[Senate Hearing 116-445]
[From the U.S. Government Publishing Office]
S. Hrg. 116-445
REVIEW OF THE FY 2021 BUDGET AND FY
2022 ADVANCE APPROPRIATIONS REQUEST
AND OVERSIGHT OF CARES ACT
SUPPLEMENTAL APPROPRIATIONS FOR
THE DEPARTMENT OF VETERANS AFFAIRS
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
JUNE 3, 2020
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
44-629 PDF WASHINGTON : 2021
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SENATE COMMITTEE ON VETERANS' AFFAIRS
Jerry Moran, Kansas, Chairman
John Boozman, Arkansas Jon Tester, Montana, Ranking
Bill Cassidy, Louisiana Member
Mike Rounds, South Dakota Patty Murray, Washington
Thom Tillis, North Carolina Bernard Sanders, (I) Vermont
Dan Sullivan, Alaska Sherrod Brown, Ohio
Marsha Blackburn, Tennessee Richard Blumenthal, Connecticut
Kevin Cramer, North Dakota Mazie K. Hirono, Hawaii
Kelly Loeffler, Georgia Joe Manchin III, West Virginia
Kyrsten Sinema, Arizona
Caroline R. Canfield, Republican Staff Director
Tony McClain, Democratic Staff Director
C O N T E N T S
----------
JUNE 3, 2020
SENATORS
Page
Moran, Hon. Jerry, Chairman, U.S. Senator from Kansas............ 1
Tester, Hon. Jon, Ranking Member, U.S. Senator from Montana...... 3
Boozman, Hon. John, U.S. Senator from Arkansas................... 11
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 13
Cassidy, Hon. Bill, U.S. Senator from Louisiana.................. 15
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 17
Rounds, Hon. Mike, U.S. Senator from South Dakota................ 20
Hirono, Hon. Mazie K., U.S. Senator from Hawaii.................. 21
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 23
Manchin, Hon. Joe, III, U.S. Senator from West Virginia.......... 25
Sinema, Hon. Kyrsten, U.S. Senator from Arizona.................. 29
WITNESSES
Wilkie, Hon. Robert, Secretary of Veterans Affairs; Accompanied
by Richard Stone, MD, Executive in Charge of the Veterans
Health Administration; Paul Lawrence, PhD, Under Secretary for
Benefits; and Jon Rychalski, Assistant Secretary for Management
and Chief Financial Officer.................................... 5
APPENDIX
Moran, Hon. Jerry, Chairman, U.S. Senator from Kansas, prepared
statement...................................................... 36
Wilkie, Hon. Robert, Secretary of Veterans Affairs, prepared
statement...................................................... 38
Joint Statement of the Co-authors of the Independent Budget:
Disabled American Veterans Paralyzed Veterans of America
Veterans of Foreign Wars....................................... 58
Response to hearing questions from Department of Veterans Affairs
submitted by:
Hon. Jerry Moran............................................... 71
Attached PDFs................................................ 167
Hon. Jon Tester................................................ 91
Attached PDFs................................................ 191
Hon. Sherrod Brown............................................. 113
Attached PDFs................................................ 242
Hon. Richard Blumenthal........................................ 123
Hon. Mazie K. Hirono........................................... 133
Hon. Joe Manchin III........................................... 144
Hon. Kyrsten Sinema............................................ 146
Hon. Mike Rounds............................................... 158
Hon. Dan Sullivan.............................................. 158
Attached PDFs................................................ 246
Hon. Marsha Blackburn.......................................... 160
Hon. Kevin Cramer.............................................. 164
REVIEW OF THE FY 2021 BUDGET AND FY
2022 ADVANCE APPROPRIATIONS REQUEST
AND OVERSIGHT OF CARES ACT
SUPPLEMENTAL APPROPRIATIONS FOR
THE DEPARTMENT OF VETERANS AFFAIRS
----------
WEDNESDAY, JUNE 3, 2020
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 3:12 p.m., in
room SD-106, Dirksen Senate Office Building, Hon. Jerry Moran
presiding.
Present: Senators Moran, Boozman, Cassidy, Rounds, Tillis,
Sullivan, Loeffler, Tester, Brown, Blumenthal, Hirono, Manchin,
and Sinema.
OPENING STATEMENT OF CHAIRMAN MORAN
Chairman Moran. Good afternoon everyone. The Committee will
come to order.
Before we proceed to today's hearing, I would like to take
a moment to recognize that last Monday was Memorial Day. It was
a different Memorial Day for me and for other Americans than
normal, and it was more difficult for us to gather together.
But last Monday gave us an opportunity that we should take
every day, to pause and remember the brave Americans who gave
their lives in defense of our country, and we honor the
sacrifices they made to keep us free.
While--let me start by saying that the veterans that we
honored on Memorial Day, they served our country, and that
peaceful protests are a demonstration of the freedom that our
veterans served to safeguard and to protect. While we reject
the defacing of our national monuments, I would take another
moment to express my gratitude to the National Park Service,
its employees and volunteers, who quickly restored our
memorials, all of them, but especially those that recognize the
service of our men and women, particularly the World War II
memorial.
I know that this Committee will continue to further our
Nation's pledge--one nation under God, indivisible, with
liberty for all. We do that by honoring those who served to
make certain we live in that country and we, again, use this
Committee as an opportunity to pay our regards and respect to
veterans who lost their lives to protect our freedoms.
Today's hearing is on the VA's Fiscal Year 2021 budget
request and the supplemental appropriations contained in the
CARES Act to respond to the COVID-19 outbreak. We welcome
Secretary Wilkie as well as Dr. Richard Stone, Executive in
Charge of the Veterans Health Administration; Dr. Paul
Lawrence, Under Secretary for Benefits; and Jon Rychalski,
Assistant Secretary for Management and Chief Financial Officer.
I appreciate your presence here today and we certainly have
done our job to socially distance. Mr. Secretary, despite the
distance between you and me and your team, there is nothing
other than COVID-19 that causes that to occur, and I look
forward to continuing to work closely with you at every
opportunity.
I look forward to discussing with you all today how we can
work together to improve outcomes for veterans in our country.
I would also like to acknowledge the passing of veterans
and VA personnel who lost their lives due to COVID-19. Part of
our discussion today is to make certain the VA has every tool
it needs to minimize the loss of life during these
unprecedented times, and I also want to thank the VA nurses,
our doctors, and support staff who work tirelessly to deliver
care to veterans during the COVID-19 pandemic.
In addition to serving veterans, the VA has executed its
fourth mission, to support the American health care system
struggling during this national emergency. This response from
these health care professionals has been and continues to be
admirable and important and necessary.
While the VA continues to devote resources to suppress the
pandemic, veterans will continue to rely on the VA for their
needs, such as education, home financing, and transition
services. To this end, the pursuit of the well-being of our
Nation's veterans must continue unabated.
Between the release of this budget and today's hearing,
Congress passed legislation to support Federal agencies
responding to the pandemic. Following a supplemental
appropriation request from the President, Congress passed the
CARES Act, signed into law on March the 27th. CARES provides
$19.6 billion for medical services, including telehealth
services, equipment, and supplies, personal protective
equipment, and emergency room and urgent care. CARES also sets
aside $2.2 billion for IT, in order to increase telework
capacity and other telehealth needs.
I am interested to learn how the COVID-19 emergency has
affected the VA health services and its budget.
Retrospectively, did the CARES Act appropriately fund the right
places, and prospectively, given the shifting health care
demands, does the President's Fiscal Year 2021 budget still
address VHA's projected needs?
Released before the COVID-19 emergency, the President's
Fiscal Year 2021 budget request includes a proposed increase of
$22.8 billion in funding for the VA for a total of $243.4
billion. This represents a 10.2 percent increase above Fiscal
Year 2020 enacted levels. I look forward to hearing from you
how the proposed budgetary increase will create better outcomes
for our Nation's veterans.
I was pleased to see the budget request includes an
increase for medical community care as the VA continues to
implement the MISSION Act. As we have discussed, many veterans,
especially those in rural States like Kansas, depend upon
community care providers for access to timely and quality care.
The MISSION Act was a bipartisan effort to transform
veterans' access to community care, it is strongly supported by
every veteran service organization, and you have been a
champion, Mr. Secretary, to ensure its proper implementation.
We all want veterans to receive the care they need through the
VA or in their community, and I look forward to discussing the
future of the MISSION Act today.
Addressing another of the Committee's health priorities, I
appreciate the additional requested funding for mental health
and for suicide prevention. Mr. Secretary, I know you share our
priority. In January, this Committee unanimously reported the
Commander John Scott Hannon Veterans Mental Health Care
Improvement Act to provid targeted resources toward research,
grants for community partners, and improved coordination
between the Department of Defense and the VA to quell the rates
of veterans who die by suicide. It is my hope that you will
continue working with us to get this bill signed into law soon.
Mr. Secretary, as always, I thank you for being here. I
appreciate the difficulty of your job as the Administration
works to find a whole government solution to the pandemic. I
look forward to hearing your views on the Fiscal Year budget,
and I now turn to my colleague and the Ranking Member of this
Committee, the Senator from Montana, Senator Tester, for his
opening remarks.
OPENING STATEMENT OF SENATOR TESTER
Senator Tester. Thank you, Chairman Moran, I want to thank
you for having this hearing. Before I get into my prepared
Statement, I want to say 10 days ago was Memorial Day, and it
was a different Memorial Day than I have ever experienced. It
gave me an opportunity to think about everything that veterans
have given us in this country--the freedom and the promise to
live with liberty and justice for all. I think it is
appropriate that as we have all said, every day is Veterans Day
in this country, because, quite frankly, without the
sacrifices, without the job that our military has done over
generations, this country would certainly be a different
country than it is today.
I hope with all my heart, that we keep in our mind that
this country is about liberty, and it is about justice, and it
is about liberty and justice for all.
So thank you to the veterans out there, and, Secretary
Wilkie, I want to thank you and I want to thank your leadership
team for being at the hearing today. Today we get to go over
the details of the President's budget request. In the last 4
months, the world has changed, and the VA has changed. More
than 106,000 Americans have died, many of them veterans who
have returned from wars abroad to die fighting a very different
battle here at home.
The VA is our largest integrated health care system in the
Nation, and I know the VA has been focused on saving as many
veterans' lives as possible, with more than 12,000 veterans
having been diagnosed with COVID-19 by the VA. While many are
recovering or convalescing, we should never forget that more
than 1,270 have died.
As part of this mission, VA has also taken care of non-
veterans and has deployed staff and supplies to non-VA
facilities like State veterans' nursing homes.
