    [House Hearing, 119 Congress]
    [From the U.S. Government Publishing Office]

                      U.S. DEPARTMENT OF VETERANS AFFAIRS
                        BUDGET REQUEST FOR FISCAL YEARS
                      2026 AND 2027 ADVANCE APPROPRIATIONS

    =======================================================================

                                    HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                             THURSDAY, MAY 15, 2025

                                   __________

                               Serial No. 119-21

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                        Available via http://govinfo.gov

                                    __________

                       U.S. GOVERNMENT PUBLISHING OFFICE
    61-163                    WASHINGTON : 2025

    -----------------------------------------------------------------------------------

                         COMMITTEE ON VETERANS' AFFAIRS

                         MIKE BOST, Illinois, Chairman

    AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking
        American Samoa, Vice-Chairwoman      Member
    JACK BERGMAN, Michigan               JULIA BROWNLEY, California
    NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire
    MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,
    GREGORY F. MURPHY, North Carolina        Florida
    DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky
    MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois
    JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois
    KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York
    JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon
    ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey
    KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota
        Mariana Islands
    TOM BARRETT, Michigan

                           Jon Clark, Staff Director
                      Matt Reel, Democratic Staff Director

    Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
    hearing records of the Committee on Veterans' Affairs are also
    published in electronic form. The printed hearing record remains the
    official version. Because electronic submissions are used to prepare
    both printed and electronic versions of the hearing record, the process
    of converting between various electronic formats may introduce
    unintentional errors or omissions. Such occurrences are inherent in the
    current publication process and should diminish as the process is
    further refined.
                             C  O  N  T  E  N  T  S

                                  ----------

                             THURSDAY, MAY 15, 2025

                                                                       Page

                               OPENING STATEMENTS

    The Honorable Mike Bost, Chairman................................     1
    The Honorable Mark Takano, Ranking Member........................     3

                                    WITNESS
                                    Panel 1

    The Honorable Douglas Collins, Secretary, U.S. Department of
      Veterans Affairs...............................................     6

                                    APPENDIX
                         Prepared Statement Of Witness

    The Honorable Douglas Collins Prepared Statement.................    73

                           Statements For The Record

    National Association of Veterans' Research and Education
      Foundations Prepared Statement.................................    77
    Housing Policy Council Data for the Record Submitted by The
      Honorable Chris Pappas, U.S. House of Representatives, (NH-1)..    79

                      U.S. DEPARTMENT OF VETERANS AFFAIRS
                        BUDGET REQUEST FOR FISCAL YEARS
                      2026 AND 2027 ADVANCE APPROPRIATIONS

                                  ----------

                             THURSDAY, MAY 15, 2025

                        Committee on Veterans' Affairs,
                                 U.S. House of Representatives,
                                                        Washington, DC.
        The committee met, pursuant to notice, at 2 p.m., in room
    360, Cannon House Office Building, Hon. Mike Bost (chairman of
    the committee) presiding.
        Present: Representatives Bost, Bergman, Mace, Miller-Meeks,
    Murphy, Van Orden, Luttrell, Ciscomani, Self, Kiggans, Hamadeh,
    King-Hinds, Barrett, Takano, Brownley, Pappas, Cherfilus-
    McCormick, McGarvey, Ramirez, Budzinski, Kennedy, Dexter,
    Conaway, and Morrison.
        Also present: Representative Deluzio.

                OPENING STATEMENT OF MIKE BOST, CHAIRMAN

        The Chairman. Good afternoon. The committee will come to
    order without objection. The Chair may declare recesses at any
    time. Before we begin, I ask unanimous consent that all members
    have five legislative days in which to revise and extend their
    remarks and include any extraneous material. Hearing no
    objection. So ordered.
        Before we begin, I want to thank Secretary Collins for
    being here today. You know, this is his first time to testify
    before our committee, but not his first time in the House.
    Welcome back. I want to ensure that we have a productive
    hearing today. To have a productive hearing, I want to ask that
    all members be respectful to other members and the witnesses.
    Let us follow the House rules on decorum. We are here to review
    the Department of Veteran Affairs budget requests for Fiscal
    Year 2026. One couple other things I want to add to that is
    what we are going to do is rather than 5 minutes, we are going
    to have 7 minutes for the questions. We know that. We are also-
    I and the Ranking Member-will wait and ask our questions
    probably last and the reason we are doing that is we know that
    probably 2 hours into this, which odds are it will take more
    than 2 hours, we will be called for votes. I know many of you
    will want to catch a flight if you can. That is the idea and
    intent is to try to get the members that have to have flights
    out have an opportunity to ask questions.
        Let us get right to it. The president has requested 187.2
    billion for (VA) U.S. Department of Veterans Affairs for next
    year. That includes 134.6 billion in discretionary funding and
    another 50 billion from the Toxic Exposure Fund. That is an
    increase of more than 17 percent over last year. Now, it is a
    serious proposal and a clear reflection on the priorities, I
    believe, of this administration. While it seems there is not
    much common ground to be found in Congress these days, one
    issue does unite us, and that is the belief that VA should be
    fully funded to provide top notch care to our veterans and
    their families. House Republicans will continue to ensure that
    promise remains true. While I am optimistic about the proposal
    so far, I am hoping that this administration can avoid the
    total chaos and financial mismanagement that we witnessed
    during the end of the Biden Administration. Despite receiving
    the largest VA budget in history, the department reported an
    alleged shortfall late last year, not because of underfunding,
    but because of poor internal accounting and a lack of fiscal
    discipline. That is putting it nicely.
        Biden VA officials misused the hiring and pay authority
    Congress provided then when the numbers did not add up, they
    turned around and tried to shift the blame. They needlessly
    alarmed veterans and accused Republicans of putting them their
    care at risk, all while refusing to take responsibility for the
    decisions that got them there in the first place. It was
    political theater at its worst. While doing that, the
    department budget practices have become harder, not easier to
    follow. It makes you wonder if it was on purpose. Key
    obligations were shifted between accounts; basic funding needs
    were moved around. That is not what Congress intended. It is
    not what veterans deserve. I would also like to take a moment
    to address and recognize efforts underway at the VA. Over the
    last few months, I have heard baseless accusations from my
    colleagues on the other side of the aisle about how Department
    of Government Efficiency (DOGE), ``Boogeyman'' and Secretary
    Collins are planning to reduce VA's workforces by 83,000
    employees. This is simply not true.
        As we have heard countless times from the Secretary, VA is
    currently reviewing its organizational structure to find
    reforms that best suit the needs of our veterans today. By the
    way, this review is long overdue. The one reoccurring theme
    that we have constantly hear from the VA in our hearings is
    that VA bureaucracy poses a greater danger to the health of our
    veterans than the illnesses they seek treatment for. I applaud
    the Trump Administration for conducting this necessary review
    to change course and ensure veterans have access to the care
    they deserve.
        We will also hear from the other side that Secretary
    Collins refused to answer their questions and will not
    communicate with Congress. That is also not true. On several
    occasions the Secretary staff have come up the Hill to brief
    the Committee staff in both the House and the Senate on the
    status of the reorganization efforts. To tell my fellow
    veterans when my colleagues try to catch a sound bite and tell
    you that Secretary Collins and the Trump Administration are
    dismantling the VA, do not take the bait. I would also like to
    remind my colleagues about the lack of transparency under the
    previous administration.
        Last Congress, our committee sent countless letters and
    inquiries to Secretary McDonough and that were simply went
    unanswered. In fact, Secretary Collins office when he took
    office, VA's mailbox was full of our unopened letters for
    oversight requests. That is not a way to run a department, and
    it is certainly no way to work with Congress. To my colleagues,
    I would say those who live in glass houses should not throw
    stones. From my position as Chairman, I look forward to
    Secretary Collins' efforts to restore transparency and
    accountability. Because of that, that makes VA work better and
    I know he shares that goal. Our obligation to veterans demands
    proper leadership in ensuring that this budget is applied to
    veterans' care and benefits. This is a more disciplined budget
    request, focusing on delivery, not distraction. That said, we
    know this is just the beginning of the process. We still have
    not received the full, detailed budget. I, along with many of
    my colleagues on both sides of the aisle, have questions about
    the VA plans to spend these funds, how those decisions will
    improve care for veterans and their families.
        We are all ready to do our part. We appreciate Secretary
    Collins being here today, and I look forward to the productive
    conversation. Not fear mongering, not political posturing, but
    to deliver to the men and women that we serve. Ranking Member
    Takano, I now recognize you for your opening statement.

