the table to modify
    private health network behavior in this regard?
        Secretary Shulkin. Well, first of all, we have said to the
    Cerner Corporation that we are not going to sign a contract
    that is going to allow proprietary protection and information
    blocking to continue. We will not allow that for veterans.
        The Cerner Corporation has been extraordinary in working
    with us to respond to that. So I believe we will soon be in a
    contract that will be groundbreaking for new rules in
    interoperability.
        This is going to mean that Cerner Corporation is not going
    to hold intellectual proprietary rights to open APIs. Open APIs
    are the key to having free flow of information, as well as
    adhering to industry standards--these are called FHIR
    standards--that, again, we are going to build into this
    contract. When you have open APIs without intellectual property
    protection, you allow people to be able to develop them on
    behalf of veterans, and you use industry standards. You are now
    breaking open interoperability in a way that has not been done
    before, and we are going to do that.
        We have gotten 11 major hospital systems to sign on to a
    pledge that they will adhere to open APIs and industry
    standards. And more and more health systems who want to work
    with veterans--and I know all across the country there is a
    commitment to this--are going to be working with us on this
    pledge. We are going to change care not only for veterans, but
    across the country for all Americans by working with industry,
    by working with leading health systems to get this done. And we
    are working with CMS, of course, and the Office of the National
    Coordinator and the Federal Government to get this done.
        Mr. Dent. Thank you, Mr. Secretary.
        At this time, I would like to recognize the ranking member
    of the subcommittee, Ms. Wasserman Schultz.
        Ms. Wasserman Schultz. Thank you, Mr. Chairman.
        Just piggybacking on the chairman's question on the EHR
    process, what is a little troubling to me--I mean, I know you
    find it exciting that they are going to release their
    proprietary hold on their product--but the risk there is that
    you would have it lead to increased customization. And so, I
    mean, it is an internecine very vast network. You have already
    had some trouble with getting buy-in, and you have physicians
    and hospitals who like your own proprietary system that you
    invented--there is a great deal of pride there--but it is a
    DOS-based system, and it is the 21st century.
        So what oversight mechanisms are you putting in place to
    ensure that the VA has sufficient understanding of existing
    business processes so that you avoid--while you are going do
    have a bunch of open APIs--that you avoid costly customization
    that means that, essentially, you don't have an interoperable
    system that is seamless with DOD or across your whole system?
        Secretary Shulkin. I think what you are bringing up,
    appropriately, is this is a very, very risky, complex
    implementation. And you are absolutely correct that a lot of
    things could go wrong. But this is not so much about the
    technology as about how we manage change and management across
    the system. We are going to go from 130 instances to a single
    virtual instance in the VA. That is going to require the type
    of standardization that you are talking about, and that is
    really very complex.
        In order to do that, we are standing up a project
    management office. The project management office's job will be
    the oversight of that exact process of the change management
    process. And that needs to be clinician led and driven in the
    way that you are exactly right about where this could go wrong
    if we don't include our clinicians in this process.
        The open API process, I believe, in conjunction with these
    FHIR standards, will eliminate some of the risk of everybody
    doing their own thing. If you do it with open standards--and we
    are going to publish our model instance so that the whole world
    can see what we are developing and what the data points are--
    that is going to allow us, I think, to avoid some of this
    proprietary customization that is going on in the market right
    now.
        Ms. Wasserman Schultz. I know we had spoken--I am not sure
    during which meeting or conversation we spoke about this--but
    that there has been an ongoing concern over whether
    interoperability would extend to the private sector. And
    MITRE's review, I know at least took a look at that, have those
    concerns about interoperability with the private sector, and
    will the private sector be able to share with the VA. Have
    those been alleviated with that part of their review? And
    overall, with your pause, are you following the recommendations
    of MITRE? I am not sure I am pronouncing the acronym right.
        Secretary Shulkin. No, you are.
        That was the total purpose of the pause in the review that
    we brought in MITRE for, who brought in experts around the
    country.
        They generated 51 recommendations. We are now building in
    all 51 recommendations.
        And, in addition to that, we have sought additional
    expertise, even beyond MITRE, because we know we have one shot
    at this. And, as you said, this is an expensive investment, and
    it is a long investment. And if we don't get it right in the
    beginning, I don't think that we are going to have a chance to
    go back and do it over.
        So we are taking extraordinary lengths to get the expertise
    around the country to give us their input. But we absolutely
    did build in the MITRE recommendations, and we are still
    looking to do a few more reviews before we say that we are
    ready to move forward. And, hopefully, that will be soon.

                                 INFRASTRUTURE

        Ms. Wasserman Schultz. Okay. Just like one and a half more
    questions, Mr. Chairman, and then I am done.
        I mentioned in my opening remarks and to you, in our closed
    door meetings, about the concern and the difference between
    what our budget agreement was, which was to spend the increase
    in the budget for the VA on infrastructure investment. And as
    our ranking member said, the Mulvaney budget has abandoned that
    principle and put it into VA Choice and community care. That is
    on top of the $4.2 billion in the emergency supplemental.
        Can you explain why the additional funds were not used for
    infrastructure, and are we on the same page now that that is
    where the funds should go?
        Secretary Shulkin. I can't explain where the disconnect
    was. I think the chairman said it well, which is that there
    maybe was some informal communications that your intent may not
    have been understood the way that they are. We understand that
    this is your decision.
        We will be looking in 2018 for a $2 billion investment in
    our recurring maintenance, which I think is desperately needed
    and we greatly appreciate that.
        In 2019, the money was suggested to be moved into our
    Choice and community care funding, which is also needed, on top
    of the President's budget that requested an unprecedented
    increase in infrastructure and major or minor construction.
        So we think that the budget balance is appropriate, at this
    point, to make sure that we are addressing veterans' needs, as
    well as the investment in the infrastructure.
        And, Jon, I don't know if there is anything that you want
    to add to that.
        Mr. Rychalski. I would just say that, when we looked at the
    requirement, as Dr. Shulkin expressed, we suggested maybe $2
    billion in 2018. We also have in the omnibus, I think, the
    potential--depending on how that turns out--of $2.1 billion
    between nonrecurring maintenance and minor construction. And
    then our request in 2019 is pretty substantial.
        So we felt that, between those three, that would probably
    adequately address us now for infrastructure needs. And,
    frankly, we do have a need in Choice. So it just seemed like a
    balanced approach where we would have enough for infrastructure
    and still meet the needs for care.

                            PRIVATIZATION OF VA CARE

        Ms. Wasserman Schultz. Okay. And my leftover half a
    question here is, piggybacking on our ranking member's and your
    response on the lopsided difference between the increase in the
    size of the female suicide rate in private care versus VA care.
    I mean, I think that underscores the point about not going
    pell-mell in the direction of privatization and investing more
    than a 9-percent increase in your needs on that side in the VA
    side of the House, but what you didn't really answer in the
    last round for me was: Has this administration, or anyone,
    pushed you to move the VA in the direction of privatization?
        Secretary Shulkin. First of all, I think your observations
    are absolutely correct. It is the reason why I am not in favor
    of privatization, because you can't take 9.1 million veterans
    getting care in the VA system, 60 percent that carry a mental
    health diagnosis----
        Ms. Wasserman Schultz. Who wait longer now than they do at
    the VA.
        Secretary Shulkin. Right, exactly.
        And just release them into the general public and think
    that we are going to honor our commitment to our veterans. It
    just simply couldn't work by turning on a switch and
    privatizing it.
        The President is very, very committed to improving services
    for veterans. There is no pressure to privatize. There is
    pressure to fix the system.
        And the way and that we are going to fix the system is by
    investing in VA where it needs to be improved, the way that you
    are pushing us to, as well as by working with the private
    sector, where they can do it better or they have better access
    than we have.
        And so that is really the only pressure to get this system
    working better and not to have the continued problems that we
    have been seeing for decades in the VA.
        Ms. Wasserman Schultz. Okay. Well, I look forward to
    continuing to work with you toward those goals. Thank you so
    much. Thank you for your service.
        Mr. Dent. At this time, I would like to recognize the
    gentleman from Virginia, Mr. Taylor, for 5 minutes.
        Mr. Taylor. Thank you, Mr. Chairman.

                      VACANT AND UNDER-UTILIZED BUILDINGS

        One quick thing before I get to suicide. On the request for
    $2 billion in fiscal year 2019 and then a substantial request
    in 2019 for infrastructure, understanding that there are
    infrastructure needs--just real quick--I know, earlier on in
    the year, we had a hearing and we talked about the not utilized
    or underutilized office space--700 or something buildings.
    Where are we at in terms of progress for that, because that
    sounds like it could be a significant savings?
        Secretary Shulkin. We have, to date, disposed of--when I
    say ``to date,'' since February of 2017--disposed of 131 of
    those facilities. Eighty-three percent of the remaining
    facilities have historic preservation status, which just makes
    it a longer process. But we maintain the commitment to get out
    of all 435 of the vacant buildings; the rest that are
    underutilized, another 700 or so, we are working to make sure
    that we adhere to not investing resources in places where
    veterans aren't getting advantage of it. And so we are
    continuing to work on that list. We knew this would be
    challenging, but we are making progress.
        Mr. Taylor. Thank you. Following up on something that
    Congressman Rooney talked about, and then also Congressman
    Ryan. I believe some veterans have been overprescribed drugs or
    just money thrown at the problem. And, quite frankly, even on
    the veteran side, there have been folks that have taken
    advantage and claim PTSD or TBI or something like that to get
    benefits and then not seek treatment. So I think, veterans, we
    have to look ourselves in the mirror, too, and be responsible,
    because if someone does that, you are just taking away from
    someone else.

                           COMMUNITY OUTREACH PROGRAM

        On that note, the $190 million spent on outreach with VSOs
    and telehealth and hotlines and such, the Congressman brought
    up a great point in terms of veterans who are out there, and we
    know from suicides, a lot of them are over the age of 50. How
    or are we also sending out letters to the folks that are in the
    database that are known veterans to say, ``Hey, listen''--not
    just looking for them with the VSOs or faith-based
    organizations, but directly to the veterans, ``Hey, if you are
    having these problems, come see us''.
        Are we doing that, and if not, are we going to?
        Secretary Shulkin. We are trying a number of things. That
    is why this is our top priority. And we are going to continue
    to try new approaches here.
        We do have a community outreach program, a public service
    message. Tom Hanks is our national spokesperson, #BeThere or
    www.BeThereforVeterans.com. And we will continue to try to get
    the message out there.
        But, in addition, we are using big data analytics,
    predictive analytics.

                              PREDICTIVE ANALYTICS

        Mr. Taylor. If I may, I am sorry. I love Tom Hanks, but
    directly to the veterans. To his point, he hasn't gotten
    anything, and I haven't gotten anything saying that. But is
    there something that is going directly to veterans, not just
    looking for them?
        Secretary Shulkin. What we are using in predictive
    analytics is identifying those that are at the highest risk.
    And we are doing direct outreach calls to them, asking them to
    come in. Every medical center is involved in this now. Those
    that we know can use the benefit the most and proactively
    reaching out. We are adding suicide prevention coordinators at
    each of our medical centers. These are people whose job it is
    to outreach specifically the veterans.
        If you have additional ways that you think we should be
    reaching out, we are open to new ideas.
        Mr. Taylor. Okay. I appreciate that.
        And another thing you mentioned is prevention, which I
    think is extremely important, too. There is a verifiable gap.
    And you have heard me say this before, certainly especially in
    Special Forces, where they do a great job in Active Duty, and
    these are the populations that are going back and forth in
    combat over and over again; they do a great job on Active
    Duties to prevent suicides. But then they get out, and we are
    certainly part of that group, that 14 that will never seek care
    from the VA or a hotline or anything like that. But there is
    definitely a gap there.

                   DOD AND VA SUICIDE PREVENTION COORDINATION

        Has the VA coordinated with DOD in terms of prevention,
    like pilot programs, you know, speaking about the best
    practices in these units that know they have issues and they
    have problems and do a good job of preventing suicides on
    Active Duty, has the VA coordinated with them to figure out
    what the best practices are--perhaps baselines with units that
    are more susceptible to TBI and blast and CTE and stuff like
    that--to figure out, ``Okay, you have a baseline, this is where
    you are,'' which is something that we are implementing in Naval
    Special Warfare, but it sounds like something that could be a
    partnership with the VA and DOD to prevent it, therefore,
    saving lives, saving families, and then costs as well?
        Secretary Shulkin. I think you are right. And, first of
    all, I should say Secretary Mattis has been extraordinary to
    work with. Many of the barriers that existed in the past
    between DOD and VA have just gone away, and we are working much
    closer together.
        I did what I thought the very best thing to do, to get that
    closer working relationship, is that we took the head of
    suicide prevention from the DOD and moved her over to VA on
    detail. So we have now singular leadership who understands
    exactly what you are saying about DOD and VA who are directing
    our efforts. And she is Dr. Franklin. She is bringing us really
    much closer together on these efforts. I have met with Admiral
    Lane. I have met with the heads of the Services to talk about
    what we know that we can work better together on, and this is a
    priority.
        Mr. Taylor. Is there anything we can do as Members of
    Congress to help that effort?
        Secretary Shulkin. I have to tell you, I don't see anything
    standing in the way right now. We are all focused on this
    issue. It seems like we are making more progress now than we
    have in years.
        Mr. Taylor. Thank you, Mr. Secretary.
        Thank you, Mr. Chairman.
        Mr. Dent. I recognize the gentleman from Georgia for 5
    minutes, Mr. Bishop.
        Mr. Bishop. Thank you very much, Mr. Chairman.
        I would like to return for a moment to the issue of
    construction. I think it was touched upon earlier.
        One of the priorities that you have laid out is to focus
    resources more effectively, and you allocate nearly $2 billion
    for major and minor construction.
        Can you discuss with me what the VA is doing to ensure that
    construction is done in the most efficient and cost-effective
    manner?

                                  CONSTRUCTION

        And I ask this because I have long awaited for construction
    on the Columbus, Georgia, community-based health clinic to
    begin. And I am also awaiting word from the VA on the recipient
    of the award for the contract.
        And, moreover, there have been issues that have been
    brought to my attention that have arisen with VA's construction
    process.
        One specific project is the emergency room expansion at the
    VA North Health Care center in Dallas, Texas. I am told that
    this particular project experienced numerous concerns, such as
    extraordinarily slow implementation of contracts, which
    resulted in extension of an 18-month project by 16 months;
    improper direction from the contracting officer, suggesting
    that the contractor should submit the application for payment,
    although the VA hadn't obtained funding for a change order on
    the work; and various other contractor problems.
        What is the VA doing to really manage this construction
    process and to make sure that the contractors are performing,
    or are allowed to perform, and that the contracting officers
    really are adequately and efficiently managing the contracts?
        Secretary Shulkin. I think the facts of the past and the
    history suggest that we should have a lot of reason to be
    concerned about our ability to construct on time and on budget,
    so this is clearly a work in progress. As you know, we have
    been asked to bring in the Army Corps of Engineers on our major
    construction projects for greater oversight.
        In terms of the way that we operate internally, we are now
    in the process of a reorganization of our construction and
    facilities program. That is going to be reporting directly up
    to our Deputy Secretary to provide greater Department oversight
    and visibility into these processes.
        We do know that there is significant risk in dollars in not
    doing this right.
        The specifics on the Dallas facility, I am going to have to
    get back to you with further information on that. But we know
    there are enough examples like that that suggest that we have
    to be organized differently in order to be better stewards of
    taxpayer resources, quite frankly. This is something that the
    Deputy Secretary is taking on directly.
        [The information follows:]

        Construction on the Dallas VAMC emergency room expansion
    project was completed on July 6, 2018. Ribbon cutting occurred
    on August 9th.

        Mr. Bishop. I appreciate that. And let me go to the
    question of medical research.
        As one of four statutory missions, the Department is
    required to conduct education and training programs for
    students in health professions to enhance the quality of care
    that is provided to veteran patients within the VHA healthcare
    system. As you know, one of my major concerns over the years
    has been the VA's relationship with Historically Black Colleges
    and University Medical Schools.

                VA PARTNERSHIPS WITH HISTORICALLY BLACK COLLEGES

        Can you elaborate on VA's partnerships with Historically
    Black Colleges and Universities and what the VA can do to
    increase targeted training and education programs at the
    Historically Black Colleges and Universities, and other
    minority-serving institutions, and what plans the Department
    has to expand relationships with these institutions?
        Secretary Shulkin. We have reached out to these leading
    organizations around the country, and we want to do more. We
    think that VA offers tremendous training opportunities, and,
    frankly, it is in our interest to train these students so that
    they will look at VA as a potential future career.
        Just this week, I received a letter from the dean of
    Meharry Medical College and Morehouse Medical College
    reinstating their commitment to work with us on this and asking
    that my office be directly involved in making sure that we
    continue the progress.
        Our previous chief of staff had the lead in this, and since
    she has left the organization, we want to make sure that there
    is not a gap or a drop in that commitment, which we are
    extremely committed to, and they are committed to. So we are
    going to continue to work very closely with them to get more
    educational opportunities for their students into our
    organizations.
        Mr. Bishop. Thank you, Mr. Chairman.
        And thank you, Mr. Secretary.
        Mr. Dent. Thank you, Mr. Secretary.
        Ranking Member, do you have any additional questions at
    this time?
        Then, Mr. Secretary, I would like to thank you for your
    presentation. It is great to be with you again. Thank you for
    all the great work you are doing at the VA. It is a pleasure
    working with you.
        The next hearing is going to be on April 10.
        With that, this meeting is adjourned.

       [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                              Thursday, April 12, 2018.

    FISCAL YEAR 2019 BUDGET OVERSIGHT HEARING ON ENERGY, INSTALLATIONS, AND
                                  ENVIRONMENT

                                   WITNESSES

    HON. LUCIAN NIEMEYER, ASSISTANT SECRETARY OF DEFENSE OF ENERGY,
        INSTALLATIONS, AND ENVIRONMENT, DEPARTMENT OF DEFENSE
    LIEUTENANT GENERAL GWEN BINGHAM, ASSISTANT CHIEF OF STAFF FOR
        INSTALLATION MANAGEMENT, U.S. ARMY
    VICE ADMIRAL DIXON R. SMITH, DEPUTY CHIEF OF NAVAL OPERATIONS, FLEET
        READINESS AND LOGISTICS, U.S. NAVY
    MAJOR GENERAL VINCENT A. COGLIANESE, COMMANDER, MARINE CORPS
        INSTALLATIONS COMMAND AND ASSISTANT DEPUTY COMMANDANT, INSTALLATION
        AND LOGISTICS, U.S. MARINE CORPS
    MAJOR GENERAL TIMOTHY S. GREEN, AIR FORCE DIRECTOR OF CIVIL ENGINEERS,
        DEPUTY CHIEF OF STAFF FOR LOGISTICS, ENGINEERING AND FORCE
        PROTECTION, U.S. AIR FORCE

                       Opening Statement of Chairman Dent

        Mr. Dent. Good morning. Good morning, everybody, and I
    would like to welcome everybody to this morning's hearing, and
    oversight Hearing on Energy, Installations and the Environment
    for Fiscal Year 2019.
        It is great to see that the fiscal year 2019 budget request
    of $11.3 billion for military construction and family housing,
    including Overseas Contingency Operations (OCO), is an increase
    of $1 billion, or 9.6 percent above fiscal year 2018 budget
    requests and about $412 million above the fiscal year 2018
    enacted level.
        So hopefully this increase will address some of the most
    urgent construction needs within the services. The bipartisan
    budget agreement modified discretionary spending caps imposed
    by the BCA for fiscal years 2018 and 2019, which I am sure was
    a great relief to all in this room.
        The committee is still concerned how force structure
    changes will affect the military construction budget in fiscal
    year 2019 and beyond.
        Another high-profile issue is the European Deterrence
    Reassurance Initiative, which our allies are very interested in
    and for which the fiscal year 2019 budget request includes
    $921.4 million for 11 countries.
        Last, we have all a keen interest in managing our
    facilities better in terms requirements versus capacity, both
    overseas and in the United States. The panel before us today
    has a lot of answers to these questions, I am sure.
        But before I introduce our witnesses, I would like to turn
    to the ranking member, my friend and colleague from Florida,
    Ms. Debbie Wasserman Schultz, for any opening remarks that she
    might like to make at this time.