VA's front-line workers and their work force have done an
incredible job and deserve more than just a thank-you, because
that is not enough for the work that they have done. It has
been stellar. We must ensure that the VA has everything it
needs to keep the employees that we have safe and take care of
our veterans in the process.
Today's hearing is an opportunity for us to take stock of
where we are and where we need to be. Mr. Secretary, at the
outset of the Nation's response to COVID-19, Congress fulfilled
VA's request for nearly $20 billion to support its ability to
take care of veterans. We do need a better understanding of how
VA has spent those funds and whether unspent dollars will be
available to address veterans' needs, whether it be COVID-19 or
otherwise, in this next fiscal year.
We also need to ensure that the President's budget request
for VA in-house care meets the anticipated health care demands
of veterans when looked through the lens of the coronavirus. We
also need to know whether private sector providers are prepared
to safely administer care to veterans, given the virus'
unprecedented effect on American health care. We must
anticipate the economic ripple effects of coronavirus on
industries across the board, prepare for a potential increase
in enrollment and reliance on VA, and evaluate whether the
President's budget meets those demands.
We have seen the devastating physical effects that
coronavirus has had on those who have contracted the disease,
but I think we have also seen large-scale negative
psychological impacts such as physical distancing and
isolation, the death of loved ones and lack of access to
traditional in-person mental health resources.
The VA needs to look to new and innovative approaches to
providing mental health care to veterans across the country,
such as increased access to telehealth services. As we have
seen with this COVID-19 crisis, VA facilities need more space
and certainly not less. We need capacity, and we will not get
there by short-changing VA's infrastructure.
With veteran unemployment on the rise, it is also critical
that the VA communicate what programs we need to support in
order to get veterans educated, trained, back to work, and able
to provide for their families. One way we help veterans provide
for themselves and their families is to ensure their claims are
processed timely and accurately. I am truly concerned with the
mounting backlog of claims from the COVID-19 pandemic due to
deferred and disrupted in-person examinations for veterans, and
with how these delays will affect them and their families.
So I look forward to today's hearing, and learn more about
how this budget request and the Department's response to COVID-
19 has progressed, and I look forward to our conversation. Once
again, thank you, Mr. Chairman, for having this hearing, and I
want to thank all the witnesses for being here today.
Chairman Moran. Senator Tester, thank you for joining us. I
appreciate the relationship that you and I have, whether we are
close or far apart. Maybe sometimes this works better for us.
But I am delighted that you are with us.
I would tell the Secretary and his team that we have almost
every member of the Committee present, either here, in person,
or remotely. This is a hearing that our Committee members take
seriously, and they are participating. While I am pleased that
all of our members are here, I also want to acknowledge the
presence of Senator Boozman, who chairs the MilCon-VA
Appropriations Subcommittee, who has a lot of interest and
involvement in your appropriations. So Senator Boozman, thank
you especially for joining us with your expertise and interest.
Mr. Secretary, before I introduce you I would say not only
thank you for being here but you have been very kind with your
time to Senator Tester and I throughout the pandemic. I could
not ask for more opportunities to have conversations with you
and your team, Dr. Stone and others, and that was very helpful
as we explored, and hopefully made suggestions and asked
questions that were beneficial to you in fulfilling your duties
during this pandemic.
Mr. Secretary, welcome, and please proceed with your
testimony.
STATEMENT OF THE HONORABLE ROBERT WILKIE; ACCOMPANIED BY
RICHARD STONE; PAUL LAWRENCE; AND JON RYCHALSKI
Secretary Wilkie. Thank you, Mr. Chairman and Senator
Tester. You stole the first line. I intended to say, and
actually I will say, that in my experience working in this
institution, everywhere from the majority leader's office to
finishing with Senator Tillis, that I can say that there is no
committee of authorization that has been more collaborative or
more supportive of the Department that it oversees than this
Committee, which is why I do say, with a straight face, it is a
pleasure for me to be here.
I also want to pick up on what you and Senator Tester said
about the events of Memorial Day. Memorial Day has been part of
my life for as long as I can remember. As Senator Tillis says,
I was born in khaki diapers and am very proud of it. But this
Memorial Day I looked out from the podium at the Quantico
National Cemetery and saw three families scattered amongst the
thousands of veterans at that cemetery and realized that this
really was a different time.
But I will say that we have, at VA, made sure that every
obstacle possible was removed, so that on that day of days,
those families could be in our cemetery, representing the 1.1
million Americans who have lost their lives since the first
shots were fired at Lexington in April of 1775.
Mr. Chairman, you noted that last year we presented the
largest budget in the history of this Department. That has now
been surpassed by the budget presented to this Committee this
year. But I want to say that your support in that budget
reflects trust in VA that did not exist 6 years ago. This is
not the VA you read about in 2014. Today we are rededicated to
Lincoln's vision that we take care of all who have borne the
battle and for their families.
Our record of turnaround is something that may be
unprecedented in the history of the Federal Government. In just
a few short years we have implemented major reforms. Under the
MISSION Act we have successfully given veterans real and
permanent choice. While some said that the MISSION Act meant
the privatization of Veterans Affairs, the numbers show that
the opposite has happened.
In the last fiscal year, we completed more than 59.9
million internal episodes of care, a record high. While we were
doing that, between June 6th and the declaration of the
national emergency, we sent almost 4 million veterans into the
private sector to fulfill the MISSION Act's mandate. We
implemented critical updates to the Colmery Bill, we took on
the new task of caring for thousands of Blue Water Navy
veterans, and we continue to make progress in the highly
complicated development of the electronic health care record
that we will share with the Department of Defense so that
people like my father will never be burdened with an 800-page
paper record ever again.
Today we continue to implement those reforms even as we
cope with, as you and Senator Tester said, a radically new
normal that none of us could have foreseen the last time I
appeared before this Committee. This epidemic was a shock to
health care systems around the planet, but you should be proud,
as I am, the thousands of VA employees who put themselves in
harm's way to create an indispensable resource, not only for
our veterans but for our Nation.
We continue to perform well because we took steps early on
that allowed us to keep serving veterans even when there was so
much uncertainty. Those steps included the immediate
implementation of emergency management procedures in the last
week of January, expanding telehealth access and prohibiting
visitors to our VA nursing homes and spinal cord injury
centers.
Here is where we stand today. As of this week, more than
12,000 veterans nationwide have been diagnosed with the virus,
but 80 percent of those veterans are now at home, having
recovered. We are caring, as we speak, for 1,200 veterans with
the virus, a number that has fallen in the last 2 weeks from
2,200. We have, currently, about 1,100 VA employees who have
tested positive, but we estimate that our infection rate, with
330,000 employees in Dr. Stone's department, to be one of the
lowest infection rates of any health organization on the
planet. It is less than .5 of 1 percent.
Our staffing is stable because we have hired, in the last 7
weeks, 16,000 Americans who have agreed to join us and serve
veterans. That means 3,300 registered nurses, 22 CRNAs, 535
physicians, and 202 nurse practitioners who are with us now
full-time.
More importantly, we have the lowest rate of infection
amongst our nursing home residents, the lowest rate of
infection of any system in the country, because early on we
took very difficult steps to close off our veterans, sadly,
from their families and their friends. Because of that we have
19 veterans in our nursing homes, 19 out of the 7,000, who are
infected with the virus. I believe that we have set an example
on how to care for our Nation's most vulnerable.
That stability in operations has allowed us to open our
doors for the fourth mission, which is to back up the national
health care system in times of crisis. We are now in 47 States
and territories. By April, we were accepting requests to open
dozens of our hospitals to non-veterans across the country. Our
expertise in caring for nursing home residents is in the
highest demand. We have deployed 294 VA staff to community
nursing homes around America, and 330 VA staff have been
deployed to help at State veterans' homes.
The crisis, as I mentioned, was not costless for us. COVID
has claimed the lives of 32 of our VA families. But in April,
April brought us irrefutable evidence that the tide at VA has
turned for the better. On the last day of the month we released
a survey showing that a record 90 percent of veterans across
the country now completely trust VA care. That is a record high
and is a record high even in a pandemic.
That is today's VA. It is a learning organization, filled
with employees who can turn on a dime to keep veterans and non-
veterans safe, even during this time of incredible uncertainty.
Mr. Chairman and Senator Tester, I again thank you for your
many courtesies to me and everything you do for our Nation's
most deserving.
Chairman Moran. Mr. Secretary, thank you very much. Let me
begin with a handful of questions and then turn to Senator
Tester. Committee, we will do this seniority, not knowing the
presence of every member at the moment. We will work our way,
alternating between Republicans and Democrats by seniority.
Mr. Secretary, can you walk us through why we are seeing a
steady growth and increasing funding in both internal VA
medical services and community care? Let me use this
opportunity to say that I believe that whether the care is
provided in the community or provided internal to the VA, both
are VA care. They are both part of the Department of Veterans
Affairs and they are not separated.
You indicated the hiring of 10,000 medical staff. This, in
my mind, could lead toward a greater capability of seeing more
people internally within the VA, and maybe result in less
people involved in community care.
You have also indicated, to me and Senator Tester over a
long period of time, the increasing use of telehealth. How does
that then have a consequence on the amount of veterans being
seen internal and in community? I mean, I raise this question,
in part, because we are being requested in this budget for more
money in both categories, internal VA care and community care.
Secretary Wilkie. Mr. Chairman, let me answer the
telehealth question first, and I think that is a separate
category because it rests on a priority that I gave to this
Committee when I had my confirmation hearing.
The two communities in this country who serve the Nation in
higher numbers than any other communities are rural Americans
and Native Americans, the two populations that are the hardest
for us to reach, no matter what the MISSION Act does. But what
we have done with telehealth is increase our footprint in rural
and Native America.
I will give you an example. In April, we had over 900,000
telehealth encounters. That is an increase of several hundred
percent. The reason that is important is at a time of crisis,
when those veterans cannot get to our facilities, or they
cannot get to their private sector provider, we have offered
them a window to help with their health conditions. I intend to
expand our footprint through telehealth into rural and Native
America.
On the community care side, I am fully committed to
expanding that choice. Even during this time, 60 percent of our
normal MISSION Act community care appointments have been
carried out. The one thing that we have discovered during this
crisis is that many of our veterans are not going into the
private sector, and you have seen that all across the country
with declining rates not only of wellness visits but visits to
the emergency rooms.
That has been the makeup of how we have reacted both to the
expansion of MISSION but also the expansion in the confidence
that people have in VA. I will let Dr. Stone add some comments
about the numbers and budget.
Dr. Stone. Mr. Chairman, the growth in the budget reflects
enhanced enrollment--we are anticipating about 30,000 more
veterans to be enrolled with us--and enhanced dependence upon
the system. As you know, about 80 percent of the veterans that
are enrolled with us have other health insurance. They do not
get all of their care from us. About 20 percent do get all of
their care. But increasing amounts of dependence upon us, as
well as the growth in referral to community care.