            OPENING STATEMENT OF MARK TAKANO, RANKING MEMBER

        Mr. Takano. Well, thank you, Chairman Bost. Mr. Secretary,
    good afternoon. When I first heard of your nominations at this
    position, I recall saying to my staff, I think we will be able
    to do some good work at VA with Doug Collins. I had optimism,
    based on your time as a member of this chamber, that you would
    have an appreciation for our duty to perform oversight. When a
    new secretary is confirmed, every member of this committee,
    Republican or Democrat, wants to see them succeed, and because
    veterans deserve leadership, not chaos. Well, I have to say,
    this is why I am incredibly. It is incredibly upsetting and
    frustrating to me that the questions my colleagues and I have
    about decisions you have made in your short tenure at VA remain
    unanswered.
        You came in with an opportunity to build trust across this
    institution and across the aisle, but instead, you have
    undermined it, not just with me, but with VA staff and with the
    veterans who rely on VA every day. I reviewed your Senate
    testimony, and any reasonable viewer would have to would
    conclude that you were evasive and not transparent with your
    answers. I hope you will not do that with us today. I would say
    to you, you have the power to change course. Veterans need
    answers, not excuses. We will see today whether you are ready
    to lead or just continue to blame. This hearing is the first
    time we have met in person since you were sworn in. You have
    not so much as called me since your confirmation 99 days ago.
    My experience with your predecessor was that he would
    proactively call both me and the Chairman before major news
    broke about VA, so that our first time finding out about it was
    not from reading the paper or seeing it on television. For
    instance, he would have called us before canceling a program as
    important as Veterans Affairs Servicing Purchase (VASP), where
    the consequences for veterans are as dire as foreclosure on
    their own homes. This is the basic transparency that I expect
    from the Secretary so we can work together on the challenges
    facing VA.
        Now, VA is not perfect. It has never been perfect. We are
    not satisfied with the status quo at VA and that is what
    brought all of us to work on this committee. We are not just
    going to going to blindly support your changes at VA without
    you giving us all the facts or any semblance of a plan. You
    have not earned our trust, at least not yet. That is what I
    will be listening for today. Answers that contain facts and
    plans that are based on those facts. Last week before the
    Senate, you failed to answer questions asking for details about
    decisions you have made as Secretary. Senator Hirono asked you
    the exact dollar amount that VA claims to have saved from
    firing staff. You rather flippantly threw out a culture war
    statement about Diversity, Equity and Inclusion (DEI) instead
    of answering her question. Senator Boozman raised questions
    about VASP and you gave a rather incomplete answer. Questions
    about how many clinical trials are on pause and how many
    veterans are affected by that pause on clinical trials were
    also unanswered.
        This morning in the Military Construction, Veterans
    Affairs, and Related Agencies (MILCON-VA) Appropriation
    Subcommittee you admitted that VA shifted over $300 million to
    private, for-profit community care without following the law.
    That money was meant to support care and capacity inside VA.
    Instead it was siphoned away from veterans hospitals and
    clinics and handed off to the private sector. Now the law is
    very clear. If VA needs more funding for community care, it
    must ask Congress not illegally raid funds meant for direct VA
    care. Both the Chair, Chairman Carter and Ranking Member
    Wasserman Schultz of the Appropriations Subcommittee agree,
    agree with what I just said. You know, so does the Chairman of
    the full Committee-Chair of full Appropriations Committee-and I
    hope Chairman Bost joins me and joins the appropriation four
    corners in demanding accountability on this very point.
        Now this morning before the MILCON-VA Appropriation
    Subcommittee, you also gave very disturbing answers to
    questions about the effects of pauses on clinical trials. You
    said that having clinical trials paused is not affecting
    veterans health care, that it is above and beyond health care.
    Is that really what you are saying to veterans with cancer
    whose hopes are pinned on clinical trials that they can no
    longer access? All of the questions we are going to ask today
    are ones that you should have come prepared to answer and I
    will be disappointed if you are not prepared. We have already
    asked many of them in letters. Many of them have already been
    asked in your previous appearances before the Senate and before
    the House Appropriations Subcommittee. This is basic
    congressional oversight.
        The members and staff on both sides of this committee
    collectively have centuries of experience working on VA policy
    and serving our Nation. We have written some of the most
    consequential pieces of veteran legislation in history,
    including the Honoring Our PACT Act. We can only carry out our
    oversight responsibility as mandated in the Constitution if you
    answer our questions fully and truthfully. We have serious
    concerns about your plans related to the VA workforce, and this
    hearing is an opportunity for you to put our minds at ease. VA
    is comprised of over 400,000 dedicated employees who show up
    every day motivated by the call to service to deliver the care
    and benefits veterans have earned.
        The majority of veterans are satisfied with their VA care.
    Let me say that again. The majority of veterans are satisfied
    with their VA care. Yet many have expressed to me the weight of
    the chaos and turmoil they have witnessed during Trump's first
    100 days and are left wondering what will happen to the care
    they rely on and love. They are worried that their provider,
    with whom they have spent years building rapport and trust,
    could lose their job. Now I have a poster behind me. We have
    heard from a veteran for whom this fear sadly became a reality.
    This veteran lost her whole health coach, who she described as,
    quote, the only person really making a difference in my life.
    We have heard countless stories of the trauma and harassment VA
    staff have endured at the hands of Trump's senior advisors and
    political appointees since day one of this administration. I
    want to hear directly from you today whether you agree with the
    director of Office of Management and Budget (OMB), Russell
    Vought, that the trauma is the point. Does this administration
    want to traumatize public servants into submission or into
    quitting their jobs so the work can be farmed out to Trump's
    billionaire friends?
        Let me tell you one thing clearly, Mr. Secretary. VA is not
    for sale. I am truly worried about the combative tone you have
    taken in addressing VA staff. You have instilled a culture of
    fear by making them sign non-disclosure agreements (NDA) and
    accusing them of rumors and innuendo. Frankly, it is insulting
    and demeaning that you continue to accuse VA staff and veterans
    of lying about their experiences, their concerns, and the
    things they are seeing with their own eyes. How are the
    veterans supposed to be inspired? Excuse me. How are employees
    of VA supposed to be inspired to fight for a better VA with you
    if you are constantly positioning yourself against them as if
    they are the enemy? I would say fear as a tactic for leadership
    is not effective. As one clinician put it behind me, I have it
    up in print. Quote, I have felt harassed by and have diminished
    faith in the leadership of the VA secretary who continually
    throws VA employees under the bus and has shown no interest in
    learning about the concerns of his frontline staff. His line
    about VA now putting veterans first particularly irks me. In my
    15 years of working at two different VA medical centers, I know
    we have always put veterans first. That is from a VA
    psychiatrist.
        We need more answers about your plans for VA. These plans
    directly affect veterans staff and the economy in all our
    districts. You have set a goal to fire 83,000 employees. It is
    a goal and it has been publicly stated. Leaving VA staff waking
    up every morning with the torture of not knowing if that day is
    their last one with a job. You took away veterans last lifeline
    to keep their homes when they faced foreclosure, when you ended
    the VASP program. You are doing all these things during a time
    of financial turmoil for families in America while we deal with
    the impacts of Trump's chaotic tariffs and economic policies.
    We are all trying to make sense of it all so that we can better
    serve veterans.
        Mr. Secretary, I hope that this hearing today is an
    opportunity to build some trust and I want to have confidence
    and your leadership. As the leader of VA, you owe it to VA
    staff and you owe it to veterans to be transparent and
    forthcoming and to take some accountability. You have the
    opportunity to answer our questions fully and truthfully, and I
    hope that you will seize that opportunity. With that, I yield
    back.
        The Chairman. Thank the Ranking Member for yielding back. I
    know some housekeeping things. In accordance with the Committee
    rules, I ask unanimous consent that Representative Deluzio from
    Pennsylvania be permitted to participate in today's committee
    hearing. Without objection. So ordered.
        Alright, if Secretary Collins would please stand and raise
    his right hand. Do you solemnly swear under penalty of perjury
    and the testimony that you are about to provide is the truth,
    the whole truth, and nothing but the truth. Thank you. Let the
    record reflect that the witness has answered in the
    affirmative.
        [Witness sworn.]
        The Chairman. Now, I would like to recognize people, as I
    said, 7 minutes for each person. We are going to hold sticks to
    that 7-minute rule because we are under the pressure of votes
    later on. With that, I now recognize General Bergman. Oh, I am
    sorry. Was I wrong? Oh, wait a minute. How about you give an
    opening statement? That would be really good. Mr. Secretary,
    you are recognized for your opening statement.