             Opening Statement of Ranking Member Wasserman Schultz

        Ms. Wasserman Schultz. Thank you, Mr. Chairman. I am
    pleased that we are going to be able to talk about the
    President's 2019 military construction budget request today.
    And while we normally have the civilian leadership here, we are
    really thrilled to have the distinguished servicemembers who
    are able to join us, so you can help explain military
    construction priorities and services.
        As you all know, we are once again functioning under
    another 2-year budget compromise passed by Congress earlier
    this year. The budget compromise raised the fiscal year 2018
    defense spending level from $549 billion dollars to $629
    billion, which is an $80 billion increase. For the second year
    of the deal, it provides an $85 billion increase.
        It was my hope these additional funds, however, would be
    better distributed among the Defense Department's needs,
    notably to ease the crowding barracks and address the mold and
    rust and other challenging conditions that we sometimes see.
    However, it appears that the focus remains on weapons systems
    and readiness.
        I am concerned about the Department's investment priorities
    for infrastructure. From 1990 to 2017, the percentage of MILCON
    family housing and the Department's obligational authority only
    increased from 1.2 percent to 4.5 percent. I am troubled that
    the Department is neglecting this need.
        If you remove specific initiatives like Overseas
    Contingency Operations (OCO) construction, base realignment,
    closure rounds and grow the force initiatives, the MILCON
    percentage of total Defense Department funding is likely much
    lower.
        While I believe that each of you has done a great job
    prioritizing your service's needs with the resources you have
    and doing what is best for the warfighter with the funds you
    request, this lack of investment compounds over time, as I have
    said to some of you when we met in my office. And it has real,
    often negative consequences for those who serve.
        For example, at Alaska's Joint Base Elmendorf-Richardson,
    the Air Force was concerned that they would have to park their
    $100 million F-35 outside because the hangar was simply not
    sufficient. I have been to other bases where outside parking of
    very expensive aerial equipment is a problem, so it is not just
    Alaska that is the problem.
        In Hawaii, at Joint Base Pearl Harbor-Hickam, the National
    Guard parks the F-22, a fifth-generation fighter that costs
    $339 million per airframe, inside a clamshell hangar made of
    semi-permanent tensile fabric and aluminum. Given that I live
    in hurricane alley, I can assure you this is simply not
    optimal.
        In addition to the lack of investment in our facilities
    that we need to house our weapons systems, I believe we are
    failing to invest in our most important asset; the soldier, the
    Marine, or the airman or sailor who protects our nation.
        Servicemembers and their family are regularly voicing
    frustrations over poor barracks conditions. I have had those
    frustrations expressed to me directly, the very places that we
    often ask our warfighters to return home to after tours. These
    brave men and women deserve decent shelter, and I fear that we
    are not always providing that.
        I am especially concerned that quality of life projects
    continue to be set aside as you all are forced to focus on
    other needs of the department. The Department of Defense
    leadership needs to do a better job of investing in critical
    infrastructures, and request a realistic number for military
    construction to ensure we have 21st century facilities to go
    with our 21st century weapons systems.
        What happens is that MILCON gets the leftovers. I mean,
    that is basically what happens. All the other budget priorities
    are taken care of and then whatever is left over is parked in
    MILCON. I would bet if we had more extensive conversations
    privately, each of you would agree.
        Mr. Chairman, in addition to making sure that we have
    modern infrastructure, we need to make sure that the Department
    is able to get rid of the infrastructure that it no longer
    needs.
        The recent National Defense Strategy stated that the
    department, quote, ``Will also work to reduce excess property
    and infrastructure, providing Congress with options for a base
    realignment and closure.'' I was surprised to see that after 6
    straight years of requesting a BRAC ground coupled with a
    National Defense Strategy, the Administration chose not to do
    so for fiscal year 2019.
        While I understand that a BRAC would be difficult for
    members, we cannot keep maintaining infrastructure that we no
    longer need. I am curious as to why we are taking a tool for
    saving money off the table.
        In addition to excess infrastructure, I have questions on
    why the Department plans to build another prison at Guantanamo
    Bay, a facility we should be closing. A $69 million facility--a
    $69 million facility--is a complete waste of valuable
    resources.
        And building a brand new facility for less than 50 people
    is a serious misallocation of resources, especially when you
    factor in that we will have to pay the sustainment costs for
    the next 5 years while the prison is being built.
        There are far higher MILCON priorities for which we could
    use that funding, some which I just described. As you can see,
    Mr. Chairman, we have some difficult issues to cover today, and
    I thank you for the opportunity to share my concerns.
        And if I could, Mr. Chairman, though, before we begin, I
    want to take a brief moment to acknowledge someone very special
    to me, who has been a part of my team on and off for a very
    long while.
        My Deputy Chief of Staff, Rosalyn Kumar will serve her last
    week with the United States House of Representatives next week,
    and this is her last hearing with us. I just wanted to thank
    her for her service, and not only to our country, but to me and
    the constituents of Florida's 23rd Congressional District.
    [Applause.]
        Ms. Wasserman Schultz. With that indulgence, I yield back
    the balance of my time.
        Mr. Dent. Thank you for those comments, Representative
    Wasserman Schultz. And Rosalyn, thank you for your service. It
    is much appreciated and we wish you all the best in your next
    chapter in life, whatever that may be.
        And but thank you for your dedicated service to the
    Congress when you entered this institution. It is deeply
    appreciated. We can't say thank you enough to a lot of the
    staff around here who really do a lot to help make us look very
    good on a regular basis.
        So with that, I would like to now introduce our very
    distinguished panel of guests, starting first with Mr. Lucian
    Niemeyer, Chadds Ford, Pennsylvania's finest.
        Mr. Niemeyer. Amen.
        Mr. Dent. Amen, yes, okay. Assistant Secretary of Defense
    for Energy Installations and Environment, Office of the
    Secretary of Defense.
        He is accompanied by Lieutenant General Gwen Bingham,
    Assistant Chief of Staff for Installations Management, U.S.
    Army. Thank you for being here.
        Vice Admiral Dixon Smith, Deputy Chief of Naval Operations,
    Fleet Readiness and Logistics, Navy.
        Major General Vincent Coglianese, almost Lansdale,
    Pennsylvania's finest, by the way, Commander, Marine Corps
    Installations Command and Assistant Deputy Commandant for
    Installations and Logistics FACILITIES.
        And Major-General Timothy Green, Director of Civil
    Engineers and Deputy Chief of Staff for Logistics, Engineering,
    Force Protection, Air Force. I am glad that civil engineers get
    a shout out in your title.
        And thank you for taking time to be here and for sharing
    your perspectives and expertise. And without objection, all
    written statements will be entered in the official record. Due
    to the number of witnesses, Mr. Niemeyer, please summarize your
    statement in about 5 minutes, if you would, so that we can
    maximize a time for dialogue between the panel and the
    subcommittee members.
        With that, you are recognized, Mr. Niemeyer.

                           Statement of Mr. Niemeyer

        Mr. Niemeyer. Chairman Dent, Ranking Member Wasserman
    Schultz, I really appreciate the opportunity here to discuss
    with you the President's fiscal year 2019 installations and
    environment programs.
        We look forward to working with this committee to support
    the priorities of the department and the quality of life for
    the military members and the family members who are called to
    sacrifice so much on behalf of our country.
        I have submitted my written statement for the record, and I
    am honored to speak on behalf of my colleagues representing the
    services here this morning.
        I wish we had prizes for how long our titles are. It seems
    that we get the longest in the Department of Defense, but I am
    definitely honored to speak on their behalf, and I am sure you
    will be able to talk to them more during the question period.
        Chairman Dent, I also realize this may be my one and only
    time testifying before you. I want to personally thank you on
    behalf of the women and men in the military for your service to
    our country and Congress. And I really appreciate the
    opportunity.
        We are grateful to Congress and the American people for the
    recently enacted Bipartisan Budget Act of 2018, which provided
    the resources to begin the recovery from the impacts of
    sequestration.
        We have a responsibility now to honor that trust of the
    American people, by spending each defense dollar wisely to
    address the most urgent priorities, to build a more lethal,
    resilient and rapidly innovating joint force.
        Earlier this year the President released a national
    security strategy, which guided the development of a national
    defense strategy to clearly articulate the threats and the
    challenges our nation faces around the world.
        Our mission is clear. We must be prepared to defend the
    homeland, remain the preeminent military power in the world,
    and advance international order that promotes security and
    prosperity.
        The strategy confronts the stark reality that the homeland
    is no longer a sanctuary. America is a target, whether from
    terrorists seeking to hurt our citizens, malicious cyber
    activity against personal, commercial or government
    infrastructure, or political and information subversion.
        Attacks against our critical defense, government and
    economic infrastructure must be anticipated, and more
    importantly, must be deterred. The strategy laid out by the
    Secretary of Defense also requires each of us in the department
    to help drive budget discipline and affordability in order to
    direct resources to the highest warfighter requirements.
        In our responsibilities for those who are at the table, we
    strive for the effective use of installations and ranges. Our
    2019 budget priorities enable the department to establish a
    foundation for rebuilding the U.S. military into a more
    capable, lethal and ready joint force. Each military services
    has distinct readiness recovery plans, and the increases are
    targeted to advance these plans.
        I know I speak for my colleagues to emphasis that
    readiness, modernization and reform are our top three
    priorities for each service. The Department of Defense supports
    these efforts.
        Continued congressional support for installations ensures
    that we sustain a total force that is lethal, efficient and
    trained to counter all threats across 21st century multi-domain
    battle space.
        In supporting these priorities, DOD representatives before
    you today provide warfighter capabilities through over 585,000
    installations facilities and over more than 500 bases.
        With replacement costs exceeding $1 trillion, and that
    doesn't include the 27 million acres that we train on, we also
    construct facilities to provide our combatant commanders
    overseas, in partnership with our allies, the base capability
    and adaptability needed for worldwide flexibility.
        The continued support of Congress, and in particularly the
    hard work of this subcommittee, enables us to enhance agility,
    resiliency and the readiness and lethality of our forces around
    the world.
        With a clear understanding of the roles of this team at
    this table supporting that strategy, we have set forth the
    following objectives to confront the challenges posed by years
    of underfunded facility accounts and as well as infrastructure
    accounts.
        Number one, we are using every program and funding source
    available to us to eliminate waste in Department of Defense
    (DOD) installations in infrastructure.
        Number two, we continue to advocate for adequate funding
    for the installation and infrastructure accounts to meet
    mission requirements and to address risks to safety and
    readiness.
        Number three, we are working to protect installations and
    ranges from incompatible development and to enhance the combat
    credibility of our nation's test and training ranges. And that
    is an important point. How do we actually start simulating more
    of what we may face around the world, and the abilities to
    resource that to be able to provide our warfighters an adequate
    training and test environment?
        We are implementing programs to enhance the inner security
    of our forces and assets. This is one of our highest priorities
    here, and we ask for the support of the committee. What more
    can we do to make ourselves more resilient, more secure from
    those who want to attack our electrical grid, or attack or
    exploit our facility related control systems where we really
    need this continuous support of this committee in those
    particular priorities.
        We are exploring new opportunities, number five, for third-
    party partnerships engaging with industries to determine the
    best practices for our current challenges.
        Number six, we are working with the military engineering
    contracting community to develop smarter contracts and to
    execute our contracts more smartly.
        We continue to provide for the safety and welfare of our
    people and our resources through unparalleled environmental
    stewardship and occupational safety programs.
        And last, but definitely not least, we are enhancing our
    collaboration with the hundreds of defense communities that you
    represent and we represent around the nation, supporting our
    bases and providing for the quality of life for our troops and
    their families.
        These guiding principles will allow us to apply the
    resources requested in fiscal year 2019 budget to achieve real
    results. We have requested $10.5 billion for military
    construction and family housing appropriations, an increase of
    about $700 million from the fiscal year 2018 base budget.
        While this request before you makes significant progress in
    recapitalizing facilities in poor and failing condition, this
    year's funding will not fully restore the damage caused by
    years of sequestration.
        Many of our facilities have degraded significantly from
    reduced investments in all accounts. As the ranking member
    pointed out, the department currently has an unfunded backlog
    exceeding $116 billion. A lot of our facilities are in either
    failed or poor condition.
        This will ultimately result in DOD facing larger bills in
    the future to go ahead and restore or replace facilities that
    deteriorate prematurely. The stark reality is that it may be
    too costly to buy or sell us out of this backlog.
        The Department must ensure that its infrastructure is
    ideally sized to increase the lethality of U.S. forces while
    minimizing the costs of maintaining unneeded capacity, which
    otherwise diverts resources from critical readiness and
    modernization requirements.
        As noted in the National Defense Strategy, we continue to
    work to reduce excess capacity in infrastructure. And we will
    work with Congress on options for base realignments and
    closures.
        We realize that we have asked for 6 years, and for 6 years,
    Congress has said no. We can't keep doing that. We have to work
    with you on a common way forward that will allow us to make
    prudent reductions in our infrastructure.
        We must ensure that our basic infrastructure is ideally
    sized to increase the lethality of our forces while minimizing
    the costs of maintaining unneeded capacity.
        These efforts will be enhanced by a careful evaluation we
    are currently conducting of how and where we base new forces,
    new technologies, new capabilities in support of the national
    defense strategy. Where and how we base new hypersonic systems,
    autonomous vehicles, cyber forces that will have an impact on
    their lethality.
        We need to assess the ideal methods for the training and
    deployment of the directed energy programs, electronic warfare,
    and artificial intelligence programs. All of these concepts,
    which are called for and this country desperately needs, needs
    to have a basic infrastructure that will allow us to be able to
    train them effectively.
        In lieu of another BRAC request in 2019 to authorize
    initial BRAC round, we are reviewing our facilities to include
    facility usage optimization. Are we actually ideally sized and
    are we putting the right number of people in our buildings to
    ensure we have a better accounting of excess infrastructure.
        Our efforts will allow us to work with Congress further on
    fair, objective and transparent options for future base
    realignments and closures.
        Absent a new request and a new BRAC round, DOD has also
    largely been focused on routine demolition and renovation of
    buildings is part of our MILCON program. The Department is
    dedicated additional resources in fiscal year 2019 to demolish
    more unneeded facilities, including $442 million specifically
    for demolition and another $65 million as part of our MILCON
    program. This is one step we can take now to go ahead and meet
    that goal.
        In order to deliver maximum results for our MILCON program,
    we are targeting funding into key areas and I will go through
    that. As actually I have submitted those for the record, and I
    will go ahead and point those out, but they are stated for the
    record.
        One program that is absolutely essential to us, Mr.
    Chairman, is the ERCIP program. That is the Energy Resiliency
    Conservation Improvement Program (ERCIP). We are using that
    $150 million, and we hope at some point we will be able to
    raise that, to allow us to address those critical resiliency
    projects that are absolutely important for us for energy
    security.
        For many years we have been doing energy projects that
    don't necessarily feed those critical missions. We are trying
    to get that changed right now, put investments so all those
    projects we worked on the last few years, we can now power our
    critical facilities.
        The Department is also committed to protecting the quality
    of life for military personnel and their families by ensuring
    access to suitable, affordable housing and unaccompanied
    barracks. The environment and quality of life which our forces
    and families experience, has an impact on their ability to do
    their job and the ability of our departments to recruit and
    retain.
        We do have a significant unaccompanied barracks
    recapitalization program, well over $1 billion. And we look
    forward to help us renovate or upgrade over almost 2,000 new
    beds. And we are very proud of the fact that we continue to
    invest in those types of quality of life projects.
        We do have challenges we are facing. We have an unstable
    bid climate, particularly as a result of the storms that have
    affected the southern part of the United States and Puerto
    Rico.
        That is driving uncertainty in our military construction
    programs, for which we are asking for to have the flexibility
    to be able to continue to apply bid savings for those projects
    that we desperately need that are high priorities that we need
    to continue, even though we might have a higher bid than usual
    due to what is happening with our labor markets. But ask for
    your support in helping us maintain those unobligated balances.
        We also have challenges with project delivery. This
    committee and the Appropriations Committees last year had some
    serious discussions and we have taken on some serious efforts
    with the Army Corps of Engineers and Naval Facilities Command
    on trying to get better project delivery.
        Too many of our projects are coming in behind schedule or
    over budget. We are working very diligently with our
    construction manager partners to try to rein that in.
        Restoring the military readiness requires us that we
    maintain access to training lands and for the protection of the
    health of our force.
        The Department's environmental budget accomplishes these
    objectives through activities ranging from managing critical
    habitats to avoiding training restrictions to addressing
    drinking water health advisories are making the best use of
    limited clean-up dollars.
        Our warfighters also need unencumbered access to land,
    water and air space to----
        Mr. Dent. Mr. Secretary? Mr. Secretary, may I ask that you
    wrap up your remarks quickly because I would like to let the
    other panelists make some brief remarks. I want to keep as many
    members as I can here for questioning.
        Mr. Niemeyer. Sure thing. I will go ahead and just point
    out the fact that we are also working on land management
    issues. And I will go ahead and just finalize comments to the
    extent of saying thank you, Mr. Chairman. Thank you, ranking
    member and thank you for the members of the panel for your
    support for our priorities and continued support for the men
    and women of the military. Thank you.
        [The information follows:]

      [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Dent. Thank you. And I would like to see if any of the
    other panelists would like to make any opening remarks for the
    record?

                       DOD JURISDICTION FOR A BORDER WALL

        If not, then I will go right to the questions. We will
    start right in. And first, Mr. Niemeyer, I would like to talk
    about the so-called border wall. Ultimately, the border wall
    would be a function of the Department of Homeland Security. It
    would be under their bill if it were to ever be funded.
        What part of the wall would be at the cost to DOD and
    specifically for military construction? And what authorities
    currently exist to enable MILCON dollars to be used to pay for
    the so-called wall? Are there any new authorities that would be
    required?
        Mr. Niemeyer. So we are in the preliminary stages of
    responding to the President's desire to want to do more on the
    border. As you know, we have already deployed forces there,
    consistent with what has been done in the past.
        And as far as additional investments for the wall itself,
    we are exploring options about what potentially could be done.
    We are very much in the preliminary stages of that. There are
    authorities that do exist in law, but we understand that
    Congress provided those authorities for very specific
    instances.
        And we are looking to see to what extent that they could be
    used, to what extent they are appropriated more importantly.
    Our continued desire to want to work with the committees to
    making sure that we are working with you on the use of those
    authorities.

                      COST OF DOD PORTION OF A BORDER WALL

        Mr. Dent. And what do you think the cost to DOD would be in
    terms of MILCON? You haven't been able to determine that?
        Mr. Niemeyer. First of all, we have determined that we
    would be looking at a relatively small portion of the overall
    1,900-mile construction. So we are really looking at the
    portion that runs adjacent or along the Barry Goldwater
    Military Range. So we are talking total of about 37 miles.
        We don't have a firm estimate because there is a range of
    options about what we would be asked to do there. So we are
    still exploring that, to what degree we can do that and what
    ultimately it would cost. I don't have any firm estimates for
    you at this time.
        Mr. Dent. Okay. Is it correct too that DOD can only build
    on DOD property?
        Mr. Niemeyer. That is the current understanding, sir.
        Mr. Dent. Okay. And you said the approximate number of
    miles is about 37 on the Goldwater Range? That is about the
    extent of it then?
        Mr. Niemeyer. That is what we are looking at right now and
    part of that already has a barrier, so----
        Mr. Dent. So the whole 2,000-mile border under MILCON,
    maximum you would estimate would be 37 miles?
        Mr. Niemeyer. We have not been asked to take a look at the
    entire portion for use of DOD dollars.
        Mr. Dent. Okay, and all right. Thanks for that answer. I
    appreciate that.