A small percentage of the increase is due to MISSION Act
and the increased requirements of probably not more than 2, 2.5
percent, but Jon will correct me if I am wrong on that number.
But it is really dependence upon us and the enrollment. As we
come out of this pandemic, we certainly are concerned that
financial destabilization of the veteran population may result
in even greater dependence upon us, and I will defer to Mr.
Rychalski to correct anything I said.
Chairman Moran. Mr. Rychalski?
Mr. Rychalski. I have no corrections. I would say that from
the enrollee health care projection model that we use to
predict costs, I think the big cost driver is the reliance that
Dr. Stone mentioned. I think more people are taking advantage
of the VA. So we are a victim of our own success. I think there
are more programs, more benefits, more access, different
environment, and frankly people are coming and taking advantage
of it.
Chairman Moran. Is there a way to distinguish between
increasing number of veterans accessing care and the cost of
care in your calculations of a budget?
Mr. Rychalski. There is. It gets very complicated. As you,
I think, know, and Dr. Stone alluded to, I belong to a
commercial health care plan and they sort of know that I am
going to use their health care plan for all of my health care.
The challenge that we have is, you know, we have beneficiaries
that have all kinds of Medicare, TRICARE, private insurance,
and the challenge for us is predicting how much of the VA they
are going to use. You know, we may see an increase in VA
because of this, you know, this COVID pandemic, people losing
their job, and that is something that we are looking at very
closely. But predicting that and sort of knowing is a very
difficult thing to sort through.
Chairman Moran. Thank you all for your responses. Let me
turn now to Senator Tester.
Senator Tester. Thank you. Thank you, Mr. Chairman. I want
to thank everybody who has testified. Look, you guys touched on
it, and I am going to followup where the Chairman was at. This
budget was developed long before we knew there was going to be
a pandemic, and, quite frankly, it is a boatload of money, it
needs to be right-sized. It does not need to be overly
inflated, and it certainly should not be less than you need.
Each one of you talked a second ago about an April increase
in the hundreds of percents. You talked about the fact that 80
percent of the folks have health care insurance. I think with
unemployment increasing--and you guys talked about this--you
are going to see increased dependence upon the VA. We have seen
Medicaid enrollment, for example, increase by 2.8 percent
February to April, and it is going to increase some more moving
forward.
So I think we can anticipate there is going to be more
pressure put on the VA, and I think we all can agree on that. I
think you have already said that. The question is, does this
budget account for that, since it was laid out long before we
had the COVID-19 pandemic on our hands.
Secretary Wilkie. Senator, let me--Senator--and Jon can
give more details--the one silver lining in what has happened
is that when I first started talking to you and talking to the
Chairman, we were projecting hundreds of thousands of veterans
being infected with this virus. We have mercifully been spared
those numbers. Of the 9.5 million veterans we serve, 12,300
have been infected.
What does that mean for the CARES Act and the supplemental
funding? That means of the $17.2 billion that the appropriators
allocated to us for the CARES Act, we have spent $1.01 billion
on medical services. Right now we have more than enough to
anticipate the problems that you have just outlined.
Our problems and our emphasis will be on making sure that
the claims and that the education programs and the vocational
programs are fully up and running so that when we get back to
those face-to-face encounters we will be able to provide those
veterans with the services they need.
In terms of internal appointments, I do not see it going up
much more than it has, because we have reached almost a
saturation point in terms of the number of veterans that we
have in the system, and the number of veterans across the
country is going down.
Jon, did you want to----
Mr. Rychalski. I am sorry. Go ahead, Senator Tester.
Senator Tester. Well, I would just say go ahead, very
quickly, Jon, if you could, because I have some followups.
Mr. Rychalski. Just to confirm what the Secretary said. You
know, we did not anticipate this in the budget but we have a
lot of flexibility.
The one thing I would like to emphasize, though, where we
could really use some help, is we did not get all the right
money in all the right places. We do have a real need to move
some of that CARES money into VBA--not a large amount--some
into NCA, and some flexibility for IT as well. Those are three
areas where we are going to be short. Other than that, I think
we have adequate flexibility. I think the 2021 budget is
adequate, but we did not know this when we started. It is not
all in the right places but it is not bad.
Senator Tester. So it is your intent that--and this is the
question I was going to ask you, and you touched on it, Jon--if
your intent is to get authorization to roll any unused CARES
Act money into different line items, where you would need money
in this budget?
Mr. Rychalski. Yes. In fact, you have given us authority to
move some money around within the medical care appropriation,
but we would ask for your support in expanding that a bit
with--you know, with congressional oversight, to be able to
move it to some other areas. I think we are providing weekly
execution reports. We are happy to be 100 percent transparent.
But we are going to need to move some of that money around to
other areas. That is true.
Senator Tester. That is fine. That is good. That
transparency is good, and I want to thank you for that
Statement.
So First of all, congratulations. I understand that there
have been 16,000 new people hired to the VA in April and May,
and if I am wrong you can correct me on that. So
congratulations on that. The question is, are these folks in it
for the long haul, or are these folks that have retired and
came back, that you plan on losing again, or is this really
something that we can get our arms around to help solve that
vacancy problem?
Secretary Wilkie. Yes, sir. I believe 90 percent are
permanent, and that is one of the best news stories that we can
have in government.
Senator Tester, I want to followup on something you and I
have talked about, and the reason I believe that this funding,
the supplemental funding, is so important. I am cognizant that
this will boomerang, or can boomerang on us in the fall and the
winter. I think the supplemental funding that the Congress has
provided us will be our hedge against what could possibly come.
We have demonstrated, I think, that we have the procedures in
place to ensure that if it does come back we will be ready, and
I believe we have the funding to meet that challenge.
Senator Tester. I appreciate that Statement, Mr. Secretary.
Thank you for that. I also say that I do not know what happened
in April and May. This is not to what you touched on, but what
you said is incredibly important, because if this does
boomerang back you have got to be prepared for it. It sounds
like you are working in that direction. Thank you.
Whatever you did in April and May, to hire 16,000 people,
can you repeat that in June and July? If you do that for a few
more quarters we will be in really good shape----
Secretary Wilkie. Yes, sir.
Senator Tester [continuing]. from an employment standpoint.
Secretary Wilkie. Yes, sir.
Senator Tester. The last thing, and I will be very quick
because if my eyeballs do not deceive me I have got about 50
seconds left. The issues around testing are really important,
and you have said that any employee that wants to get tested
can get tested. We are not hearing that. We are not hearing
that from the folks on the ground. We are still hearing that
they are not being tested. Could you shed some light on that as
to what the heck is going on?
Secretary Wilkie. Senator, you are exactly right. We are
not there yet, although we have tested over 12 percent of our
employees. It is our intent to have on-demand testing for all
of our employees. We are not there yet. Most of that relates
not to the machines that we need. We have the ability to do
60,000 tests a week on our machines. It is the availability of
cartridges that go into that from the various vendors and the
availability of swabs.
Simply, when we issued the guidance to go to on-demand
testing for our employees, we ran out of swabs in a--because of
some problems with UPS shipping. That was a national problem
with the crashing of UPS systems for a weekend. We have now
recovered from that. Right now we have about 60,000 tests
available, but we do not have the ability to institute on-
demand testing from our employees, but it is our intent to get
there.
Senator Tester. Mr. Secretary, thank you. If I am 3 minutes
and 20 seconds over, Mr. Chairman, thanks for not gaveling me
down, but I should have been. Sorry.
Secretary Wilkie. Mr. Chairman. may I----
Chairman Moran. Mr. Secretary.
Secretary Wilkie [continuing]. may I add to that 3 minutes
and 30 seconds, because Senator Tester just finished, but this
is also addressed to Senator Sullivan and Senator Rounds, and
those Senators who have large Native populations.
We have brought into our VA over 2,000 Native Americans for
treatment. We have gone into the Native nations, and we are in
several of those communities, and it is my intention to expand
our footprint there, some of our most vulnerable veterans but
also some of our most vulnerable Americans. As Senator Sullivan
knows, we have 114 individual Tribal agreements, and it is my
intention to expand that so there is no Tribal community that
we miss.
But I did not want to go without mentioning our help for
the Indian Health Service. Someone criticized me a few days ago
for not getting payments. I will worry about that much later.
The most important thing is getting those services and that
treatment out into Indian country.
Chairman Moran. Mr. Secretary, thank you. Senator Tester, 4
minutes and 51 seconds over, if you include the Secretary's
remarks, and I will try to be more disciplined with my
colleagues.
Senator Boozman?
SENATOR JOHN BOOZMAN
Senator Boozman. That is almost twice.
Chairman Moran. Almost twice.
Senator Boozman. No, we appreciate you, Senator Moran, Mr.
Chairman, and Ranking Member Tester for holding this hearing,
which is so, so very important. We appreciate you, Secretary
Wilkie, and your team for the great job that you do.
This is just a comment. I hope that we can continue to give
you the ability to do the hiring process like you are doing it
now. I do not know how long it would normally take you to get
those people on board, but it would be a long, long time. So
again, we appreciate you all working so hard and using the
flexibility we have given you.
The Fiscal Year 2021 VHA veterans' health budget request is
$90 billion, a $10.8 billion increase from the prior year. If
you look at 10 years ago, in Fiscal Year 2011, the budget
request for veterans' health then was $52.1 billion. It is
really remarkable the growth--to be precise, 73 percent in the
last 10 years.
We talked about some of the drivers that were doing that,
and I would argue, having been on the Committee in the House
and now in the Senate for many years with our distinguished
Chairman, veterans health is so much better than it used to be,
and we have the confidence now. Lots of people using the
system.
We also--is it correct that we have an aging veteran
population in a sense with our World War II, our Korea, Vietnam
veterans, again, with multiple problems facing, and then the
increase in health care costs. So it is a lot of money, but it
is something certainly that we are committed to doing. But the
good news is I think the thing that is spurring it, as much as
anything, is just the confidence that we are seeing in our
veterans in continuing to use veterans health care when they
could go to Medicare or some other insurance.
Dr. Lawrence, recently we visited, or the staff visited.
They were told that the recent suspension of the C&P exams due
to COVID that were understandably creating a significant
backlog. We have worked so hard to get that down. Can you talk
about the plan? What can we do to get that back under control?
I think what are we, 116,000 exams, something like that? Is
that in the ballpark?
Mr. Lawrence. Yes, you are being charitable. This morning
it was 119,000. You are correct, sir. On April 2d, when VHA
stopped doing C&P exams, we follow their lead, so on April 3d
we told our vendors they could no longer do in-person exams. We
started conducting ACE exams and using their medical records to
do things like fulfill their claim or provide partial benefits.
