[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]
SUBCOMMITTEE ON MILITARY CONSTRUCTION,
VETERANS AFFAIRS, AND RELATED AGENCIES,
ASSESSING THE VETERANS HEALTH
ADMINISTRATION FISCAL YEAR 2025 POTENTIAL
SHORTFALL
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTEENTH CONGRESS
SECOND SESSION
_______________________________________________________________________
SUBCOMMITTEE ON SUBCOMMITTEE ON MILITARY CONSTRUCTION, VETERANS
AFFAIRS, AND RELATED AGENCIES
JOHN R. CARTER, Texas, Chairman
DAVID G. VALADAO, California DEBBIE WASSERMAN SCHULTZ, Florida
JOHN H. RUTHERFORD, Florida SANFORD D. BISHOP, Jr., Georgia
TONY GONZALES, Texas SUSIE LEE, Nevada
MICHAEL GUEST, Mississippi HENRY CUELLAR, Texas
RYAN K. ZINKE, Montana CHELLIE PINGREE, Maine
STEPHANIE I. BICE, Oklahoma
SCOTT FRANKLIN, Florida
NOTE: Under committee rules, Mr. Cole, as chairman of the full
committee, and Ms. DeLauro, as ranking minority member of the full
committee, are authorized to sit as members of all subcommittees.
Jason Wheelock, Arianna Delgado
and Emma Lou Ford
Subcommittee Staff
___________
PART 3
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Department of Veterans Affairs........
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Printed for the use of the Committee on Appropriations
U.S. GOVERNMENT PUBLISHING OFFICE
61-961 WASHINGTON : 2026
_______________________________________________________________________
HOUSE COMMITTEE ON APPROPRIATIONS
----------
TOM COLE, Oklahoma, Chairman
HAROLD ROGERS, Kentucky,
Chairman Emeritus
ROBERT B. ADERHOLT, Alabama
MICHAEL K. SIMPSON, Idaho
JOHN R. CARTER, Texas
KEN CALVERT, California
MARIO DIAZ-BALART, Florida
STEVE WOMACK, Arkansas
CHARLES J. ``CHUCK'' FLEISCHMANN,
Tennessee
DAVID P. JOYCE, Ohio
ANDY HARRIS, Maryland
MARK E. AMODEI, Nevada
DAVID G. VALADAO, California
DAN NEWHOUSE, Washington
JOHN R. MOOLENAAR, Michigan
JOHN H. RUTHERFORD, Florida
BEN CLINE, Virginia
GUY RESCHENTHALER, Pennsylvania
MIKE GARCIA, California
ASHLEY HINSON, Iowa
TONY GONZALES, Texas
JULIA LETLOW, Louisiana
MICHAEL CLOUD, Texas
MICHAEL GUEST, Mississippi
RYAN K. ZINKE, Montana
ANDREW S. CLYDE, Georgia
JAKE LATURNER, Kansas
JERRY L. CARL, Alabama
STEPHANIE I. BICE, Oklahoma
SCOTT FRANKLIN, Florida
JAKE ELLZEY, Texas
JUAN CISCOMANI, Arizona
CHUCK EDWARDS, North Carolina
ROSA L. DeLAURO, Connecticut,
Ranking Member
STENY H. HOYER, Maryland
MARCY KAPTUR, Ohio
SANFORD D. BISHOP, Jr., Georgia
BARBARA LEE, California
BETTY McCOLLUM, Minnesota
C.A. DUTCH RUPPERSBERGER, Maryland
DEBBIE WASSERMAN SCHULTZ, Florida
HENRY CUELLAR, Texas
CHELLIE PINGREE, Maine
MIKE QUIGLEY, Illinois
DEREK KILMER, Washington
MATT CARTWRIGHT, Pennsylvania
GRACE MENG, New York
MARK POCAN, Wisconsin
PETE AGUILAR, California
LOIS FRANKEL, Florida
BONNIE WATSON COLEMAN, New Jersey
NORMA J. TORRES, California
ED CASE, Hawaii
ADRIANO ESPAILLAT, New York
JOSH HARDER, California
JENNIFER WEXTON, Virginia
DAVID J. TRONE, Maryland
LAUREN UNDERWOOD, Illinois
SUSIE LEE, Nevada
JOSEPH D. MORELLE, New York
----------
Susan Ross, Clerk and Staff Director
(II)
SUBCOMMITTEE ON MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED
AGENCIES, ASSESSING THE VETERANS HEALTH ADMINISTRATION FISCAL YEAR 2025
POTENTIAL SHORTFALL
----------
Wednesday, November 20, 2024.
DEPARTMENT OF VETERANS AFFAIRS
WITNESSES
SHEREEF ELNAHAL, UNDERSECRETARY FOR HEALTH
JOSH JACOBS, UNDERSECRETARY FOR BENEFITS
Mr. Carter. Come to order.
We have a--oh, yeah, there you go.
We got a couple of nice folks going to talk to us today
about some misunderstandings we have got with the Veterans
Affairs Committee. Dr. Shereef Elnahal, close?
Mr. Elnahal. Yes, sir.
Mr. Carter. All right. And Mr. Joshua Jacobs.
We want to welcome both of you and we hope you can give us
good answers to the questions we have.
The Subcommittee recognizes and appreciates the work done
by the Veterans Administration. We know that since the PACT
Act, enrollment in the VA healthcare has grown significantly as
we provide earned benefits to our veterans.
Unfortunately, the inability to accurately forecast is
hindering these efforts. In July, the VA alarmingly notified
Congress of a potential $15,000,000,000 shortfall, including
12,000,000,000 in fiscal year 2025 for the Veterans Health
Administration.
Oddly, VA opted to notify Congress of this immediately
following, the House and Senate marked up bills for the fiscal
year. Given the dire emergency expressed by the VA of the
potential September lapse in pensions, disabilities, and
education benefits, Congress quickly acted and passed the
Veterans Benefits Continued Accountability Supplemental
Appropriations Act.
Unfortunately, we recently found out that none of the
nearly $3,000,000,000 provided in that act was utilized in
fiscal year 2024, as intended. In fact, the VA carried over
$5,100,000,000 into the new fiscal year or the next fiscal
year.
This inability to accurately forecast is unacceptable. The
VA's irresponsibly insisted fear that benefits and pensions
would be interrupted for American veterans caused us certain
concern. That brings us to today's primary hearing topic to
discuss the VA's request for $12,000,000,000 in additional
funds for Medicare account in Fiscal 2025.
Failing to immediately utilize the $3,000,000,000 as
indicated, it is kind of a natural question that we would have
the accuracy of your predictions. So we will also remain
steadfast in our commitment to our veterans and we'll make sure
they receive the benefits they have earned, but current
estimates continue to raise questions.
We hope we have a candid conversation this morning on this
request test and we look forward to hearing from you.
Ranking Member Wasserman Schultz, I will now yield to you
for any opening remarks that you would like to make.
Ms. Wasserman Schultz. Thank you, Mr. Chairman.
I thank the gentleman for yielding and welcome Dr. Elnahal
and Mr. Jacobs, and thank you both for being here today and for
your service.
So we are here to discuss some of the budget challenges
that VA is facing as they work to accommodate the growing
number of veterans who rely on services by the Department,
which is a good thing.
Before we get into that, I want to quickly walk through how
we got here today. Two summers ago, we passed the PACT Act,
which was the largest expansion in a generation of healthcare
and disability compensation for veterans who were exposed to
toxic substances during their military service.
We also created the Toxic Exposures Fund, or the TEF, which
ensured that these expenses would be covered on the mandatory
side of the ledger because our veterans deserve to have
certainty that all of their qualifying needs will be taken care
of year after year.
And when we make promises like the PACT Act, we must keep
them. Since the passage of this bill, the Biden Administration
has worked tirelessly to make sure that veterans who qualify
receive the benefits and the healthcare that they deserve.
The Administration has been so successful that VA has seen
a 37 percent increase in veterans enrolled in VA healthcare and
serviced 7.5 million more healthcare appointments than last
year.
Additionally, VA processed over two and a half million
disability benefit claims, a 27 percent increase over last
year. And those claims are being granted at higher rates. And
this year, Veteran trust in VA has reached an all-time high of
over 80 percent.
Clearly, the PACT Act is working. Such success, though,
does bring challenges. And one of those is predicting how much
it will all cost, all of this will cost.
Now, I recognize how difficult that can be, but it is also
incredibly concerning that the VA incorrectly estimated its
costs. In June, VA told us that there would be major shortfalls
in both VBA and VHA. In fact, at that time, VA told us the
shortfall would be $2,800,000,000 for VBA and 12,000,000,000
for VHA.
VA also told us that the 2,800,000,000 billion for VBA was
urgently needed by September 20th of this year. So Congress
quickly worked to appropriate this funding, only to find out
two months later that VBA had more than enough carryover to
cover all of its needs for the year.
Now, while I join my colleagues in asking the tough
questions as to how we got here, it is important to understand
a key fact here. The fact that VA did not need the full
supplemental is rare.
In this case, the government agency actually needed less
money than anticipated and was still able to provide high
quality benefits and care without going over budget.
Now, some of us have been in this Congress where we have
had to go and pass appropriations because an agency overspent
their money, including VA, a number of years ago. And Judge
Carter and I, you and I were in that Congress and so we have
dealt with overspending line items.
In this case, we have a situation where they actually spent
less. I would always prefer that an agency, particularly one as
important as the VA, try to make sure that they have all the
money they need to serve our veterans rather than them spending
like drunken sailors overspending their line items and then we
have to rush in and appropriate more because they have over
promised and not delivered in the way that they should.