                      RHINE ORDNANCE BARRACKS ENERGY STUDY

        I would like to also now move to another issue for you, Mr.
    Niemeyer. In fiscal year 2018 a House report for the committee
    we directed the Defense Health Agency to report to Congress on
    specific changes in Germany Energy Law that delayed the Rhine
    Ordnance Barracks Medical Center's replacement lifecycle cost
    analysis. That is a mouthful, and what effect the changes have
    on current facilities and construction in the region.
        Could you provide us an update on the energy study and what
    effects, if any, the changes would have the replacement
    project?
        Mr. Niemeyer. So I can give you some overall response to
    that legislation. I think the Army can give you some specifics
    about what we are looking at for that particular area. We
    definitely understand the intent of Congress.
        There is a concern that using sources that would be
    dependent on Russia is probably not in our best interests right
    now because it is subject to potentially as being disrupted. So
    we are looking at a dedicated preferred domestic source of fuel
    that will allow us to have the flexibility and the freedom
    without necessarily relying on foreign energy sources.
        And, you know, I am not sure--General Bingham if you have
    anything to add to that?
        General Bingham. Good morning, Mr. Chairman. I really can't
    talk to the specifics of the source for that particular
    hospital, but I can tell you that decision-making process is in
    progress. And we will look at the reliability of those energy
    sources.
        What I can tell you as it relates to in the broader scheme
    of energy security and resilience, last year our Acting
    Secretary signed out a directive whereby all our installations
    would get after being able to provide for energy and water
    security for a period of 14 days. We are taking our threats
    very seriously to that end and going about it that way.
        Mr. Dent. Thank you for that answer.

              BIPARTISAN BUDGET AGREEMENT INCREASE FUNDING FOR DOD

        And now my final question before I yield to the ranking
    member. As a result of the budget deal for fiscal years 2018
    and 2019, there is an increase in Department of Defense
    funding, as you all know. I supported that budget agreement and
    want the department to spend the money wisely.
        I do not support any intention or idea to alter this
    agreement at this time. Could you provide some insight to the
    committee on how the department plans on spending the increase
    in military construction dollars?
        Mr. Niemeyer. For?
        Mr. Dent. For 2019.
        Mr. Niemeyer. For 2019?
        Mr. Dent. Yes.
        Mr. Niemeyer. Mainly looking at our National Defense
    Strategy and seeing where we have additional requirements that
    could be funded. It runs the gamut from operational facilities.
    We are looking at some additional projects overseas for 2019
    that we added to our budget. But as far as significant cuts it
    is about a $700 million total that we were able to add to our
    overall requests.
        Mr. Dent. Thank you.
        And at this time I recognize the ranking member for her
    questions.

                     HIGH VALUE DETENTION FACILITY AT GTMO

        Ms. Wasserman Schultz. Thank you, Mr. Chairman.
        Mr. Secretary, I mentioned in my opening remarks my concern
    about the Administration's proposed fiscal year 2019 $69
    million expenditure for a high value detention facility at
    GTMO. That facility would be built for 41 people at best. Due
    to potential transfers that have been reported in the press,
    that number could drop.
        But even with the 41 detainees, it would cost $1.7 million
    per detainee for this facility. It is a facility that wouldn't
    even be finished until 2022.
        Given that in my opening remarks and in our conversation in
    my office, we have both acknowledged that there are very high
    priorities, many of which the chairman and I have seen; whether
    it is in Puerto Rico, in Florida, across the country, across
    the world in MILCON, that I would say are a much higher
    priority in terms of their deterioration than the plight of
    providing a better facility for a maximum of 41 detainees in
    GTMO, a facility that should be closed.
        Can you explain why we need a facility for 41 people to
    spend $1.7 million----
        Mr. Niemeyer. Yes, ma'am.
        Ms. Wasserman Schultz [continuing]. Per detainee rather
    than making sure that we can take care of our service personnel
    who certainly could benefit much more from those funds?
        Mr. Niemeyer. Yes, ma'am. I mean, this is a tough
    situation. Our policy in Guantanamo Bay has been contentious
    for many years. I know there are still bad guys out there that
    want to kill people that have been determined by this
    administration we need to go ahead and detain, continue to
    detain at Guantanamo Bay.
        That particular facility is a replacement facility and so
    we have realized we have some pretty poor and continuing to
    deteriorate existing facilities.
        And for years while we were looking at the policy to close
    GTMO we didn't really reinvest that facility so it is in pretty
    bad shape right now. And we do have a responsibility if we are
    going to maintain a function down there that we do need to
    offer adequate facilities for the care of the detainees we do
    have. The cost is very expensive.
        Ms. Wasserman Schultz. Secretary, forgive me, but why would
    it be a higher priority to provide more comfortable facilities
    for these 41 people and not build more barracks so that we have
    more comfortable facilities for our soldiers, airmen, seamen
    and Marines?
        Mr. Niemeyer. Yes. I am not sure we are actually creating a
    better quality of life for them. I think there is a
    realization----
        Ms. Wasserman Schultz. If you are building them a brand new
    facility, that is a better quality of life than a deteriorating
    facility.
        Mr. Niemeyer. We have had 8 years where we have had no
    investments in there because we felt that we had a policy that
    we were trying to close our detention operations there.
        Ms. Wasserman Schultz. Right.
        Mr. Niemeyer. So there has been no investment. So what we
    are really trying to is, okay, now we have made the decision,
    okay. Guess what----
        Ms. Wasserman Schultz. What I am asking you is why is it a
    higher priority to build a facility that would provide, you
    know, better conditions for 41 so-called bad dudes, as the
    president refers to them, than for the good dudes that are
    serving our country and trying to keep us safe?
        Mr. Niemeyer. I think we have a responsibility to anybody
    that is under our care whether it be bad or good----
        Ms. Wasserman Schultz. Why do we have a higher
    responsibility to the bad dudes at GTMO than we do to our
    military service members who are protecting our country?
        Mr. Niemeyer. We balance the full range of our missions in
    the Department of Defense to include maintaining detention
    operations. And so we have priorities for our women and men in
    the military, but we also have a responsibility that if we are
    going to maintain our operation there that at least we address
    the life, safety, health concerns that might be getting worse
    for that particular facility.
        Ms. Wasserman Schultz. The President made a campaign pledge
    that is not really an answer. And if your answer is that we
    should put the needs and well-being of 41 detainees at GTMO
    higher than the people who serve our country, than that is
    really demonstrative of this Administration's backwards
    priorities.
        But the President has also made a campaign pledge to load
    up GTMO with some bad dudes. Are there plans to ramp up
    operations at GTMO?
        Mr. Niemeyer. That I don't know. I mean it is really
    difficult to anticipate who you might be catching in the
    future, and it is beyond my understanding. I just know that we
    were given a military construction requirement to replace the
    deteriorating----
        Ms. Wasserman Schultz. It is not difficult. I mean, while
    we are searching--are we planning on, as we search and hunt
    down bad dudes, are we planning to use GTMO and ramp up
    operations there to add to the detainees that are there now?
        Mr. Niemeyer. I am not at a point right now where I can
    answer that. I just know we have a military construction
    request----
        Ms. Wasserman Schultz. Why?
        Mr. Niemeyer. Because it is tough to anticipate what we
    think we may need in the future.
        Ms. Wasserman Schultz. Well, you are building a brand new
    facility for 41 people at best. To me, that signals--which
    won't even be ready until 2022--that you are ramping up
    operations there. Unless, you are just being colossally
    fiscally irresponsible and think it is okay to spend $1.7
    million per detainee.
        Mr. Niemeyer. From our perspective it signals that we
    realize that we are going to have a long-term operation there
    and that we need to then make sure----
        Ms. Wasserman Schultz. So your answer is yes.
        Mr. Niemeyer [continuing]. That they are adequately
    housing--I am sorry?
        Ms. Wasserman Schultz. Your answer is yes then?
        Mr. Niemeyer. About what?
        Ms. Wasserman Schultz. About ramping up operations.
        Mr. Niemeyer. I just--no, I don't know if we are going to
    ramp up operations. I don't know who we might end up having in
    the future?
        Ms. Wasserman Schultz. What does long-term mean?
        Mr. Niemeyer. Long-term is as long as those folks we can
    either adjudicate their process or in some case now they have
    been convicted and for the long term it is a----
        Ms. Wasserman Schultz. Some of them haven't even been----
        Mr. Niemeyer [continuing]. Detention facility. That is
    correct. We are in the process of working that.
        Ms. Wasserman Schultz. How will this facility be used after
    the Joint Task Force (JTF) mission ends?
        Mr. Niemeyer. I don't know what the follow-on mission would
    be. It is tough for me to make that call right now. We do know
    that we have taken a prudent step. I mean, with the area cost
    factor in GTMO being so high, it is an expensive facility.
        The reason why it is going to take until 2022 is if we want
    to accelerate it it would cost us more. So we have made some
    prudent decisions on trying to minimize the cost to the
    taxpayer while addressing the life, safety, health concerns.

                     SUSTAINMENT COSTS OF CURRENT FACILITY

        Ms. Wasserman Schultz. Lastly, since you touched on that,
    before I yield back, Mr. Chairman, thank you for your
    indulgence. Obviously, you are going to have to use operation
    and maintenance money to sustain the facility. What are the
    current sustainment costs and how much has been invested in the
    facility since it started to fail?
        Mr. Niemeyer. The existing facilities? I would have to get
    that for the record. I don't have that with me.
        Ms. Wasserman Schultz. Okay. If you could do that?
        Thank you, Mr. Chairman. I yield back.
        Mr. Niemeyer. Yes, ma'am.
        Mr. Dent. I would like to recognize the gentleman from West
    Virginia for 5 minutes. Mr. Jenkins.

                         NATIONAL GUARD TRAINING LANDS

        Mr. Jenkins. Thank you, Mr. Chairman.
        Welcome. It is an honor to have you all here and thank you
    for all you do for our men and women in uniform. Thank you for
    your service. I am from, as the chairman said, West Virginia
    and candidly, we have been ravaged over the last 8 years, the
    war on coal. We have got a lot of hardworking coalminers put
    out of work.
        These are people who have gone into the bowels of the
    earth, done tough jobs, worked with their hands, are problem
    solvers. But we have also got a lot of land in West Virginia.
    In fact, there is a piece of property originally called Hobet
    Mine--it is Rock Creek now--12,000 acres, less than a drive's
    day from over one half of the nation's population.
        And I was struck by your use of the word simulating and in
    your also written comments about readiness and prepare for the
    battles that we fight around the world. We have got steep
    hills. We have got flat land. We have got almost, like, desert
    terrain.
        So my question is our National Guard in West Virginia,
    which we are so proud of, is already using--they are saving
    money on transportation, on other training cost factors.
        Where is this 12,000 acres on your-all's radar screen as a
    possibility for investment in DOD to simulate, to train, to
    repair equipment? It is geographically pretty darn good, and it
    is a pretty special area that could be put to good use.
        Mr. Niemeyer. So Congressman, the military services take
    the lead and they are in the process right now of looking at
    what they need for additional training lands in a whole
    different variation of topographies around the country. The
    Navy is working on a significant land expansion for Naval Air
    Station (NAS) Fallon to what degree we could use the terrain
    that is unique.
        I have actually been out that area. It is something that I
    would wanna work with the National Guard on, work with the
    Department of the Army and see, okay, how does that fit into an
    overall training regimen, particularly when General Milley is
    looking for variations, new ways to train his forces. So that
    is something we will take a look at.
        I don't have specifics on it right now. I am not sure if
    the Army does, but go ahead.
        General Bingham. Thank you, Congressman Jenkins. I
    appreciate your question because I often find myself, as a
    former senior commander, saying that there is absolutely
    nothing we do inside our gates without the full support and
    partnership of our community leader and state leaders outside
    our gates.
        And so what we could do is link your team up with our Army
    G-3 to assess what you are proposing and get back to you on
    that.
        Mr. Jenkins. Well, we would welcome that. And you have got
    a very ready and willing partner inside the gate and outside
    the gate. As an outside-the-gate guy, who is proud father of a
    son who is inside the gate, you really would have incredible
    support from community, from state and local government and
    certainly the federal representatives.
        And my sense is you might find outside the gate in some
    states not as welcoming as you would be. We are a proud
    military state, probably from a per capita standpoint, one of
    the highest military service member state in the country.

                               READINESS CENTERS

        The other area of quick attention--and thank you for your
    commitment to work with our office and others to see if we
    can't put this land to good use--and that is our readiness
    centers in West Virginia. We have 31 readiness centers.
        I certainly, obviously, don't expect to hear at this point
    the commitment or the deep familiarity with those particular
    facilities, but we really would like to work with you about our
    readiness centers in West Virginia.
        We have got 5,000 National Guardsmen and women and 31
    readiness centers, so there is a real facility needs in our
    state. And we look forward to looking with you and your budget
    line items. Any comments about readiness centers and the
    investment to making sure that those are up to the standards
    that we would expect?
        General Bingham. Thank you again, Congressman. Actually,
    the National Guard has a transformation plan that really is the
    blueprint, if you will, for what we look at as we look to
    investment. And so our investments in those readiness centers
    is informed by that plan. We know that the guard has well over
    1,000 readiness centers.
        And when we look at sustainment dollars, restoration
    modernization dollars and MILCON dollars, we certainly wanna
    get after those that bring about readiness for your guardsmen.
    Currently, our guard requests in fiscal year 2019, there are
    five projects that total $106 million
        Mr. Jenkins. Thank you.
        General Bingham. Thank you for your question.
        Mr. Jenkins. Thank you so much. Look forward to working
    with you about Rock Creek, Hobet, our readiness centers, and
    thank you again for your service.
        I yield back.
        Mr. Dent. Thank you, Mr. Jenkins.
        At this time, I would like to recognize the gentle lady
    from California, Ms. Lee, for 5 minutes.

                   ENVIRONMENTAL REMEDIATION AT CONVEYED LAND

        Ms. Lee. Thank you very much.
        Welcome. Thank you for your service. And just if you don't
    know, I am the daughter of a veteran, 25 years a military brat,
    stationed at Fort Bliss, Texas, born in El Paso.
        And so quality of life issues for our troops and our
    veterans are extremely important to me. I know personally the
    sacrifices that are made by our servicemen and woman, and want
    to make sure everything that we do ensures their safety, but
    also that they are able to live healthy lives and continue
    forward with their service.
        Wanted to ask you a couple of questions with regard to
    specifically my district in the East Bay, including Alameda
    Point. I think, Vice Admiral Smith, maybe you could answer this
    question for me. The City of Alameda took title to about 1,400
    acres of land from the Navy in I believe it was 2013 and the
    V.A. took about 624 acres.
        It has cost about $560 million now as it relates to
    environmental cleanup. Still not completed, but I think the
    repurposing of Alameda Point with this V.A. clinic, it is a
    good example of what can be done. The environmental remediation
    efforts are still continuing.
        And I wondered when you think that may be completed and
    what the next steps would be in terms of long-term
    environmental sustainability and the overall stewardship
    efforts of that?
        Admiral Smith. Yes, ma'am. Thank you for the question. And
    you articulated with the numbers, we have transferred the
    majority of it. We are down to about 19--new environmental
    issue we have got.
        And as a result of that, we are now working with V.A.
    regulatory folks to figure out what is the right way ahead on
    that. Based upon that, now we are looking at finishing
    transferring probably around 2022, ma'am, right now.
        Ms. Lee. 2022?
        Admiral Smith. Yes, ma'am.
        Ms. Lee. Why is it taking so long?
        Admiral Smith. Well, because, you know, we want to make
    sure that we are turning over land that has been properly
    decontaminated and we don't run into the problem that we did
    with the land we have already transferred there that we now
    have that problem with.
        Ms. Lee. Yes.
        Admiral Smith. And so we have gotta do it right. We are not
    sure how to remediate it yet, so we have gotta work through
    with the regulatory agencies to make sure we do it the right
    way. And as you know, with PFOS-PFOA, we as a country have not
    figured out the right way to deal with that yet, so we are
    working through it.
        [The information follows:]

        The remaining environmental remediation and discovery of
    radium at NAS Alameda is not anticipated to impact or delay the
    housing projects or VA's outpatient clinic.

        Ms. Lee. Okay. And let me just ask you--I want to clarify
    for myself. This is not going to impact the construction and
    the work with regard to the V.A. clinic in terms of your
    timeframe of the environmental cleanup.
        Admiral Smith. I am going to have to take that for the
    record. I don't have that specific detail.
        Ms. Lee. I don't know if it is that same area or not. I
    will double-check.
        Admiral Smith. Yes, yes. So I owe that to you.

                         OAKLAND ARMY BASE REMEDIATION

        Ms. Lee. Okay. With regard to the Oakland Army Base, I
    guess--Lieutenant General Bingham, good to see you.
        General Bingham. Good to see you, too----
        Ms. Lee. Yes.
        General Bingham [continuing]. Congresswoman.
        Ms. Lee. Lieutenant General.
        General Bingham. Thank you.
        Ms. Lee. That is awesome. [Laughter.]
        General Bingham. Very humbling.
        Ms. Lee. That is awesome.
        General Bingham. Very humbling.
        Mr. Niemeyer. Hopefully general someday, huh? [Laughter.]
        Ms. Lee. Wow. The Oakland Army Base remediation, what are
    any of the current issues that you see? I know there have been
    some difficulties in terms of this remediation effort. Not sure
    exactly what they are, but we are trying to get this done as
    quickly as possible.
        And again, we have got a lot of work to do on that Army
    base and I wanna see if there are any outstanding issues that I
    need to know about that or that our people in the city need to
    know about.
        General Bingham. Thank you, Congresswoman Lee. We are
    working through two remediation projects there in Oakland Army
    Base at this time. We are pretty much going through the
    schedule, I should say, as it relates to the cleanup effort. I
    don't see any problems at this time, certainly none to involve
    you. And I think those efforts are ongoing.
        But if there should be a problem with that, we will come
    back to your office and let you know. But at this time, we
    don't foresee any problems. Although, we have those two
    remediation efforts ongoing.
        Ms. Lee. Do you have any idea of when they will be
    complete?
        General Bingham. I don't know. I can come back to your
    staff with an estimate----
        Ms. Lee. I would like to get a sense of completion date.
        General Bingham. I will be happy to come back to you with
    that.
        [The information follows:]

        The Army is currently working on two remediation projects
    at Oakland Army Base. They are designated as Parcel 1 and
    Operable Unit 2.
        Army is negotiating with the California Department of Toxic
    Substances Control on final terms for the Parcel 1 site revised
    Record of Decision (ROD), which will include the schedule for
    clean-up and property transfer. The revised schedule will be
    provided to your office and stakeholders upon resolution of
    outstanding issues and signature of the ROD. Fieldwork will be
    complete approximately 4 months after ROD signature.
        Regarding Operable Unit 2, the Army is preparing a draft
    Wetland Focused Feasibility Study that will inform the
    appropriate cleanup remedy for the site. Required fieldwork to
    complete the study is delayed, pending physical access to the
    wetland area through railroad property owned by the Port of
    Oakland.
        Actions at Operable Unit 2 do not affect the Parcel 1
    property transfer.
        The Army will continue to provide periodic updates on
    remediation progress at Oakland Army Base to you.

        Ms. Lee. Okay. Thank you.
        General Bingham. Thank you.