                      STATEMENT OF DOUGLAS COLLINS

        Secretary Collins. Thank you, Mr. Chairman. Thank you,
    Ranking Member. If we did not want to go through that, we can
    go. I think it is interesting to set the tone for our opening
    statements, and I think that, you know, the tone has sort of
    been set here. I think the undeniable aspect of this is that I
    have one purpose and one purpose alone, and that is to make the
    VA exactly what it is supposed to be, and that is to take care
    of our veterans and do so in the most efficient and effective
    way, whether it be in our Veterans Health Administration (VHA),
    our Veterans Benefits Administration (VBA) or National Cemetery
    Administration (NCA). The one thing that I have had to do for
    the first, and I am glad to be here today and to answer all the
    questions that you might have, I will be frank with you, and
    what I have found over the last little bit is I can answer
    questions, but if we do not like the answers, then we just say
    I am not answering the question. That is just simply not always
    the case. We are going to deal with that as we go forward
    today.
        Specifically, you know, and just as I just had to sit
    through, I will say that the VA psychiatrist that you just
    referenced is exactly the kind of employee that I want to see
    at the VA, someone who is putting the veteran first, somebody
    who is concerned about taking care of that. They have
    absolutely nothing to be concerned about when it comes to
    restructuring of the VA or looking at our VA healthcare
    systems, because when you look at what we do, the VA doctor is
    exactly the person that has been protected from day one in
    this. We have put 300,000 positions off limits. In fact, they
    are being hired as of this day. If you are in a hospital, as I
    told just told the folks in Minneapolis when I was just there
    this week, if you are in a hospital taking care of veterans,
    you are the ones that we want and want to have and be a part
    of. You are the ones that should be the most happy in the sense
    of you are getting to do your job now because you have a
    Secretary who actually wants to cut the red tape, wants to cut
    your decisions, and so that we do not have to continually get
    in our own way.
        The VA, unfortunately, over the years has become the
    absolute, at many times frustrating point for many of our
    veterans of what is known as red tape, of going through the
    process of trying to get things to happen, and yet it being
    denied. The sad part about it is, for the last number of years,
    and I have been in this body as well, and I voted for some of
    those pieces of legislation, the John S. McCain III, Daniel K.
    Akaka, and Samuel R. Johnson VA Maintaining Internal Systems
    and Strengthening Integrated Outside Networks (MISSION) Act,
    also our Accountability Act and other issues that came before
    this body as we look forward to how do we actually better serve
    our veterans. Over the last few years, it seems that as we have
    looked at this issue, and we have looked at it from afar, even
    as far as back that we began to believe that the only issues in
    VA could be solved by simply giving more money and giving more
    employees. In fact, we have actually increased 52,000 full-time
    equivalents from 21 to 24. Things still have not gotten better.
    In fact, to be honest, according to the metrics of the VA that
    was established before I ever got there, they have gotten
    worse.
        You have to simply ask yourself the question is what we are
    doing and how we are doing it the same way, the same way,
    making a difference. The answer is no. When your wait times go
    up, your backlogs go up, and you are not fulfilling the mission
    to the veteran, that is an issue that we have. Now when we look
    at these as we go forward, I am not going to be shy addressing
    the issues that we do and will in this room address today. That
    is that we are looking at our structure of our workforce and we
    are looking at a structure, by the way, as has been said, we
    have 465,000. It goes up actually a little bit depending on the
    day because we still in our VHA organization have 409,000
    employees. We have over 28,000 physicians, 91,000 nurses. What
    is also not said, and it has not been said in this room today,
    is many of those doctors and many of those nurses do not see
    patients on a regular basis, if at all. Yet we still have
    doctor shortages, nurse shortages in clinics and hospitals in
    which we are hiring for every day.
        My question is simple when I look at an organization plan
    is why are we simply looking at numbers that are not affecting?
    Why are we keeping a bureaucracy level that has grown
    tremendously over the last little bit with billions of dollars
    and with people. Yet the very metrics that this committee,
    under both Republicans and Democrat uses to judge efficiencies
    at the VA are going the wrong way, just to let you see. One of
    the things that concerned me from the moment I stepped into
    this job was 10 years ago, the Government Accountability Office
    (GAO) said that the VA was on the high-risk list. The GAO, not
    Doug Collins, not Democrats or Republicans. The GAO said that
    and they have renewed that every year. In fact, February we got
    our last needs improvement and also high risk. The answer has
    simply been many times to just, let us just add more and add a
    little money and add this to it to see if we get any better. It
    is not worked. Many things of what we have tried so far. When
    it comes to the workforce and it comes to what we are doing is
    actually not having chaos, but actually freeing up our doctors
    and our nurses and our disability claims adjusters to actually
    do their jobs, to give them the tools. I found a department
    that could not even tell me how many employees we actually had.
    It took a week and a half. Where has oversight been on that? I
    think an organization that looks at it from a perspective of
    the bills that have been passed. We have been looking at
    Mission Act, The Sergeant First Class Heath Robinson Honoring
    our Promise to Address Comprehensive Toxics (PACT) Act, which
    is being implemented, although it was put together rather
    quickly. We are now getting it underway. In fact the numbers
    are pretty good in the sense that we have already had 6
    million-over 6 million exposure screenings. We have added
    985,404 total enrollees for health care on the PACT Act since
    it was signed in law. That is over a 2-year period and over 6
    million 6 PACT Act disability claims approved.
        When we look at what we have going on, we are addressing as
    many things as we possibly can. When we come at it at this, I
    will also say this, and I hope to answer your questions today.
    I hope we will can find some common ground and the Ranking
    Member if we cannot find common ground, we will attempt to find
    common ground. You and I came in together, we have been here a
    while and I commit to that. I will not say that we will see
    everything the same. To a VA workforce out there who has had to
    endure 100 days of false rumors and innuendo and what somebody
    from behind a paywall says, that is what scares veterans, that
    is what scares employees. I ask anybody on this committee today
    as we go through these questions, as we look at what we are
    trying to do and how we are trying to do it, if you are cutting
    away the red tape, if you are trying to get a doctor to be able
    to be seen or have more doctors in the clinics and more nurses
    in the clinics, that is the things we need. If you are wanting
    more and quicker disability claims and our backlog drop, which
    by the way, Mr. Chairman, I am happy to report that when it was
    I took office just 99 days ago almost, it was 260,000 in the
    backlog, it is now at 200,000. We have cut it 21 percent in
    less than 100 days.
        When we look at this going forward, I look forward to your
    questions. I look forward to honest answers as we go forward
    from both sides. What we cannot do is deny that VA needs to
    change. The VA has things that need to be fixed, but we cannot
    continue to do the same things and call it a victory. As we go
    through today, I look forward to your questions and I
    appreciate the opportunity.