So we should be digging into the VHA shortfall because
quite frankly we need to reexamine your $12,000,000,000
estimate. And I know you are taking a closer look at that
number and you are awaiting OMB's review, but it is absolutely
essential, as you and I spoke about Dr. Elnahal, that your new
estimate be as accurate as possible.
In addition to managing the 37 percent growth in
participation, VHA is also facing the rising costs of
healthcare, which I think all of us understand is occurring,
which adds to the uncertainty around your budget needs.
So we would like to better understand what those cost
increases are. I feel confident in saying that we are all here
to support all of us. This Committee has repeatedly shown that
we are all here to support the needs of our veterans.
We want to ensure that we keep our promise to care for
those who have served in our nation's military and for their
families, caregivers, and survivors. But what truly worries me,
in the coming year, is what the incoming administration is
saying about ``government efficiency'' by threatening to defund
unauthorized programs.
$119,000,000,000 in VA healthcare is on the chopping block.
Everyone needs to understand that that cares about our
veterans. Congress must not delay our work into next year. I
think, as appropriators, we all prefer an omnibus bill to a CR.
We should be passing full year appropriations bills and we
should be working on them right now so that we fully fund the
benefits and care our veterans have earned.
However, here we are one month away from the expiration of
the Continuing Resolution still without any top line agreement.
And at the same time we need to appropriately fund all of our
non-defense programs so that we are not constantly facing
shortfalls and requiring supplementals just to fund our
government's basic functions.
Responsible governance requires taking care of our
veterans' needs inside the VA and I hope our friends on the
other side of the aisle continue to keep that in mind and I
look forward to your testimony and I yield back the balance of
my time.
Mr. Carter. We have been joined by the Ranking Member of
the Appropriations Committee, Ms. Rosa DeLauro, and I am happy
to yield you for any opening remarks you consider to make.
Ms. DeLauro. Thank you so much, Chairman Carter, and I
appreciate the opportunity to be here. And thank you and
Ranking Member Wasserman Schultz, for holding this important
hearing on the potential shortfall for the Veterans Health
Administration.
Again, my thanks and a warm welcome also go to today's
witnesses, Under Secretary for Health, Dr. Elnahal, and Under
Secretary for Benefits, Mr. Jacobs. Thank you for appearing
today and look forward to your testimony.
While today's hearing covers a vitally important topic, I
just have to echo something that the Ranking Member said. I
really am dismayed that the Committee is disinterested in
completing the work of the Appropriations Committee on time.
We do sit one month from the expiration of the Continuing
Resolution that we passed in September and the date is December
20th and we, to date, do not have a top-line agreement.
What we should be doing, this committee and the Congress,
really laser focused on finishing appropriations bills, bills
that we ought to have become law before the end of the year.
There are some of my colleagues who want to delay our work
until well into next year and they would like to pass another
Continuing Resolution. Well, Continuing Resolutions are never a
good way to fund the programs and services that our veterans
depend on.
We need to properly fund the government so that we are not
constantly facing shortfalls, needing supplementals to keep the
government functioning to ensure veterans receive the
healthcare services that they are entitled to.
So Congress needs to do its job. My view, let's not adjourn
without enacting full year appropriations bill. Democrats are
at the table and ready to negotiate on a final full year bill
that can gain the support of Democrats and Republicans in the
House and the Senate for that is what is needed in order to
keep the government open. So I really do implore the majority
to join us.
On the topic of today's hearing, thanks to the successful
outreach efforts of the Biden Administration, the VA is serving
more veterans than ever before. But that increase in
beneficiaries in addition to the rising cost of health care has
led to a funding shortfall for VA medical care.
This is a success story and we should applaud the Biden-
Harris Administration for ensuring America is upholding its
promises to our brave veterans.
Over two years ago we enacted the PACT Act. We promised
veterans that they would receive benefits and medical care that
they require after exposure to toxic substances with dedicated
funding. And we extended that to all veterans, all of them.
And thanks to the Administration's outreach to veterans
entitled to the care, the number of veterans seeking care from
Veterans Health Administration has increased beyond projections
necessity facilitating additional funding to bridge the gap.
In fact, more than 760,000 veterans have enrolled in VA
health care since the PACT Act was passed, which represents a
nearly 37 percent increase compared to an equivalent period
before the legislation was signed.
So we must provide this dedicated funding to uphold our
promises. Our nation's veterans laid down their lives, their
bodies on the line for this country's freedom and security. And
we talk about it all the time. We pride ourselves in talking
about these issues. We take pictures with veterans when we go
overseas. We take pictures of the young men and women who are
serving abroad for this thing.
So they are entitled to this care. We said it was there.
They now have said, hey, I need the care. So we need to ensure
that this care is provided for. This should be nonpartisan and
non-controversial.
Before I conclude, let me address the VA benefits
supplemental that we passed in September. While it remains
clear that there is a large resource gap that we must take
steps to address to ensure our veterans receive the benefits
and the care that they deserve and they're entitled to, I am
concerned by the Department's apparently unnecessary request
for an expedited 2,800,000,000 for Veterans Affairs, which was
in fact not needed prior to October 1st.
Quite frankly, it does make it more difficult for this
Committee to pass and provide the necessary supplemental
appropriations if we cannot be confident of the accuracy of
what agencies are telling us about their need and when they
need it.
So I look forward to receiving more information about how
this costly error occurred. What steps the VA is taking to
ensure that future estimates are as accurate as possible.
Having said that, the purpose of today's hearing is on VA
healthcare, and I look forward to a robust discussion and how
we can support our veteran's health needs.
We stand together, as the Ranking member pointed out. There
is no difference of views as to our support and our dedication
to the young men and women who have fought and served this
great nation. But that means we send them off with a blare of
bugle and a ruffle of drums. But we have to deal with the
issues that they face when they return. And we must ensure that
we uphold promises that we made to our veterans. Thank you very
much for being here. I yield back.
Mr. Carter. Thank you. Thank you, Madam Ranking Member. We
thank you for your hard work. Chairman Cole could not be here
today because he had something that interfered with his ability
to, but he did send a written statement which, without
objection, his prepared remarks will be included in the record.
Without objection, your entire written testimony will be
included in the record.
Now we will recognize each of you for an opening statement
and then we will proceed with questions.
Dr. Elnahal, you may proceed.
STATEMENT OF SHEREEF ELNAHAL
Mr. Elnahal. Thank you, Mr. Chairman, Ranking Member
DeLauro, Ranking Member Wasserman Schultz, and members of the
Subcommittee, thank you for the opportunity to testify today on
the ongoing budget needs for the Veterans Health Administration
to continue serving our nation's veterans.
Since President Biden signed the PACT Act, we've provided
veterans with more care and more benefits than ever before. We
know that VA care is the best and often the most affordable
care available to vets and that those in our care are less
likely to be lost to suicide.
That is why we have opened the door to VA eligibility for
health care at every possible turn we could under this law,
launching the most aggressive outreach campaign in history to
educate veterans about the resources available to them.
Thanks to the resources provided by Congress and our
relentless efforts to reach more veterans, we exceeded even the
most aggressive projections for care delivered last year. At
the end of Fiscal Year 2024, nearly 800,000 veterans had
enrolled in VA Healthcare since the enactment of the PACT Act,
a 37 percent increase over the period prior to the PACT Act.
Additionally, over 900,000 veterans saw an increase in
their priority group, meaning reduction in their co-pays and
qualifying for more services like dental and long-term care for
many veterans.
We also set an all-time record for appointments delivered
last fiscal year, all while driving down wait times for primary
care and mental health and these trends have continued in the
initial weeks of fiscal year 2025.
At the same time, VA care continues to outperform non-VA
care and external care reviews around quality and patient
safety. In fact, the most recent CMS Overall Hospital Quality
Star ratings show that nearly 60 percent of VA hospitals were
rated four or five stars compared to only 40 percent of non-VA
hospitals.
And for ten quarters straight, we have outperformed our
counterparts in the CMS HCAHPS Survey measuring patient
satisfaction with inpatient care. And most importantly, we've
increased veteran trust in VA healthcare, reaching an all-time
high of 92 percent trust for veterans who receive an outpatient
appointment.
These outcomes are the direct result of hard work from our
frontline employees and leaders alike across our system.
Through a series of access sprints earlier this year, teams
made it easier and faster for veterans to access VA care by
offering night and weekend clinics and by increasing the number
of veterans scheduled into daily clinics.
Today, we continue to see their impact and shorter wait
times for primary care and mental health. And through the
Referral Coordination Initiative, we're working to maximize the
number of options we offer to every veteran, including more VA
options alongside community care options when they qualify.
And veterans have voted with their feet often choosing
these VA options even when they did not qualify, even when they
did qualify rather for community care, contributing to a slower
growth of referrals in the community than over the last few
years.
Our clinicians have also become more productive, achieving
a nine percent increase in productivity per clinician since
pre-pandemic levels in 2019, and a seven percent increase in
physician productivity specifically in fiscal year 2024 alone.
While we're optimizing every resource provided by Congress
to deliver world class care to vets, we also face many of the
same cost challenges as the private sector. In fact, the cost
for drugs and medicine in fiscal year 2024 increased by just
over 13 percent compared to the approximately nine percent
increase that was estimated at the time of the 2025 President's
Budget, and we continue to estimate further cost escalations
this coming year.
Because of our aggressive efforts to manage responsibly
within the budget VA achieved this historic growth in veteran
care while staying just under the fiscal year 2024 enacted
budget. We stayed within the budget, an outcome that we did not
expect when we initially submitted our supplemental request to
Congress this past July.