                    FORT BLISS HOSPITAL CONSTRUCTION DELAYS

        Ms. Lee. And then Assistant Secretary Niemeyer?
        Mr. Niemeyer. Yes, ma'am.
        Ms. Lee. Yes. Good to meet you. Fort Bliss, Texas--and I am
    working with Congressman O'Rourke who represents El Paso and
    Fort Bliss on these issues. And again, as I said, I was born in
    El Paso, and I have a very keen interest in what is taking
    place at Fort Bliss.
        And Congressman O'Rourke and myself, we are aware of the
    significant delays as it relates to the contractor who is
    building--the construction delays for the new Beaumont
    Hospital. And I am wondering just in general, seeing what has
    taken place in terms of the history of this construction of
    Beaumont, how are you looking at cost overruns now and how do
    we manage this moving forward?
        Because it is severely over budget, this one project, I
    know, 'cause I have looked at it with Congressman O'Rourke. And
    how do we correct for that in the future?
        Mr. Niemeyer. Ma'am, that is an outstanding question and we
    have been spending a lot of time on that in the last 8 months
    as I took this position. I have been meeting with General
    Semonite personally on that.
        This is a project that not only is behind schedule, it is
    significantly over cost. It really is a posterchild for us on
    what we need to do better in the future.
        There were some management changes on the part of the both
    the Corps of Engineers and the contractor. So really what we
    had was some bad relationships going. There is no way a
    personal relationship should interfere a project like that, so
    we have made some changes. More importantly, looking forward,
    we are using that as an example where we can get better across
    the board across the Department of Defense.
        And at the same time, we are also trying to work very, you
    know, diligently, meeting once every 2 weeks right now at the
    senior leadership levels to make sure that project gets back on
    track, we deliver that critical capability to women and men at
    Fort Bliss. It has been a tragic series of errors that has led
    to that almost a year and a half delay.
        Ms. Lee. Mr. Chairman, let me just ask you, though, are
    there ever any penalties associated with these huge cost
    overruns with contractors that mess up big time like they have
    at Fort Bliss? Or do we just say moving forward now, that was
    then and this is now, and we are gonna make sure it is done
    correctly in the future''?
        Mr. Niemeyer. So Congress asked us to actually get the
    Inspector General involved, so we have a DOD I.G. investigation
    going on on that particular project to determine if there is
    any culpability or any concerns that we need to take a look at.
    There are damages that are applied when the contract is running
    late, normally they are called liquidated damages onto the
    contractor.
        It may not be enough to change behavior right now, and I am
    not sure the construction contractor is solely the problem. I
    think we had a problem with the design and some other issues,
    too, with the program management.
        Ms. Lee. Yes. Okay.
        Mr. Niemeyer. So the goal for us, ma'am, is to get to the
    bottom of this, to making sure we understand clearly what went
    wrong, when. If we need to hold people accountable, we will.
    But more importantly is to use this as--first of all, get this
    project back on track, but not to make these mistakes again in
    the future.
        Ms. Lee. Okay, thank you very much. Could you just keep
    Congressman O'Rourke and myself----
        Mr. Niemeyer. Absolutely, ma'am.
        Ms. Lee [continuing]. Informed of this?
        Mr. Niemeyer. Yes, ma'am.
        Ms. Lee. Thank you, Mr. Chairman.
        Mr. Dent. Let us move to Mr. Taylor from Virginia.

                             CONTRACTING MECHANISM

        Mr. Taylor. Thank you, Mr. Chairman.
        And appreciate you guys being here, appreciate your
    service, and please give our best to the men and women who
    serve under you as well and we appreciate them.
        A couple things--let us see--bids. You know, you talked
    about bid costs and, obviously, there is a plus-up and we have
    a timing issue, of course. Are you guys using things like Other
    Transaction Authorities (OTAs) and Small Business Innovation
    Research (SBIR) for contract vehicles to make sure that we are
    being able to spend the money and do it efficiently and
    effectively?
        Mr. Niemeyer. So we have been given a lot of money in a
    short amount of time, particularly in the O&M accounts. And I
    think that is something that all the Services and the Execution
    Agencies have taken seriously. We have about 5 months to
    address some of the readiness needs in our country.
        We are pursuing any possible opportunity to include
    expedited contracting while still being able to provide a good
    product that addresses our warfighter needs. It is going to be
    a challenge, but the services are dedicated to coming up with
    the best projects and the best way to spend the money between
    now and October 31st, particularly in O&M.
        Mr. Taylor. Are they using those----
        Mr. Niemeyer. Or October 1st.
        Mr. Taylor [continuing]. Those contract vehicles, like OTAs
    and SPIRs?
        Mr. Niemeyer. That and others. I mean, we have a whole
    range of abilities to be able to put money towards good
    projects.

                          BASE CLOSURE AND REALIGNMENT

        Mr. Taylor. Appreciate it. You spoke about 6 years asking
    for a BRAC and Congress saying no. I agree. I just want to be
    on the record that I agree with that statement. I think that we
    need to make some courageous decisions up here, otherwise, we
    are contributing to the problem, if you will.

                         RESILIENCY AND SEA LEVEL RISE

        Virginia Beach and the State of Virginia have been very
    good about spending monies, if you will, dealing with
    encroachment on things like Oceana and trying to work with
    resiliency.
        And on the subject of resiliency, of course, we have sea
    level rise in Virginia that does affect our bases. Have there
    been studies, actions, requests for money to ensure resiliency
    around those bases?
        Mr. Niemeyer. Yes, that is the key step here is right now
    is we are taking a look at what needs to be done, what has been
    done. We have always responded to flood conditions as part of
    what we have done as military engineers, why we look at
    preserving our military capabilities across the country. And we
    will continue to do that.
        In the Hampton Roads area in Virginia Beach, wherever we
    can make good decisions about how high we raise a dry dock or
    how high we raise a dam, those are all engineering decisions
    that we make every day. And we will continue to make those as
    we see, you know, conditions change around the country.
        Mr. Taylor. If I may, and specifically in the Hampton Roads
    area with sea level rise, not being reactionary, but are we
    also looking at potentially investing in the future and
    understanding where we are gonna be years out?
        Mr. Niemeyer. Right, so we are looking at adjustments to
    what our engineering forecasts are and to what degree we can
    start planning now, and just making prudent engineering
    decisions across the board and be able to make our facilities
    resilient to whatever may happen. You know, could be a lot of
    things that ultimately could affect environmental conditions
    and affect our facilities. The goal is resiliency across the
    board.
        Do you want to add?
        General Green. Yes, sir. I would like to add, for Langley
    Air Force Base, which is in that same region, we have already
    raised the elevations of our new construction. We have already
    moved mechanical rooms and things like that from basements up
    to higher elevations.
        So part of it is just, as you said, prudent planning, and I
    think that is being done both on the Navy side but certainly on
    the Air Force side. We are already altering how we do the
    engineering work to protect our facilities and our missions.

                   EXCESS CAPACITY AT MILITARY INSTALLATIONS

        Mr. Taylor. Appreciate that. You know, we were talking
    about realignment and talking about getting monies for demo,
    and General, we spoke about it as well. And I have had meetings
    with senior military leaders, installation commanders, talking
    about excess infrastructure and the cost. And like I just said,
    I am on the record about that Congress has to also make some
    tough decisions on that note.
        But can I just get a quick briefing from each of the
    services. We talked to the services in OSD and requested, you
    know, where they are. Can you just speak your current posture
    as it pertains to excess infrastructure and any plans for
    targeted demolition going forward?
        General Bingham. Thank you, Congressman, I appreciate the
    question. Actually, we have looked at our excess
    infrastructure. We know we have about 170 million square feet
    of excess capacity. It is not all contiguous space.
        So what we did in the Army, we took on an initiative we
    call the reduce the footprint, which we were able to
    consolidate our soldiers into our best facilities first, use
    conversion authority and then demo those facilities that were
    in poor and failing condition that we know we wouldn't use
    again.
        We have really taken on our demolition budget since 2016.
    We have increased it significantly. And I can tell you in 2018,
    we have about $100 million that is going toward demolition. In
    fiscal year 2019, we more than doubled that, well over $200
    million. So we are taking it seriously and we are trying to rid
    ourselves of that excess because we know it is costing dollars.
        Mr. Taylor. Thank you.
        Admiral Smith. Now, Congressman, so for the Navy we
    estimate we have between 7 percent and 9 percent excess
    infrastructure right now. This year, with the increased budget
    proposal, for the first time in several years, we are putting a
    significant amount of money to demolition in the order of $122
    million.
        We have currently got an integrated priority list of about
    $311 million, so about a little of a third we are going after
    in 2019. That compares to zero dollars to demolition last year,
    $8 million the year before. So much like the Army and I am sure
    all the services, we are going after it this year as proposed
    budgets gives us that opportunity to do it.
        Mr. Taylor. Thank you.
        General Coglianese. Congressman, thanks for the question.
    We talked a little bit about this yesterday. In the
    infrastructure reset program that was signed by the commandant,
    it is really a Comprehensive program and demolition is a big
    part of it.
        We are looking to reduce footprint over the FYDP by 11
    million square feet. We are investing in PB 2019 is 1.8 million
    square feet, about $77 million.
        And what does that give us? In the strategy itself, we want
    to reduce and optimize the infrastructure footprint, make
    facilities investments at the lowest lifecycle cost and
    leverage the best practices and process and align the
    installation management enterprise we govern. So we signed--
    recently the Assistant Commandant of the Marine Corps signed a
    governance.
        And the 1.8 million square feet, what does that equate to?
    It is really a great return on investment because it is about
    $19.4 million of cost avoidance or ability to invest in another
    program, you know? And so I said $77 million for PB 2019 pretty
    much with a goal across the FYDP to reduce 11 million square
    feet just for this FYDP.
        So we are going after it. The low-hanging fruit is easy
    right now. I mean, the demolition to go after it and as we get
    rid of that excess and we kind of consolidate our forces and
    better use of space management of our facilities it will be
    harder to get after that next round, but thank you for the
    question. I think it is a really important part of our
    strategy.
        General Green. Thank you, sir. So like the others we are
    working on space management and how we utilize that. We don't
    have so many units that have stood down and so we don't have
    vacant buildings per se so it is about how we use the space
    within that.
        And then as you hear the Air Force talk about excess
    capacity much of that is also associated with ramp space, where
    we have the ability to park aircraft. And so as long as we have
    got missions there it is about how we need to better leverage
    our facility space and consolidations, and you have given us
    some new authorities from Congress to do that better in the
    future.
        And then we spend roughly--we have budgeted roughly about
    $25 million a year, give or take, but we are usually over-
    executing that amount to do consolidation and demolition.
        Mr. Taylor. Thank you, General. Thank you.
        Thank you, Mr. Chairman.
        Mr. Dent. Mr. Valadao.

                NAVAL AIR STATION LEMOORE MILITARY CONSTRUCTION

        Mr. Valadao. Thank you, Mr. Chairman.
        Thank you, guests, for your time today and for your service
    to our nation. My questions are mostly aimed at Vice Admiral
    Smith, but if the Assistant Secretary wants to touch in, please
    do.
        The Navy's installation master plan for 2030 for Naval Air
    Station Lemoore highlights that a large portion of then--
    Lemoore facilities and infrastructure are original to the base,
    which was commissioned in 1961.
        The master plan lists a series of prioritized military
    construction projects needed to support the Navy's vision for
    NAS Lemoore as the premier strike fighter master jet base.
    However, the master plan separates master plan priority
    projects and those needed to support the arrival of the F-35C.
        Given the high importance of both new mission military
    construction and the maintenance of existing facilities, how
    does the Navy plan to prioritize investments, support current
    missions and plan growth in personnel and families? And I would
    like something touched upon especially with the hospital,
    clinic and how our sailors have access to and their families
    health care there on the base?
        Admiral Smith. Yes, sir, Congressman, thank you. And thank
    you for that. So as you are aware, between fiscal year 2015 to
    2023 we are putting in over half a billion dollars into
    Lemoore. The preponderance of that is for F-35. With respect to
    other parts, especially on the other side of the base on the
    quality of life side, we have put a lot into the quality of
    life part of that. And whether it be renovating the gym,
    putting in treks, the things that you have seen.
        So it is a balanced approach. Yes, the preponderance is to
    support F-35 and the requirements that that aircraft has.
        With respect to the clinic, the branch medical clinic
    there, so after our discussion yesterday I went and pulled some
    more data on that. So OB deliveries are done at a local clinic
    by Navy physicians. Based upon some of the concerns that were
    raised that you articulated yesterday, the acute care clinic
    hours have expanded so they now run from 7:00 in the morning
    until 11:00 at night.
        For inpatient they are using Hanford Hospital. So I spoke
    to the surgeon general's office yesterday to relay the concerns
    that you are hearing from our sailors that are out there to
    make sure he understands that. And we are aware of that to
    continue to work for and address those concerns as best we can,
    sir.

                 HOSPITALS INSTEAD OF CLINICS ON INSTALLATIONS

        Mr. Valadao. Okay. Well, and the clinic used to be a
    hospital there on the base----
        Admiral Smith. Yes.
        Mr. Valadao [continuing]. Was something that I have heard
    from a lot of sailors. Every time I go out anywhere around the
    world and visit with our sailors or even there on the base that
    is the first thing they mention is they always appreciated
    having that hospital knowing that their family had somewhere
    close to home in case of an emergency for their loved ones.

                               DROUGHT CONDITIONS

        The other question has a little bit to do with the drought.
    California has been experiencing historic drought conditions. I
    mean, it got a little bit better last year, but this past year
    we are kind of on path again.
        And as you know, such conditions change the operating
    environment at Naval Air Station Lemoore. During dry periods,
    dust, ground debris and increased bird strikes exacerbate
    operational safety challenges for flight operations.
        Additionally, drought conditions increase public health
    concerns for military personnel and dependents, specifically at
    NAS Lemoore where valley fever poses a threat. What is the
    current status of drought preparedness and resilience at NAS
    Lemoore? And are there any additional actions that can be taken
    to improve operations out there?
        Admiral Smith. Yes, sir. So as you know, there are 12,000
    acres out there that is ag land and to be able to farm that
    land water is essential. And so Lemoore is working closely with
    the water district out there, as you are well-aware.
        This also kind of ties into what we are doing to the
    question we discussed yesterday with respect to the solar PV
    that is going out there. So that is solar PV. We are providing
    930 acres for that. That will not provide any power to Lemoore.
    That will go into the local grid.
        Mr. Valadao. Yes.
        Admiral Smith. The delay right now is because they are
    trying to find a utility provider who will actually connect to
    the grid. So the in-kind we will get back from that is a 4.5
    megawatt generator to power the critical facilities in case of
    a loss.
        So it is a win-win for us because it does give us
    additional redundancy and capability from an energy needs
    perspective, but it also takes of that 12,000 acres it is
    taking almost 1,000 out of the agricultural requirement with
    the drainage settlement agreement and then the company that
    runs the PV farm is responsible for maintaining BASH
    requirements there.
        Mr. Valadao. All right. Well, thank you.
        And Mr. Chairman, I yield back.
        Mr. Dent. Mr. Fortenberry:

                               ENERGY RESILIENCE

        Mr. Fortenberry. Thank you, Mr. Chairman.
        Thank you all for appearing before us today. I want to ask
    you about three areas of policy concern, two of which, or all
    three actually, were in the initial statement: The conservation
    initiatives, the issue of energy resilience, as well as what
    you all keep referring to as BRAC. And so we are going to have
    a little challenging conversation on that.
        First, regarding conservation, I was pleasantly surprised
    to see a lengthy section in your written testimony about the
    DOD's initiatives in this regard. I have recently introduced a
    bill. It is called Recovering America's Wildlife Act.
        And interesting you point out that there is a surge of
    potential endangered species being listed coming. And that the
    DOD is orienting itself to participate in preventative measures
    in that regard.
        This is exactly what the Recovering America's Wildlife Act
    does. Bipartisan initiative taking some monies that come from
    our mineral revenues, off of federal lands and plowing it back
    into state wildlife management plans, which is a federal
    mandate. In Nebraska we work voluntarily giving landowners
    choice in this regard.
        But the DOD as a part of your policy planning culture
    should really take a look at this because it could help us
    create the continuity of habitat with existing public lands, as
    you are already doing, that addressed environmental species
    problems. Because once that starts you are in the midst of
    litigation, the regulation moves to litigation it is a horrible
    mess.
        So not many people win, not many communities win. Species
    don't necessarily win because it takes so long.
        So this is an innovative approach to, again, trying to
    provide the continuity of habitat by funding existing state
    initiatives with federal mineral resource revenues, and so it
    is actually being a good steward of the revenues that we have
    or the resources that we have, revenue extraction back into
    resource recovery.
        So Recovering America's Wildlife Act I would like you,
    again, to be aware of this and to potentially incorporate it
    into your policy planning culture, because it could greatly, I
    think, assist you in the larger goal. Our problem is we address
    this in small verticals rather than in a continuity.
        And given the large footprint of the DOD particularly with
    land holdings, this could be extremely helpful.
        So I am very pleased that you raised this in the testimony.
    So can I have some mild commitment that you will integrate this
    into your policy planning?
        Mr. Niemeyer. Congressman, we will definitely take a look
    at it. And as I said in my written statement, we are working
    really diligently with Department of Interior (DOI) across the
    board to----
        Mr. Fortenberry. I saw that, yes.
        Mr. Niemeyer [continuing]. To see what we can do to get in
    front and proactively manage. We are not in any way trying to
    dismiss the Endangered Species Act. We think it is absolutely
    critical----
        Mr. Fortenberry. Well, this is an attempt to move from,
    again, regulation and litigation----
        Mr. Niemeyer. Right, right.
        Mr. Fortenberry [continuing]. To collaboration----
        Mr. Niemeyer. Yes, that is----
        Mr. Fortenberry [continuing]. Which ends up saving all of
    us a huge amount of money in the long run and actually achieves
    the mission of the Endangered Species Act. So it is a novel
    approach.
        Mr. Niemeyer. Well, we are working very consistently with
    what you are proposing there.
        Mr. Fortenberry. Well, we are also working with the
    Department of Interior in this regard, so we may be back in
    touch. OK?
        Mr. Niemeyer. Yes.
        Mr. Fortenberry. Energy resilience you have a 25 percent
    goal of use of renewable resources by 2025. How are we coming?
        Mr. Niemeyer. Coming along.
        Mr. Fortenberry. What is the best case story out there, the
    best return on investment? Do you have some case studies that
    are showing that could be scalable templates that could be
    implemented?
        Mr. Niemeyer. We are continuing to look at all sources of
    energy. Renewable is one source, but we are looking across the
    board. We definitely have a desire to want to take our goals
    with----
        Mr. Fortenberry. Yes, but that is your mandate, 25 percent
    renewable by 2025.
        Mr. Niemeyer. Right. We are working towards that goal, but
    honestly we are as concerned with providing security, energy
    security to our most critical facilities. To what degree that
    goal is compatible with our overwhelming compelling urgency to
    making sure our critical facilities can be powered----
        Mr. Fortenberry. Okay, do you have case studies or actually
    implemented processes that could be scalable across the system
    that meet your goal for security and energy resilience but
    actually is consistent with the broader mandate here?
        Mr. Niemeyer. We are working across a whole range of
    efforts.
        Mr. Fortenberry. But specifics? I need examples.
        Mr. Niemeyer. Certainly, if I can ask the services----
        Mr. Fortenberry. Examples?
        Mr. Niemeyer [continuing]. To provide specifics?
        Mr. Fortenberry. Okay.
        General Coglianese. Yes, sir, thanks for the question again
    and the support. So each installation is different because of
    the environments, and I will give you a good example of energy
    security. And we are----
        Mr. Fortenberry. I have two military installations,
    Strategic Command and Offutt Air Force Base, do I get it.
        General Coglianese. Yes, sir.
        Mr. Fortenberry. I mean, so but just back to specifics----
        General Coglianese. Sure.
        Mr. Fortenberry [continuing]. That are might possibly
    scalable. I am sorry. I am just running out of time. I need to
    hurry along.
        General Coglianese. Yes, sir. So an example is Miramar
    where we are taking methane off a----
        Mr. Fortenberry. Right.
        General Coglianese [continuing]. A wasteland----
        Mr. Fortenberry. Good.
        General Coglianese. It is how we are getting methane. We
    will be putting a microgrid in there and we will be able to--
    our goal is to operate off the grid.
        Mr. Fortenberry. Okay, let me ask you this. That is great.
    That is very helpful. What is the process internally by which
    you are sharing best practices? Is there some continuity of
    initiatives going on or is it up to each base to sort of crate
    its own culture in this regard?
        Mr. Niemeyer. At the Office of Secretary of Defense (OSD)
    level we are working very closely with the services. It is
    every project that comes in we are taking a look at where can
    we use that? Those lessons are in another----
        Mr. Fortenberry. Okay, I may come back to this in the next
    round because I am running out of time, but thank you. Thank
    you. So we--hold the thought so let us unpack it a little bit
    further.
        General Coglianese. Yes, sir.