        [The Prepared Statement Of Douglas Collins Appears In The
    Appendix]

        The Chairman. The written statement of Secretary Collins
    will be entered into the hearing record. Now. We will proceed
    to questions. General Bergman, you are recognized for 7
    minutes.
        Mr. Bergman. Thank you, Mr. Chairman. Mr. Secretary, good
    to see you.
        Secretary Collins. Good to see you, too.
        Mr. Bergman. I will cut right to the chase. I was
    encouraged by your recent comments at a Cabinet meeting
    highlighting the importance of advancing research into
    psychedelic treatments to improve care for our veterans,
    actually breakthrough therapy care. Last January, VA issued a
    request for application for proposals from VA Network
    researchers to study such treatments. In December, VA announced
    1.5 million in funding for 3,4-Methylenedioxymethamphetamine
    (MDMA) assisted therapy, the first VA funded study for
    psychedelic assisted therapy since the 1960's.
        Question would you talk a bit, even if a little bit, about
    the studies being supported by these funds? Do you have any
    visibility on that yet?
        Secretary Collins. We are getting there, Congressman. I
    think that is one of the things that I have started to look at.
    I am also probably one of the first of the secretaries who have
    actually decided that we will take a look at it. We are not
    simply putting it off and we are going to do everything we
    possibly can under the rules given to us by Congress to
    actually continue that. Look, what we are seeing so far is
    positive. What we are seeing so far in some of the studies that
    are related to VA and also outside of VA as well, is that there
    has been, especially when it comes to PTS and also traumatic
    brain injury (TBI) and others, we are seeing some actual
    positive outcomes there, especially when it is coupled with
    intense counseling. I think that is one of the keys that we
    look forward to.
        There are 11 current studies that are either with VA or
    around VA and that we are going to continue to look at. I am
    committed to working with the Administration, but also in what
    we are doing across the lines with Health and Human Services
    and also at U.S. Department of Defense (DOD) to say how can we
    actually make this a possibility? Now, I will say this. I do
    not believe it is a magic cure. I do not believe that it will
    work for everyone. It is something that could work for some. We
    are going to continue to look at it.
        Mr. Bergman. Thank you. Congressman Correa and I lead the
    Congressional Psychedelics Advancing Therapies (PATH) Caucus
    here in Congress. I would like basically to consider you
    consider committing to incorporating congressional voices in
    some of these important conversations because over the last
    couple of years, we as the caucus have had some really
    spectacular research speakers come in. If we can be included as
    appropriate, that would be great.
        Secretary Collins. Of course, Congressman.
        Mr. Bergman. Second, Choice for Veterans. I appreciate your
    acknowledgment that VA is in desperate need of reform. For too
    long, veterans have been forced into a ``one size fits all''
    bureaucracy that fails to deliver to them the earned care and
    benefits in a timely manner. Under the Biden Administration,
    the agency experienced huge backlogs and rising care wait
    times. Something has to change and it is our job to make the
    change. The VA Committee recently approved the Choice for
    Veterans Act here last week in this room, a bill that Chairman
    Bost and I had introduced to help veterans secure their
    disability benefits by expanding access to accredited
    representation and imposing new penalties on bad actors in that
    space who are seeking to prey on vulnerable claimants. Do you
    believe that expanding the options available to veterans,
    particularly by allowing them to work with trusted accredited
    representatives, that that could help improve the outcomes they
    experience when they are pursuing their benefits? Basically,
    all good actors accredited, no bad actors.
        Secretary Collins. I think anyone that helps the veterans
    get what they need is something that we need to look at. I am
    going to also take it a different step for just a second. It is
    fundamentally flawed in my mind that we have a system in which
    veterans have earned benefits that they feel like they need to
    get somebody to help them with to get. I think this is, I
    guess, goes back to a core statement for whichever, you know, I
    think for both sides of the aisle. Why do we have a system in
    which you have a veteran who has served our country, earned a
    benefit, have to go through a process in which they feel like
    that they have to get outside help to do that, whether, you
    know, accredited, unaccredited, I mean, have that choice. What
    we are looking at right now, and I have talked to every
    regional office I have went to and every other is how do we
    make this process simpler? I mean, there is a simple.
        There is an interesting page for me that I found the other
    day that when you are beginning your claim for disability, do
    you realize that we have a whole sheet that asks for your
    entire military history, basically, and where you served and
    when you served? We do not need that. We just need their name,
    their Social Security number, their date of birth. We can get
    that. Why are we making them fill that out? This is the kind of
    stuff we are talking about. That makes general sense to most
    everyone. We are looking at, you know, any way we can to help
    the veteran get the benefit they need. We are starting
    internally to make sure that we can do the administrative stuff
    we need so that you can cut through the bureaucracy to get the
    benefit that you need and get it done quickly.
        Mr. Bergman. Absolutely. The idea that only within the VA
    can the responsibility reside for really solid, exact
    accreditation on all counts. Who is ever asking to be
    accredited. That is in the, in the VA's ballpark and that is
    what we are asking for, is that the VA will actually accept
    that responsibility. That is where the key is, I think in the
    better outcomes for the veterans in the appeals process.
        Secretary Collins. Yes. I think that is one of the things I
    will state that to get that started with us in accreditation,
    it is sort of outside our scope as far as us accrediting
    outside individuals. We are willing to do whatever the Congress
    asks on that and we are going to focus it and we will make sure
    that the resources are available to make that happen. Can I
    also hit though you talked about community care because this is
    actually where this all goes. I do not agree, and this is just
    a difference of opinion. I do not agree that community care is
    a giveaway to private physicians in public hospitals. In fact,
    I think that is the actual non-intent of the Mission Act was if
    you met criteria you could go outside the system or wait times
    or even the fifth number is where it is the best medical
    interest of the patient, between the doctor and the patient.
        This is something we have got to deal with as well is that
    that is the intent of the law and that we are not taking VA
    care from one and giving it to other. VA care we expressed in
    our hospitals are expressed in through community care and which
    we are paying for is VA care and we are going to hold it to the
    highest standards.
        Mr. Bergman. Thank you. With that, Mr. Chairman, I yield
    back 40 seconds.
        The Chairman. Gentleman, yield back. Representative Pappas-
    Ms. Brownley. Recognized. Ms. Brownley, you are recognized.
        Ms. Brownley. Thank you, Mr. Chairman. Thank you Mr.
    Secretary for being here. I am going to start out with a
    question and I do not want you to think I am being combatant
    here. I am not. I just want to understand what is going on. It
    is a question around non-disclosure agreements that I am
    hearing. I have a copy of a non-disclosure agreement here that
    it appears as though you are requiring supervisors at VA to
    sign these nondisclosure statements as you go through this
    reduction in force plan. I think one of the things in this non-
    disclosure that seems to be not in it is a protection for
    whistleblowers. I think Title V requires that there needs to be
    protection for whistleblowers. That seems to be lacking in this
    non-disclosure agreement.
        I am also hearing from employees that they are saying that
    spyware is being installed in their computers to monitor their
    emails and teams messaging, et cetera. You know, generally my
    question is this kind of feels as though you are not creating
    an environment that is where people are motivated to work as
    hard as they can for our veterans. You know, I was selected at
    the same time you were. You know, certainly I would think as a
    former member as you are, you would be asking similar
    questions, I think. I am just asking, why are you doing this?
        Secretary Collins. Thank you, Congresswoman. It is good to
    see you again. We did come in together. Look, the NDA simply
    restates, you know, Title 18 USC 1905, in which the employees
    and others are not to discuss is to keep sensitive information
    in any department internal. We are dealing with a issue right
    now that is a dramatic change for the VA and we are looking at
    workforce and one of the issues that we are having to deal with
    workforce is one of the things. I am going to just, I will be
    very upfront with all of you here today before we even go down
    some of the line of questioning. There is not a time that I am
    going to, in a public setting go into details as far as this
    group of people being looked at, that group of people being
    looked at, not in a setting like this. That is not fair to
    them, and it is not fair to this Committee.
        This is simply a restatement. All of the protections that
    are afforded a whistleblower or work with, communication with
    Congress, classified information, any reporting to Inspector
    General, mismanagement, anything else, are all protected in
    that NDA. It does not curtail them. This is simply an