However, many of the strategies we used are not sustainable
in the long run. For instance, we cannot continue to delay
medical equipment purchases year over year, and we continue to
believe that growth in staff, rather than attrition, is needed
to meet increases in veteran care demand.
Due to the updated information about our financial position
at the end of last year, we're continuing to evaluate our
fiscal year 2025 funding requirements and we now estimate that
we will need less than the amount that we requested in July.
With more updated information, we're analyzing our revised
funding need carefully and methodically, and we will share the
revised need with this committee as soon as we finalize it with
OMB.
If VA medical care does not receive additional funding in
FY25, VA will be forced to make difficult decisions to remain
within the current budget, most notably on outreach, care
coordination, and more.
That is why our excellent field leaders have been briefing
you and your teams this week about the real and specific
impacts to veteran care if VHA has not afforded additional
resources this year.
To conclude, the most important reason we need more
resources is our record in delivering more care and more
benefits to veterans than ever before, and our hope is to
continue this historic level of outreach and care delivery and
we appreciate the consideration of this committee. I look
forward to your questions.
[The information follows:]
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Mr. Carter. Mr. Jacobs.
STATEMENT OF JOSH JACOBS
Mr. Jacobs. Good Morning Chairman Carter, Ranking Member
DeLauro, Ranking Member Wasserman Schultz, and members of the
Committee. I appreciate the opportunity to appear before you
today.
As you know, VA is currently delivering more benefits to
more veterans, family members and survivors than ever before.
This historic success stems from implementation of the Sergeant
First Class Heath Robinson PACT Act and our unprecedented
proactive outreach to connect veterans with the benefits that
they've earned.
This summer, VA identified several factors that required us
to reassess our FY24 mandatory funding needs, largely driven by
an increase in the total number of anticipated disability
compensation and pension claims.
Our goal was to ensure sufficient resources would be
available to carry us through the end of the year and deliver
on our promise to provide veterans and survivors with earned
benefits on time and without interruption.
We were mindful that a funding shortfall of just $1 would
have prevented VA from processing its September pay file,
delaying monthly disability compensation, pension, and
education benefit payments to the approximately seven million
veterans and survivors who rely on them.
When we recognized the risk of exceeding our performance
targets and jeopardizing timely payments, VA notified the
Committee and kept Congress apprised of developments in the
subsequent months.
Veterans and survivors rely on these payments and any delay
could have been devastating to them and their families. This
was a risk we simply were not willing to take and slowing
benefits delivery was not an option because we know the
transformative impact these benefits have on the lives of
veterans.
We serve veterans like Dave Hale and his wife Carrie. Three
years ago, Dave survived a vehicle collision with only minor
injuries. But months of persistent neck pain ultimately led to
a diagnosis of a rare cancer.
Following Dave's diagnosis, Carrie quickly became his
caretaker. Dave's claim was denied, but Carrie didn't stop
fighting. After attending a PACT Act outreach event and working
with both VA employees and advocates, she got the help she
needed and Dave's cancer was finally granted 100 percent
service connection in June of 2023.
In his final days, Dave's only worry was his family and
comforted by the knowledge that they would be taken care of,
Dave passed away less than two months later.
This is the power of the PACT Act life changing support for
veterans, their families and survivors and Carrie and Dave's
story is just one of millions that demonstrates the impact of
this historic law you helped to pass.
Since the PACT Act was signed into law, VA has approved
more than 1.3 million PACT Act related claims equating to over
$8,000,000,000 for veterans and survivors.
In fiscal year 2024, VA delivered an all-time record
$187,000,000,000 in benefits to nearly seven million veterans
and survivors. We also processed more than 2.5 million
disability benefits claims, a 27 percent increase over last
year's all-time record and thanks to the largest, most
aggressive outreach campaign in VA history, veterans, family
members, and survivors are applying for and receiving a variety
of benefits at higher numbers than ever before.
We are grateful to Congress for providing the supplemental
funding we requested. While those funds were not immediately
used, prudent management compelled VA to request the funding so
veterans benefit payments could continue without interruption.
In October, the amount of the supplemental funding and more
was used directly providing disability compensation, pension,
and education benefit payments for veterans, families, and
survivors.
Moving forward, we're incorporating lessons learned to
adjust our budget projections, including estimates for the 2026
President's Budget, so we can avoid this situation in the
future.
That means accounting for the capacity of our workforce to
deliver at record levels, anticipating higher rates of annual
growth and average disability ratings, and continuing to
transparently share our status of funds reports every month.
We will provide updated estimates when they're finalized
and will continue providing these monthly updates to the
Committee. We remain focused on delivering more benefits to
more veterans and survivors more quickly than ever before and
we thank you for your continued support. I look forward to
answering any questions members of this Committee may have.
[The information follows:]
[GRAPHIC] [TIFF OMITTED] T1961P3.010
Mr. Carter. Thank you. And we appreciate you being here to
explain this. And I don't think anyone sitting at this dais
would disagree that we are very proud of the way the VA has
reacted to the PACT Act and the way that you have done a great
job to take care of our fighting people.
But what the question we have here is communication with
the people who pay the bills. That's us. And accurate as can be
communications. And I would like to hear, and I hope everybody
else would like to hear, exactly how you make your estimates.
I am going to have a question about that. What do you use
to make these decisions? It was sort of coincidental that we
got this information one day after the presidential election
was called.
And so that seemed a little circumstantial, as we would say
in the courtroom. But anyway, we are concerned about, and we
still don't have a real number. We are talking $12,000,000,000
right now as you study it or as you talk to OMB or whatever is
coming up.
We need clear communications is what we are talking about.
Because this is a lot of money. It is a lot of money on the
short fuse. Nobody's criticizing you, but that you are
accomplishing great things in the VA. You are. But we have to
pay the bills and we have to know what is going on. That is
what this is, at least I am trying to shorten what we are
thinking about.
We are talking about why are we in the dark? And if you
get, and if you don't know, then you don't know. But we are
going to have the same situation. We will have timed on each
question. And I will start.
I will start and then the Ranking Member will follow me and
then we will go as you came into the hearing.
Our office was briefed earlier this month about status of
the funds and projections for VA's funding for FY25. And as I
mentioned, it is oddly coincidental that one day after the
President's election was called, he told us about the
12,000,000,000. This raised a flag. There was something strange
about that.
And OMB, you said OMB is working on it. Your statement
continues that we are at the same place, OMB is working on it
right now. According to your response to the letters we were
sent, VA projected that you would have nearly 12,500,000,000
unobligated funds carried over into FY25.
Now that we are more than halfway through November, please
tell us the burn rate, fiscal year to date, and the latest on
the projections for the remainder of the year.
While we appreciate that you relayed to us the
$12,000,000,000 shortfall as an overestimate, you still said
more funds would be needed as you projected to the end of the
year. When do you expect to provide the revised number to us so
that we can resolve this matter?
It is critical that the VA answers us so that we can assess
this matter swiftly. Veterans and this body deserve to have
honest, transparent, and documented budget needs to enable us
to provide the great care to all of our veterans.
How do you anticipate this request to come forward? And the
final proposal of moving to the mandatory side is not viewed by
at least this side of the aisle as a viable last option.
So with that, if you would answer the questions is how do
you make projections? And you say more projections are going to
be made and give us an example of how they will be reported to
this body so that we can have a continuing idea of where we are
going to be.
Appropriating in the dark is very difficult for
appropriators and we would rather not do that. So if either one
of you would like to give us what device you use to make
projections, it would be of interest to me.
Mr. Elnahal. I'm happy to start, Mr. Chairman.
I think you're more than right to demand transparency or
it's our constitutional obligation to grant you that
transparency, which is why in July, when we were mid-year, not
knowing where we would necessarily end up, we came forward with
our projected funding need into the end of fiscal year 2025.
So we went as much in advance as possible with that
request. That estimate has proven to be an overestimate, as you
said, based on the data up to that point in the fiscal year on
our care execution levels, on things like the cost per full-
time employee.
As we briefed to your staff, we were off by about two
percent on ultimately what the cost per full-time employee was
amounting to about $3,000 per employee. But because we have a
more than 400,000-person workforce, when amortized over the
entire organization, that ended up being well over a billion
dollars of costs that we didn't actually obligate when we
expected to in July. And so that's one reason that our estimate
was off.
In the coming weeks Mr. Chairman, we are going to make sure
that we methodically and carefully recalculate what that need
is, because we need to get it right, or at least more right
than we did in July. We don't want to be giving you something
that was as ultimately inaccurate that we gave you in July.
Now, that was, again, our best estimate with the data we
had at the time. Another factor was that our operational
leaders across the organization manage to the budget by making
key decisions to be able to achieve that. So, we did stay
within the FY-24 enacted budget, but some of the actions they
took are ultimately not sustainable.
So, for example, deferring and delaying equipment
purchases. We also anticipate continuously increasing costs in
pharmaceuticals and prosthetics. Medical inflation is far
exceeding consumer price index, and so these are cost pressures
that the entire healthcare system is facing, Mr. Chairman.
Normally we project our funding needs through actuarial
models called the rolling healthcare projection model. Mid-
year, we had to do an estimate run with a different
methodology. We're now going to be using more up to date and
hopefully more accurate assumptions when we calculate and
deliver our funding to you.
Mr. Jacobs. Mr. Chairman, on the benefits side, we estimate
our cost requirements, looking at the number of claims we
anticipate receiving and producing, and that could be
influenced by the total number of employees we have, their
efficiency levels, the availability of overtime funds.