But you are right. The simple math of what took place, and, you
know, you all deserve some positive responsibility for that.
Through the Blue Water Navy Act, we began to receive a lot of
claims in January, and now there are over 125 days. So that is
correct.
We have a plan to open following VHA's lead, and that would
begin--they opened 20 hospitals. We are opening in that area
June 8th. We will startup again C&P exams in certain parts of
the country, and we will continue that. The vendors know and
they are making phone calls now to schedule it.
We are not happy about the backlog. In November it was
64,000. Our team is very proud of processing claims quickly, so
we want to get that right away.
Two things, sir, to answer your question. The first thing
was what Mr. Rychalski just said about reprogramming some
money, so we will have overtime money to do the claims. The
second, we have a piece of legislation, a legislative request
in front of you, to allow doctors to conduct C&P exams across
borders, and in addition some flexibility for non-doctors to
conduct the C&P exams, nurse practitioners and the like. We
would ask you to consider that, and that would be one way for
us to expand the capacity to work the C&P backlog--work the C&P
exams and therefore the backlog.
Senator Boozman. Very quickly, Secretary Wilkie, the fourth
mission has been a big success. As a result of that, FEMA, HHS
owes the VA some money. Can you talk quickly about the plan and
actually recouping that? What is going on with that? Certainly
that would be very helpful to us as we work through the budget.
Secretary Wilkie. Jon might have exact figures, but as you
know, statutorily, FEMA and HHS have to reimburse us when we go
on missions that they have approved. One thing that I did,
though, was I just started calling Governors. We went out ahead
of many of those missions because particularly in State
veterans' homes there was a crisis, and FEMA has caught up with
those requests.
But I will get you figures on how much we are owed so far,
unless Jon has new figures.
Mr. Rychalski. I was just going to say, sir, we are
tracking it closely. We have worked with FEMA. We have not
billed them nor collected anything, but we will be doing so. We
can provide you a breakout of that.
Senator Boozman. Thank you, Mr. Chairman.
Chairman Moran. Senator Brown.
SENATOR SHERROD BROWN
Senator Brown. Thank you, Mr. Chairman and Mr. Secretary.
Thank you and Ranking Member Tester. Thanks for eating up some
of my time, Jon. I appreciate that.
We are here to discuss VA's budget and the Department's
COVID-19 pandemic responses. Today VA reported 1,200 veterans,
32 VA employee deaths since the start of the pandemic. Our
country is in a crisis. People are dying of a disease that
continues to spread, particularly among seniors, and especially
among the black and brown workers who are keeping our society
afloat right now.
We know who essential workers are. They are too often paid
too little. One essential worker said to me, ``I do not feel
essential. I feel expandable. I am not paid very well. My work
conditions are not very good,'' and that is something that all
of us on this Committee should think about, especially when
they are veterans.
Protesters are in the street now because their government
is failing them. It is failing to protect our workers. Not only
has it failed to protect black and brown American workers, for
generations of people who are supposed to protect everyone it
has too often been turned against them.
Peaceful protesters should not be tear-gassed or pelted
with rubber bullets so the President can exploit a house of
worship, to stage a photo op. They are not terrorists. American
cities are not battle spaces. I know that the great majority of
veterans, I assume the great majority of VA workers agree with
that, and they too are embarrassed when the President disbands
peaceful protestors and then brandishes a Bible as a weapon.
On this Committee we honor those who have chosen a life of
service. Nothing is more patriotic than upholding the
Constitution and exercising our fundamental rights. We need to
continue working together to address injustice and inequality
to ensure that all Americans are treated fairly.
I have directly heard from student veterans about how this
pandemic has affected their GI Bill benefits. Congress worked
to provide relief. I am still concerned that the information
from VBA is not reaching all the colleges and universities in a
clear format. I urge the Secretary and the staff to work a
little harder on that. We need to make sure work-study students
still are paid or that when classes are only offered online, GI
Bill benefits continue as if classes were in person. Even after
we passed legislation to address these issues, my office has
heard from veterans in schools.
My First question, Dr. Lawrence. Would you commit to work
with my staff, with Anna and Drew on my staff, if we hear of
additional concerns about this?
Mr. Lawrence. Absolutely.
Senator Brown. Okay. Thank you. I figured you would say
yes, and you have always been cooperative. Thank you.
Mr. Secretary, I appreciate Senator Tester asking about
vacancies. I had the same question. We need to continue to
drive down the time it takes to hire medical professionals at
VA. Can you commit to retain the expedited hiring practices
that you have ably scaled up during the crisis?
Secretary Wilkie. Oh, absolutely, and if I need additional
authorities I will come to this Committee. I think we have
shown, Senator Brown, that the government can work, and we have
cut months, almost years off of the hiring process.
One quick thing. One of the incentives that we gave is that
we told people if you joined us you can stay in your hometown
or in your home State should you so desire. I think that is a
huge incentive.
Senator Brown. That is very important. I wanted to take
this opportunity to urge you to find a way to negotiate in good
faith with the VA unions. I and veterans know they get better
care, and employees know their concerns are addressed where
union representation is at the table. We know that workers are
more productive and they are better treated.
Dr. Stone, Dr. Lawrence, have you reviewed the white paper
released by the National Veterans Legal Services Program and
the Jerome Frank Legal Service Organization at Yale Law School.
Veterans who were stationed in Guam for a decade in the 1960's
and 1970's were likely exposed to dioxin-containing herbicide
agents, including Agent Orange. Have you looked at that paper
and do you agree with the assessment? For Dr. Stone and Dr.
Lawrence.
Mr. Lawrence. Sir, let me go first. Yes, sir. We reviewed
the paper and I believe we responded to a letter to you all
about, you know, the inability of us to find the use of the
dioxin in that area. I know it was a very complicated paper
that required analysis from our team. I am happy to discuss it
more with you, but yes, it has been reviewed.
Senator Brown. Okay, thank you. Dr. Stone, do you want to
add anything?
Dr. Stone. Sir, I have reviewed the paper and I agree with
Dr. Lawrence. It is very complex in its process and we look
forward to coming to resolution on it.
Senator Brown. Okay. It is important that the VA always
stand--as you know, always stand with veterans and Agent
Orange. We are sometimes slow to that. With burn pits and now
with this study it is important always that we come down on the
side of veterans.
Last comment, Secretary Wilkie and Dr. Stone. The VA has
made a major shift toward telehealth to decrease possible
spread of COVID-19. When we passed the CARES Act we included
specific funding to increase veterans' access to internet and
telehealth. Some areas of Ohio are rural. Many of the Senators
on this Committee have even more rural areas than I do. They do
not have great access to broadband. This is especially
important as veterans rely more heavily on telehealth for the
foreseeable future.
I hope you will share--my time is up, but please share with
the Committee at some point what steps VA, or with my staff,
what steps VA has taken to enter into contracts to expand
broadband and telehealth services for our veterans.
Thank you, Mr. Chairman. If you would just--you can answer
that question in writing, or if you want to take the time now.
Secretary Wilkie. We will. It is a priority for us,
particular, as you mentioned, in rural America.
I did want to say something about your opening comment
about--I believe you mentioned gender disparities. We are in an
interesting position at VA. Forty-nine percent of eligible male
veterans are in our system. I can say to this Committee today
that 42 percent of all eligible female veterans are now in the
VA system. Dr. Stone has just hired an assistant, special
assistant, to monitor those issues, any disparities, and report
directly to him. I think we are the only health care system in
the country to monitor gender and racial disparities in terms
of health care and health care outcomes.
So we are in the lead, and I think for many of those
communities the health care outcomes are much better within our
system than they are in the private sector. So I take your
point to heart.
Senator Brown. Thank you, Mr. Secretary. Thank you,
Chairman Moran.
Chairman Moran. Senator Cassidy. You are welcome.
SENATOR BILL CASSIDY
Senator Cassidy. Thank you all. Thank you for your good
service and thank you in New Orleans, which had a lot of COVID.
You all did a lot of work to kind of mobilize resources. I
really appreciate that.
A couple of things. I have heard--again, as a physician I
get these phone calls from physicians all over the country. Now
one thing that has been said that in the referral to outside
specialists for different aspects of care the intensity of the
care is greater than it would be if it were given in the VA,
that every test is done that is imaginable, and some of which
you would not think would be indicated. Maybe you cannot
establish that they are not, but they ordinarily would not be
done in a more well-run system.
We are speaking not just for the VA in general but we are
also speaking for specific facilities, because you want to have
a kind of a spectrum of that. Dr. Stone, I think you have been
flagged for this.
Dr. Stone. Yes, sir. We authorize standard episodes of care
in which we define the scope of services to be done. But we do
find a greater utilization of services out in the commercial
space than we do----
Senator Cassidy. Now that assumes, Dr. Stone, just because
I have limited time, if you do have greater utilization of
services, either there is an underutilization within the VA or
an over on the side. Now I will just say, as a doc, if you do
too much, bad things happen. It is not benign to do something
which is not indicated. On the other hand, it should be done if
indicated.
So do you have a sense of inside versus outside as to the
relative weight of that?
Dr. Stone. Yes, and, sir, that is why we designed the
Community Care Program to be highly integrated with the VA at
the center and the primary care clinician at the center of
that, to make decisions in the best interest of the veteran,
and to work with the veteran for how to proceed. We fine, in
some very simple areas, like physical therapy, dramatically
higher uses in the commercial space that is done within VA.
Senator Cassidy. But begging the question, is it
appropriate increased intensity, or not?
Dr. Stone. Not always.
Senator Cassidy. So is there--I presume then that you all
are taking measures, because that is one, expensive, but two,
it is also perhaps contraindicated, which is more important.
Dr. Stone. We are, and that is the beauty of the health
information exchange, which allows us to utilize and to
integrate health care information systems for the veteran so
that there is not repetitive work being done, and we have full
visibility.
Senator Cassidy. Is it possible that you could give this
Committee a report on a per-institution basis? The Dartmouth
study suggests that it is regional, or even State, or even
community located in which you have increased intensity of
certain services. I think the individual members of the
Committee would like to know how the VAs in their bailiwick, if
you will, are responding to this challenge.
Dr. Stone. We would be happy to work with your staff and
the Committee staff to really work through that request.
Senator Cassidy. Let me ask, Mr. Secretary, you mentioned
the success in hiring new people, but I was recently told it
can take as long as 6 months for someone to be offered a
position for them to actually be onboarded and to be seeing
patients. Any comments on that?