    opportunity for us to have open and honest dialog about where
    our workforce should be shaped.
        Ms. Brownley. Where does a whistleblower go if they feel
    the need that -
        Secretary Collins. Office of Whistleblower Protection. We
    have it inside our own agency. That is where they go.
        Ms. Brownley. It is still there? It is still operational?
        Secretary Collins. Yes. It never went anywhere. Ted is
    still there.
        Ms. Brownley. I am not sure what you are saying, but
    anyway. Okay, so let me move on. The Elizabeth Dole Bill. I was
    very involved with the Elizabeth Dole Bill and was wanting to
    hear from you about when you think the it will be implemented.
    It was passed about, I think 6 months or so ago. It is
    certainly something that our veterans and certainly the
    Elizabeth Dole Foundation is very anxious to see implemented
    and get started. Could you speak to when the implementation is
    going to take place?
        Secretary Collins. We have already started the meetings in
    internal operations only Dole Act on how to actually we are
    going to be doing that, but we are not rushing through it. One
    of the things I think that we did learn from the PACT Act was
    that something even a good idea such as the PACT Act, if
    implemented quickly, could lead to issues of budgets, issues of
    staffing and who actually how it is actually rolled out.
    Probably over the next couple of months we are going to see we
    have already been meeting, and I think there is actually been
    some conversations with the Hill and staff and we can be happy
    to get you more on where we are exactly at right now. We are
    looking to do that and get it on time with the requirements of
    the Dole Act.
        Ms. Brownley. When our staff was being briefed, they were
    told that Section 120, which is an important section because
    this is where the 65 percent cap on expenditures for non-
    institutionalized care is lifted. We were told that the VA is
    not planning on implementing that until January of next year. I
    bring this up because we have veterans, Amyotrophic Lateral
    Sclerosis (ALS) veterans, veterans with spinal cord injuries
    that need and want their care at home for a quality of life. I
    think that they deserve and they cannot. They are out there and
    they cannot have it because this cap is on there and there is
    not enough resources to have them stay at home with dignity.
    They are out there waiting.
        We have actually heard that some veterans who have been on
    ventilators have lifted the ventilator because they do not want
    to go into institutionalized care and really have just taken
    their own life. They are out there, you know, just hoping,
    praying that this will be implemented so that they can be taken
    care of with the dignity, as I said, that they deserve.
        Secretary Collins. Yes, thank you, Congresswoman. I agree.
    We are going to move as fast as we can and make sure that it is
    actually done properly to get it to everybody so that when
    implemented it will be done. I will check into the year there
    and go back and get you more information on that and we, what
    we are finding is as we get into it there may be times that we
    can actually implement things quicker. I think they want to
    give a timeframe that may be workable but could be done
    quicker. We will actually look into that.
        Ms. Brownley. Well, and I will say to you that the
    implementation of the Elizabeth Dole you will save money
    because getting the care at home is less expensive than it is
    an institutionalized care. It is a win-win because that is
    where veterans want to be cared for is in their homes,
    particularly aging veterans, disabled veterans. That is what
    the Elizabeth Dole bill was really all about. It is, you know,
    it is a win-win all the way around. I know you are trying to,
    you know, use resources as effectively as possible. Well,
    implementation of this bill is a road to go down quickly where
    you can save money and invest in other areas.
        Secretary Collins. I agree. That is also one of the issues
    that we are making sure that we do have the investment because
    some of the bills is still, you know, we are still determining
    what the funding mechanisms were because they were not funded
    in the act as we go through. Those will be issues that we are
    going to work toward. Let me just say on a personal note, I
    understand that completely. Having a daughter who has spina
    bifida and in a wheelchair, the needs at home sometimes can be
    just something that you have to prepare for. We have had to do
    things in our own house over the last 30 years that I would
    have never thought I would have to.
        Ms. Brownley. Very good. Well, my time is running out but I
    did wanted, I wanted to ask you, I know you have talked about
    world class healthcare for our veterans. Just hoping that you
    will uphold the world class standard of team based the team-
    based model of anesthesia within our hospitals. I think it is
    really important and with that I yield back.
        The Chairman. Gentlewoman yields back. Dr. Miller-Meeks,
    you are recognized for 7 minutes.
        Ms. Miller-Meeks. Thank you very much Chairman Bost,
    Ranking member Takano. Thank you very much Secretary Collins
    for being here. As both a veteran and a physician, thank you
    for your advocacy and support of our veterans. Let me also just
    start off before my question echoing Ms. Brownley's last
    statement about the team-based model in anesthesia care. As
    both a nurse and a physician, married to a nurse and a veteran,
    I would echo that sentiment that we want to deliver the best
    care to our veterans. The committee has heard about reports of
    a referral coordination initiative being used as a means to
    bring back care into the VA once a veteran has been referred to
    community care. I am also going to say that I was a proud
    veteran delivering community care within a community for
    veterans. I have been part of that process on the delivering
    end of community care.
        You made a statement that community care is VA care. My
    presumption would be that it should be left to the veteran to
    make that determination or whether they, if they have had
    initial community care, if they want to transfer back. Could
    you give me your thoughts on that?
        Secretary Collins. Yes, that is. That is exactly right. I
    think this is a choice that we need to give to the veteran
    because it is in law and this is the way the law is
    interpreted. You meet the qualifications, you get the choice of
    community care. I think that is one of the things that we have
    seen, though, unfortunately in the last few years is. This is a
    story I will tell, and it is because it is very concerning to
    me because we, unfortunately for some, the MISSION act and some
    with internally in the VA seem to view the MISSION Act as
    setting up an us against them scenario, the VA care versus
    community care that the doctors here and the doctors there. In
    fact, it was unfortunate this past week I was asked a question
    when I was traveling in Minnesota in which somebody was not
    happy with, with me and that is normal, but you know, we get
    it. They actually said through the reporter and the reporter
    asked me the question, well, why would we need to keep all
    veterans in VA. VA has the quality care and the community does
    not. I thought to myself, why would somebody who is one
    protesting us degenerate all the doctors in Minnesota? That is
    exactly what they did.
        Whether they meant to or not was irrelevant. That is what
    they did. We have got to get over this idea that it is one
    doctor against another. There is also a thought inside the VA
    that the VA doctors in some way are supervising the community
    care doctors. This is slowing some of our work down. The other
    issue with community care that is problematic and we can, I
    hope we get to talk about this today is our electronic health
    records (EHR) management system, which does not allow us to
    communicate with doctors. For us, it is just about getting the
    care to where the-again, veteran first, not VA first, veteran
    first. The VA is there to exist to serve the veteran.
        Ms. Miller-Meeks. Thank you. This FoxGrant program is set
    to expire at the end of this fiscal year. What do you see as
    the long-term role of this program in VA suicide prevention
    strategy?
        Secretary Collins. I think it is a great program because it
    actually brings in some different voices into the conversation.
    I am not satisfied at all with where we are in our response to
    our veteran suicide issue, our death by suicide issue. This is
    just not something that is tolerable. To the folks on this
    committee and especially if you are new to this committee. Just
    understand, since 2008, our veteran suicide number has not
    changed. Understand 2008, our veteran suicide number has not
    changed. Yet over the past few years, we have added $588
    million every year for the last few years to veteran-to suicide
    prevention. It is not working. I want to use grants and
    programs like this to reach out beyond the scope of where we
    are currently reaching to say how can we actually touch the
    veteran that is not being touched right now by these programs?
        Here is another thing for you out of that, whether you use
    17 is your number, 22 is your number, whatever number you have,
    half of those have never had VA connection. Half of them we
    have never had a chance to touch. We have got to do better at
    using the grants, using our programs to go outside the normal
    bubble and use others to help get the word out.
        Ms. Miller-Meeks. You may not hear this question. I agree
    with that. Also General Bergman's comments about emerging
    breakthrough therapy. Never thought in my medical career I
    would be talking about that. Yet it does show promise in
    reducing Post-Traumatic Stress Disorder (PTSD) and suicide. The
    VA's leasing process continues to face long delays, overruns,
    and cost overruns with outpatient clinic leases. The building
    for those leases, the construction, I mean, often taking years