On the education side, we're looking at economic indicators
trying to assess the rate of utilization for those education
benefits, to include whether veterans and beneficiaries are
using those benefits in a full time or part time capacity
online or in person.
What we found in looking back at fiscal year 2024 is the
primary driver, and the primary reason why we came to you and
requested the additional funding is we updated our projections,
assessing that we would complete 2.5 million claims, not the
2.2 million we had originally projected and thought was
aggressive yet achievable. Well, it turns out we did in fact
exceed 2.5 million claims completions. What we didn't
anticipate is that the proportion of those claims was more
heavily weighted on veterans receiving a claim for increase
rather than new veterans getting a claim for the first time.
And the cost differential there resulted in us not exceeding
the amount of mandatory funding as we had anticipated.
The other point that I'll mention is that without the
supplemental funding on the education account, we would only
have carried over about half a percent of our total funds,
which would have meant that if we had had even about 5,000 more
students utilize those training and education programs, we
would have exceeded the total level.
So, as we look forward to improve on our budget formulation
process, we're taking into account the lessons learned,
increasing total production estimates, trying to dig deeper
into the proportion of claims that are new versus claims for
increase, and we're making sure that we also anticipate a
greater growth in the average disability rating for veterans.
Mr. Carter. Ranking Member Wasserman Schultz.
Ms. Wasserman Schultz. Thank you very much, Mr. Chairman.
I'm going to come back to the short fall, and just want to
begin by underscoring the concern that I raised in my opening
remarks.
President-Elect Trump recently announced that Vivek
Ramaswamy would co-lead a so-called Department of Government
Efficiency, which sounds like it is not even actually going to
be a governmental agency. And he's already made headlines
saying that unauthorized programs should no longer receive
appropriations. His precise words were that, ``we can and
should save hundreds of billions each year by defunding
government programs that Congress no longer authorizes.''
As you well know, veterans healthcare benefits are
currently not an authorized program, so if--and perhaps my
colleagues are unaware of that. But--so if Republicans in the
majority follow through on Ramaswamy's wishes, it will mean
that veterans would no longer be eligible for in-patient
surgeries--for--no longer be eligible for in-patient services,
like surgeries, acute care, and injuries that may require
urgent care and outpatient services like health appointments,
immunizations, and nutrition and education.
Ramaswamy's strategy would strip this committee members--
this committee of our authority to determine how the federal
government should be funded. All members of this committee
should be outraged about that. It appears that we should be
reminding the incoming administration that our nation's
founders gave Congress the power of the purse.
So, Dr. Elnahal, my question is, this stated strategy
would obviously have a devastating impact on our veterans. Can
you further elaborate on what eliminating almost $119 billion
in medical care would mean for our veterans?
Mr. Elnahal. I'd be highly concerned about it,
Congresswoman. Right now, we take guidance from our general
counsel and our authorities. And so, we have a 1996 law that
established the medical benefits package that clearly does
state that our authority to provide care is related directly to
the advance appropriation that we get every year.
So, we're pretty confident in our authority to provide the
full scope of medical care. And we're in a position now,
because of the historic growth in the number of veterans
enrolling in VA, but also the number of veterans who are
relying on us more because we're doing things like increasing
priority groups when Josh and his team out of VBA offer more
service connected benefits to these vets who are already
enrolled. That is actually substantially increasing care
demand.
And so, we'd be highly concerned about any cuts. In fact,
we need to grow our workforce to a level of 405,000 employees
as we estimate to be able to deliver that care in a timely way.
Despite these increases in demand, we've seen wait times on
average go down instead of up for primary care and mental
health. We've seen historic performance on quality, patient
safety, veteran satisfaction and trust. We want to make sure we
maintain those outcomes while we provide accessible, high
quality care to vets.
Ms. Wasserman Schultz. Thank you, and just to my colleagues
on appropriations, you know, we have a culture here that we are
proud of that is--that there are Democrats, Republicans, and
appropriators. And I mean, I think we all have to think through
if this is a plan that actually is moved forward, about the
number of laws that have expired in a sense and no longer have
an authorization that we fund here, even without the
authorization, which is our right and Congress's authority.
And so, it's just something that I wanted to make sure that
I shined a spotlight on, because it would dramatically affect
the--Congress's authority more broadly, and specifically our
authority as a--as a committee.
On the VHA shortfall, Dr. Elnahal, as I mentioned in my
opening statement, both the increasing cost of healthcare and
the uncertainty around the number of veterans with PACT Act
qualifying needs who will be coming to rely on your services
adds to the uncertainty in your cost estimates certainly.
And you in your testimony and your answer to Chairman
Carter just now pointed to that, particularly in pharmacy and
prosthetics. With the success of the PACT Act, can you give the
committee some insight into how many veterans you are now
serving, and where the shortfalls exist?
For example, what types of providers will you need to be
hiring, and can you be more specific about exactly what costs
are increasing, and how that's impacting your ability to not
just predict your costs, but to sustain a high level of care?
Mr. Elnahal. Yes. So, we face systemic cost increases,
again, as does every health system in America, Congresswoman,
on pharmaceuticals, prosthetics, key elements of veteran care
delivery that VA shoulders a responsibility for.
We're a very integrated, comprehensive healthcare system.
We have one of the largest pharmacy operations in the country.
We bear those costs and deliver those needed medications to
vets. And so, we anticipate that we will see an increase. We
observed an increase, I should say, of about 13 percent in
pharmaceutical costs this last fiscal year.
We're projecting an increase of up to 24 percent into FY-
25, both because of the intensity and volume of medications
we're delivering, but also because of the newer types of
medications for obesity that are high cost, but can ultimately
help and serve veterans across the country. And so, those are a
lot of the systemic costs. When it comes to our fulltime
employee needs, Congresswoman, we have been relentlessly hiring
frontline employees and clinicians and folks who directly serve
veterans.
The vast majority of employees that we hired at historic
levels in FY-23 were frontline employees. We are budgeting for
physicians, nurses, housekeeping aides, food service works, and
the entire gamut of employees needed to make hospitals and
clinics move to give veterans timely care, and that's really--
we're going to be indexing--should be able to get these
supplemental funds.
Ms. Wasserman Schultz. And just one more brief thing. How
has the growth in community care impacted your budget,
particularly as it relates to this shortfall?
Mr. Elnahal. Every single referral into the community is an
added--what we'll call variable cost--and an added cost to
ultimately the agency. Now, I've supported community care from
day one in my tenure. Community care is absolutely needed for
many veterans when we don't have a service available, and when
we can't offer timely services. It's actually the law under the
MISSION Act for us to be able to offer those services.
What we've done instead of limiting access to community
care is actually over-indexed and offered more VA care over the
last fiscal year. So, we're offering telehealth appointments,
more in-person appointments. We are offering appointments
between medical centers that more veterans are taking us up on,
and veterans are voting with their feet. So, between 2022 and
2023, and 2023 and 2024, there was a significant difference. It
was 18 percent over the last period, and we grew by about 14.8
percent between 2023 and 2024.
So, we're slowing the growth of community care, not because
we're limiting those options, but because we have a more robust
workforce than ever. Our clinicians are becoming more
productive, and we're offering a lot more VA options to vets
whether they qualify for community care or not.
Ms. Wasserman Schultz. Great. Thank you. Thanks for the
indulgence, Mr. Chairman. I yield back.
Mr. Carter. Mr. Valadao
Mr. Valadao. Thank you, Chairman. Thank you to our
witnesses for testifying before the committee today. Like the
rest of my colleagues, I am incredibly concerned with the VA's
ongoing challenges in accurately estimating demand utilization
and cost, and reiterate the need for more transparent and
detailed explanations of what the VA needs to fulfill its
mission of providing for our nation's veterans.
I know it's been hit on a little bit, but even chatting
with my colleagues on the authorizing side, there's a lot of
concern--there's not a lot of clarity on the way that these are
estimated, and there was a letter that was signed by our
chairman here, Chairman Carter and Chairman Bost, specifically
requesting quite a few different clarifications, and it sounds
like there has been little to any response at all on those, and
a lot of excuses. Any response to what's taking so long to give
the answers to, what is it, 15 questions on there?
Mr. Jacobs. Congressman, I was under the impression we had
responded, but I can go back and confirm if I am mistaken. We
certainly--as Dr. Elnahal mentioned--we have a Constitutional
responsibility to cooperate in a transparent manner to provide
you with the answers you need to do your duties to the people
you represent, and to the taxpayers of this country. We owe you
that, and we will commit to doing that.
We will be transparent. We have provided monthly status of
fund reports since the summer; those will continue. And we are
also complying with requirements associated with the
supplemental appropriation you passed to provide reports
detailing information about our budget formulation process.
Mr. Valadao. After that supplemental was passed, we were
under the impression, or at least it's come out that we--it was
no longer needed. When did you actually know we didn't--that
you didn't need those $3 billion?
Mr. Jacobs. We identified that after we had received the
funds. It takes us several weeks to reconcile our accounts and
make sure that we've identified things like prior recoveries,
and kind of the--all of the numbers. And so, once we had
verified that, we communicated that.
Mr. Valadao. And so you knew a few weeks afterwards that
you didn't need the extra 3 billion that was----
Mr. Jacobs. The full----
Mr. Valadao [continuing]. [Crosstalk].
Mr. Jacobs. The full, complete--I think we had a sense of
the C&P earlier, and the RB took a little bit longer, but then
we had to reconcile and verify that.
Mr. Valadao. All right. How does the VA plan to measure
long term outcomes and increase funding, particularly in areas
like mental health, homelessness reduction, and caregiver
support?