Secretary Wilkie. Senator, before Dr. Stone answers that,
as a physician might answer that, we have been able to cut
through most of the Federal flotsam and jetsam when it comes to
hiring people. I have shaved off weeks and months out of the
hiring process. When people apply, that hiring application goes
straight to the medical center or to the department that would
be hiring that person. The onboarding is done quickly. So we
have cut down years, months into weeks, and I do not know that
anyone right now is experiencing that 6-month delay. Now there
may be one or two specialties that might, but Dr. Stone can
answer that.
Dr. Stone. Sir, it was not uncommon for us to take 6 months
to bring a clinician on, mainly because of the prime source of
verification of their education. With the help of Office of
Personnel Management we have cut that down to 7 days now, that
if you apply today, in 7 days we will have you at work.
Senator Cassidy. Really?
Secretary Wilkie. We have hired almost 600 physicians just
in the last 6 weeks.
Senator Cassidy. I have got 36 seconds left. Let me ask you
a 4-minute question. During the COVID, coronavirus crisis we
have been using more tele mental health and telehealth
services. To what degree can we continue to use those tele
mental health? Have you found them as effective as traditional
mental health services?
Secretary Wilkie. We certainly have, and I think this is
the wave of the future, particularly for mental health. In
addition to what we have provided, we have now entered into
agreements with--I will give you an example--Walmart. Senator
Tillis knows, I cut the ribbon on a Walmart Veterans Health
Clinic that exists behind the pharmacy wall, where a veteran
can come in and talk to a mental health provider--this is in
Asheboro, North Carolina--anywhere in the country.
This is the wave of the future. It prevents veterans from
having to experience the pressures of a large clinical setting.
It takes the pressure off of their families. I expect it to
grow. I think the one benefit of this epidemic, it has allowed
us to stress the test.
I will finish by saying--I am going to make a Louisiana
comment. My grandmother is watching, in New Orleans. She was
born in the middle of the Spanish Flu at the early part of the
20th century. She is still in New Orleans. She survived this
one. So that tells you the resilience of the Crescent City.
Senator Cassidy. Thank you. I yield back.
Chairman Moran. Senator Blumenthal.
SENATOR RICHARD BLUMENTHAL
Senator Blumenthal. Thank you, Mr. Chairman. Thank you all
for being here. Thanks for your service. I saw a report, I
think this morning, in the Military Times, that the number of
active COVID-19 cases at VA medical centers nationwide has
risen by more than 7 percent in the last 5 days. That is a
pretty alarming turnaround, in contrast----
Secretary Wilkie. I can answer that. The system--the
accounting system was down for several days. But overall, 9.5
million veterans that we serve, we have had 12,300 infections.
Of those 12,300 infections, we have less than 1,500 active
infections. I think there is no health care system in the
country that has been able to keep those numbers down as we
have. I think we did it because we acted early. We were acting
in February.
Senator Blumenthal. My question to you, though, is the
trend. What has been the trend over the last 5 days? Are you
saying that the Military Times was in error?
Secretary Wilkie. I am saying their interpretation was in
error.
Senator Blumenthal. Well, you are saying they were in
error.
Secretary Wilkie. I said their interpretation was in error.
Senator Blumenthal. What are the numbers?
Secretary Wilkie. I gave you the overall numbers.
Dr. Stone. Sir, if I might add to this, I would ask you,
Senator, to consider two things, one, the number of cases, and
second, how many are hospitalized. Our hospitalization numbers
are stable and are not increasing. I think as we increase
testing, and we are doing 3,000 to 4,000 tests a day in
veterans, you are going to get numbers going up. It is just
like in each of your States, that as you penetrate with----
Senator Blumenthal. Well, that is an explanation, but the
numbers are showing an increase. Correct?
Dr. Stone. The actual number is showing an increase, but
not in hospitalizations. Hospitalizations----
Senator Blumenthal. It is an increase in the number of
active cases. I understand hospitalizations are different from
active cases.
Secretary Wilkie. Yes, and most of those cases are at home.
Senator Blumenthal. At home?
Secretary Wilkie. Because they do not require----
Senator Blumenthal. Well, that may be true----
Secretary Wilkie [continuing]. they do not require----
Senator Blumenthal [continuing]. I am asking you for
numbers.
Secretary Wilkie. Well, I just gave you the numbers.
Senator Blumenthal. I just want to make sure that I
understand. The trend is up by around 7 percent of active
coronavirus cases. The Military Times was correct in that
report.
Secretary Wilkie. The trend--Look. The interpretation is
that there is an explosion.
Senator Blumenthal. Let me move on to another topic because
I am limited in terms of time. My understanding is that you
have spent only--you have obligated only about $2 billion out
of the $19.6 billion that has been provided under the CARES
Act. Why so small a percentage of the funding obligated?
Secretary Wilkie. Well, because mercifully the original
projections that I discussed with the Chairman and Senator
Tester of several hundred thousand infections did not play out.
Those were the projections we were looking at at the beginning
of this.
Senator Blumenthal. So you do not need the money?
Secretary Wilkie. I also mentioned earlier, Senator, that I
am standing by for a rebound. We do not know what is going to
happen in the fall and winter.
Senator Blumenthal. So if that 7 percent trend that I just
mentioned continues, you might need the money more than you do
now?
Secretary Wilkie. Well, I think with the rebound you would
see people who have had no contact with the virus be
susceptible to it in the fall and the winter.
Senator Blumenthal. Let me ask you, with respect to PPE,
how many--and this is relevant to the potential rebound--how
many weeks of supplies do you have now in PPE?
Secretary Wilkie. We have multiple months of supply of PPE.
Senator Blumenthal. Multiple months?
Secretary Wilkie. Yes.
Senator Blumenthal. So you have more than ample personal
protective equipment.
Secretary Wilkie. If I can add, the Chairman and I have
talked, and so has Senator Tester. We are setting up a system
that is something that you were familiar with in your Marine
Corps days. The Marine Corps and Navy had supply depots all
over the country--spare parts, technicians. We are doing that
with our PPE and our medicines. I think this is our hedge for
the future, so that we will not be susceptible to a disruption
in the supply chain. So I have adopted the models that I saw as
a young naval officer, and we are preparing by stocking up.
The other thing I would say is that we never fell below 2
weeks of supplies during this crisis.
Senator Blumenthal. I have one last question. I have many
questions. Some I will submit in writing, but one more question
I want to ask you here. I introduced a bill last year that was
supposed by 18 veteran service organizations to remove the 1-
year manifestation period for three illnesses linked to Agent
Orange, and I would like your support for that bill, 50 years
after the veterans suffered the harms that are still affected.
Secretary Wilkie. Well, I certainly--as the son of a combat
soldier from Vietnam I understand it probably as well as any
dependent. Dr. Stone and I will be reviewing that, as well as
several other studies that are tangential to your legislation,
in the coming weeks.
Senator Blumenthal. While you are reviewing that, maybe you
could also indicate why you have not categorized as a
presumptive disability three--several conditions that are
classified by the National Academy of Sciences in that regard.
I know that ordinarily you follow their recommendations. In
2016, the National Academies recommended adding four new
conditions to the Agent Orange presumptive disability list,
including bladder cancer, hypothyroidism, hypertension, and
Parkinson-like symptoms. Despite that scientific backing, you
have not added those conditions.
Dr. Stone. Sir, we and the Secretary have spoken previously
about this, and we are waiting for these two additional studies
to finish, that are broad studies of death rates as well as the
health status of the Vietnam veteran before we come to
agreement on that. We have talked to the National Academy of
Sciences and looked at the statistical variance that they have,
and frankly, I am not as convinced as the National Academy of
Sciences is. But we will defer to those two studies and then
make recommendations to the Secretary.
Secretary Wilkie. Mr. Chairman, if you would indulge me to
finish the original question Senator Blumenthal asked about the
7 percent increase and why I was questioning the
interpretation. We have 9.5 million veterans in our system. We
have had 12,300 infected, mercifully, an incredibly low number.
Of those 12,300, well over 9,000 have completely recovered. So
a 7 percent increase--and why I was challenging the
interpretation--sounds like there has been an explosion in
terms of the number of veterans infected. It has been
mercifully low if you look at the entirety of the community we
serve.
Senator Blumenthal. My time has expired. I thank you, Mr.
Chairman.
Chairman Moran. You are one of my Ranking Members, as is
Senator Tester, and you almost got as much overtime as he did.
Senator Rounds?
SENATOR MIKE ROUNDS
Senator Blumenthal. Thank you.
Senator Rounds. Thank you, Mr. Chairman. Mr. Secretary,
gentlemen, thank you all for your service to our country.
Mr. Secretary, in a call we had with you just a few weeks
ago you were confident that any overdue provider claims were
old Choice-era claims, but earlier this week, in preparation
for this hearing, leaders from your department told members'
staff that there are aged MISSION Act claims among the VA's
current backlog. This does line up with your written testimony
today, page six of your testimony, in which you have indicated,
and I will quote, ``The VA realizes it needs to do a better job
of paying claims from community providers.'' It is certainly
reflective of what my experience is and what I continue to hear
from my providers in South Dakota.
Looking at your request for $18.5 billion for community
care for Fiscal Year 2021, what I would like to know is, is
this enough to make sure your department can do what needs to
be done to get our community providers paid in the time that
the law currently requires? Just as an example, is this enough
money to get the eCams up and running at 100 percent capacity?
I think according to discussions with staff earlier this week
it is running at about 33 percent capacity. Our expectation,
based on a February discussion, was that it would be up and
running by about May 4th or so. So we have got a ways to go
yet.
Is this enough money to clear your backlog of the 2 million
claims, and help the VAs transition out of the direct payer
role altogether?
Secretary Wilkie. Before Dr. Stone answers the way forward
I will say, and I have been in South Dakota twice in the last 6
months, since MISSION kicked in on June 6th of last year we
have processed 22 million claims and disbursed $6.9 billion. I
can say that with the coming of new management to our regions
right now the number is at 57 percent of all claims are now
paid within 7 days. That still means we have a backlog, but it
is moving in the right direction.
Dr. Stone. Senator, the last time you and I talked about
this I had between 3.2 and 3.4 million claims in backlog. That
number is now down to 1.9 million, and we disbursed over $1.3
billion in payments last month, in the month of May. I think we
are going in the right direction. eCams has not come on board
at the rapidity at which we wanted, although it is running
well. What we are looking for is auto-adjudication, where it,
on an automatic basis, adjudicates a claim. That, you are
exactly correct, it's not at the level it should be. I have
been reassured by Dr. Mathews and her team, who are running
Community Care that in the next month we will take a dramatic
upturn in the amount of auto-adjudication that is driving this
down.