    to complete. Do you have a plan for that? If not, I would love
    to meet with you. I have met with people within my district who
    actually do construction. They are more than happy to save the
    VA money at their behest, making less money for them in order
    to have a more efficient process.
        Secretary Collins. Congresswoman, this is going to be the
    one time I am looking at the Ranking Member and the Chairman
    and just as I did this morning with the appropriations
    committee and everybody in this community, help me. Our
    procurement system, especially when it comes to construction
    and new facilities, is broken. I mean, and we are not even at
    the point where, and this is not throwing anybody under the
    bus. It is just they are given a system that does not work. I
    was here and many, several of you were here when we had the
    issue first come up and we started. One was in Colorado. Then
    there was others that, you know, were right now, it is no
    reason, in all fairness that it takes a billion six to build a
    medical center. There is positions on this panel. Your local
    hospitals, in fact, in my hometown just built a hundred plus
    you know, several hundred plus bed system, put an Operating
    Room (OR) in it, put an Emergency Room (ER) in it. They built
    it in less than 2 years and it is a lot less cost.
        Our leasing programs need to be streamlined, our building
    programs need to be streamlined because right now there is not
    really, if you would, as I call it, that touch point, that one
    belly button touch point where I can actually say you are
    responsible for this or holding them accountable for contracts
    in which they do not meet their deadlines. I am asking for help
    here on this one.
        Ms. Miller-Meeks. Be happy to help you with that in our
    Communities Helping Invest through Property and Improvements
    Needed for Veterans (CHIP IN) Act. Then this is just a very,
    very minor thing, and I know it is minor, but I have had
    veterans in my district contact me and send me photographs of
    our VA hospital which show a blank wall and the photographs of
    the President and the Vice President are not there. I know it
    is a minor issue. Is this something that comes from the VA or,
    or how can I help these veterans and answer their problems? If
    you could just address that quickly. I know you gave me extra
    time, so.
        Secretary Collins. No, I appreciate you. No, they should
    have the pictures. There was a delay and I think one of them
    was at the Vice President's picture was one of the delays. My
    picture. You know, look, it is out there in the President's
    picture. It is. It is very important to our veterans. I get
    those calls all the time. We are doing everything we can to get
    those pictures out and make and this is a change to any
    administration. It needs to happen quicker. It did not. It does
    not most of the time. I think it is being done as quickly as
    possible.
        Ms. Miller-Meeks. Thank you so much. I yield back.
        The Chairman. Representative Pappas.
        Mr. Pappas. Thank you very much, Mr. Chairman. Mr.
    Secretary, thanks very much for your comments. I want to ask
    you about an issue that is critically important to veterans in
    New Hampshire. New Hampshire remains the only State in the
    contiguous 48 states without a full-service VA hospital. The
    Manchester VA Medical Center was built in the 1950's. It
    continues to experience serious infrastructure issues. Pipes
    bursting in the winter, flooding, heating outages, even insects
    in the operating surgical suite. On May 9th, the Trump
    Administration announced an executive order (EO) directing a
    feasibility study at the VA within 180 days of the order,
    submitting a plan to the president, an action plan to expand
    services at the Manchester VA into a full service medical
    center.
        Veterans have been asking for this for about 20 years now.
    They are ready to move past the talking stage and to see some
    action on this. I am wondering if, as this study is moving
    forward, you are going to work to engage with veterans and
    stakeholders in the State of New Hampshire to make sure you are
    hearing directly from them and capturing their feedback.
        Secretary Collins. Yes, Congressman, I appreciate that and
    I appreciate you carrying the torch for that. Also, I have
    talked with your Governor about this as well, and I can report
    to you that that feasibility study started this week and we are
    going to be working with our stakeholders in New Hampshire and
    other places to make sure that this goes through. Following
    through the promise of the President who made the promise to
    look at your facilities up there, that is what the EO said and
    we are already started that process and we started it this
    week.
        Mr. Pappas. I appreciate that. Do you start this process
    with the commitment to establishing a full-service hospital in
    New Hampshire?
        Secretary Collins. I believe that is the desire of the
    administration as we go forward and we are looking at it from
    that. You have a system in which we are going to look at and
    make sure that we get the proper needs and the proper care in
    that area.
        Mr. Pappas. Thank you. I appreciate your attention to that.
    Before I get to my next questions, Chairman Bost, I ask
    unanimous consent to enter into the record data received from
    the Housing Policy Council showing over 80,000 veterans State
    by State, who are at extremely high risk of foreclosure.
        The Chairman. Without a rejection.
        Mr. Pappas. Thank you very much. I disagree fundamentally
    with VA's decision to end the VASP program. I want to ask you a
    little bit about the timing around that because it was
    extremely unclear who was informed and when. VA briefed
    committee staff on April 9th that VASP would stop accepting
    applications from lenders on May 1st. I am wondering when VA
    first publicly posted the information to the general public
    about its plans to stop accepting VASP applications.
        Secretary Collins. As far as an exact date on when
    published, I would have to get you an exact date. I think going
    the VASP program in general, though, this is a program that I
    think many on this committee have strong feelings about. Should
    have never started to begin with. This was not a congressional
    mandate. This was not a congressional program. It was stopped
    and it had already got into an area VA did not need to be in to
    start with.
        Mr. Pappas. We have the date. Basically, April 23d is when
    that was posted publicly. Literally a matter of days before
    veterans were made aware of the fact that this program was
    coming to an end. I ask about this because we heard directly
    from a constituent who was caught up in this. He is a veteran
    who-his name is Daniel. He is 100 percent service disabled,
    veteran of the first Gulf War, reached out to our office days
    before the end of VASP, understanding that he might still have
    a chance to get into this program and to make sure that he
    could start making payments and stay in his home along with his
    service animals. I am wondering if you have any guidance for
    veterans like this who have been caught up in this period of
    time where VASP is coming to an end. There was not clear
    communication from the department. What do veterans like Daniel
    do to be able to stay in their homes while we wait for Congress
    to take the important step forward to develop a partial claims
    program?
        Secretary Collins. Well, I think that is what the first
    step is, is Congress needs to act upon this. This should not
    have been a program that was taking money away from other
    things to start and getting the VA into a mortgage business. I
    mean, the numbers here, I think at this point, it stopped on
    May 1st. No one who is currently in VASP was taken off VASP.
    Anybody who currently is working through VASP is still on VASP.
    We just did not take any more.
        Mr. Pappas. Respectfully, it is not a good enough answer
    for my constituent. He is someone who understood that the date
    was coming May 1st, was trying to work with his lender to get
    into the program, and now he is not sure he has any other
    opportunity to protect his home and to stay in his home. We are
    facing a housing crisis in New Hampshire as we are in states
    across the country. Would you be open to a foreclosure
    moratorium in the interim while we await action in Congress to
    develop a bipartisan plan for a partial claims program?
        Secretary Collins. I am not going to commit to a program on
    the fly here in the middle of the hearing. I think I understand
    your concern in looking at it, but again, sort of, we set up a
    problem that was going to end up developing. The reason VASP
    was stopped was because the VBA, which took money from other
    programs, reprogrammed from other things to do this program,
    came forward and they were now going to ask for multiple
    billions of dollars out of their mandatory program to go
    forward, which I would have had to come to Congress for. It was
    just an area that it had to be a time to cut it. We did it as
    much as we could. It is not an answer I know you want to hear
    or the veteran might want to hear, but this is just, it is a
    program we should have never gotten into.
        Mr. Pappas. Look, I disagree with that answer. I think the
    fact is this was a last resort program that was a should,
    should have been a stopgap while Congress developed something
    that was more permanent and we are working on that. We have got
    to be looking out for constituents like this who number 80,000
    across the country, people that are at risk of foreclosure,
    veterans who deserve our support. I want to get to just a final
    statement here. I hear from veterans across New Hampshire that
    are deeply concerned with some of the moves they see being made
    by VA. Now, I agree with your statement that you made in your
    testimony that we have got to be looking out for end veterans,
    and I believe that we do that on this Committee. I have served
    here for 6 years now through administrations of both parties. I
    take exception to the claim of what you have said, which is