Mr. Elnahal. I'll take that one, Congressman. So, the most
important public health and clinical priority we have is
veteran suicide. And so, that is going to be--it continues to
be the most important metric that we measure when it comes to
the mental health and well-being of our vets.
We also measure access to care. So, we've been able to
reduce average wait times for a new patient in mental health by
about 14 and a half percent year over year from fiscal year
2023 to 2024, mostly because we hired thousands of mental
health frontline clinicians to be able to see more vets, but
also because we've been working on productivity and ensuring
consistent standards on the number of patients seen per
provider, and of course we also have a large gamut of metrics
on quality and reliability of care delivery when it comes to
mental health, and we're happy to follow up with you on exactly
how we're measuring those outcomes. I was just handed a note
that says we did send back a 46 page response to the letter
that you mentioned on November 8th, but we'll make sure we'll
double back with you and your team on that response.
Mr. Valadao. So, for--on the responses they have gotten so
far, the numbers don't add up to the $12,000,000,000 that you
are asking for. And that is a huge problem. When we talk about
a number of $3,000,000,000 that was given and then not
necessary. Now there's a $12,000,000,000 request, but there is
no clarification on what those needs are.
I feel like we need a little more transparency on that. And
if you can bury in a 38-page letter actual facts, I think that
would be helpful on.
Mr. Elnahal. I don't disagree, Congressman, that our
projections could have been more accurate. Conceded that for
sure. What we're trying to do is make sure we work very
diligently to make sure that the number we do give this
Committee is much more accurate. And that is taking time and
we're going to work as methodically as we can with OMB. But
yes, the projections as of July were an overestimate.
Mr. Valadao. All right. What mechanisms are you currently
using to keep these numbers as transparent and accurate as
possible moving forward?
Mr. Elnahal. We have monthly budget execution reviews,
Congressman, with every single one of our network leaders. We
have robust participation from our medical centers. We're
tracking full-time employee levels, community care utilization,
pharmaceutical costs, prosthetic costs, productivity, a number
of metrics that are giving us much more real time information
directly from the folks managing our system.
And so that information is available to this committee
upon request at any time when it comes to our budget execution.
I will say that a large part of the reason why we're here and
we ultimately need less money this fiscal year is because our
operators grew care significantly while holding down costs as
much as they could responsibly.
And so we're seeing wait times go down, we're seeing care
volumes go up. And we stayed within the FY24 enacted budget not
by accident, but because we have excellent leaders across our
system managing the costs very, very closely.
And so that was an unexpected outcome, ultimately a good
one because we have more resources going into this year, but
our projections need to be more accurate.
Mr. Valadao. I am under the impression that one of the
administrators at the Department actually used the phrase SWAG.
So scientific wild ass guess as a way of some of the estimates
that were projected and why they were so far off.
And I think that was actually addressed in the letter. And
I mean that's a scary thought when you think about the billions
of dollars that were being budgeted, spent, not spent, asked
for. And then when you hear phrases like that from
whistleblowers, I think that is a pretty scary thing for us,
especially when we are all in the same room here. I think we
all care about the same thing. Making sure that we take care of
our veterans and the amount of money that is being thrown
around is irresponsible for the taxpayers.
A lot of veterans are taxpayers as well. A lot of them left
the services and go out in private sector and work hard, pay
taxes. We want to make sure that we are as responsible as
possible. And when we hear phrases like that, I think we owe it
to our citizens to make sure we do our best to not play these
games anymore.
And I hope that in the response we can find some of the
answers to the questions I had and that the Committee had.
Thank you.
Mr. Carter. Mr. Bishop.
Mr. Bishop. Thank you very much, Mr. Chairman, Dr. Elnahal,
and Mr. Jacobs. Thank you so much for being here today and
thank you for your commitment to ensuring that our veterans
receive the care and the services that they deserve.
I greatly appreciate your service and your invaluable
contributions to this important discussion. I really think that
while there has been discussion about the overestimates of
cost, I want to congratulate you because it appears to me that
by any metrics of quality and care that you have taken your
mission to take care of those who have served very, very
seriously.
This Committee, for over several years now has insisted
that we not come up short on care for our veterans and even
made it a part of our annual process to advance fund medical
care for our veterans to make sure that regardless of what
exigencies might happen here on the Hill, that our veterans
would be cared for.
But by all of the metrics of performance, you have done a
tremendous job, better than in many, many, many decades. And so
I want to congratulate you for that. I would like to associate
myself with the comments of the Ranking Member because I think
that it is better to have the resources and not need them
urgently than to need them and have our veterans come up short.
And I think that you gave our veterans the benefit of the
doubt in those estimates and fortunately, budget wise, you
didn't have to expend it. But nevertheless, I appreciate, and I
think our veterans appreciate the fact that you had them in
mind and you did not want them to come up short.
So I certainly congratulate you on that. But I want to ask
you, with the fluctuations and costs related to pharmaceuticals
and your need for additional staff, the fact that your managers
were able to cut costs to stay within the projected budget, but
as you say, those cost-cutting mechanisms are not sustainable,
you have got to invest in the future. You have got to hire more
staff. You have got to anticipate the additional cost increases
that will be coming for the quality of services and equipment
that you have to acquire.
What is it that we can do, on this Committee, to give you
additional tools to more accurately project and to make sure
that we never, ever have to come back for additional funds
because we have targeted and have sufficient resources?
Mr. Elnahal. So I'll start, Congressman. I appreciate your
comments very much. As the Secretary compels us to do every
day, we are not going to relent on our outreach to more
veterans across the country to give them their earned
healthcare and benefits. And we've acted that way since the
PACT Act was signed.
We accelerated healthcare eligibility eight years in
advance of what was required for the law for different cohorts
of veterans as of March 5th of this year, including every
veteran who's deployed to a post 9/11 conflict now qualifying
for VA Healthcare, every veteran deployed to the Gulf War,
every veteran deployed to the Vietnam and expansive deployment
locations.
And that is the primary reason why we are here. We're given
the authority to bring more vets into the system. Every single
veteran we enroll, on average, reduces their risk for suicide,
which is reason enough to do this.
Mr. Bishop. I am hearing from my veterans every day that
they are really, really happy with the recent support that they
feel from the VA. They feel like their claims are being
addressed, that they are getting better care, they are
increases where they deserve an increase, are coming quicker,
the wait times are better. They seem to be happy.
And the data that you supplied in your testimony indicates
that the confidence in veterans is much, much increased. And so
I really have to congratulate you for that. I think this
Administration has done a tremendous job in that.
Mr. Elnahal. Thank you, Congressman. But I know that we do
need to work on our budget formulation, and that is something
we're commissioning an external review to assess. And we're
going to make sure our projections get better and better over
time.
Mr. Carter. Mr. Rutherford.
Mr. Rutherford. Thank you, Mr. Chairman. And I thank our
witnesses for being here this morning.
You know, I want to echo Mr. Bishop's thanks. As a Navy
dependent growing up, my father was a World War II and Korean
veteran. And, you know, I know what veteran benefits and all
meant to my family growing up.
I know Mike and Scott and others in the Appropriations
Committee who have served this country and are veterans
themselves. The future of veteran care in America couldn't be
in better hands, I think, from an appropriation standpoint,
nobody is going to be cutting care to our veterans.
Now, can we do it better? Sure. And we need to look at
that. And I want to ask because in my previous life, I had to
put together big budgets every year. And you know something
that I noticed, I could really hit it on the dime when it was
simply carrying everything forward the way it had been for 10
years, you know, 15 years. But when you throw in a new program
like the PACT Act, that's where the SWAG comes in, I know.
Now, it is scientific, but you try to base it on something,
but you don't have those former events that you can really turn
to to gauge what's the response going to be. You don't know how
many veterans are going to respond to PACT Act. And I first
want to say also I think you all did an amazing job getting the
call out to all the veterans, making them aware of the PACT Act
existence even.
And so, but not knowing how they're going to respond to
that, you know, for you to try and put together a budget,
that's, I know that's tough. And I think when you look at the
size and scope of veteran healthcare and veteran benefits, I
think you all did a pretty good job, quite frankly.
Now there is also processes that are in place where we can
do rescissions and that sort of thing. So it is not like the
money is just gone. But I do want to ask you one thing because,
and the reason I would rather see you overestimate than under
is because I know how important, and I think you would agree,
preventative healthcare is early healthcare.
You know, I have members in my family that have had
screenings and things that have literally saved their life and
saved the system a whole lot of money because they don't have
to pay for the more serious illness down the road.
So my question is the PACT Act and in the call that you all
put out, getting these folks in earlier, getting to them more
quickly, four years, I think, versus eight, those kind of
changes.
Is there any projections on, and it may be too early yet,
but are there any projections on how much is actually being
saved by addressing these health needs earlier by the clarion
call that you all put out?
Mr. Elnahal. Yeah, Congressman. So we believe that
preventative care is the best care, and that was one of the
main motivations for us to accelerate healthcare eligibility
under Section 103 of the PACT Act, which you granted us as an
authority under that law.
And for the first time for many, many veterans, they no
longer had to prove that they needed to have a service-
connected condition to get access to VA healthcare. The benefit
of the doubt on their need for healthcare was given to the
veteran for the first time for millions of additional veterans.
And so we could say for the first time to those veterans
that we can be there for you in a preventative posture rather
than waiting for you to get sick and ultimately get granted
service connection before we treat a condition you already
have.
Mr. Rutherford. Exactly.
Mr. Elnahal. We'd much rather be in a preventative posture
as you may. Now, in terms of projections on cost savings, that
remains to be seen. This is a historic piece of policy that
will be thoroughly analyzed into the future. But the main
motivation, Congressman, as you know, isn't cost, it is
preventing illness and prolonging the life and allowing
veterans to thrive across the country.