Now the first question you asked was, is $18 billion going
to be enough? It looks like it. It looks like even with the
growth in the dependents and the unknown that we have as we go
into a potential second wave, or even third wave of this
pandemic, we will be Ok with that number.
So I am confident in that number. What I am still not happy
with is the amount of backlog claims. We must be a good partner
to every provider or we are not going to keep the 880,000
providers who have pledged their commitment to Americans
veterans.
Senator Rounds. Thank you, and I think that is really the
crux of it for us, is if we are not paying these providers in a
timely fashion. A lot of them do not have real deep pockets,
and if they cannot get paid to continue to pay their bills,
then at some point--and so far none of them have declined the
veterans, but we most certainly do not want to get them to the
position where they feel that they may.
Dr. Stone. Senator, they have not, and we are keenly aware
that the American health care systems in the private space are
losing $50 billion each year, and we have worked really hard to
make sure that we can do our part to maintain their liquidity.
Senator Rounds. Great. Thank you.
Mr. Secretary, can you give me a walk-through of the
decision to decrease your requested funding for the VA's Rural
Health Initiative this year by 10 percent, from $300 million in
Fiscal Year 2020 to $270 million in Fiscal Year 2021? It seems
that with your emphasis--and I know you have been to South
Dakota twice and you have talked about what we need to do to
work with IHS in our rural areas. But to see that decrease kind
of caught me by surprise.
Secretary Wilkie. I will go back and look. I think it is
because of the emphasis on telehealth, which has cut down on
costs. But I will give you a line-by-line breakdown of why that
happened.
I would also add--and this is a parochial matter for you--I
was on KELO yesterday, and I wanted you to know that I renewed
the commitment to Hot Springs on South Dakota television, and
my staff has been in contact with your staff to make sure that
when we deal with that record of decision it is not only
airtight, it is also in line with the legislation that you put
in the appropriations bill.
Senator Rounds. Thank you. Thank you, Mr. Chairman.
Chairman Moran. Senator Rounds, thank you very much. I
meant to mention after Senator Blumenthal's questions that this
Committee will have a hearing next Tuesday. He was asking the
Secretary--Senator Blumenthal was asking the Secretary about
PPE. Our Committee will meet next Tuesday afternoon to have a
hearing. The title of the--the subject is ``Building a More
Resilient VA Supply Chain.'' So we are going to spend some more
time with the Department in regard to this topic.
Now Senator Hirono.
SENATOR MAZIE HIRONO
Senator Hirono. Thank you very much, Mr. Chairman. What is
happening in our country right now is a tremendous
acknowledgment of the disparities that have existed in our
country for far too long. The pandemic has further exposed the
disproportionate access people of color have to critical
services, like health care, housing, education, social
supports, and protests are happening all over the world, in all
of our country, including, of course, in Hawaii, in response to
violence against black Americans.
We are at a time in our country when we cannot just go back
to doing things as usual, and if ever there was a time to have
some kind of reckoning to move us forward, this is it.
When the top leadership of our agencies does not reflect
the people they serve, that can have real lasting consequences.
So, Mr. Secretary, I would like to ask you, would you agree
that diversity in those who are making decisions that impact
the lives of all the diverse group of veterans that you serve,
is not diversity in leadership a good thing in order to provide
truly equitable services to veterans?
Secretary Wilkie. Senator, I will be careful in my answer.
I grew up in this world. I think you will find that the Armed
Forces of the United States have been the great leveler when it
comes to equal treatment. I have surrounded myself with people
who have the same experiences. Everyone at this table has
served in uniform. We understand the culture and we speak the
language. My deputy, she graduated from--she graduated from the
United States Air Force Academy. Our Assistant Secretary for
Legislative Affairs, who is sitting behind me, I actually
served under in the Air Force.
We have one goal. It does not matter where we come from, we
have all served. I think for us, at VA, that is the most
important thing. I would also add what I said earlier. We are
the only health care system, Senator--and you and I have talked
about this--we follow gender disparities. We follow racial
disparities. We have now brought up, just in the last few
years, the percentage of veterans who are women to 42 percent.
The percentage of veterans, eligible veterans, who are male are
49 percent. So we are moving up.
Just a few years ago there were only a few, less than
200,000 women in the system. Today there are 500,000. So I
think we have----
Senator Hirono. I acknowledge that. What I am talking about
are the people who are making decisions on behalf of the
diverse group of veterans that you now have, and many of them
are women. We are already acknowledging that they may have
different kinds of health care and other kinds of needs, and
therefore you are programmatically seeking to address those.
But it is really the people who are making decisions.
Let's face it. I am not disparaging anybody who is in the
military, by the way, and there should be an acknowledgment
that we all have implicit bias. No matter how fair we may all
think we are, that unless you walk in the shoes of somebody
else then it is--it is not the kind of thing where we can, ``Oh
yes, I know what you feel. I know what you are thinking.''
Secretary Wilkie. My, my----
Senator Hirono. So this is why I would say, diversity in
leadership is important.
I do have a question for you before I run out of time.
Secretary Wilkie. I will just say my deputy, she served 30
years in the Air Force, and I think that is a testament to how
far VA has advanced along the lines, that you----
Senator Hirono. I am all for women in decisionmaking, but
we all know within the military there are still major issues
relating to sexual assault and sexual harassment, but that is a
whole other matter. We also know there are disparities within
the VA, and I am glad that you acknowledge it and you will, I
hope, do something about it.
But do you do implicit bias training within your leadership
group in the VA?
Secretary Wilkie. Yes, Senator, we do.
Senator Hirono. Good to know. For years, I have brought up
the Advanced Leeward Outpatient Health Care Access Project at
hearings and meetings with VA leadership. The project was
scheduled to be completed by Fiscal Year 2020, but has
encountered multiple delays. Earlier this year, the VA said
that this lease award was expected by mid-May, but in the
recent weeks we have learned that that has been delayed due to
COVID-19. Now a lease award is not expected until mid-August,
and the project is not expected to be completed until spring of
2023.
You can see where the veterans are very concerned that this
project keeps being delayed. Can you explain to me what exactly
is causing yet another delay and how VA is working to address
it and provide a--could you provide a detailed timeline for the
ALOHA project so that I can let the veterans in Hawaii know
when they can expect this facility to be built?
Secretary Wilkie. Yes, Senator, and you know I have been in
Hawaii several times, and the ALOHA Clinic is a classic example
of what happens when there are too many layers of Federal
bureaucracy. Some not attached to the VA gets involved in
construction projects. This is a problem that I will bring to
the Chairman, and I think I have mentioned it to Senator Tester
as well. The way CBO scores these projects is not realistic.
The other thing that I will bring to the Chairman is that for
projects like the ALOHA Clinic in Hawaii, which have stopped
and started because of CBO and GSA bureaucracy, we want to give
more flexibility to the Department and to the leaders on the
ground to be able to engage in these contracts, contracts that
reflect the situation in Hawaii, and not a one size fits all.
So I take your point. You are absolutely right, and we are
working on providing this Committee with hopefully some
legislative solutions so what happens in Hawaii does not happen
again.
Senator Hirono. Thank you so much for acknowledging that,
and of course things are much more expensive in Hawaii, and one
size fits all where the costs are not fixed do not do it for us
in Hawaii. So I will do whatever I can to assist you, Mr.
Secretary.
I am glad that one of the----
Chairman Moran. Senator, your time has expired.
Senator Hirono. Oh, I am sorry. I will send more questions
for the record. Thank you, Mr. Secretary.
Chairman Moran. Thank you, Senator Hirono. The announcement
about the vote has been delayed 10 minutes, so it is now at
4:40. So we have--I do not know what we have.
Senator Tillis?
SENATOR THOM TILLIS
Senator Tillis. Just enough time for my round.
Chairman Moran. Apparently you are the lucky one.
Senator Tillis. Thank you, Mr. Chairman. Senator Tester, it
is great to see you have found your flat top again. It is a
good luck.
Mr. Secretary and for all the witnesses, I want to go back
on--I have completed 45 telephone town halls, updating people
in North Carolina on COVID, and one thing it has required me to
do is to take a look at the numbers and not view any one number
in a vacuum. I am sure that you guys are taking a look at any
increase in cases, you are adjusting that, you are looking at
the rate of doubling, you are looking at how you adjust that
for the rate of testing, and those numbers.
So Dr. Stone, in your opinion, do you believe--because this
hearing people could leave saying that the VA admitted there is
a 7 percent spike. But are you looking at all those numbers,
and in that context doing it as a manageable number that is
within your expectations?
Dr. Stone. Yes, sir. Early in this we were dealing with
very rapid doubling rates. We are now dealing--your State has
had gradually increasing numbers, but with a doubling rate that
extends out to between 30 and 40 days.
Senator Tillis. Right, and early in the crisis we were in
5-and 10-day increments.
Dr. Stone. We were in 1-and 3-day doublings. So yes, sir.
Senator Tillis. So I just wanted to level-set that. Before
anyone takes any one number they really need to understand the
numbers if they want to do it justice----
Dr. Stone. Yes, sir, and----
Senator Tillis [continuing]. on the trends. Because clearly
you would be surging if you had a concern.
Secretary Wilkie. Senator Tillis, and I was not trying to
be disrespectful, but--and you know that I went into the law
because I could not do math.
Senator Tillis. Yep.
Secretary Wilkie. But when we have an infection rate that
is as low as ours, a 7 percent increase is in the tens or
maybe, at most, the dozens. That does not mean it is not
serious, but it is not a crisis. I think we have shown since
this began that we have been able to manage, and our veterans
have responded. We have set out well over 50 million individual
communications to veterans and families. We have warned them of
what was out there. We have given them instructions and they
have responded magnificently, which is why I think the numbers
are as low as they are.
Senator Tillis. Thank you. Jon, you mentioned the need for
reprogramming some of the additional dollars. I think you have
been good stewards. I think you would have spent all $18
billion if you thought it was necessary. You are demonstrating
good stewardship on the money that was allocated under the
CARES Act.
I would expect--I know IT is something that you mentioned--
I would expect that as you scale up telehealth, as maybe you
scale up capacity for some of the underlying information
systems, that those are some areas where you need flexibility
to deploy resources. We need to make sure that we get that
information.
I also think that--I am looking ahead to a surge. If we
take a look at the breakdown of patients, particularly acute
cases and deaths, it is clearly in congregate care facilities
and populations where we have higher risk categories, over age
65, underlying health conditions, et cetera.
We are going to have another wave. The question is how many
therapeutics do we have and what have we learned in terms of
protocols to reduce the spread. But also I think, and
particularly among the senior veteran populations and
congregate care facilities writ large, we should already be
creating a mentality for a posture that we take before we hear
of the first case in November or December. Are you all taking
those steps and trying to inculcate that as a part of your
culture?