    that, quote, literally all VA stakeholders agree with what
    needs to be done and that is reflected in the action that you
    are taking.
        I do not think that is true because veterans I talked to do
    not agree with the abrupt ending to VASP. They do not agree
    that we should put more veterans at risk of foreclosure. They
    do not agree with the fact that we have seen crisis line
    employees lose their jobs who are in probationary status. They
    do not agree with the fact that your stated goal is to fire
    83,000 workers. That would cut deeply into VA's ability to meet
    the needs of our veterans and provide the kind of care and
    benefits that they deserve. We have got work to do to make sure
    that we are improving services at VA, that we are getting
    things done for veterans. Let us be willing to work together
    and do what it takes to meet the needs of these heroes who have
    worn the uniform and have done everything to serve the United
    States of America. Veterans know that we need more. We need
    better cooperation. We need better leadership from you to get
    the job done. I yield back my time.
        Secretary Collins. Mr. Chairman, can I answer? Alright,
    that is fine. We will keep going. Just keep going.
        The Chairman. Just real quickly. We are scheduled to pass
    the Partial Claims Bill next week off the floor over to the
    Senate. I would encourage everybody to support that so that we
    can cure those type problems and then go and encourage our
    Senators to do the same as quickly as possible. With that, Dr.
    Murphy, you are recognized for 7 minutes.
        Mr. Murphy. Thank you Mr. Chairman and welcome Secretary
    Collins, I am very heartened to see someone of your caliber,
    intellect, and desire to help our veterans. We appreciate your
    service. You know we started off the Committee, we talked about
    what things are different now. It is oversight, it is
    accountability. Personally, I liked our last secretary, but I
    thought he was extremely ineffective. We come in here and we
    were riddled with a sexual scandal cover up that occupied
    unfortunately a couple hearings in this Committee. We had cost
    overruns, but they were not cost overruns. It is time actually
    for people to come in and as you said, the VA is broken and
    continuing to pour money and to hire individuals who by the
    last administration's report over hired. It just is nonsense.
    It does not help our veterans. To that point, you have been in
    this job 4 months. Can you tell me on a scale of 1 to 10 how
    good you believe our VA is efficient?
        Secretary Collins. An overall number would probably not do
    justice to everything. I think there is some areas that we are
    completely inefficient and then there is other areas that we
    have been able to do things better. I think it is, I am not
    going to make a blanket statement on that we are a four or
    five. I mean I was, I do not rating a record but yes, I think,
    I think we are probably at a special age when it comes to our
    Information Technology (IT) programs, when it comes to our
    employee management, when it comes to our efficiencies in doing
    things such as contracting, payroll, Human Resources (HR). We
    are probably, you know, lower than we need to be, especially
    when compared to the industry.
        Mr. Murphy. Yes. You know, you spoke, you spoke a little
    bit about building a hospital. I have been intimately involved
    in a lot of administrative stuff. I still practice, I still see
    veterans. If the outside world can do things infinitely more
    efficiently, less cost effective, why can the VA not do it?
    This is just emblematic of what you know, some people feel our
    government should do is just pour money into a system that does
    not work. I appreciate the efficiency and accountability that
    you bring into the office.
        One thing speaking of which, I would love to bring up the
    EHR issue. I have sat on this Committee now, I think close to 6
    years and I am still dumbfounded at the billions and billions
    and billions of dollars that have been poured into an EHR that
    should have never been done to in the first place. It is not a
    system that should be used for the largest healthcare system in
    the country. I know this is a big priority, yours, and I would
    love to know your thoughts about how we can actually implement
    a system that is only in just a few hospitals and centers at
    this point.
        Secretary Collins. Thank you, Congressman. This was the one
    that was dropped on my plate from day one. Frankly, it was just
    dropped as a, you know, just a cold fish, so to speak. It was
    just nothing was happening. The previous administration, the
    previous secretary had put a pause and basically it was just
    sort of a death knell because nobody was talking, nobody was
    doing anything to move anything forward. This was after we had
    poured billions of dollars into the system. Now, I choose to. I
    could go back and I could, you know, talk for days about how it
    was, you know, probably poorly started, poorly funded, poorly
    integrated, poorly everything. What I chose to do was from day
    one is walk in with fresh eyes and say, okay, here is what I
    have been given. Here is what we have to do.
        What we did was we basically took the two positions, the VA
    position and Oracle position, and we came to see what each said
    about each other. Then we put them in a room and then I had
    them basically talk to each other and then I locked them away
    and said, we got to fix this system. Do not come out until you
    fix it. What we are at right now is instead of maybe four next
    year in the Michigan area, we are actually going to be doing 13
    across that entire Veterans Integrated Service Network (VISN).
    Let me just tell you what I have control over and also what I
    have control over a vendor or a client, which I believe Oracle
    to be. VA is, we had almost, I think it was eight or nine
    committees that everything had to go through to determine what
    standardization would look like. In other words, if we wanted
    to code something, it had to go through eight different
    committees differently then to come to a final committee before
    then could go to be discussed with Oracle.
        I did away with every committee except the final committee
    after they had their meeting. We only have one committee now.
    Dr. Evans talks directly to Oracle, Oracle talks directly to
    Dr. Evans on standardization issues. We are going standardized
    from here on out, which is what every other hospital in the
    world does. We have about 10 percent that is unique to VA, and
    we are going to work through those again as we go forward. By
    doing that, that was able Then to allow us to speed up the
    process and allow us to add the nine more sites that we are
    going to. This also then takes into account looking ahead to
    gain momentum. Is anybody here in a longer system? If you go
    back to DOD and for both sides of the aisle, the DOD did this
    over the years. They had a pause and they actually came out of
    the pause and were standardized and got it done. They finished
    their side of it and roughly the same time the VA was supposed
    to be. We are just looking to actually now get the momentum so
    we can go into others 20 to 25 to 30 to get this done.
        Mr. Murphy. I applaud you at that. It was criminal that
    nothing more was done. This has been a failed system from the
    start. It is neglect, it is point blank neglect that this is
    not already in every VA system. To your point earlier about
    being able to communicate with community care doctors,
    everything. I do not know what the hatred is about community
    care on this, on in this committee. Sometimes I swear to God,
    they just do not. I do not understand it. I have taken care of
    patients. We want a seamless approach, and we want the best
    physicians and the most readily accessible physicians. It is
    nothing a pro or con, anything against or for the VA. It is pro
    veteran. It is what is being done. We need to be able to
    communicate with those individuals. I do not know how many
    times I have seen a veteran and I cannot get records from hell
    about the patient itself. Thank you for actually doing
    something about it.
        I am going to follow up with one other point that is
    already been stated twice. Anesthesiologists need to be in
    charge of the operating room. It is a team approach. There
    needs to be a quarterback. I do not care if the fullback says
    that they are as good as the quarterback. They are not. That is
    what we want. We want the best for our veterans and that is the
    period. Finally, an issue that is near and dear to me. You have
    talked about veteran suicide. We have talked and talked and we
    have poured money upon money upon money and we have not moved
    the needle. I have scrubbed a particular therapy that I truly
    believe moves the needle in the State of North Carolina. It is
    doing tremendous things to help our veterans. That is
    hyperbaric oxygen. I do not know why this is a partisan issue.
    They are using it all over in Israel. They are using it in
    other places in the country. I have a bill, H.R. 1336, Veterans
    National Traumatic Brain Injury Act, that heretofore the VA has
    opposed the bill. We want to do everything for those
    individuals who are at the end of their rope. I would love to
    have the VA drop its opposition. This is something our veterans
    should have in their arsenal.
        Secretary Collins. Congressman, I look forward to working
    your bill through the Congress. We will be from our
    perspective, giving the treatments we have had, the research
    that we have to provide you, the research that we have seen and
    where we can find that it might work. They will be happy to see
    that. Come on. We will follow the lead of this Congress.
        Mr. Murphy. I appreciate that commitment. Thank you, Mr.
    Chairman, I yield back.
        The Chairman. Representative Cherfilus-McCormick, you are
    recognized for 7 minutes.
        Ms. Cherfilus-McCormick. Thank you, Mr. Chairman. Thank
    you, Secretary, for being here today. I have a few questions
    for you. Would you agree that housing is an important priority