Mr. Jacobs. Congressman, I would just add, as we look at
the two decades leading up to enactment of the PACT Act, our
obligations for the compensation and pension account grew at an
average rate of eight percent. In the two years since the law
was enacted, it grew at 17 percent and then 16 percent. So
there's been tremendous growth. We carried over significantly
more money in the last two years at about a 10 and 11 percent
rate relative to what we had done previously.
We obviously were a little too tight in this past fiscal
year. And so we'll work to apply those lessons moving forward.
But your point is a good one. The PACT Act has fundamentally
expanded our ability to deliver more benefits to more veterans
and survivors.
It's an incredible authority. But it's challenged us with
respect to budget formulation, and we'll make sure we apply the
lessons learned moving forward.
Mr. Rutherford. Thank you. Look, linear projections are
easy. Dynamic projections of what human behavior is going to be
is tough. And quite frankly, I think you all did a good job.
Thank you. I yield back.
Mr. Carter. Mr. Cuellar.
Mr. Cuellar. Mr. Chairman, thank you. And to the Ranking
Member also, and I want to thank our witnesses for being here.
And I certainly want to thank you for all the work that you do
for our veterans. So I want to say thank you.
My question goes on the shortfall. I know it has been
asked, but I want to ask it a little differently. So in July
2024, you all projected a $15,000,000,000 budget shortfall.
Then it was revised in November to 5,100,000,000. That is a
shift of about a little bit over 20 billion. Not 1,000, not
thousands, not millions, but billions. That's a large amount of
discrepancy. And I got serious questions, if you all can write
down the questions.
What measures are being implemented to enhance the accuracy
of future budget forecasts and prevent similar situations is
one question. And in that what internal controls are being
strengthened?
The second question, to ensure financial accountability
within the VA and to go into some of the questions, I assumed
that the financial projections were influenced by three things,
lower than expected workforce costs, I assume? If that was one.
Delay equipment purchases, I assume that was another one?
Slower growth in community care, I assume that was another one?
But my question when you talk about the measures to
strengthen internal, I assume you all are using the internal
control systems within the standards set forth by the GAO that
is the Green Book, the Standards for Internal Control of
Federal Government. I assume you all are doing that now?
I assume also that you all are conducting your yearly
evaluations internal control systems to comply with the Federal
Managers Financial Integrity Act of 1982 to make sure that we
have the effectiveness and the efficiency in operations,
reliable financial reporting, and of course compliance with
applicable regulations.
And I assume, also, you all been implementing the OMB
Circular A123 also to do this. On the measures, and I say this
to my colleagues, 14 years ago we changed the law to ask you to
do performance measures. The only thing is I couldn't get
across was I was trying to add this to the appropriations where
we could actually have an input and we can still do that, Mr.
Chairman.
Right now the way the measures are being done, including
cost savings, they are left up to the agencies to in many ways
pat themselves on the back because they will put certain
measures that are a lot easier to achieve. But I hope sometimes
we can talk about where Congress can have a say so on the
measures that include cost savings.
If we put in $1, what do we get for $1? What are the cost
savings? And I haven't seen your measures in a while, but a lot
of the measures we are looking at were just measures of
activities and not results or results oriented. And I think you
know what I am talking about.
But anyway, I have a couple questions that are down the
line as the Chairman and the ranking woman also, but I want to
ask you about some of the internal measures.
Mr. Elnahal. Absolutely, Congressman.
Just to clarify one thing, we had estimated a potential
need in FY25 as of July to be 12,000,000,000 for VHA. We have
not yet submitted what that revised number will be. We know it
will be lower, potentially substantially lower, again based on
all the factors I mentioned.
Our operators managing as closely as they could to the
budget and ultimately staying within the enacted budget,
affording us the carryover approximately that we had estimated
originally in the budget.
But then there are also elements that we expect like
increased pharmaceutical prosthetic costs and other systemic
factors in healthcare that will factor into that ultimate need.
On the budget formulation review that we're doing, as
Congressman Rutherford mentioned, you know, dynamic factors in
play here. We hired a huge number of people, unprecedented
number. An all-time record of more than 60,000 people in FY23
precisely to prepare for robust implementation of the PACT Act.
Because we were also doing an unprecedented outreach campaign
to bring more veterans in.
And so even if we are off by about two percent in the cost
per FTE, which is approximately what we were off by as of July
versus what we know now, that translates into well over a
billion dollars of difference in the actual outcome. And so
we're really looking at these factors.
We want to make our projections as better and ultimately
more accurate. But there's a very dynamic last few years in
play here. We also just finished our audit with the OIG on
complying with all of the different parameters that you
mentioned.
And so we're taking that. We've improved year over year,
but there are still things that VA needs to work on. And of
course we welcome your oversight and accountability on
outcomes. Our most important outcomes are veteran trust, which
stands at an all-time high of 92 percent, quality and patient
safety outcomes, which VA outperforms the private sector by 60
percent, getting the top two grades versus 40 percent of the
private sector.
And of course access wait times are down in primary care
and mental health. And when it comes to actual care delivery,
we are up significantly, breaking records every year in
appointments delivered.
Mr. Cuellar. And we thank you. My time is up, Mr. Chairman.
But if you recall, in the state of Texas we actually did put
performance measures where we actually sat down with the
agencies and looked at them.
And there's a way we can add them to the report language at
least so we can see customer service like you mentioned. And
thank you for a good job on that. You can look at cost savings.
There's a lot of things we can do and maybe next year we can
look at some of that.
And Florida also has done that also. I know Texas and
Florida and probably the other states, also Nebraska and the
other folks have looked at this, but it is something that we
should start thinking about having to say so on performance
measures.
But with that, thank you Mr. Chairman, Ranking Member and
to both of you, thank you for what you do to help our veterans.
Thank you.
Mr. Carter. Ms. Bice.
Ms. Bice. Thank you, Mr. Chairman. And I want to thank Dr.
and Mr. Jacobs for being with us today.
I first want to say that it is disappointing to hear the
ranking member politicize this topic. No one is suggesting that
VA benefits are going to be cut. No one is suggesting they're
going to be eliminated.
The next administration will do everything they can to
ensure that our veterans' care is a top priority. It didn't
happen under the first Trump Administration and it is not going
to happen under the next one. So I think it is important to
point that out.
I want to talk about a couple things. First and foremost,
the budget relied heavily on unobligated funds. You all had
quite a bit of that. Can you talk about what specific factors
led to the assumption and why were these risks not highlighted
to Congress early on?
Mr. Elnahal. Are you referring to the medical care
carryover that we budgeted?
Ms. Bice. Correct.
Mr. Elnahal. Yeah. So this has been a consistent pattern of
advanced appropriations over the last many years where, for
reasons that I think are very veteran centric, you all have
authorized funding for us that would more than complete the
needs for the current fiscal year and then carry over a
substantial amount into the next fiscal year to minimize the
risk that ultimately the agency would run out of money.
Ms. Bice. What percentage would you say are these
unobligated funds?
Mr. Elnahal. Yeah. So in terms of amount, we approached
about $12,000,000,000 that we carried over into this fiscal
year. Out of a denominator for this fiscal year, a budget
approaching $150,000,000,000, and so----
Ms. Bice. Eight percent.
Mr. Elnahal. It's a substantial amount. And again, I think
the point is to make sure that we're well resourced. But
because of the PACT Act and because of historic care delivery
rates, we are going to be requesting additional funds. It's
just not going to be 12,000,000,000 and that's what we're
working out right now.
Ms. Bice. Thank you. In the 20 October 2024 report to
Congress, it was identified that the VA still needs to hire
about 5,000 additional employees specifically for mental health
care. Did you hire fewer medical employees this year than
anticipated?
Mr. Elnahal. We think we need to hire more employees,
Congresswoman, than we were able to this fiscal year because we
had a budget that was tighter just like every other agency
under the Fiscal Responsibility Act.
And so that is why we came forward in July saying we know
we're going to need more employees. This is what we're
estimating to deliver timely, high-quality care. We still think
we're going to need about 405,000 employees into the next
fiscal year, which is higher than what we are currently at
right now.
And we again are going to be over indexing. And the vast
majority of them are going to be frontline clinicians and folks
directly serving veterans.
Ms. Bice. Did you slow hiring because of your budgetary
concerns?
Mr. Elnahal. We had to, we had to slow hiring. Now, we were
still thankfully able to maintain better access, good outcomes.
We're concerned though about our ability to do that if we don't
get additional funds this fiscal year, which is why we came out
in July with that request.
Ms. Bice. Was slower growth in community care because
providers weren't available to provide the care, such as dental
or specialty care for the new priority veterans that were
adopted into the program?
Mr. Elnahal. So we're dealing, Congresswoman, with
significant growth in community care year over year. So that's
the first point. You know, we're talking about 14.8 percent and
2024 compared to 2023, 18 percent from 2023 to 2024.
So we're all talking about growth across the board. We were
able to slow that growth not by impacting eligibility for
community care or denying community care to veterans, but
rather by offering more VA options reliably to veterans thanks
to the hard work of our employees across the system.
So every time a veteran now qualifies for community care,
we attempt to also say, here's a telehealth option, here's your
in-person option, and empower the veteran with the choice. We
want the veteran in the driver's seat choosing where they get
care next and if they choose the community when they qualify,
we have to honor that and we should honor that.
Ms. Bice. You mentioned at the beginning of your testimony
that there were 1.7 new enrollees and increased priority
rankings. What was your estimate for each of those initially?