                                  BRAC NAMING

        Mr. Fortenberry. One more comment, Mr. Chairman, if you
    will indulge me? Look, we keep doing this--we keep using the--
    it is now a word, BRAC. Does anybody remember what it means?
        Yes, but it has become its own word like Xerox means copy.
    So we need to move past this, okay? That was somebody else's
    idea 25 years ago. Not the intention necessarily, but the way
    in which we speak about this because we are not implementing it
    in this way.
        So I am proposing this to you all as I have proposed before
    previous panels for years that we move away from the term
    because the term causes such indigestion. Okay? This is a new
    term: MISC. It stands for miscellaneous military installation
    savings commission. It is a much less threatening kind of
    prospect and it is consistent with what you all are already
    doing.
        And if I could, maybe in the next round, and perhaps you
    said this earlier, I apologize because I wasn't here, but I
    would like to know the excess inventory across all branches. So
    if we could just have that in the forefront of our mind again.
        But when you start saying this closes, this closes, which
    is, frankly, not real in the environment we are up here, rather
    than well, look, we have got this outbuilding here that could
    be sold to Lincoln Parks and Recreation and then carved out.
    That is a higher and better use for the community.
        That is consistent with this and it is a lot less
    frightening and it is more politically viable than the large-
    scale base realignment closure commission, which again, that is
    just not reality.
        Thank you, Mr. Chairman.
        Mr. Dent. Thank you, Mr. Fortenberry.
        I have an acronym I am gonna share with you a little later.
    [Laughter.]
        Thank you.
        Mr. Fortenberry. Stop. [Laughter.]
        Mr. Dent. I would like to recognize the ranking member, Ms.
    Wasserman Schultz.
        Ms. Wasserman Schultz. Thank you----
        Mr. Dent. We are starting the second round of questioning.

                                   DETAINEES

        Ms. Wasserman Schultz. Thank you, Mr. Chairman.
        Just to put a bow on the end of my last series of
    questions, I had a chance to look up what the average cost
    according to the Federal Register is of incarcerating federal
    inmates. Fiscal year 2015 is the most recent year we have
    numbers for. $31,977.65 as opposed to a $1.7 million cost per
    detainee at GTMO--a colossal waste of money and an example of
    backward priorities.

                                  BORDER WALL

        Mr. Secretary, I have questions for you about the border
    wall. How would moving money from other priority projects,
    which we have already appropriated for in the omnibus bill,
    using existing DOD authorities to build part of the border
    wall, not circumvent Congress' appropriations authority, which
    was decided in the omnibus appropriations bill?
        Mr. Niemeyer. We don't have a lot of ability to do that. We
    can use bid savings, for instance, collectively. All the
    projects we executed we have excess money we could then, you
    know, identify that as a source.
        We do have a very limited ability with consultation with
    Congress. It would require us to come over and talk to you. And
    if we feel we have a compelling need that we can find lower
    priority projects and to further execution--cancel them to
    further execution take those dollars and apply it to what we
    would have to convince you is a more compelling requirement and
    then have the ability to backfill those projects in the future.
        Ms. Wasserman Schultz. What type of projects would the
    Department not be able to execute if you choose to use that
    authority to execute a border wall?
        Mr. Niemeyer. Oh, I can't say we would not execute it. It
    would maybe be defer. It would be project that we feel we don't
    have a compelling need to carry out in that year.
        Ms. Wasserman Schultz. What type? What type?
        Mr. Niemeyer. Oh, gosh, I am----
        Ms. Wasserman Schultz. We need more specifics.
        Mr. Niemeyer. Oh, I couldn't tell you right now what
    specific project or what types of projects.
        Ms. Wasserman Schultz. Respectfully, if you already have
    been asked, as I know you have been, to draft potential options
    for how to move money to build whatever portion of the border
    wall you can, you do have an idea specifically of what kind of
    projects would not be able to be executed, would be delayed----
        Mr. Niemeyer. Yes, ma'am.
        Ms. Wasserman Schultz [continuing]. In order to--yes.
        Mr. Niemeyer. We have not been asked to get into that level
    of detail. All we are looking at is exploring what is even the
    range of congressional law or congressional authorizations,
    what is that range? And we haven't gotten to----
        Ms. Wasserman Schultz. Again, respectfully----
        Mr. Niemeyer [continuing]. Build the list.
        Ms. Wasserman Schultz [continuing]. If you know that 37
    miles of the wall in Arizona would be built then you know what
    projects you would be moving the money from to be able to build
    that 37 miles of wall. If you know where you would be able to
    build it, then you know from where you would take it to build
    it.
        Mr. Niemeyer. We have not built a list of projects from
    prior years that we would defer, not cancel, and then more
    importantly the first thing I would want to do is look at prior
    year unobligated balances and apply that first. We don't have
    to change any priority. We don't have to effect any other
    MILCON project.
        Ms. Wasserman Schultz. So what plans are you drafting then?
        Mr. Niemeyer. It is more just exploring options. It is
    really is looking at the range of what authorities exist.
        Ms. Wasserman Schultz. So, you are exploring options
    without any detail at all?
        Mr. Niemeyer. At this point we have not been asked for more
    detail.
        Ms. Wasserman Schultz. Okay, you understand that that
    doesn't make any sense, right? You have to know where you are
    taking the money from in order to know how much you are going
    to have, in order to build what it is you are planning.
        Mr. Niemeyer. So we laid out for the president a range of
    options of which he has chosen to deploy forces to the border
    consistent with previous administrations.
        The other options really haven't gone beyond just hey, they
    are out there. We have not actually been asked to take any
    action doing the planning.
        Ms. Wasserman Schultz. Okay. The chairman and I just had an
    opportunity to go down to Puerto Rico to look at the impact
    that Hurricane Maria and Irma have had on the military
    facilities there. They are in pretty bad shape.
        Mr. Niemeyer. Yes, ma'am.
        Ms. Wasserman Schultz. It is really not good. One of the
    biggest issues that you have is energy resilience. They were
    without power for days.
        Mr. Niemeyer. Yes, ma'am.
        Ms. Wasserman Schultz. You really haven't mentioned Puerto
    Rico at all. What is it that you are doing to make sure that
    this key component of our defense infrastructure, which is
    energy resiliency is a high priority?
        Mr. Niemeyer. And as you know, PREPA, I mean there was a
    lot of concerns about the entire island and they are in the
    process right now of reassessing the entire utility
    infrastructure. And the Corps of Engineers has got a big part
    of that long-term planning and ultimately having crucial
    resiliency for the entire island.
        Fort Buchanan had some redundant power sources. Those did
    survive, but it is still long term it may not be the answer. So
    that is part of what we are looking across the board. Where can
    we enhance our energy security and resilience, as opposed to
    other priorities?
        Ms. Wasserman Schultz. There were numerous stories that we
    have heard about how services are still using World War II era
    facilities. We saw some of those facilities. They were in bad
    shape to begin with and we gave them the authority in a
    supplemental to build beyond just the existing standard.
        How many World War II era facilities are there across the
    entire DOD enterprise?
        Mr. Niemeyer. Yes, I don't know that off the top of my head
    how many older facilities we had. You know a lot them are
    historical so they are still being well-used.
        And so I would have to go back and pull, you know, exactly
    the data pre-World War II, which I assume we would know that
    are obsolete or no longer needed is what you are looking for,
    right? I can take that for the record.
        Ms. Wasserman Schultz. Thank you, Mr. Chairman. I yield
    back.
        Mr. Dent. Thank you.
        Mr. Niemeyer, I was going to ask quickly about--it is a
    mouthful--addressing PFOS and PFOA. I won't read the acronym.
    And by the way, on the acronym came up with one, didn't I?
        Mr. Fortenberry. It is quite good actually.
        Mr. Dent. FORT, funding our readiness together okay----
        [Laughter.]
        As opposed to this. Mr.----[Laughter.]
        Fortenberry, so okay, but----
        Mr. Fortenberry. It is brilliant, Mr. Chair. [Laughter.]
        Ms. Wasserman Schultz. You guys have another side option if
    you quit your day job.
        Mr. Dent. That took me 15 seconds----
        Ms. Wasserman Schultz. Coming up with acronyms. [Laughter.]
        Mr. Dent. But addressing the PFOS and PFOA, DOD has tested
    all 524 DOD-owned drinking systems worldwide. Can you provide a
    list of the affected installations broken out by BRAC active
    and reserve component and what appropriations account was
    responsible for funding that cleanup?
        Mr. Niemeyer. Yes, ma'am. Yes, sir, I can do that.
        Mr. Dent. That would be great. And then----
        Mr. Niemeyer. I can't do it right now.
        Mr. Dent. Yes, I understand. [Laughter.]
        So at a later date, I understand. I didn't expect you to
    have that at your fingertips, but that is a very important
    issue to some of us and some of our communities where we have
    had these----
        Mr. Niemeyer. It is an issue which we are spending so much
    time in the department on that, Mr. Chairman, with the services
    coming up with the right way to respond. We would love to
    continue to work with EPA. I think some of that requires a
    federal response how we are going to address that issue.
        Mr. Dent. Okay. I would like to now move--this is kind of
    more or less to all the witnesses before us today. The fiscal
    year 2019 budget request proposes a decrease of funding in
    every reserve and guard component construction account. The
    guard and reserves have pressing needs for access control
    points and ranges, in some locations aircraft hangars.
        For example, the Air Force Reserve has two hangars and one
    main gate on the Air Force unfunded priority lists and Air
    Force Reserve has one hangar and two small arms ranges also on
    the unfunded priority list. Of note the Army and active reserve
    components have not submitted any unfunded priority lists at
    this moment.
        How can it be expected the guard and reserve to be properly
    trained if you are providing them inadequate resources for
    their facility? Maybe I would start with the Air Force and we
    will go back to the Army. We will do it that way.
        General Green. So thank you, Mr. Chairman. Thank you, Mr.
    Chairman. the resources provided for the guard and reserve
    mirror those provided to the active component. And so in this
    case when we talk about a reduction in funds this year it
    mirrors the reduction in funds that the active Air Force has.
        So it has really been about prioritizing amongst all of our
    ranges of missions in accordance with the national defense
    strategy. So as we focused on readiness and lethality and
    modernization this year, we made choices that resulted in
    reduced accounts across the active guard and reserve components
    for facilities and infrastructure.
        Mr. Dent. Could you also answer this, too? Are of the
    projects on the unfunded priority list for the Air Guard and
    Reserve requested in the future defense program or are they
    truly unfunded requirements?
        General Green. Typically we have brought forward items that
    were already in the future years' defense program, and I would
    have to go back and look at each individual project, but that
    is how we have done that on both the active guard and reserve
    in the past is if we can accelerate a program or a project as
    appropriate that is what we choose to ask for your support in
    doing.
        Mr. Dent. And I would like--General Bingham, would you like
    to add anything? Thank you.
        General Bingham. Thank you, Chairman Dent. As you
    mentioned, we did not submit MILCON on the CSA's UFR list was
    not on it. I will tell you though that as a total Army the
    projects that we have in fiscal year 2019 are well-represented
    across both the guard, reserves as well as the active
    component.
        And so what we do we prioritize those facilities as it
    relates to operational requirements, whether they be motor
    pools, airfields, railheads or the readiness centers in the
    case of the guard and reserves to make sure that we across the
    force have what we need.
        Mr. Dent. Anybody else, either the admiral or general?
    Either of you want to add anything on this issue?
        Admiral Smith. So I don't have any--I mean, we are working
    on our Navy Operational Support Center (NOSCs) and we have got
    consolidation projects we are trying to bring in the fence
    line. There are no specific MILCONs this year for the NOSCs.
        Mr. Dent. Okay.
        General.
        General Coglianese. Chairman, I know just on sustainment we
    have increased from 2018 to 2019 on FSRM for MARFORRES and also
    construction. So it is pretty stead for us and no decrease as
    far as I have in front of me. I can get back to you the exact
    numbers though, sir.
        Mr. Dent. Okay. Thank you, General.
        At this time I would like to recognize the gentlelady from
    California, Miss Lee.
        Ms. Lee. Thanks very much. Let me ask Secretary Niemeyer
    about the issue as it relates to waste, fraud and abuse in
    general. Now, for years I have been working with Congressman
    Burgess and other Republicans. We have been doing this in a
    bipartisan way to try to get an audit of the Pentagon.
        Three years delayed now, who knows when it is gonna be
    complete. Several years ago it was reported in the Washington
    Post that maybe $125 billion in waste, fraud and abuse. That
    report was somehow squashed.
        Listening today to the comments with regard to the border
    wall, the possible $69 million for maybe 41 or less inmates at
    Guantanamo, and this upcoming military parade. I mean, this is
    one of the reasons--I don't vote for the defense budget. I vote
    for our budget generally here because this is more about our
    troops and quality of life.
        But how do you see this whole issue of waste, fraud and
    abuse within your jurisdiction and what can we do to make sure
    that we move the Pentagon along if that is something that you
    can do? Because this is getting to be outrageous because it is
    taking away from quality of life priorities for our troops.
        Mr. Niemeyer. So each of the services and and the military
    departments--I mean, military departments and defense agencies
    are dedicated and working on it right now. We have a process
    where we are doing internal audits. It is called FIRE is the
    acronym.
        We are spending a lot of time and resources on trying to
    get to an auditable financial statement for each of the
    servicers that we can present to Congress. It is an effort
    which has been delayed. It has been going on for a while.
        Our goal here is to be as transparent, as accountable for
    every dollar we spend. I know that is our priority right now.
    Secretary Mattis has made it very clear to us.
        So we are committed to trying to get to auditable financial
    statements for each defense agency. You saw DLA have theirs
    released a few months ago. Other agencies will follow. Services
    aren't that far behind. Actually Marine Corps is doing some
    good work.
        And so I think we are getting there. It is definitely
    taking longer than the American people deserve or expect. But
    we are making some good progress, particularly in the last 2
    years on trying to get to those financial statements.
        Ms. Lee. Do you have any role in this upcoming, quote,
    military parade that this president is presenting to the public
    for whatever reasons he is doing this?
        Mr. Niemeyer. No, ma'am, I do not.
        Ms. Lee. You don't have any--you don't have any fiscal
    responsibility----
        Mr. Niemeyer. No, ma'am.
        Ms. Lee [continuing]. For this parade?
        Mr. Niemeyer. No.
        Ms. Lee. Okay. Let me ask you with regard to your
    contracting as it relates to minority, women-owned, veteran-
    owned businesses. I am a former small business owner, 11 years
    8-A (it's a specific class) contractor. And it was really hard
    to break into DOD. I wanted to find out right now how your
    agency is doing as it relates to contracting and subcontracting
    with minority and women-owned and veteran-owned businesses?
        Mr. Niemeyer. So my office works within the secretary of
    acquisition sustainment and that is a top priority of Ms. Lord
    is to take a look at what can we do to break down the barriers
    to have innovative young businesses, small businesses come up
    with an adaptive acquisition framework where we can open the
    doors to some of these smaller businesses with their innovative
    ideas and come in and do business with the department of
    Defense?
        It is difficult not just for small businesses but for all
    businesses to have to enter into the bureaucracy of the federal
    acquisition regulations and other forms and all kinds of things
    we impose upon our contractors.
        We are diligently working not just for the bigs and the
    mids, but also those small businesses to what degree we can
    incentivize them to want to continue to do business with the
    department.
        Ms. Lee. Okay. Not just small businesses, mind you.
        Mr. Niemeyer. No. Yes.
        Ms. Lee. Do you know the distinction?
        Mr. Niemeyer. Oh, yes, ma'am, I do.
        Ms. Lee [continuing]. Between minority-owned business----
        Mr. Niemeyer. Yes, ma'am.
        Ms. Lee [continuing]. Women-owned businesses, veteran-owned
    businesses and small businesses because if you have the
    reporting data--if you have the data it will show, as many
    agencies show that the small businesses contracting and
    subcontracting may be a bit better than the contracting with
    minority-owned businesses, specifically African American-owned
    businesses and women-owned businesses and veteran-owned
    businesses.
        Mr. Niemeyer. So we track by categories making sure we meet
    our quotas across the board for the full range acquisition
    programs within DOD.
        Ms. Lee. Could you submit to us the report?
        Mr. Niemeyer. Yes, ma'am.
        Ms. Lee. And I would like to see, if you can, disaggregate
    the data based on gender and ethnicity.
        Mr. Niemeyer. Yes, ma'am.
        Ms. Lee. Okay. Thank you very much.
        Thank you, Mr. Chairman.
        Mr. Dent. Mr. Fortenberry.
        Mr. Fortenberry. Thank you, Mr. Chairman.
        General, I interrupted you, so if you would like to
    continue your train of thought about best practices in terms of
    implementation of stable energy projects?
        And then if someone would comment further as to how this is
    discussed internally in terms of sharing templates or ideas,
    just tell me the process. That would be helpful.
        General Coglianese. So with the goal, and we have always
    had the goal. I mean, our installations are combat power, to
    project combat power in time of peace and support a national
    defense period. And that is what we are out there for.
        So over the years we have done some, I think, some really
    good projects to force the ability to operate off the grid,
    whether it is pulling methane off the San Diego, whether it is
    co-generation plants at twentynine Palms, which we would be
    able to operate off the grid, whether it is Albany, Georgia, a
    depot, which we are basically net zero down there.
        But it is about operating combat power and each
    installation depending, as you know, sir, whether you are in a
    warm hemisphere area or a desert or a mountainous area, what
    renewables, what type of energy resiliency, it applies more
    geographically than it.
        We share that within the Department of Navy and then with
    OSD. So I think the information is out there. Now we just have
    to make the right investments, I think, to ensure not just the
    renewable energy but that microgrid ability or wheel energy
    around that base in order to generate combat power.
        Mr. Fortenberry. Look, your comments are fair, that your
    mission is to keep us safe and you have to do that through the
    means that are available to you. However, because again, the
    footprint is so large and the investment is so big, sometimes
    what by thinking constructively and creatively you actually
    can, for the long term, enhance the ability to deliver a
    mission under adverse circumstances while also furthering a
    larger societal goal.
        And you have talked about it here in terms of environmental
    protection, but also in terms of establishing the next phases
    and generations of what we need to move to anyway in terms of
    bridging to a more sustainable future.
        So it is not putting that fundamental mission on the DOD
    but to the degree you can partner with it and leverage it for
    your own sake, but also furthering this broad societal public
    good is necessary. That is why I am trying to understand best
    practices that are out there and then the internal dynamics in
    which those are shared.
        From my perspective, looking from the outside in, dealing
    primarily with, not in this capacity but in who I represent
    back home, we have just kicked off the initiative to try to
    create a working group around deeper exploration of how is
    geothermal possible, is wind where we are possible.
        Solar has potential, but there are some complexities where
    I live. So can anyone address this? Yes, General?
        General Bingham. Thank you, Vice Chairman Fortenberry, and
    I would like to comment on when I talked about partnerships and
    working outside the gates, if you will. When you talk about it,
    think about energy security and resilience in the state of
    Hawaii right now, the Army has taken on a partnership with
    Hawaii Electric Company for a 50-megawatt biofuel plant.
        And the intent of that is in the case of a natural disaster
    or power interruption we are able to sustain the whole of
    Schofield Barracks, Wheeler Airfield, Kunia Field and one of
    the local hospitals for a period of 30 days. It is above the
    tsunami zone and we think that is a model, a partnership----
        Mr. Fortenberry. Okay, all right, well, you now live in a
    state where there is public power, so sometimes it is a little
    easier for us to actually urge a municipal entity to partner
    constructively with another municipal entity and that is what
    we are trying to do.
        But there are all types of distributed generation options
    that are out there, and again, they might be able to
    incorporate depending on circumstances, sustainable energy
    models.
        Mr. Niemeyer. I will also say that the Army and the Air
    Force actually collaborated their efforts. They took their
    energy offices and combined them into one. So they are taking
    the lessons learned every day and they are applying them.
        And now we are looking at, okay, now let us bundle them at
    more than one installation. Let us look at our range of
    missions as to what we can do working with a local utility
    company on addressing the utility needs without just having to
    be in these stovepipes.
        So there is a lot of that collaboration going on right now
    within DOD.
        Mr. Fortenberry. Okay, good.
        Yes, sir?
        Admiral Smith. Sir, I was really going to echo the same
    thing. So the Navy has got an office that focuses on this. They
    also work collaboratively and share the----
        Mr. Fortenberry. Called the Energy Office?
        Admiral Smith. Yes sir. REPO, Renewable Energy Office that
    is now actually Resiliency Office, that resides in Naval
    Facilities Command and we have done a lot of work over the past
    couple years putting in projects. We have got a lot of projects
    going right now. And I can easily get you a list of what has
    been done and what is happening with specifics.
        Mr. Fortenberry. Well, that is okay. That is just more work
    for you guys, because I would just ask you to keep doing this
    because it is important for this broader reasons that we just
    discussed here.
        But again, I don't know if it is a mandate or a strong
    suggestion, somewhere embedded in law, but by 2025, 25 percent
    now. I hear what you are saying about geographic diversity and
    it has got to be consistent with the fundamental mission. I get
    that, but I think it can be.
        So we are pushing on this back home as well just to let you
    all know, so I may have officials at the installations that I
    work directly would come directly. Would that be all right, Mr.
    Secretary?
        Mr. Niemeyer. Absolutely.
        Mr. Fortenberry. Secondly, back to the Military
    Installation Savings Commission, what is just a quick summary
    of your excess inventory across the branches?
        General Green. So we will go from my end. The last reported
    savings that we had was roughly 30 percent or excess. The
    majority of that, as I alluded to earlier, is really built upon
    ramps. And so we are right now working toward getting our arms
    better around facilities. So people normally associate
    facilities and excess facilities, and I don't have a good
    figure to give you.
        Mr. Fortenberry. What do you mean on ramps? Runway?
        General Green. So bases, so when we talk about ramps is
    where we park out aircraft and so if you have reduced the
    number of aircraft in a wing over time or reduced the number of
    squadrons, then we have excess parking spaces.
        Mr. Fortenberry. So that is a little bit harder to deal
    with. I think the types of things that we are talking about
    what we spun off or sold----
        General Green. Yes sir.
        Mr. Fortenberry [continuing]. Or integrated in the
    community in a constructive manner so you are not disrupting
    community lives.
        General Green. Yes sir, so what you are looking for I don't
    have at hand right now to tell you. We will come back and get
    you the best answer we can.
        Mr. Fortenberry. So that 30 percent figure includes these--
    --
        General Green [continuing]. Excess ramps, yes sir.
        Mr. Fortenberry. Well, these large infrastructure that in
    all likelihood doesn't have a repurposed use for some type of
    community need.
        General Green. Yes, sir, that is correct.
        General Coglianese. Sir so, we know right now what we have
    is--just in Q3 and Q4, 17 percent or is in the facility or Q3
    to Q4 conditions. The Q4 we would say we need to demo now.
        So there are about 733 buildings that we know we can get
    rid of now. But part of the infrastructure reset is
    recapitalization is as important or more important sometimes
    than MILCON, taking that money from the MILCON, as opposed to
    new platform from the MILCON.
        So as we are doing our basic facility requirements, so what
    is the infantry battalion rate space-wise? And that is where we
    are coming up. This is where you rate and this is what you
    should have.
        And if you are a typical Marine and if you get a facility
    you will expand that facility. You will use it for martial
    arts. You will use it for storage of equipment and things like
    that. So we are coming up with standards.
        We actually have them now, and we are consolidating
    Marines, moving Marines from barracks into, you know,
    consolidating. Maybe they were spread out in two barracks and
    put them in one to get the occupancy rate.
        And as we do then then we can recapitalize that building
    for another purpose or if it is not in good condition to demo
    it. So right now we know low-hanging fruit, there are, like,
    733 Q4 buildings.
        Mr. Fortenberry. So I think this question of excess
    inventory perhaps is too broad. There are a lot of subsets of
    this. As you are talking about that kind of infrastructure
    really transitioning into something else, minimal likelihood,
    so it has lessening and lessening value.
        You are talking about a consolidation of assets that you
    already have versus in my mind I am thinking of, again, going
    back to BRAC where you are actually spinning off or closing
    certain things.
        But rather than looking at it through that lens, how do you
    actually integrate those into some other community use. So I
    think that we need some subsets of what excess inventory means.
    I think that is----
        Mr. Niemeyer. And Congressman, also it is not just the
    savings. It is military value. The biggest part of the BRAC
    process----
        Mr. Fortenberry. Well, that is savings----
        Mr. Niemeyer. But what I am getting at is----
        Mr. Fortenberry [continuing]. In that sense.
        Mr. Niemeyer [continuing]. We have to assess what future
    value would those facilities be to future missions? So we are
    having to do that level of complexity, too.
        Mr. Fortenberry. Okay, but one more moment, Mr. Chairman,
    if you would? But the general suggests, I guess we have heard
    for many years, particularly from the Air Force, is you have
    got 30 percent excess inventory.
        Well, what that implies is that you have got wasted space
    sitting out there. We are just paying electrical utility bills
    or it is not meeting its highest and best use in terms of
    community repurposing.
        But it is not exactly right. That is what I am trying to
    get to. What is the percent of assets that could be sold off,
    reintegrated into or repurposed into another community use or
    repurposed as you are suggesting into a higher value for the
    military itself.
        Mr. Niemeyer. So we have been working on that. Congress has
    given us authorities over 15 years to take an unutilized or
    sub-optimized piece of property or a building and go ahead and
    spin it off. Go ahead and lease it, give to somebody else, get
    it off our inventory.
        We have been working at that. We have been working at
    demolition. So we have been exploring those other ways to
    reduce that number of excess facilities. We are getting to the
    point where all the low-hanging fruit is done. Now, we have got
    to get to a bigger process here that allows us to think like
    holistically at the enterprise.
        Mr. Fortenberry. Thank you, Mr. Chairman.
        Mr. Dent. Sounds like you are advocating for a BRAC in
    this--or a FORT, a MISC? Okay, so with that----
        Mr. Fortenberry. A MISC.
        Mr. Dent. So I would like to, at this time, recognize the
    ranking member for any closing comments she might have.
        Ms. Wasserman Schultz. No closing comments, just a motion
    to include this graph, which indicates MILCONs as a percent of
    total DOD appropriation for the record.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Dent. Without objection. I have other questions that I
    will ask, but not today. I will submit them to you and then you
    can then send them back to us with responses on the official
    record.
        So with that, thank you all for being here and this
    committee meeting is adjourned.