Secretary Wilkie. So we have, and the nursing home
community is the example. We serve a little under 8,000
veterans in 134 nursing homes. We put in emergency protocols
very early on in this. We test everyone in the nursing home. We
also test all of the employees. We stopped visitors and
families--a very difficult decision, because more than half of
those veterans are from Korea and World War II.
Senator Tillis. Yes, and Secretary Wilkie, because I want
to ask an open-ended question and finish before the red light.
I think it is just important. You know how heartbreaking it is
when you want to go visit someone in these facilities. I think
if we set the expectation now, so that they just know that that
is standard operating practice, it is going to be easier to
manage that and make it less likely that we see anything
approaching it. I do not believe we will see anything
approaching what we have in this wave.
The last question, and it is really maybe something for you
all to think about. I have had this discussion with DoD. As you
are looking at deadlines and you are looking at other
requirements Congress has placed on you, that you could
rightfully assert that maybe you need a little bit more time to
get certain things done--it could be projects, it could be
reports, it could be any number of other things---I hope that
you will report back to us and let us know, to the extent that
that is going to require statutory action. I think you would
have a rational basis for knowing what those are.
Offline we will talk about the electronic health record
implementation. I know it was delayed somewhat. I would be
interested in knowing whether or not there are resources that
we could put in so that we can continue it maybe through tele-
implementation and a number of other things. I know the
platform providers implement it in the private sector.
Thank you.
Chairman Moran. Thank you, Senator Tillis. Senator Manchin.
SENATOR JOE MANCHIN
Senator Manchin. Thank you, Mr. Chairman. I thank all of
you for being here before us today.
First of all, I am just going to take a moment to thank all
of the Veterans Affairs employees that we have in our State,
and that you have around the country, because they have been
stalwarts. They have been on the front line there and they have
done a great job. They really have.
My concern has been, and I think Secretary Wilkie and I
spoke about this, the testing. Veterans are having a hard time.
They are confused about the testing. They are told they have to
pay for it, and that it has been, you know, pre-approved, and
going through all the red tape. Have you been able, Dr. Stone,
maybe to work through that, that clarifies this for them, to
make sure that our veterans can get tested if needed?
Dr. Stone. Sir, I appreciate your advocacy for this, and
you and I have talked about it. Where we are having trouble is
this drive-through testing. When the drive-through testing is
being done by somebody not enrolled in our system is where we
are having trouble with it. What we would like to get, and what
we have reached out to do is try and look at every drive-
through testing, any place we can find it, and try to enroll
those health care systems in this.
Unfortunately, some of them----
Senator Manchin. Is there something we can do to help you?
Is there anything that we can do legislatively, or something
through our office officially to help you?
Dr. Stone. Yes. I think that we will work with your staff
on it. Right now Community Care believed that they were well on
their way to working their way through this, to make sure that
there was no bill sent out to any veteran. I can reassure you
that within our system there have been no bills sent out for
COVID testing, and if there is we will reconcile it.
Senator Manchin. Okay. Well also--and, Mr. Chairman, you
have said that the PPE, we are going to be doing that next
week?
Chairman Moran. I am sorry. Yes.
Senator Manchin. The PPE? Because I know--we have put
nearly $20 billion in that in order to train, so we will get an
accounting. There is no use for me to ask that question if you
are going to get back into that next week.
Chairman Moran. We will.
Senator Manchin. Sir, and Dr. Stone, on the VA in
Clarksburg, 2 years. The rumors going around now are just
unbelievable in the local circles, about even the person of
interest maybe still working, or being employed, or coming back
as a contractor. Have you been----
Dr. Stone. Sir, I can reassure you, as of a discussion
yesterday, that is absolutely untrue.
Senator Manchin. Well, I think it is too. It is a vicious
rumor going around that is hurting an awful lot of families.
But the most important thing is the 2-years. Do you see any end
in sight?
Dr. Stone. Sir, the answer to that question has to be done
by the IG and the Justice Department.
Secretary Wilkie. Senator, I have expressed my frustration
with this. You and I talked, and Senator Capito was on the
phone. This investigation began before I was Secretary.
Senator Manchin. Right.
Secretary Wilkie. That is a disservice to the people of
West Virginia.
Senator Manchin. It is just--I cannot explain it. I mean,
you can imagine what the families are going through. Why would
you put anybody through this? I know you are not
intentionally--I know that, Secretary Wilkie, you could not
believe either, the insensitivity of what is going on. But we
have got to get an answer. I am going to go, I think, to
Attorney General Barr. I have got to go to Attorney General
Barr. I have gone there before but now it is urgent now, 2
years. Now with these rumors starting to creep up, you
understand the whole uncertainty of what is going on and these
people being left in limbo like that. It is just-----
Secretary Wilkie. Sir, this is a disservice to every
veteran in that community, and as you know, this is a small
community. These employees have done a great job of cooperating
every step of the way, and we look forward to resolution.
Senator Manchin. Anything you can do to help us we
appreciate.
Secretary Wilkie. Thank you.
Senator Manchin. Thank you.
Chairman Moran. The next senator--I think we only have
Senator Sinema left, and she is to call in at 4:40, which is
now. Senator Sinema, are you available?
[Pause.]
Chairman Moran. Let me ask a question then, Mr. Secretary,
which I had intended to ask at the end of the hearing. I was
caught--my attention was caught by the two questions by both a
Republican and Democrat about testing and about the 7 percent
increase. I want to make sure I understand what that reflects.
My assumption is that as more people are tested we are
going to see more positive numbers. Perhaps this is a question
for Dr. Stone, but what is it that we should--what---if
something happens, what should we be concerned about? What is
the standard by which it raises a concern or a significant
challenge for the VA, based upon its numbers, in caring for
veterans?
Dr. Stone. So what you should be concerned about in a
community is the prevalence of the disease. We began this whole
thing when we built the budget for this, anticipating that 2 to
3 percent of the population would be infected. We are dealing
with a fraction of that, frankly. We are dealing with a tenth
of that.
Second, what VA must be concerned about is the ability to
take care of sick people. About 20 percent of the positive are
really sick, and do we have enough beds, do we have enough
equipment, do we have enough personnel to care for them? Hence,
the reconfiguration of the VA's delivery system to grow by
almost 4,000 beds as we went through this, and the hiring of
massive numbers of people, and the reconfiguration and
retraining of ambulatory nurses and providers to provide care
and support for the less ill, so our critical care providers
can care for that.
The VA is well positioned to remain the backstop of the
American health care system and to fulfill the mission that the
Secretary gave us and that you all expect of us. At this time,
as we enter this, I am at 37 percent on our ICU occupancy,
meaning that two-thirds of our ICU beds are now empty today,
across the system. Second, we are at about 53 percent occupancy
on our medical-surgical beds. Those are the key questions that
you want to know as we walk through.
Now what we have seen across this Nation is this slow
background of cases, not in rapid spikes like we saw earlier in
the disease, in late February and early March, where we saw
these huge spikes. We have seen this slow background. We
anticipate having about 600 patients as inpatients for COVID
right through the fall.
The question will be, will this repeat the activity of
summer to fall 1918, where wave two is much more malignant, a
much tougher disease, so that wave two really resulted in
dramatic deaths in late 1918 and in the early winter of 1919,
January, February.
Chairman Moran. Dr. Stone, what does medical scientific
evidence have to say about that at this point? Anything?
Dr. Stone. At this time we have no idea. But what I think
your expectation of us should be, and I know what the
Secretary's expectation of me and my leaders is to build a
system that can appropriately backstop.
Secretary Wilkie. Mr. Chairman, I mentioned that we started
preparing for this early on. We have done things like purchase
mobile hospitals that we did not have to deploy but they are
ready. I also mentioned the creation of a military-like depot
system.
The other part of that is that I signed a memorandum of
agreement with the Defense Logistics Agency so that we are
joined at the hip with them and their computerized systems so
that VA is no longer the ad hoc system that it has been. The
year that I became Secretary there were over 4 million credit
card transactions, buying everything from tongue depressors to
radiological equipment. These reforms go a long way to
eliminating that and making us better prepared for what may
come in the fall.
Chairman Moran. Thank you, Mr. Secretary. Thank you, Dr.
Stone. I am going to turn to Senator Tester for a second
question, and then Senator Sinema is joining us now.
Senator Tester?
Senator Tester. Thank you, Mr. Chairman. A couple of
things, and these could be really quick, guys. But on masks I
know there have been multiple versions of guidances put out on
masks about how they are to be used, if they are to be reused,
all that stuff. Have you guys been able to put anything in
writing, to direct the staff so they know what the expectations
are on the N95s?
Dr. Stone. Yes, sir. The guidance you reflect occurred on
the 7th of April, and then when we went to a crisis mode, and
then we went to contingency mode on the 14th or 15th of April,
and I will get you the exact date. So it was only for 1 week in
this that we went to crisis mode on utilization, and we remain
at the guidance that was given on the 14th or 15th of April,
which provides one mask per day, per patient that needs an N95,
which is those employees in direct contact with COVID patients.
Senator Tester. Okay. That is good. I mean, I think that
there is some confusion out there, but if you guys got it out
and you field it, that information is flowed to the proper
sources, that is all you can ask for.
Electronic health records. I do not really want to talk
about this, but I have got to.
Secretary Wilkie. Well, I want to talk about it.
Senator Tester. Well, I mean, here is the deal. It seems
like every position I have ever been in in government, an
elected position, over the last 20 years, has dealt with a
fiasco when it comes to programming. We have spent about $2.5
billion so far, and I think--and correct me if I am wrong,
Secretary Wilkie--there is a request for about $2.6 billion for
electronic health records. I think everybody around the table,
everybody on this Committee understands that this is important
or we would not be allocating the money and we would not be
pushing to get it done.
I guess the question is, and I know you have been impacted
by COVID, but what have we gotten done so far? Have we got
value for the money we have spent? What kind of timeline are we
on here to get this up? Is it going to be user friendly enough,
where we do not have to send doctors and nurses to training
for, you know, a month, to be able to get them to be able to
understand how to use the damn record when they should be
treating patients?
Secretary Wilkie. So this is a good-news story. I mentioned
in my opening Statement that I believe VA has demonstrated that
it is the most agile of the Federal departments. We have been
working EHRM even this pandemic, and on April 18th we were able
to show that the Joint Health Information Exchange works. We
talk to DoD. DoD talks to us. The private sector can work the
records.
We are going to be going live on the scheduling portion in
Columbus, Ohio, and then I expect that Spokane and then later
Seattle will be up and running sometime later this year.