Mr. Elnahal. So we were not sure exactly how many veterans
would take us up on this. So that's a big variable that was
hard to predict. Right now we're close to 70,000 veterans
enrolling because of the Section 103 authority alone.
And we are now well over 800,000 veterans enrolling since
the PACT Act was signed. And so what's interesting is that if
you take our most recent data up to where we are in November,
right Now we're actually 47 percent more enrollments than the
equivalent period before the PACT Act.
So if anything, we're potentially accelerating that growth.
And the fact that we increased priority groups for veterans was
actually an accelerant to get more veterans qualifying for
dental care, long-term care, for folks who ended up in the
highest priority group.
So that's a whole set of services, some of which,
especially in long-term care is very costly. But we're still
going to do it and we're obligated to do it because that's what
these vets have earned.
Ms. Bice. And if I just can just with my closing, give a
shout out to Wade Vlosich, who is the VA director back in
Oklahoma City, who is doing an absolutely remarkable job of
making sure that my vets back home are well taken care of. So
shout out to him.
And with that, Mr. Chairman, I yield back.
Mr. Elnahal. Agree.
Mr. Carter. Mr. Franklin.
Mr. Franklin. Thank you, Mr. Chairman, and thank you to our
witnesses for your time here with us today. And I would like to
echo a lot of the comments my colleagues have already made.
When you get to the end of the dais a lot of those
questions that I had originally have been touched on, but it
also gives me a chance to kind of assimilate and assess kind of
what I have been hearing. And I really do hope you all
understand the significance of this.
I mean, you put us through big hoops to try to get money
appropriated. Our phones lit up back home. We had veterans
scared to death thinking they were going to lose all their
benefits. And it turns out this was all in a big budget screw
up, really.
Dr. Elnahal, I do appreciate your comments that we need to
get it right. You are looking at an outside group to come in
and help do a review and that it is important to work hard to
improve the accuracy of these projections. I fully agree with
you.
I know you have had service on the private side and the
public, you know, on the private side, you don't have the
luxury of missing budgets like that. You just don't. In the
government, we can always make it up. We just create money out
of thin air and we press on down the road.
So it is easier. It is always easier to underestimate and
have carryover than to miss your budget. And Mr. Jacobs, I get
it, I understand your point that we can't afford to miss. We're
certainly not going to leave our veterans hanging. But to say,
you know, it is a risk we are not willing to take to under
budget by a dollar and you know, you have made the comment
about it being prudent management.
I guess I just want to understand, do you feel that this
whole episode was prudent management?
Mr. Jacobs. Congressman, when we identified the updated
projections that identified the potential need for additional
money, we had a couple options to make. One, which we chose to
do was to elevate the risk, to communicate it and to seek the
funding knowing that if we're even $1 over our spending cap, we
would have to delay benefits for all nearly seven million
veterans and survivors.
Unlike other mandatory programs, we don't have authorities
to provide such sums as are necessary. And so we're limited by
that fact. We considered a couple of other options.
One is we could keep our head down, hope everything worked
out and pray to God that we didn't exceed the cap and have to
come to you telling you that we are going to delay payments
because we know the impact that would have on the customers we
serve.
The other option we considered was, okay, maybe we can slow
down benefits so we don't hit the cap. That's what I assume
would happen in the private sector. That wasn't an option we
thought was fitting with a veteran centric ethos of delivering
more benefits to more veterans.
And so I'm certainly not happy with the way things turned
out. In an ideal world, we wouldn't have to come here. I spent
10 years working in Congress. I worked for an appropriator. I
know how significant it is to make a request of this nature and
secure the funding.
I'm incredibly grateful for you, for everyone, for making
this happen. And we want to make sure we apply the lessons
learned moving forward so it doesn't happen again.
Mr. Franklin. So it sounds like some of the brakes you did
put on though were reducing the hiring, the pace of hiring
personnel and the equipment, bringing on new equipment?
Mr. Jacobs. On the benefits side, we did not. All of the
funding we're talking about was dollars in the pockets of
veterans, families and survivors. And I'll defer to Dr. Elnahal
for----
Mr. Franklin. I am interested in the equipment purchase
delays because here it is we are in a new budget year and the
safe thing to do, if our standard of performance is to never
screw up and be as safe as possible, are we holding back on
these equipment purchases now because it is early in the new
fiscal year and then we may get to the end of this fiscal year
and we are kind of worried again so we kick the can on down the
road? What kind of equipment are we talking about and what are
we suffering by not making these purchases have been
appropriated?
Mr. Elnahal. It ranges, Congressmen, from some of the more
most complex equipment we have at our medical centers.
Upgrades, maintenance, entirely new equipment to deliver
complex surgeries and high acuity care to more simple things
like the rising costs of, you know, CPAPs and home devices that
veterans need.
We're anticipating significant cost increases, as is every
other health care system across the country. And so that is why
we know we are going to need additional funding.
Mr. Franklin. So why didn't you, once you got the extra
appropriation, and then you realized, whoops, we really didn't
need all that money, why not make end of the year equipment
purchases instead of rolling it forward? Why not execute the
things that you thought you were going to do at the beginning
of the fiscal year?
Mr. Elnahal. I think, Congressman, what was enacted as a
supplemental was the veteran's benefits money for compensation.
I don't know if you want to comment on that, Josh?
Mr. Franklin. Okay, I understand.
Mr. Elnahal. Yeah.
Mr. Franklin. Different pot of money, right?
Mr. Elnahal. Yeah.
Mr. Franklin. Got it.
All right, thanks, Mr. Chairman, I yield back.
Mr. Carter. I guess we can have a second round, short.
So I have a question just popped up. Who's doing the
external review?
Mr. Elnahal. We're still trying to secure the folks who are
going to do that on the outside. It's going to be contract
based and it's going to look at our budget formulation
processes.
And so once we have that available, of course we'll share
it with the IG, we'll share it with this Committee. We're
committed to that.
Mr. Jacobs. And Mr. Chairman, the Inspector General is also
conducting an independent review of our budget formulation
process. I believe that's a requirement of the law you enacted.
Mr. Carter. That is an inside review.
Mr. Jacobs. Yes, sir.
Mr. Carter. He is very competent. Very competent.
Well, with all the issues that we have got that we are not
getting any information, then AI lies out on the perimeter and
people are going to start speeding things up.
I don't know if you thought about that or not, but one of
the things that, you know, we knew all about this, you knew all
about this back in July, all right? Now, if I understand AI
correctly, it's like a, it goes vroom. I mean, it just
instantly covers every kind of information you ever wanted to
know, maybe something you didn't want to know. I am totally
ignorant in what it does.
But so far I've seen nine or ten people come talk to me
about getting it, and everything has to do with speed. Speed is
very important. I think I want you to be, at least be, thinking
about the fact that you are overwhelmed without speed.
If you don't get accurate numbers and figure out a way to
get accurate numbers with speed, then that is going to make it
even worse. And I fear that for Appropriations too.
Consistently we are moving money around when we have the
opportunity to move money around and aren't on a CR. And if we
speed things up, it is going to be a lot harder to get this
thing all figured out.
And I think that is the real reason all of us are saying we
have got to be kept current. A billion dollars, 1,000,000,000,
to the American public, is a tremendous amount of money.
$15,000,000,000 is almost beyond anybody's comprehension. And a
trillion dollars is beyond anybody's comprehension except the
people that deal with it.
So when we start, when you realize that, and I loved what
he said, what we have to realize is there is nobody staying
more current on what is going on with the VA than our veterans.
They pay attention. They belong to organizations that keep them
informed. And the minute they see something they think might be
going wrong, they light up the telephones all over this country
and good for them, you know?
I made a mistake one time when I was on my first trip
overseas and I went to Korea and I decided I would be smart and
hold a town hall meeting with the, woah was that rough. Those
soldiers, they knew exactly what they wanted to ask me and
although I appreciate it and I enjoy doing it, but I mean,
these guys pay attention to these current events because it is
their livelihood, a lot of them.
Just like people on Social Security pay attention to that.
People on Medicare pay attention to that because if something
goes wrong, they are left out in the cold. And I understand a
lot of talks going on, but I don't think I can guarantee you
that I am not going to be standing for anybody trying to
abolish anybody's anything to do with our Veterans
Administration.
And I don't think my colleague is either. We are with you
110 percent, but keep us informed. And I hope the external
audit, or whatever you want to call it, is going to give you
some information about tools you can use because you know, I
know you are not, we haven't mentioned it, but we are in an
inflationary period right now. That gives people the ability to
raise prices above a legitimate value, in some instances,
because of inflation. I know the cost of this weight loss drug
because I am using it. It is $1,000 a month. That is a lot of
money. But I have lost a lot of weight, so I am happy.
But bottom line is that we have got, medicine is hard to
deal with, but the shock of a number and the coincidental shock
of the number right after the presidential election was
confirmed looked very political, to be honest with you, and
very concerning to the people on this side of the aisle.
A day after the change is coming and you people are subject
to that change and we know that. Those kind of things bring
politics into it and you shouldn't bring politics into this.
So I ask you to please, I am not going to have a question,
I am just going to make a speech. I ask you and if you don't
then I am going to be really mad. I don't get mad very often,
but when I do, it is pretty dangerous.
So please, I'm asking you and then I am going to be over
there knocking on doors if I don't get the answers.
I yield back to my friend and colleague, Ms. Wasserman
Schultz.
Ms. Wasserman Schultz. Thank you, Mr. Chairman.