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                                               Tuesday, April 17, 2018.

                                  MEMBERS' DAY

                                  ----------

                                    WITNESS

    HON. TIM WALZ, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MINNESOTA

                       Opening Statement of Chairman Dent

        Mr. Dent. Good afternoon and I want to welcome everyone to
    today's Member Day hearing for MilCon, VA and Related Agencies.
    Chairman Frelinghuysen asked all subcommittees to hold these
    hearings to ensure that all members have an opportunity to
    provide input in the appropriations for fiscal year 2019. We
    are pleased that we have six members here to discuss a variety
    of military construction and veterans programs.
        I would like to recognize my friend and Ranking Member Ms.
    Wasserman Schultz for any remarks she would like to make before
    we get into the hearing testimony.

             Opening Statement of Ranking Member Wasserman Schultz

        Ms. Wasserman Schultz. Thank you, Mr. Chairman. Looking
    forward to hearing from our colleagues today, each of whom I am
    sure will provide us an important perspective, that is why
    being a representative body like the House of Representatives
    gives us a chance to really on a Member Day like this to look
    through their lens.
        But most importantly, I think it is especially appropriate
    to acknowledge your announcement, your service today. You
    announced that you will be resigning from the House of
    Representatives in several weeks, and being a classmate of
    yours, having been elected together in the class of 2004,
    serving together side by side on this committee, having an
    opportunity to be your ranking member and to work with you, you
    have always been not only incredibly fair but have provided a
    perspective that was sorely missed and too infrequent,
    promoting bipartisanship, being rational, reasonable and
    straightforward and having the kind of integrity that your
    constituents deserve and that Americans deserve.
        And most importantly, it has been incredible to get to know
    you and to call you a friend and I look forward to your last
    few weeks. But we know you will be gone, but never forgotten
    and will continue to serve this country in other ways.
        Mr. Dent. Well, thank you, Congresswoman Wasserman Schultz,
    for those very kind words. It has been a pleasure serving with
    you and I remember we came into Congress together in 2004,
    elected in 2004, we were there with our young families and they
    are a little less young now and so are we but it has just been
    a pleasure serving with you and, frankly, everybody on this
    subcommittee and the full House.
        I've got to tell you, everybody is a friend here and I just
    want to thank you for the kind and generous words. And I know
    that all of you will carry on the great traditions of this
    institution and this subcommittee which has had a great
    tradition of bipartisan cooperation. So, it is with mixed
    emotions that I am leaving. But nonetheless I thought it was
    just the right time and I will have more to say about it in the
    not too distant future, but thank you again and I appreciate
    it.
        And so, without objection, I would just like to mention
    that your written statements will be entered into the record
    and please feel free to summarize your remarks for five minutes
    and I will go through the announced order.
        We will first recognize our good friend from Minnesota Tim
    Walz with whom I went on one of my first CODELs to Iraq and
    Afghanistan many years ago.

                         Statement of Congressman Walz

        Mr. Walz. Well, thank you, Mr. Chairman. And I know you are
    not dead so it is not a eulogy, but I would be remiss if I
    didn't say it because it is well-earned. Your reputation as a
    man of his word, integrity, a legislator of thoughtfulness and
    I think a friend to so many of us and I would be remiss if it
    is a little selfish, we hate to see you go.
        This place needs you. It needs the type of person that you
    are and I think many of us feel that way. And I think it shows
    that the people up here with the ranking member, Ms. Wasserman
    Schultz, also a dear friend, appreciate what you have done and
    of course, the vice chairman, Mr. Fortenberry.
        As a subcommittee and what you have done on here, you have
    served veterans well. You have always been there in a
    bipartisan way as champions to make sure we got this right. And
    over the years that you served as chairman, Mr. Dent, the
    appropriations have continued to increase for our warriors at a
    time of war and that has not gone unnoticed.
        So, I for one am grateful for your work. This institution
    will miss you. I think the American people oftentimes, they
    have good right to be a little bit cynical; they should know
    that happens here and especially with people like you in this
    committee is really why we came. So, thank you. Thanks for the
    opportunity to be here today.
        Mr. Dent. Thank you. I should mention, too, that Jeff
    Fortenberry is also our classmate. We all came in together.
        Mr. Walz. Yes.
        Mr. Fortenberry. With small kids.
        Mr. Dent. With small kids except he had five, and all
    girls.
        Mr. Walz. Well, thank you, all, for having us here today.
    Before I get started, I would just like to ask if I could have
    a couple of things entered into the record. One is a letter
    from Representatives Brownley and Larson.
        They request VA in vitro funding and adoption assistance be
    made a permanent program or extended at least through 2020. I
    support making this program permanent so our disabled warriors
    have the opportunity to have families also. And then I request
    that a table of selected VHA accounts be entered into the
    record as part of my testimony.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Thank you. And, again, I want to thank this committee and
    thank the Congress for the appropriations that we have
    received. This is our sacred responsibility to care for our
    warriors. We also have a sacred responsibility to look after
    taxpayer dollars. How that money is spent is critically
    important, because if it is not targeted at the care of our
    veterans, it is money wasted and opportunity wasted.
        And time and again we hear the concerns over privatization
    of the VA. This budget lends credibility to those concerns and
    I want to just lay out a few reasons why I think we all need to
    be concerned.
        Between fiscal year 2017 and the appropriate levels for
    2018, community care will have increased 49 percent. That is
    not taking into consideration the $4.2 billion in additional
    emergency spending that we are continuously asked every few
    months to inject into the system. That is a nine percent
    increase in care in hospitals and in the clinics.
        In February when we passed the Bipartisan Budget Act, we
    included another $4 billion over time for building and
    improving VA hospitals. That was done with the VSOs, the
    American Legion, the Disabled American Veterans, everyone,
    understanding that that money was going to be put into catching
    up on the backlog of work we need to do on our VA hospitals.
        But instead of prioritizing that, the budget proposed
    spending half that money on care in the community. That is
    after we authorized the $4.2 billion. A huge increase in
    community care is not enough. This year's budget requests
    mergers of the medical community care accounts that were
    congressionally mandated to be kept separate with the medical
    services account.
        Let me just make clear what is happening here. We made sure
    that VA kept this community care money separate when we did the
    bill in 2015 so that we would know what we are spending. There
    is no way right now to track what we are getting for our money
    in care in the community.
        And to be very clear, I am a veteran myself, I believe it
    makes sense if somebody needs a blood test in Sleepy Eye
    Minnesota, don't drive 200 miles to Minneapolis VA to get it;
    we can do it locally. Those things have always happened in the
    VA.
        But what has happened now is a massive shift to the outside
    with no accountability of it and no spending on the internal
    capacity. So, we end up in a death spiral. Well, yes, there are
    less physicians at the VA hospitals so we force more people to
    the outside.
        And so, we said let us at least have transparency in our
    system to make sure these accounts are kept separate. They are
    now asking us to bleed them together. As an oversight body, we
    should all be very concerned with this, and making no mistake
    about it, you will not be able to track where money is spent.
    You will not be able to know what is happening in the outside.
        So, instead of addressing the infrastructure, the money
    will be spent purchasing community care. To put it into
    perspective, we have spent $38.5 billion since the Phoenix VA
    crisis. During that time, we had 31,000 vacancies of providers
    that have not been filled, 4,000 to support physicians in the
    VA.
        That $38.5 billion would have paid for everything to fill
    every single one of those. I am not saying that is what we
    could have done. I am making the case that this has always been
    a balance. And when it comes to the veterans service
    organizations, 90 percent of VFW members who were polled said
    they wanted their care in the VA. They want that to be the main
    care.
        So, what I would like to say and we see this and so we
    know, we are getting information and the GAO will put out a
    report soon anecdotally that we are hearing, you go to care in
    the community, you are put outside the VA, the average wait
    time in some places is now longer than it would have been if
    the individual just stayed in VA, it is up to 90 days in some
    cases.
        So, what I am asking all of you is this philosophical
    debate about privatization while valid, does get to the heart
    of this. Our job is to provide quality care that was promised
    and must be delivered to our veterans. We have a VA system that
    in many cases does that well. In other cases, there are gaps in
    the system and we use community-based purchasing power to do
    that.
        All we are asking for is to make sure in this budget that
    it stays transparent and separate and that we have
    accountability in this budget about what are we getting on the
    outside for that. So, I would ask us to keep close eye over
    that, make sure that this budget has the capacity to analyze
    what we are getting for it, make sure we are taking into
    account that every time we transfer money out of capacity into
    care, we are forcing more veterans outside the system with no
    coordinated care and no measures of success against what the
    veterans want.
        I understand the challenge for elected members of this
    body. If you ask the general public what we should do, they
    think they are helping by saying give them a card and let them
    go wherever they want to. Nobody in the veterans community is
    saying that. Nobody wants it. There is no evidence to prove it
    works. In fact, the evidence proves it works worse than that.
        And I think, again, coming back to you, we are not asking
    you for more money. We are asking you to make sure that money
    is targeted, that it is specific and there is data to support
    where it is going and that we keep this budget separate for
    community care from the care that is happening inside the VA,
    because I think when you look at this right now, it is pretty
    hard to argue.
        And I would say this, that unsolicited, several weeks ago,
    the VA put out a memorandum to everyone and said why
    privatization isn't happening. That is the equivalent of asking
    all of you not to think about a draft. Of course, you are
    thinking of the draft, so why did they bring it up? No one
    asked them about it. They spontaneously said it because it was
    on the verge or the eve of this budget coming out.
        So, I want to be very clear that thanks to you and to this
    committee, fair and appropriate appropriations that let us try
    and tackle the things that we are obligated to do have been
    unprecedented, and for that I am grateful, that care at the VA
    continues to, I believe, improve, but it is a zero sum
    proposition, every time it falls short, we need to be there.
        And there is a role as there always has been for care in
    the community, but allowing this budget to be all put together
    with no accountability I think would be a dereliction of our
    first, responsibility to veterans and secondly, to the
    taxpayers. I don't think you will get your money's worth.
        So, thank you for the time.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                             CARE IN THE COMMUNITY