You are correct that we took practitioners off of the
program to put them on the front lines, but we are in a
position that I do not think a lot of people thought we would
be in. As a matter of fact, all 73 interfaces between DoD, VA,
and the private sector now work, and I am confident that we
have a good-news story here. It will revolutionize now. The
increase that you are talking about is to spread--and it is
something that is near and dear to your heart--the
infrastructure remodeling of our institutions so that they can
handle the electronics required for this system. As you know,
particularly out West, many of our facilities have buildings
that date back to the 19th century. That was certainly the case
in Washington State, where we were testing this.
We are in a much better position than we were when I spoke
to this Committee last.
Chairman Moran. Senator Tester, Senator Sinema is
available, and for us to make certain she has a chance to ask
her question before we need to conclude for the vote, I am
going to recognize her now.
SENATOR KYRSTEN SINEMA
Senator Sinema. Thank you so much, Mr. Chairman, and thanks
to the Committee for their patience with our technical issues.
So thank you both for holding this hearing, Chairman Moran and
Ranking Member Tester, and thanks to all our witnesses for
being here today.
You know, organizations in Arizona supporting the homeless
veteran community have continued to express concerns for the
safety of those they serve and the staff that they employ. They
also do not feel the VA is providing the necessary assistance
to this vulnerable population during the coronavirus pandemic.
One key reason is VA does not have a national coordinated plan
to support homeless veterans. A national plan should include
testing strategies for homeless populations, access to PPE for
all staff working with these communities and plans to care for
veterans who test positive for the coronavirus.
I know the VA is in need of additional flexibilities to
fully support the homeless veteran community during this time,
and I am proud to work with Senator Sullivan to introduce our
Homeless Veteran Coronavirus Response Act of 2020, which will
largely address the VA's needs.
But Secretary Wilkie, as we work to increase the resources
and flexibilities, the VA has to support homeless veterans, it
is important for VA to lead on a national strategy, support the
homeless veteran community, in collaboration with the
organizations who provide direct services to the community.
What do you need to do this, and why has it not been done
thus far?
Secretary Wilkie. Well, Senator, thank you, and I know that
this Committee and you and Senator Sullivan have been working
on this, and that is--your efforts are designed to give us more
flexibility. I can tell you what we have been doing during this
epidemic. We have used $300 million in additional funding to
augment the three major programs that we have. First is the
support to--supportive services for veterans and families, to
increase the number of vouchers available for transition and
housing. We have tripled the per diem amounts so that we are
now addressing the basic food needs of our veterans, and we
have augmented our emergency shelter programs.
In hot spots like Los Angeles, we have been out actively
working with the community to bring veterans inside the fence.
Regardless of whether they want to partake of our health care,
getting them inside the fence at least allows them access to
the food and to whatever services they will agree to have. But
that is to protect them.
I will be announcing later this month our national roadmap
on suicide prevention. As I said when I first addressed this
with you, if it was just a roadmap looking at the last tragic
act in a veteran's life it would not be worth much. So we are
taking a broad look at not only mental health and addiction but
also homelessness, the three things that, more often than not,
those three areas that the Nation as a whole has ignored.
I will let Dr. Stone answer any of the medical questions
that you have raised.
Dr. Stone. Senator, I appreciate your advocacy for this,
and it is one of the areas that we are deeply concern. I talked
earlier, as did the Secretary, about the financial instability
and the risks to this population.
We have added $300 million through the supplemental funding
to our support for homelessness. As you know that is a $1.83
billion program that we have asked to increase to $1.9 billion
in 2021. Part of that is we have increased, by 70 percent, in
the supportive services for veteran families, about $202
million that we have added to the $300 million that was already
there. We have also added $88 million in the grant per diem.
That is for emergency housing, primarily in hotels, to get
veterans off the street, especially so that we can help manage
the potential illnesses in that population.
As you know, in certain high-cost areas we were very
gratified that HUD was given enhanced dollars to raise the
amount for the HUD VASH vouchers. We have also added $10
million more to ensure that there is adequate personnel to work
those.
But we continue to be pleased with your advocacy for this
population as we work our way through this.
Senator Sinema. Just a quick followup, because I know that
my time is expiring, Mr. Chairman, and that is I would love to
circle back and talk more about this. As we know, most of the
efforts providing direct services to homeless veterans happens
at the local level, outside of the VA system. I think that is
what is leading this to be a somewhat disjointed operation
throughout the country, and again why I am advocating so
strongly for us to have a national strategy where we can work
with our local partners outside of the VA facilities to address
this pandemic.
Thank you, Mr. Chairman.
Secretary Wilkie. Um----
Senator Sinema. I appreciate your time.
Chairman Moran. Thank you, Senator Sinema.
Secretary Wilkie. Senator, let me indulge the Chairman's
patience. I think that is one of the reasons why the Chairman
has introduced the legislation that is still working its way
through something that we support, that we have those more
robust relationships with the States and localities, and
charities, nongovernmental organizations, so that we can get
into those places that VA is not.
I cannot thank the Committee enough for taking that idea
that you have just expressed and putting it into action. I
think this Committee has taken a huge step forward.
Senator Sinema. Thank you. Thank you, Mr. Chairman.
Chairman Moran. Thank you, Senator Sinema. I am going to
ask just two quick questions, Mr. Secretary, and then I am
going to see if Senator Tester has any quick questions, and we
do then need to conclude our hearing. Two more questions
related to community care, Mr. Secretary.
Your staff shared with my staff that there were 173,721
authorizations, excluding emergency and urgent care, were
written for community care from March 24 to April 29, 2020, so
while we have been through the pandemic. Could you tell me how
many authorizations of community care were provided in that
same timeframe a year ago, so I can make a comparison?
Secretary Wilkie. I am going to have to take that for the
record, and I believe we are getting that information to your
staff.
Chairman Moran. Thank you.
Secretary Wilkie. Yes, sir.
Chairman Moran. Second, your reopening plan mentions that
the VA will schedule community care and virtual care
appointments where, quote, ``clinically appropriate.'' I want
to make certain that the veteran is front and center and that
``clinically appropriate'' is not a phrase that will be used to
deny community care as appropriate, which, in most instances,
is when it is in the best interest of the veteran.
Secretary Wilkie. Yes, sir. Your interpretation is my
interpretation. I would also add that what I have seen during
this epidemic with veterans is similar to what practitioners
have seen across the country. Most instances of veterans not
going into the community have been on their wishes, and we are
going to do everything we can to ramp this thing up back to
where it was. Sixty percent is not good enough. It is not in
line with the forums that you have championed and the forums
that I believe in.
Chairman Moran. So ``clinically appropriate'' is not an
impediment to MISSION and CARE Act in the community?
Secretary Wilkie. No, sir.
Chairman Moran. Thank you. Senator Tester?
Senator Tester. Thank you, Mr. Chairman. Very quickly, the
Chairman mentioned this in his opening remarks, and it has been
alluded to throughout this hearing. Because especially with
COVID-19 I think that the challenges around mental health are
going to increase. I appreciate the work that you and your
staff have done with our staffs to make sure that the John
Scott Hannon bill is ready for prime time. I would encourage
you to keep that up, and I will encourage my side to keep that
up, because I think this bill is important. I do not think that
Senator Moran and myself would have introduced it if we did not
think that veteran mental health is a problem, and I do not
think you guys see it any differently either. We have just got
to get this going, because I am not sure that we have got our
arms around it yet. So we need to use every tool we have
available.
If you would like to comment to that, you can, but I would
just like to say I appreciate working on it, and I think we
need to get it done. It did pass the Committee unanimously, and
you know the differences of the political spectrum on this
Committee are wide. We all agreed that this was the right thing
to do.
The last thing I would say, in closing, and thank you, Mr.
Chairman, is that, you know, you guys, I have been looking at
you on TV for the last 2 hours, and I would just tell you that
if you decide to give up the VA, all four of you could be news
announcers on your local TV stations.
Secretary Wilkie. Thank you, sir.
Chairman Moran. Senator Tester, I do not know whether there
was a compliment in there. I was distracted. But I agree----
Senator Tester. They look good.
Chairman Moran. But I will assume there was a compliment
there.
Secretary Wilkie. I agree with your Statement.
Senator Tester. They look really good. Even on high def
they look good.
Secretary Wilkie. I agree with your sentiment about the
legislation. It is vital.
Chairman Moran. Senator Tester, there are two bills pending
unanimous consent request in the Senate. I was informed today
that I think one of them is ready. The other, it is cleared on
our side and not yours. If you would check with your staff.
This is something that you and I both support and something
that the Department has been asking for.
Senator Tester. I am on it, Jerry. Thank you.
Chairman Moran. Thanks very much, Jon.
Mr. Secretary, I always give witnesses in front of my
committees the opportunity to clarify, to retract, make any
corrections of something that they said or something that wish
they had said.
Secretary Wilkie. I will go back and look, but that is not
going to stop me from thanking the Committee, as I did at the
beginning. There is no better committee when it comes to the
oversight of the Department for which you have responsibility,
or a more collaborative committee.
I do want to say one thing. Thousands of VA employees have
put themselves in harm's way. I think they--well, I do not
think--they deserve the thanks of the American people. We have
opened our hospitals. We have sent people into extremely
dangerous situations. They have responded magnificently. One of
the things I would add is that we actually have a lower
absentee rate and a lower leave request rate this year than we
did last year, because people have responded to the call to
duty, as they always do, and I am very proud to be part of
their family. I thank you, sir.
Chairman Moran. Mr. Secretary, thank you for your presence
and your team here today. I thought the hearing was valuable
and I appreciate your testimony and our conversations. I would
express my gratitude on behalf of all Kansans, on behalf of all
Americans for the men and women who work at the Department of
Veterans Affairs, many of them veterans themselves, who arose
to the cause of caring for their brothers and sisters at the
Department of Veterans Affairs. We are very grateful for the
risks they take and the anxiety they and their families must
have about that service. So thank you for your reiteration of
that, and I join you in that sentiment.
Secretary Wilkie. Thank you, sir.
Chairman Moran. The Disabled American Veterans, the
Paralyzed Veterans of America, and the Veterans of Foreign Wars
have each year produced an independent budget based on their
analysis of the funding needs of the VA. For this hearing we
asked those VSO partners to submit written testimony on the
President's budget request for the VA, and they provided
valuable feedback. They have done so, and without objection I
will include their written testimony into the record. So
ordered.
Chairman Moran. Committee members, you have the opportunity
to submit for us today additional questions for the witnesses.
Please do so in the next 5 days. Mr. Secretary, please ask your
Department to respond as quickly as possible to our Committee's
further question.
Secretary Wilkie. Yes, sir.
Chairman Moran. Without further conversation we are
adjourned.
[Whereupon, at 5:02 p.m., the Committee was adjourned.]
APPENDIX
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