I just want to make sure I underscore that I am absolutely
going to be pointing out concerns that arise as a result of the
decisions of the incoming administration or the projections
about decisions of the incoming administration that affect our
veterans. That is our job.
So when we have a leader, who has been selected by the
incoming president, who has specifically said that any
unauthorized program would be recommended for elimination and
elimination of their funding, it is important to point out
here, in a public hearing, the impact of that on our veterans,
which would, as I mentioned, be very significant. There's
nothing political about that.
And to just paint a brush and say, well, we didn't do that
in the last administration. It wasn't proposed in the last
Administration. It is potentially going to be proposed in this
one. And if that is the case, as appropriators, we need to be
aware of that.
It wouldn't only affect veterans' programs. There are
hundreds and hundreds of unauthorized items that we fund here.
And Congress has the power of the purse. So it is not
political. It is a respect for the system of checks and
balances and the way the founding fathers established our role
in the Constitution, which specifically gives Congress the
power of appropriations and exclusively gives us that role.
So that having been said, I want to just ask a question
about women's health because obviously we know women make up
the fastest growing group of veterans that are enrolled in VA
health care, but many of their health care needs go
unaddressed.
And I know VA has been working to address those problems.
You have made some progress in hiring gender specific providers
and addressing harassment at VA facilities.
Can you talk about that progress in hiring providers that
specialize in issues like intimate partner violence, military
sexual trauma, maternity and newborn health services, and what
more needs to be done? And can the VHA shortfall and where you
come in around what you are going to need to address funding
some of those needs?
Mr. Elnahal. Yes, Madam Ranking Member. Absolutely. We've
been prioritizing women's health, fastest growing demographic
by far across the system. Our Office of Women's Health reports
directly to me, the Undersecretary, and we've been able to
preserve the support and the resourcing for women's health
providers even throughout this more difficult budget time.
In fact, we have specific purpose funding thanks to your
enabling legislation that requires us to do that. And so that
funding was distributed in part to retain our essential women's
health providers throughout last fiscal year, but also to hire
additional providers.
And we have the same exact program going into this fiscal
year that's actually agnostic to whether or not we get this
money because of how important this is. We need to make sure
that we are catching up to the demand of increasing numbers of
women veterans enrolling. We broke a record just this last year
with more than 50,000 women veterans enrolling in fiscal year
2024. And we hope that number gets even higher because of our
targeted outreach.
Our programming has also only accelerated our women's
health mini residencies for providers who had not been used to
seeing women. Historically, there were fewer women in the VA
and many of our clinicians have been in VA for a long time.
Our efforts to bring in more gender specific care, more GYN
specialists, more access to mammograms in the VA, but at the
very least coordinating breast cancer screening. Maternity care
coordination, we made a move to provide more coordination for
women veterans up to a year after birth rather than just eight
weeks. That was a change we made last fiscal year.
And we've been much more expansive about how we talk about
screening and mammograms to women vets across the country. So
this remains a priority, will remain a priority as long as
we're here and we can continue to push it.
Ms. Wasserman Schultz. And the VHA shortfall, is there any
way that we can address some of the resources being directed to
address those issues?
Mr. Elnahal. Absolutely. I think the shortfall, if it's
filled when we get you all a number, will allow us to net grow
our full-time employees. And so of course women need the full
gamut of medical care and they will benefit from increasing
numbers of physicians, nurses, and other frontline providers
that will be as essential for women vets as the rest of our
veteran population.
But we've been able to preserve our investment in women
vets even throughout these more difficult budget times.
Ms. Wasserman Schultz. Good.
And then Mr. Chairman, again, flagging things is not
politicizing them, but the incoming administration has not been
shy about its plan to indiscriminately fire and harass federal
civilian employees.
I really want to underscore that doing that will be
directly attacking veterans. VA has the second largest number
of civilian employees among all federal agencies, maybe some
members don't realize that, second only to the Department of
Defense. It includes VA doctors, nurses, dentists, social
workers, mental health professionals, pharmacists, people
working to streamline electronic health records, our cemetery
caretakers, many others.
And additionally, when considering the entire federal
civilian workforce, 30 percent are veterans. So cutting the
number of civilian employees means cutting healthcare and other
services for our veterans. So Dr. Elnahal, can you talk more
about how civilian employees contribute to VA's mission and
what it would mean if a subsequent administration follows
through on a plan to reduce the civilian workforce and how that
would impact our veterans?
Mr. Elnahal. Well, about a third of our employees, Madame
Ranking Member, are veterans themselves. So many more have a
veteran in their lives, a spouse of a veteran, a caregiver, and
take the mission personally. And where we've increased our
staff has overwhelmingly been for frontline employees and
employees carrying out our essential programs like veteran
homelessness.
We've been able to bring veteran homelessness to a record
low since we started measuring it. Because we've been able to
preserve and staff up on our homelessness program teams in the
field, we're now offering support and care to more caregivers
than any time in the history of the VA. About 80,000 caregivers
benefit from one part of our programming or another.
And all of this is on the backs of our excellent employees.
They're the ones executing this mission. And so I'd be
concerned about broad brush approaches to reducing the
workforce. That would have to be a very methodical effort. But
right now we estimate that we're going to need more employees
and not less.
Ms. Wasserman Schultz. Right.
Thank you. And thank you both for your service to our
nation's veterans.
I yield back, Mr. Chairman.
Mr. Carter. Mr. Rutherford.
Mr. Rutherford. Thank you, Mr. Chairman.
And first, let me begin by saying, you know, I represent
Northeast Florida and Jacksonville, St. Augustine, and I can
tell you our veterans are very appreciative of the healthcare
that we receive in Northeast Florida and the attention that
they get.
The challenge that we have is our VA Medical Center, the
closest VA Medical Center is in Gainesville, which is about a
little over an hour away. So our VA health care clinics like
the Leo C. Chase CBOC down in St. Augustine, very important to
us because of the distances to the other facilities.
We have got a little situation. I am going to get a little
parochial here, but we have got a little situation where I
think, because of their upfront folks, the numbers are not
there. They are short staffed is what I am hearing that the
phones are being rolled over to the Villages Clinic for
answering.
And what that's doing is a lot of our veterans who access
them by phone normally looking to get those community care
referrals and things, they get sent down to this clinic down
there just for the phone answering. And either they never get
the message back at the CBOC or the people that they are
talking to down in the Villages Clinic can't help them.
And so they are not getting the service, obviously, because
of this phone transfer system. I am sure it is happening
probably all over the place. So my question is, what can we do
to help hire those frontline people that really, I mean, that
is the door in. And so, you know, do you, do you hire through
staffing agencies? Have you tried that? Is there, you know,
what can we do to get these offices manned?
Mr. Elnahal. So I did get a heads up, Congressman, about
your concern on the St. Augustine CBOC and the call center. I
conferred with our network director over VISN8, which is
Florida, this morning, and he told me that we'll have at least
two new members of the call center team at the St. Augustine
that will serve the St. Augustine CBOC within the next couple
of months by the end of January.
Right now it's being diverted to the Villages Call Center
because they do have the capacity to be able to take these
calls, but you prefer to have folks who are closer to where the
veteran gets that care and has personal relationships, ideally
with the clinicians delivering that care, which is why VISN8 is
going to staff up.
So that's a concern we'll follow very closely. And more
generally, Congressman, this is why we are coming forward with
a supplemental funding request for VHA. The more resources we
have, the more frontline employees, like our essential call
center employees who are serving vets every single day to be
able to meet that need.
So yes, this is not only an issue in your area of the
country. We need more medical support assistance and call
center employees. That's part of where, if we do get the
supplemental funding, that's part of where it will go.
Mr. Rutherford. Did I understand you correctly that you
missed it by two percent on the salaries and benefits and
that's a billion dollars, right?
Mr. Elnahal. Yeah. So in general, we stayed actually about
$240,000,000 below what the enacted budget requires overall.
When it comes to a big variable about why our estimate was off,
as of July, we estimated the cost per FTE to be about $158,000
per clinician. That's skewed quite high because of the number
of physicians we have.
Mr. Rutherford. You were two percent off?
Mr. Elnahal. Yeah. And we were two percent off. We
ultimately, that number came down to 155,000 as of the end of
September. And when we got that data, that two percent
difference translated, when you over 400,000 employees to be a
very high dollar amount in the absolute terms.
Mr. Rutherford. Yeah. Thank you. Thank you all doing a good
job. Thanks.
Mr. Elnahal. Thank you.
Mr. Carter. Both of you were well informed and informed us
well. We appreciate it. We appreciate it very much. You
communicated well with us today and we are asking for it to be
communicated well either by when we write you a letter or
whatever with the kind of information you have given us.
So thank you. Thank you for what you've done. And remember,
we all are here to support the veterans of our country. And
there is no one on this Committee that is trying to do anything
to wipe out our veterans or the veteran care. And we will be
soldiers in the field fighting on your behalf if something like
that comes along.
And I will remind anybody that so far I haven't found any
agency that is authorized. Maybe somebody knows one, but I
can't think, the State Department is not authorized. There's a
lot of people who aren't authorized. The Defense Department is
not authorized. It is kind of an amateur's, no offense, an
amateur's comment about the government.
We could spend about two or three sessions authorizing
people if we wanted to. We probably should, just to get back in
the real world, but you are talking about just about the whole
government is not now not authorized. So that's another
politics I am trying to point out.
Listen, thank you very much for doing this. And I remind
the members, if you have any questions you want to submit,
submit them to us within seven days to the Subcommittee. And
with that, we thank you very much for your time.
The Subcommittee is adjourned.
[Whereupon, at 11:41 a.m., the Subcommittee was adjourned.]
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