        Mr. Dent. Thank you, Representative Walz. I want to thank
    you, too, for your leadership on the authorizing committee. You
    are the ranking member and you are obviously a servicemember
    yourself and very committed.
        I just want to make this one quick comment. Sooner or
    later, there will be some authorization, I am told,
    consolidating the various Choice and care in the community
    programs. Currently, we are funding Choice through mandatory
    dollars and, of course, that could all change once the
    authorization bill is enacted, if it is enacted.
        And I just wanted to point out one issue, too. Where I
    live, I will tell you that many of the veterans want to be
    served in the community where they live. Our closest hospital
    is 60 miles away in a town called Wilkes-Barre.
        And that is the number one complaint I hear from my local
    veterans. They want scheduled procedures to be able to be done
    closer to home out of convenience for them and their family
    members. And in many cases they feel they will be going to
    superior medical institutions and hospitals if given that
    opportunity. So, I just want to put this on the record.
        I don't have any questions but thank you for your advocacy
    and all that you have done for veterans all these years.
        Ranking member.
        Ms. Wasserman Schultz. Thank you. Thank you, Mr. Chairman.
        Congressman Walz, thank you for your service to our country
    and for your friendship. We have been friends for many years
    and as you are departing as well, it has really been a pleasure
    to get to know you. And I certainly hope you are successful in
    your endeavors.
        My question for you is do you share--well, let me preface
    my question because, Mr. Chairman, we have not seriously
    debated this but we definitely have a slightly different point
    of view when it comes to the direction that we are going in
    potentially combining these accounts and veterans seeking
    service in the community.
        There is no question that everyone, veteran or not, prefers
    to get the health care that they need closer to home. Our VA
    hospital is probably 35 to 40 miles from, say, 35 miles from
    most constituents in my district. It is also in the middle of a
    very dense urban area and hard to get to, hard to find parking.
    But we have solved a lot of that problem through clinics, as
    has the VA throughout this country.
        And so, we have a fairly large clinic that was built in
    Sunrise, in my district, the Bill Kling clinic. Much of the
    care that is provided at the main hospital is able to be
    provided there because there is a shuttle that can take
    veterans from that clinic down to our hospital and
    overwhelmingly the care that veterans say they seek, they
    prefer if they can to access it at the VA and believe that that
    is the care they have the most confidence in.
        So, with that preface, are you concerned, Representative
    Walz, about the combining of those accounts really being the
    first step, intentionally being the first step towards
    privatization of healthcare services at the VA?
        Mr. Walz. I am. And I don't deny and I think there is
    validity in this because the issue is it is not the false
    choice of privatization versus VA itself; it is a hybrid model
    of this.
        Ms. Wasserman Schultz. Yes.
        Mr. Walz. But the understanding is if this money is cycled
    away, it drains off and will kill the VA as that institution. I
    want to be very clear about that. That means all of the
    research, all the specialty care and those veterans who want to
    get care close to home, my guess is if they are members of
    Paralyzed Veterans of America, the disabled veterans, depending
    on where their injuries are, it changes where they are at on
    that.
        If you are a veteran that is getting a blood test in the
    city of Sleepy Eye, they should be able to do that. So, my
    concern is that if we are taking those sets of resources and
    transferring them somewhere else and there is, there is
    assumption on this and we have research to support this, if you
    are going to die in a hospital, you are going to die from a
    hospital-acquired infection.
        The place where you are least likely to have that happen is
    not even at the Mayo Clinic; it is at the Minneapolis VA. That
    is where the best care in terms of that is. So, this idea that
    it is cheaper, it is quicker and it is better in the private
    sector, there is no data to support that.
        But it doesn't change the chairman's point on this is if
    you are closer to home. So, we have always delivered up to 25
    percent of our care in the private sector anyway. We have
    expanded the CBOCs as the gentlelady said but I think we need
    to get out of this trap.
        There is an ideological belief and it is my belief right
    now that is dominating, certainly coming out of the White House
    that the idea is that we can go totally to the private sector
    care, no need for the VA. That is where the danger lies.
        I think for all of us, it is striking the proper balance.
    And what I am asking for is in this budget is for us to at
    least have the transparency to know where it is going. If that
    money is going into the private sector, if we are getting more
    bang for the buck and veterans are being seen quicker and they
    are getting there, I am open to the possibility that would be
    there.
        But don't forget, inside VA is all of that research, all
    that delivered care, all of that managed care on multiple
    modalities that these people are going through. If you go in to
    see your physician, when you go in to see a VA doctor, yes, you
    will see them longer and I know people complain about this
    where you spend too much time with the person.
        My veterans say, yes, when I am in there I mentioned to
    them, yes, what about this thing on my hand and they found out
    that it was skin cancer. Had I been to another doctor, I would
    have had another appointment.
        So, it is my belief that this is not the best way to manage
    the care. It is not my belief that there is not quality care to
    be delivered in the community. I represent the Mayo Clinic;
    they do a wonderful job. There is a place for that.
        But at the expense of and to be very honest, why blend them
    together if it is not just to continue to move money out of
    there. Why not keep them separate so we can see it? You are
    appropriators, you are budget people, let us see where that
    money is going.
        Mr. Fortenberry. I think it was appropriate to mention as
    Congresswoman Debbie Wasserman Schultz did that you are also
    ending your service as well.
        Mr. Walz. Well, thank you.
        Mr. Fortenberry. So, I don't want to divert from the issue
    at hand because clearly you are passionate about caring for
    veterans and have a very detailed grasp as to what ought not be
    a conflict that is I think what you are communicating.
        But either on a case by case or geography or level of
    medical infrastructure that is already in a place or not, we
    have to find the right balance between the movement toward a
    singular goal which is care for our veterans, not a debate over
    whether this is going to be public or this is going to be
    private. I think it is a fair set of comments. Thank you.
        But I primarily, I want to thank you as well for your
    friendship and your service. I don't think Mr. Dent intended
    this to be a meeting in which we are all saying goodbye but,
    nonetheless, it is kind of going that direction. But I am
    really grateful for your friendship and wish you all the best
    in your possible future leadership roles as well.
        Mr. Walz. Well, no, thank you. It does mean a lot. I think
    it is an interesting intersection of folks here who I have come
    to admire and call friends. We have worked together on some
    very diverse issues, and I think maybe this all comes together
    on what is possible, and Mr. Fortenberry was at the heart and
    the nexus of a very new way of delivering veterans care in the
    Omaha, Lincoln area of Nebraska where we used public-private
    partnerships to build a facility that wouldn't have gotten done
    by the private sector alone, wouldn't have gotten done by the
    VA alone, but it is getting done now because of that
    leadership.
        And I think if you can help us and that is all I am asking
    for on this, I think what will muddy the water is those two
    accounts coming together, not the ideological argument. And
    thank you for the kind words. Thank you.
        Mr. Dent. Thank you, again, Congressman Walz, for your
    service. And, yes, you are leaving at the end of the Congress,
    too, and good luck to you in your race. And, again, just to
    say, I don't like to use the term privatization. I would like
    to talk about the integration, a better integration I should
    say of the civilian and the veterans health systems that we
    have.
        And I often found that my local VA medical directors are
    quite skilled and I would like to see them take on a role not
    just as a provider of care but maybe a little bit more of a
    manager and a coordinator of care. They do understand the
    healthcare resources in their regions and, frankly, I don't
    think they are empowered enough to make some decisions.
        When Secretary Shulkin served here as Secretary and
    Undersecretary under the Obama administration, we had the
    debate about should the VA deliver babies. And they came, I
    think, to the right conclusion that the VA probably would not
    be able to do a very good job of it because they wouldn't
    deliver enough to be very good at it and basically that is done
    in the community as it should be.
        And so, I think we have to have a thoughtful discussion
    about where the VA can best meet the needs of the veterans in
    that system and where maybe a community option would be better
    to serve the veterans.
        So, thank you. We appreciate hearing from you and great to
    see you and see you around. Thanks.
        Let us go to Congresswoman Claudia Tenney of New York,
    recognized for five minutes.
                                  ----------

                                               Tuesday, April 17, 2018.

                                    WITNESS

    HON. CLAUDIA TENNEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW
        YORK

                       STATEMENT OF CONGRESSWOMAN TENNEY

        Ms. Tenney. Yes. Thank you, Mr. Chairman. I am sorry to
    hear the news; I just got to know you and now you are leaving.
        So, anyway, I just want to say thank you to Chairman Dent,
    Ranking Member Wasserman Schultz and the members of the
    Appropriations Committee for providing me the opportunity to
    testify today in support of the request submitted to Congress
    by the Secretary of the Air Force for a perimeter fence around
    the Air Force Research Laboratory Information Directorate,
    otherwise known as Rome Lab and I will refer to it as Rome Lab.
        Rome Lab is a premier research and development facility
    committed to our nation's safety and cyber security. As a
    leader in communications and information technologies, Rome Lab
    ensures that our defense capabilities remain on the cutting
    edge.
        In a world where defense is increasingly technological in
    nature, Rome Lab is critical to the mission success of your
    warfighters. At the present time, Rome Lab lacks a perimeter
    fence to secure the facility and meet the existing force
    protection requirements as outlined by the Department of
    Defense.
        The highly sensitive nature of Rome Lab's research and
    development projects place the site at heightened risk. The
    critical work conducted at Rome Lab necessitates appropriate
    security safeguards including a secure system of perimeter
    fencing. Without this important precaution, the facility's
    sensitive information is vulnerable. A security fence around
    Rome's perimeter will also increase the safety of the lab's
    more than 3,000 personnel.
        Additionally, the fencing will reduce the facility's
    susceptibility to terrorist-type activities. Joint Staff
    Integrated Vulnerability Assessment or JSIVA teams identified
    security vulnerability risk at Rome Lab in 2008 and then again
    in 2014. Indeed, in the last 10 years, over 240 individuals
    were detained, interviewed and released by security at Rome Lab
    due to the lack of perimeter security.
        Mr. Chairman, it is 10 years since the JSIVA identification
    that I mentioned, that is far too long a time to allow the site
    to remain unsecured. As the parent of an active duty Marine
    officer and Representative to over 50,000 veterans, I sincerely
    appreciate the important work that this subcommittee does for
    our military and our nation's veterans.
        I urge the subcommittee to provide strong consideration on
    the request for perimeter fence as submitted to Congress by the
    secretary of the Air Force and to prioritize the safety of the
    men and women who sacrifice so much to defend our nation as
    well as the vulnerability of this very sensitive military
    research.
        Thank you for allowing me to testify and I yield back the
    balance of my time or any questions you may have.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                          ROME LAB SECURITY FENCE COST

        Mr. Dent. Real quickly, this projected is on the unfunded
    priority list I believe. Do you know what the price tag is on
    this one?
        Ms. Tenney. $14.2 million.
        Mr. Dent. Okay. The only comment I am going to make, I am
    sympathetic to perimeter fences; we just were able to do one in
    my own area for the same reasons you just outlined very well.
    So, I am sympathetic.
        These facilities obviously are in great need of greater
    security given the risk of terrorists and other bad actors who
    might try to penetrate. So, I don't have any questions. We will
    do our best in the unfunded priority list to try to see if we
    can accommodate you.
        Ms. Tenney. Thank you. I appreciate your advocacy. Thank
    you.
        Mr. Dent. Okay. Well then, thank you so much, Congresswoman
    Tenney.
        Ms. Tenney. Thank you.
                                  ----------

                                               Tuesday, April 17, 2018.

                                    WITNESS

    HON. MARK TAKANO, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
        CALIFORNIA
        Mr. Dent. Representative Takano, from California. Welcome.
    We look forward to receiving your testimony. You are recognized
    for five minutes.

                        statement of congressman takano

        Mr. Takano. Thank you, Chairman Dent, Ranking Member
    Wasserman Schultz and other members of the subcommittee. Thank
    you for allowing me to join you this afternoon to discuss
    funding priorities for the Department of Veterans Affairs.
        I have been a proud member of the House Committee on
    Veterans Affairs since my first term in Congress and I
    currently serve as the committee's vice ranking member.
        The main issue I would like to address this afternoon is
    the administration's proposal to consolidate the VA's medical
    services and community care accounts. I heard Congressman
    Walz's testimony, some of it.
        Given the VA's notorious difficulty in forecasting the
    spend rate of the Choice program, I believe this proposal is
    misguided and will make it harder for members of Congress to
    provide critical oversight of how the VA spends its funding for
    medical care and in turn will undermine the care that veterans
    receive.
        Now, as many of you will recall, the Choice program arose
    from the Phoenix wait time scandal. It was a rushed response to
    a serious emergency and its implementation reflected the
    prioritization of speed over effectiveness. The program was
    actually set to sunset in August of 2017 or when the VA had
    spent the $10 billion Choice fund.
        After months of being told by VA officials that the Choice
    fund would be depleted well short of the sunset day, the VA
    revised its estimate. By spring of 2017, the VA forecasted that
    it would actually hit the 2017 sunset date with more than $1
    billion remaining in the account.
        Now, Congress then acted quickly and lifted the sunset date
    to allow the remaining funds to be spent on veterans' care.
    However, by July of that year, the VA reverted back to its
    previous estimates, prompting Congress to pass the VA Choice
    and Quality Employment Act of 2017 to provide $2.1 billion to
    the program.
        Well, by December, the VA notified Congress that it would
    again run out of funding for Choice in January 2018. So, what
    did Congress do? It appropriated an additional $2.1 billion to
    the Choice fund.
        This latest funding was expected to last through the end of
    this fiscal year, 2018. But now, the VA expects it will run out
    of funding in early June, more than three months before the end
    of the fiscal year.
        Now, if you found that narrative difficult to follow, then
    you understand my point. Tracking the cost of the VA's Choice
    fund is difficult even when it is separate from the medical
    services account. Merging the two accounts would make
    meaningful oversight nearly impossible.
        Additionally, the merger of the community care and medical
    services accounts runs directly counter to the Surface
    Transportation and Veterans Health Improvement Act of 2015
    which mandated that VA provide a request for community care in
    the budget. And most importantly, this change would invite
    community care spending to encroach upon the budget that is
    dedicated to maintaining the VA facilities and workforce that
    provide high quality care to our nation's veterans.
        Every year, roughly nine million veterans rely on VA
    services. So, I implore us to reject any proposal that
    jeopardizes our ability to ensure those services will remain
    available.
        In my remaining time, I would like to highlight the need
    for funding to fully implement the Forever GI Bill. The
    landmark bill guarantees veterans a lifetime GI Bill benefit
    rather than benefits that expire. It simplifies and
    consolidates the Montgomery GI Bill and the post 9/11 GI Bill
    and has valuable protection so that veterans don't lose their
    benefits when a school closes mid semester like ITT Tech or
    Corinthian did.
        However, for this to succeed, the VA needs full funding for
    implementation. And I am concerned that without proper funding
    for IT upgrades, the VA is ill-equipped to comply with the new
    provisions of the law and will fall short of keeping the
    promise we have made to veterans.
        I ask that the Appropriations Committee provide the full
    $30 million authorized in Section 115 of the law for claims
    processing and IT upgrades. The Forever GI Bill is an historic
    step forward and we owe it to our veterans not just to
    authorize it but to fully fund implementation so that veterans
    can receive its full benefit.
        I thank you for your time this afternoon. I look forward to
    continuing to work with you to ensure that veterans receive the
    services and support they deserve, and I yield back.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Dent. Thank you, Representative Takano, for your
    comments on the GI Bill, and as appropriators we do our best to
    try to accommodate the authorizing committee and what you have
    just stated on the GI Bill is extremely important. And we are
    deeply committed, also on the health care. I won't belabor what
    was spoken about earlier except to say that your concerns about
    transparency are well-founded. And I think we have all been a
    little bit frustrated about getting reliable data from the VA.
        And this has been going on for some time, about the cost of
    care at the agency, either that they provide or they pay for.
    So your point is well-taken. And I thank you for your
    testimony.
        Representative Wasserman Schultz.
        Ms. Wasserman Schultz. Thank you, Mr. Chairman. I would
    associate myself with your remarks and underscore that I share
    your concerns not only about transparency, but also on what
    appears to be a potential march towards privatization, which I
    find inappropriate and would not be what is best for our
    veterans. And I share their concerns on moving in that
    direction as well.
        Mr. Dent. Thank you.
        Ms. Wasserman Schultz. I yield back.
        Mr. Fortenberry. Just to take an opportunity to also follow
    through on a comment that was made when Congressman Walz was
    here. Congressman Takano also played a very constructive role
    of helping navigate the bill that we were able to pass last
    year that created the public private partnership option that we
    are now implementing in Omaha.
        So that, again, the first time I have to thank you
    publicly. I wanted to take it and really appreciated your
    negotiating skills, your flexibility and then joining with that
    team effort to get this done.
        Mr. Takano. Thank you, Vice Chairman Fortenberry. It was
    when I was the vice ranking member of the Veterans Affairs
    Committee and worked with Congressman Ashford, worked with your
    junior Senator at the time and it was a coming together of
    knowing that we could bring the private sector into how we
    operate the VA.
        And I am so glad that that came to pass. So I am very
    pleased. I just want to mention one more thing--you are from a
    state that is very rural. The thing I will say is that we are
    facing a tremendous doctor shortage in our country.
        And part of the problem with the VA is the understaffing
    and to make sure it is fully staffed out. And I imagine also in
    Pennsylvania we have also serious problems with doctors. The
    solution is graduate medical school education.
        And I really believe the VA--one of the reasons we can't do
    away with VA health care is actually in rural communities, it
    is a strategy to get doctors into those communities. And to
    fund the training of those doctors through the VA, so I would
    love to have more conversations about that in the future.
        So thanks.
        Mr. Dent. Thank you, Representative Takano.
                                               Tuesday, April 17, 2018.

                                    WITNESS

    HON. JOHN RUTHERFORD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
        FLORIDA

                      Statement of Congressman Rutherford

        Mr. Dent. Let's go to Representative Rutherford of Florida.
    You are recognized for five minutes.
        Mr. Rutherford. Chairman Dent and Ranking Member Wasserman
    Schultz, thank you, and distinguished members of the Committee,
    thank you for this opportunity to testify on behalf of my
    Northeast Florida priorities for the fiscal year 2019 Military
    Construction and Veteran Affairs appropriations bills.
        First, as a member of the House Veteran Affairs Committee,
    I want to thank all of your work to ensure that veterans are
    receiving the best care possible. And the 115th Congress has
    made great strides in increasing the access to quality care,
    improving accountability and reforming many broken systems of
    VA.
        These reforms are a testament to our two committees
    effectively working together and I look forward to continuing
    this important progress. However, I would like to use today to
    focus on two projects of high importance to Naval Station
    Mayport, which I am proudly representing here in Congress.
        The mission of Naval Station Mayport is to sustain and
    enhance warfighter readiness and is the third largest fleet
    concentration area in the United States. While serving as the
    home to an amphibious ready group, several destroyers, cruisers
    and other ships, Mayport is also the proud east coast home port
    for the littoral combat ship Freedom Class. The USS Milwaukee,
    the USS Detroit and the USS Little Rock have already been
    delivered to the Navy and homeported at Mayport.
        And as Congress strongly supported the LCS program,
    eventually a total of up to 14 LCS will be homeported at
    Mayport by 2020. As the LCS continues to be delivered to the
    fleet, it is vital that required military construction projects
    are funded by this Congress.
        That is why the president's fiscal year 2019 budget request
    includes funding for the LCS support facility and the LCS
    operational training facility located at Mayport. These
    projects are a second phase of MILCON that is essential to the
    training and equipping of the LCS squadrons as this class of
    ship begins to enter its active deployments over the next few
    years.
        Before I discuss why these projects are so important to
    fund in this coming fiscal year, I want to explain what makes
    the LCS different than other surface combatants. The LCS
    training and manning plans are designed to maximize efficiency
    of deployed ships, transferring traditional training and
    administrative functions to shore facilities.
        The Blue/Gold crew swapping in the shore facilities allow
    for training and financial efficiencies. Without these
    capabilities the Navy would require larger crews, diminishing
    the tactical advantages of the LCS in close-contested waters.
        As we see the threats across the globe on the rise, having
    this capability will prove essential in the years to come. The
    two projects requested by the President in fiscal year 2019
    will accommodate the LCS squadron command staff, classrooms,
    systems trainers, operation watch floor and other space
    critical for the LCS mission.
        It will also provide a multistory parking garage, which has
    been a need at Mayport for many years, especially as it
    continues to expand into the coming years and will convert
    other portions of the base to support the LCS mission.
        The Navy has clearly stated the need for these projects to
    be completed quickly and included them on the unfunded
    priorities list for 2018. The LCS concept of operations
    requires these facilities to be in place two years in advance
    of ship arrival in order to meet training and support
    requirements.
        The first phase of these buildings was funded in 2015 and
    later constructed. However, due to the delay in funding for
    phase two, crews have been training in temporary structures at
    Mayport and enabled base station in San Diego, the West Coast
    LCS homeport.
        This leads to inadequate training for the crews and is, in
    the Navy's own words, unsustainable. The Navy also stated that
    without these structures both the squadron and the ship crews
    cannot be adequately supported by existing shore facilities due
    to primarily overcrowding, which will serve severely impact
    ConOps in mission capability.
        And as we have seen in the recent ship collisions in the
    Pacific fleet, funding and supporting of adequate training for
    our sailors is truly a matter of life and death. The Navy is in
    many ways leading the Services and how they look at training.
        This includes the immersive virtual shipboard environment
    lab training systems that are used for these LCS crews.
    Congress has supported this game-based training strategy which
    has already proven to save training hours and can be done
    ashore instead of on the ship.
        I believe that this model has the potential to reshape how
    training is carried out across the fleet which is why funding
    this facility is so important. We owe it to the LCS crews, the
    squadron leadership, and to all of our sailors to ensure these
    training and support facilities are in place before we ask them
    to carry out their mission.
        Inadequate structures and temporary work grounds,
    workarounds for a growing program only weakens our security.
    And again, I want to thank you all for the opportunity to speak
    here today. And also I want to say thank you on behalf of a
    grateful nation for all of the hard work that you all are doing
    to ensure that our nation remains the strongest and safest in
    the world.
        And I am always available for further discussion on these
    and other topics of interest. And I yield back.
        [The information follows:]

     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                   LCS PROGRAM

        Mr. Dent. Well, thank you Representative Rutherford for
    your testimony and updating the subcommittee on the importance
    of the LCS program. It is vitally important. And I also want to
    certainly let you know that we will continue to work with you
    on the Mayport Naval Station and the unfunded priority list. I
    am sure there is going to be a lot of demand for it this year,
    but we are going to do our best to accommodate as many of the
    Members as we can, so with that thank you.
        And I yield to the ranking member.
        Ms. Wasserman Schultz. Thank you, Mr. Chairman, for the
    opportunity to greet my fellow Floridian. As you know, we were
    not able to get all of our MILCON needs in Florida addressed in
    the hurricane supplemental that recently passed and was signed
    by the President.
        Were there any facilities at Mayport specifically damaged
    by the recent hurricanes that have MILCON needs and still need
    to be addressed that weren't included in this one?
        Mr. Rutherford. I don't believe there were.
        Ms. Wasserman Schultz. Okay. Thank you.
        Mr. Dent. Thank you, Representative Rutherford. I
    appreciate your testimony and pleased to work with you over
    this appropriations process.
        Mr. Rutherford. Thank you, Mr. Chairman. And I just want to
    say congratulations on a great term and time in Congress and
    thank you for all that you have done personally for us in
    Florida. Thank you.
        Mr. Dent. Thank you. I hope to get to spend more time in
    northeast Florida.
        Mr. Rutherford. Yes.
        Mr. Dent. It's a very nice part of the world.
        Mr. Rutherford. Come and see.
        Mr. Dent. Really, I know it is a wonderful place.
        Mr. Rutherford. Thank you.
                                  ----------

                                               Tuesday, April 17, 2018.

                                    WITNESS

    HON. ANN McLANE KUSTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
        NEW HAMPSHIRE

                   Opening Statement of Congresswoman Kuster

        Mr. Dent. Okay. Thank you.
        I would like to recognize Representative Kuster of New
    Hampshire. And you are recognized for five minutes.
        Ms. Kuster. Thank you, Mr. Chairman, and distinguished
    colleagues. Thank you for the opportunity to come before you
    today to join my colleagues on the Veterans Affairs Committee
    to talk about veterans' benefits and services from my
    perspective as ranking member of the House Veterans Affairs
    Subcommittee on Oversight and Investigations. And
    coincidentally, the only Congressional delegate in our New
    Hampshire delegation to serve on either the House or Senate
    Committee on Veterans Affairs.
        It is no secret that VA's capital assets are in serious
    need of repair. For Granite State veterans, this reality is so
    much more obvious when the Manchester, New Hampshire VAMC
    experienced a catastrophic water pipe breach. Emergency repairs
    have been ongoing since this episode, which occurred within
    days last spring of the Boston Globe's report on patient access
    to care issues at the facility.
        What I wanted to bring to your attention is that my home
    state of New Hampshire lacks the same robust VA capital assets
    that other veterans across the country enjoy. We are one of the
    only states that does not have a full service VA hospital
    within our borders.
        As the ranking member of the Oversight and Investigations
    Subcommittee, it was my displeasure to learn about the gross
    misuse of funds in major construction projects like Aurora,
    Colorado while the Granite State veterans continue to see their
    needed improvements deprioritized.
        As proud, frugal Yankees, New Hampshire veterans understand
    the realities of our current budgetary environment. And from
    that perspective, I respectfully request that the subcommittee
    seriously examine leveraging innovative concepts to deliver
    veterans' health care, both economically and effectively.
        In my letter to the subcommittee dated March 16, 2018, I
    requested the prioritization of ambulatory surgical centers
    (ASC) as a solution that provides both quality health care
    while being fiscally responsible.
        As you know, ASCs have long been utilized by the private
    sector to lower cost and improve health outcomes. ASCs would
    help resolve many of the issues surrounding veteran health care
    today. And it is incumbent upon us to provide VA with the tools
    it needs to care for those who have borne the battle. It is
    imperative that the Appropriations Committee continue to
    robustly fund the Choice program. And here I join my colleague
    Mark Takano to ensure its operation while an improved community
    care program is implemented. I remain concerned, however, that
    the funding shortfalls would put patients at risk.
        And one of the most important lessons from the Manchester
    VAMC is the need for a program that values clinical input over
    budgetary issues. Patients must always come first.
        I request the subcommittee consider two aspects of my bill,
    the VA Community Care Enhancement Act, that would require VA to
    implement a demonstration program between Veterans Affairs
    Medical Centers (VAMCs) and federally qualified health centers
    (FQHCs).
        Like Mr. Fortenberry, I have a rural district. I consider
    that to be a compliment, not a slight. And I respectfully
    request that you recognize the importance of FQHCs for the
    future of the VA community care. Unfortunately, VA has not
    directed enough of its resources to integrating FQHCs into the
    VA community care network, despite the fact that right now,
    FQHCs treat over 300,000 veterans.
        My bill also provides a mechanism to potentially resolve
    the issue with improper payments. In some cases it appears
    these payments are made to incentivize participation of certain
    community providers.
        But FQHCs provide a novel solution. FQHCs receive an
    enhanced Medicare rate, negotiated to better cover their actual
    cost, while tying the rate to periodic audits by the Human
    Resources and Services Administration to ensure that FQHCs are
    only claiming legitimate costs.
        VA currently lacks the flexibility to apply these rates to
    FQHCs and it has proven to be a significant disincentive for
    their participation. I urge my colleagues on the subcommittee
    to work with the Veteran's Affairs Committee to develop these
    authorities.
        If I may, I wish to take this opportunity to applaud the
    Subcommittee for separating funds for VA's modernization
    efforts for the new electronic health records, from the VA's
    general IT account.
        This move wisely recognizes the importance of enhanced
    oversight over the VA's IT modernization. As the ranking member
    in the O & I Subcommittee, I welcome continued coordination
    between our subcommittees to ensure effective oversight.
        However, I urge my colleagues to heed the lesson and deny
    VA's proposed consolidation of the medical services account and
    the community care account. Consolidating these accounts would
    only serve to make VA's expenditures on community care less
    accountable for Congress.
        Increasing the opacity of these accounts will likely
    heighten the pressure to ration care and further dissuade
    medical centers from requesting additional funding. I remain
    encouraged by the work of your subcommittee. And it was my
    pleasure to appear before you today.
        And I want to join my colleagues in thanking you, Mr. Dent,
    for your extraordinary service to our country. We are very
    grateful.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Dent. Thank you, Representative Kuster. And you have
    got a lot in there for five minutes.
        I just want to say I think the areas of concern that you
    have highlighted are probably shared by many members of the
    subcommittee. While the funding issues are something we
    certainly can address, it seems to me that some of the
    priorities fall within your own committee's jurisdiction, and
    so to the extent that we can where funding is the issue, we
    will certainly work with you and seriously consider all the
    issues you have raised. I don't have any questions but thank
    you.
        Ms. Kuster. Thank you very much. I worked very closely with
    my chair, General Jack Bergman. And so, we would be happy to
    work with you to resolve any of these issues. Thank you so much
    for your time. I appreciate it.
        Mr. Dent. Representative Wasserman Schultz.

                            ELECTRONIC HEALTH RECORD

        Ms. Wasserman Schultz. Just a quick question. As the
    chairman mentioned, your committee obviously manages the
    authorization of a lot of the issues you mentioned. I agree
    with you on the electronic health records concerns. No
    question. In fact, we inserted in the omnibus appropriations
    bill language that would ensure, that I suggested, that the GAO
    oversee the process through the years, which will be lengthy.
        Ms. Kuster. Yes.
        Ms. Wasserman Schultz. But that helped in the past, like
    when we were trying to bring the Capitol Visitor Center
    project, which was over budget and extended far beyond its
    original completion time, so that helped a bit.
        But does your Oversight and Investigations Subcommittee
    plan to look into this issue? I mean, as you know, Secretary
    Shulkin was fired literally today before he was supposed to
    sign the Cerner contract. And we have quite a bit of
    uncertainty as to when that contract will be signed.
        Ms. Kuster. I can't speak for the Chair in terms of what he
    is planning. But I do know from previous conversations that he
    shares the concerns. In fact, our Chair, Dr. Roe, it is very
    bipartisan.
        Ms. Wasserman Schultz. Yes.
        Ms. Kuster. Our concern is about both the time table for IT
    improvements and the deliverables if you will. If it is any
    indication, we had a very good roundtable discussion this
    morning on a slightly different topic, the VA appeals process,
    but it related to new IT, and when we met with them in January,
    we had been very frustrated. We had no time timetable, no
    deliverables.
        Today with the GAO's help, they were much, much more
    attentive to the questions that we had raised and I would
    expect that that would become a model for the committee as with
    regard to the electronic health record.
        Ms. Wasserman Schultz. Good oversight process to put in
    place while you are in the process of going through instead of
    coming in at the end.

                                 AURORA PROJECT

        Ms. Kuster. Yes. And I will say, I mean, I have been on the
    committee for five years and certainly the Aurora example was
    eye-opening for everyone on the committee, that this much money
    could be spent without accountability.
        And so, I think you would find the committee to be much
    more attentive to these details at this point.
        Ms. Wasserman Schultz. Thank you.
        Ms. Kuster. And to our oversight role. Thank you very much.
        Mr. Dent. Thank you, Representative Kuster. You have raised
    the Aurora project that is the project of which we shall never
    speak again.
        Ms. Kuster. I never should have mentioned it.
        Mr. Dent. We have very good friends in Ed Perlmutter and
    Mike Coffman and your Senators have become very close friends
    to the subcommittee as a result of that project. And hope we
    never see another one like that.
        Ms. Kuster. Well, our subcommittee was out there, summer
    before last and we had an excellent hearing, but I have to say
    I was a little bit stunned that some of the testimony was that
    despite opening Aurora, that they had a large increase coming
    out of Colorado Springs of veterans that needed care.
        And it was too far to get from there to Aurora and that
    they needed additional facilities. And I shouldn't laugh, I am
    sorry.
        Mr. Dent. I know.
        Ms. Kuster. I just shook my head.
        Mr. Dent. If you don't laugh, you will cry.
        Ms. Kuster. Yes, exactly. Thank you. Thanks very much.
        Mr. Dent. Thank you. Thank you, Representative Kuster.
                                  ----------

                                               Tuesday, April 17, 2018.

                                    WITNESS

    HON. FRENCH HILL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
        ARKANSAS

                         Statement of Congressman Hill

        Mr. Dent. At this time, I would like to recognize the
    gentleman from Little Rock, Arkansas, French Hill.
        Mr. Hill. Thank you, Mr. Chairman. I appreciate Chairman
    Dent, Madam Wasserman Schultz and my friend Jeff Fortenberry
    for letting me testify today. I appreciate the chance to
    present my views.
        That was fun to hear Congressman Rutherford reference the
    USS Little Rock arriving in North Florida. They have been stuck
    in the ice in Montreal since December 16, 2017 when that ship
    was launched and they just arrived in the last two weeks.
        So it was a cold, bleary winter in Montreal in the Saint
    Lawrence Seaway for the USS Little Rock. I know they are
    reveling shore leave in Florida. I appreciate the opportunity
    to testify in front of you today to talk about expanded
    research into the U.S. Department of Veteran Affairs 40-mile
    rule.
        The Veterans Choice Program that you heard so much about
    today provides veterans with the ability to receive medical
    care from the community outside the VA when required or
    necessary.
        One requirement for eligibility under this program is for a
    veteran to live more than 40 miles as defined by driving
    distance from the nearest VA medical facility with a fulltime
    primary care physician.
        This does not account for facilities within the 40-mile
    radius that may not provide the proper services for any given
    veteran. I have three wounded warriors on my staff at our
    district office in Little Rock. And we have 50,000 veterans in
    the second congressional district of Arkansas. So it is a prime
    focus of my office as we are home to Little Rock Air Force Base
    and Camp Robinson, the National Training Facility for the
    National Guard.
        And so I hear persistent concerns from our veterans about
    the 40-mile rule within the Choice program. The program was
    designed to make it easier for our veterans to receive the care
    they deserve.
        And I don't believe the distance a veteran lives from a
    facility should necessarily affect the quality care they
    receive. For this reason, I respectfully request that you
    include the following language in the fiscal year 2019 MILCON
    VA bill.
        And I quote that language. ``The U.S. Department of
    Veterans Affairs Secretary shall conduct a review of the
    Veterans Choice Program 40-mile rule and determine whether it
    serves the best interest of our veterans.
        ``The Secretary shall issue a report to Congress on such
    policy not later than one year after enactment of the Act''. I
    appreciate the chance, Chairman Dent, to be before you today
    and also give you my very best regards and fraternal friendship
    as you leave your quality service in the Congress. Congress
    will be a less wise, less commonsense place with your
    departure. And thanks for the ability to testify today.
        [The information follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                  40 MILE RULE

        Mr. Dent. Well, thank you, Congressman Hill, really I have
    enjoyed serving with you too. It was a pleasure to get to meet
    your wife too and her service to our country on the National
    Security Council during the Bush Administration.
        So, I want to thank you for that. But now, if you are going
    to be stuck in Montreal, let it be during hockey season. And
    hope you enjoyed it up there. A couple of things just on the
    40-mile rule, I know there are areas in your state where that
    40-mile rule does limit access to care. I have been frustrated
    by that rule as well.
        I know that VA is trying to make some accommodations in the
    application of that particular rule, but I think the better
    news is that the authorizers are conferencing right now on a
    replacement program for Choice.
        And I don't think that they intend to use the mileage-based
    measures to determine eligibility for non-VA care. But we had
    three members here previously from the VA authorizing committee
    who might be able to give us some insights on what this new VA
    Choice 2.0 is going to look like. But I share your concerns on
    that issue.
        It is something that is enormously frustrating to me that
    geographic criteria is quite limiting to the people in so many
    ways, that I don't think it should be geographically based
    anymore. In many cases we are denying veterans' access to some
    of the best health care institutions in the world based on
    where they live.
        And I think that is unfair. So, with that I thank you and I
    yield to Mr. Fortenberry to see if he has any questions.
        Mr. Fortenberry.
        Mr. Fortenberry. No. I think you raised a reasonable point.
    It is just I don't know the criteria by which 40-miles is
    selected. It might be just a pure budgetary constraint, but yet
    an artificial one that perhaps keeps some people from the
    quality of care that they deserve.
        You have got to have some set of criteria that make it
    somewhat objective and yet at the same time the rules are for
    the benefit of persons and when they interfere with that, then
    the rule itself ought to be reexamined. So, I don't know where
    the authorizers are either. But thanks for raising the issue.
        Mr. Hill. Thanks for the opportunity.
        Mr. Dent. Well, thank you, Representative Hill.
        And that concludes our hearing today. I see no other
    Members here for this Member Hearing Day. Are there any others
    here who want to speak up? Say so now, or forever hold your
    peace.
        So with that any comments from the ranking member?
        If not, this hearing is adjourned.

                               W I T N E S S E S

                                  ----------
                                                                       Page
    Bingham, Lieutenant General Gwen.................................    95
    Coglianese, Major General V. A...................................    95
    Green, Major General T. S........................................    95
    Hill, Hon. French................................................   248
    Kuster, Hon. A. M................................................   237
    Niemeyer, Hon. Lucian............................................    95
    Rutherford, Hon. John............................................   231
    Shulkin, Hon. D. J...............................................     1
    Smith, Vice Admiral D. R.........................................    95
    Takano, Hon. Mark................................................   224
    Tenney, Hon. Claudia.............................................   219
    Walz, Hon. Tim...................................................   197

                                   I N D E X

                                  ----------

                      U.S. Department of Veterans Affairs

                                                                       Page
    Chairman, Opening Statement of...................................     1
    Ranking Member, Opening Statement of.............................     2
    Shulkin, Hon. David J., Opening Statement of.....................     4
    Shulkin, Hon. David J., Prepared Statement of....................     8
    A National Opioid Crisis.........................................    35
    Accountability Within VA.........................................    37
    Alameda Point....................................................    40
    Blue Water Navy Veterans.........................................    32
    Community Care versus VA-Provided Care...........................    30
    Community Outreach Program.......................................    55
    Complementary Care...............................................    45
    Construction.....................................................    57
    DC VA Hospital and Restructuring VHA.............................    50
    DOD and VA Suicide Prevention Coordination.......................    56
    Electronic Health Record.........................................28, 51
    Funding the Choice Program.......................................    27
    Health Needs of Female Veterans..................................    49
    Infrastructure...................................................38, 53
    Inpatient Substance Abuse Treatment Wait Times...................    48
    Integrate Community Care into a Single Account...................    30
    Internal Dynamics................................................    27
    Medical Marijuana................................................    40
    Military Parade..................................................    42
    Modernization and Telehealth.....................................    33
    National Center for PTSD.........................................    49
    OIG Report on Veteran Wait Time..................................    31
    Poor Performing Employees........................................    37
    Predictive Analytics.............................................    56
    Private Care versus VA-Provided Care.............................    39
    Privatization of VA Care.........................................30, 54
    Prosthetics Technology...........................................    33
    Public-Private Partnerships......................................    46
    Rural America and Broadband Access...............................    34
    Telehealth Program...............................................    43
    Transition Assistance Programs...................................    43
    The Pathway Home Model...........................................    41
    VA Partnerships with Historically Black Colleges.................    58
    Vacant and Under-utilized Buildings..............................    55

                   Fiscal Year 2019 Budget Oversight Hearing
                   on Energy, Installations, and Environment

    Chairman, Opening Statement of...................................    95
    Ranking Member, Opening Statement of.............................    96
    Niemeyer, Hon. Lucian, Opening Statement of......................    98
    Niemeyer, Hon. Lucian, Prepared Statement of.....................   103
    Bingham, Lieutenant General Gwen, Prepared Statement of..........   126
    Smith, Vice Admiral Dixon R., Prepared Statement of..............   133
    Coglianese, Major General Vincent A., Prepared Statement of......   139
    Green, Major General Timothy S., Prepared Statement of...........   146
    Base Closure and Realignment.....................................   168
    Bipartisan Budget Agreement Increase Funding for DOD.............   159
    Border Wall......................................................   175
    BRAC Naming......................................................   174
    Cost of DOD Portion of a Border Wall.............................   158
    Contracting Mechanism............................................   167
    Detainees........................................................   175
    DOD Jurisdiction for a Border Wall...............................   158
    Drought Conditions...............................................   171
    Energy Resilience................................................   172
    Environmental Remediation at Conveyed Land.......................   164
    Excess Capacity at Military Installations........................   169
    Fort Bliss Hospital Construction Delays..........................   166
    High Value Detention Facility at GTMO............................   160
    Hospitals Instead of Clinics on Installations....................   171
    National Guard Training Lands....................................   162
    Naval Air Station Lemoore Military Construction..................   170
    Oakland Army Base Remediation....................................   165
    Readiness Centers................................................   163
    Resiliency and Sea Level Rise....................................   168
    Rhine Ordnance Barracks Energy Study.............................   159
    Sustainment Costs of Current Facility............................   162

                                  Members' Day

    Chairman, Opening Statement of...................................   197
    Ranking Member, Opening Statement of.............................   197
    Walz, Hon. Tim, Opening Statement of.............................   198
    Walz, Hon. Tim, Prepared Statement of............................   206
    Tenney, Hon. Claudia, Opening Statement of.......................   219
    Tenney, Hon. Claudia, Prepared Statement of......................   221
    Rutherford, Hon. John, Opening Statement of......................   231
    Rutherford, Hon. John, Prepared Statement of.....................   233
    Takano, Hon. Mark, Opening Statement of..........................   224
    Takano, Hon. Mark, Prepared Statement of.........................   226
    Hill, Hon. French, Opening Statement of..........................   248
    Hill, Hon. French, Prepared Statement of.........................   250
    McLane Kuster, Hon. Ann, Opening Statement of....................   237
    McLane Kuster, Hon. Ann, Prepared Statement of...................   240
    Aurora Project...................................................   248
    Care in the Community............................................   216
    Electronic Health Record.........................................   247
    LCS Program......................................................   237
    40 Mile Rule.....................................................   253
    Rome Lab Security Fence Cost.....................................   224

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