    for our veterans?
        Secretary Collins. In generalization, question, I mean, is
    housing important for anyone? I mean, I am apologize, I am not
    sure what.
        Ms. Cherfilus-McCormick. Do you prioritize veterans
    benefits when it comes to housing? Making sure that our -
        Secretary Collins. I prioritize all the benefits that are
    veterans earned.
        Ms. Cherfilus-McCormick. No, specifically, it is yes or no.
    Then we can just do yes or no.
        Secretary Collins. Well, I will do that if it actually
    answers the question.
        Ms. Cherfilus-McCormick. Is it a yes or a no, sir?
        Secretary Collins. For what?
        Ms. Cherfilus-McCormick. Do you prioritize veterans
    housing?
        Secretary Collins. I prioritize all veterans benefits.
        Ms. Cherfilus-McCormick. Yes or no? Yes or no, please.
        Secretary Collins. Yes or no to what? I mean we can play
    this game back and forth.
        Ms. Cherfilus-McCormick. Secretary Collins. I am not
    interested in that. I am really getting -
        Secretary Collins. It seems you are.
        Ms. Cherfilus-McCormick. Secretary Collins. I am not
    interested in that. We have real concerns, especially in the
    State with our veterans. Could you please answer it yes or no.
    If you choose not to answer, just say you choose not to answer
    and it is not important.
        Secretary Collins. Do we prioritize housing for veterans?
    Yes. We also prioritize healthcare.
        Ms. Cherfilus-McCormick. Thank you. Do you prioritize and
    fully commit to housing veterans, especially when it comes to
    flexible assistance to homeless veterans?
        Secretary Collins. I will fully commit to helping the
    veterans in any way we can through the programs we currently
    have. I refuse to get the VA involved in something like VASP
    that we should have never been involved with to start with.
        Ms. Cherfilus-McCormick. Excuse me, could you please answer
    my question because we are not talking about VASP. Once again,
    the question is, if you would like to listen to the question is
    do you support providing flexible assistance to our homeless
    veterans like access to transportation, hygiene products,
    blanket support to help our veterans.
        Secretary Collins. The answer is we support our veterans.
        Ms. Cherfilus-McCormick. Yes or no?
        Secretary Collins. Yes. I mean, yes. The question, I have a
    question. Where are we not?
        Ms. Cherfilus-McCormick. Do you believe that access to
    lands owned by VA should be in part used to address veterans
    homelessness. That is yes or no.
        Secretary Collins. If the land is suitable, it can be used.
        Ms. Cherfilus-McCormick. Yes or no?
        Secretary Collins. I cannot give you an answer to a
    question that has a hypothetical. That cannot be answered.
        Ms. Cherfilus-McCormick. It is a yes or no.
        Secretary Collins. No, it is not.
        Ms. Cherfilus-McCormick. It is. Okay, so.
        Secretary Collins. Mr. Chairman, I mean, I cannot answer.
        Ms. Cherfilus-McCormick. Excuse me, it is my time, sir. It
    is my time. You do not need to look at the Chairman. I am right
    here, and it is my time.
        Secretary Collins. I know exactly where you are.
        Ms. Cherfilus-McCormick. Okay. Thank you.
        Secretary Collins. I cannot answer your question.
        Ms. Cherfilus-McCormick. The respect that I am giving you,
    I deserve it also.
        Secretary Collins. I will get it.
        Ms. Cherfilus-McCormick. Please answer those questions as
    yes or no, because you are taking up my time with this. The
    next question I have for you now, there is so many veterans who
    are losing their homes, especially in Florida, and we are
    finding more of them becoming homeless. My real concern is
    about the Elizabeth Dole Act. We have a clause in there that
    actually deals with that, and you have not been implementing
    it. That is why I want to identify if this is actually
    important to you or if it is a priority. My veterans do want to
    know if this is one of your priorities.
        Secretary Collins. Yes, it is a priority. Anything in the
    Dole Act we will implement.
        Ms. Cherfilus-McCormick. Why have you not taken it to
    implement it in these stances?
        Secretary Collins. The Dole Act was given at the end of
    last administration. It came in, and I have been in here over 4
    months. There are 72 total provisions in the Dole Act. We have
    completed nine. We are working on track with 55. We got two
    that we are still at risk and we are still working. We are
    doing everything we can in the time.
        Ms. Cherfilus-McCormick. If housing was in fact a priority
    for you, would not you skim it to find out which priorities or
    how can you actually make housing accessible? My question is,
    we looked at and we saw that there was a significant gains were
    made toward homelessness from January 2023 to 2024. Right now
    we are seeing that there is a potential for us to lose the
    momentum that we have been gaining. In addition to that, when
    we talk about the purchase, the Service Purchase Program, which
    you said that you would like to terminate or you are
    terminating, we want to know what are the other instances or
    what do you have in place for our homeless veterans to protect
    them?
        Secretary Collins. The issue in termination of VASP is we
    go is that we are looking to do everything we possibly can that
    is already currently there for veterans in the VA for
    assistance, whether it be their mortgage or other things. We
    also can work with other agencies such as U.S. Department of
    Housing and Urban Development (HUD) and others to find ways to
    help them as we go forward. I am willing to look and move
    forward anything we can without sacrificing also the bigger
    picture. I am not unfortunately able to just simply pick the
    areas, especially in a Dole Act where I want to get all of it
    implemented for all of the caregivers as we go forward. I think
    the Trump, Donald Trump, just a few with Congressman Pappas as
    well, that EO also talked about using facilities. The VA, which
    has been ignored and frankly under previous administrations was
    allowed land that we had that we could have helped homelessness
    in LA was actually farmed out to private schools and ball
    fields. I am trying to look at it from a State of mind.
        You and I actually agree probably more than unfortunately,
    this came off and I apologize for that. We agree on this issue
    that we need to look at what we can do within the confines of
    what we have.
        Ms. Cherfilus-McCormick. How quickly do you believe that
    you will start prioritizing or putting this in place? I have to
    answer to my veterans also to make sure that we see them and we
    understand that housing is so critically important, especially
    toward their dignity and the contract that we have with our
    veterans, which is to protect them and make sure they live with
    dignity.
        Secretary Collins. I agree with you and I will be happy to
    work with you and talk about specific answers, especially
    Florida. I have Georgia is my home. I do not get there very
    often anymore. It is a very similar situation for us on housing
    cost and housing quality. Any of those information within the
    Dole Act we are going to continue to implement. If there is
    ways that we can help expand something we currently already
    have, I am willing to look at that as well. Well, but I think
    this is just where we need to make sure that we are doing stuff
    that help and does not either have a negative impact some other
    place with other programs.
        Ms. Cherfilus-McCormick. My last question is going to be
    really quick. Even though it is a huge issue. It is about the
    dismantling of the Office of Equity Assurance. We just had a
    roundtable where we had many of our minority veterans there who
    talked about the disparities in them actually drawing down
    their benefits. Specifically, when it comes to PTSD. How are
    you going to handle these situations? Specifically when that
    office has been dismantled?
        Secretary Collins. That office, again, being dismantled has
    nothing to do with the fact of my commitment to make sure any
    veteran who has earned a benefit gets their benefit, no matter
    what their background, what their skin color.
        Ms. Cherfilus-McCormick. Specifically the disparities I
    wanted to point to. How are you going to handle the
    disparities? We have years and years of documentation,
    especially when it came to housing where we saw different
    generations that were disadvantaged. How are you going to do
    that, specifically when this office has actually been
    dismantled?
        Secretary Collins. I think it is. It is when you are
    actually supposed to be doing your job. It takes a secretary to
    lead and make sure that our organizations are not doing
    anything away from it.
        Ms. Cherfilus-McCormick. Will you be handling that? Will
    you be handling it? You said it takes a secretary.
        Secretary Collins. It takes a secretary to give leadership
    to the organizations that are supposed to be approving our
    benefits. Congresswoman, if you have somebody who has been
    discriminated against or not getting the benefits they have
    earned, then I will be happy to work with you to make sure that
    is rectified. That is something against the law that we are not
    going to break law. We are going to actually give the benefits
    that they have earned.
        Ms. Cherfilus-McCormick. Okay, so specifically, should they
    contact your office then, because this office has been
    dismantled, who should they reach out to?
        Secretary Collins. Well, the question is it is not the
    office. It was not a part of the benefits that they were not
    getting. Why are they not contacting the office of the benefits
    in which they were denied?
        Ms. Cherfilus-McCormick. Excuse me, sir. The question
    specifically is who should they contact?
        Secretary Collins. Which benefit are they looking for? If
    they should call VBA, which is the benefits, that would be the
    area to call. If it is a -
        Ms. Cherfilus-McCormick. There is not going to be, the
    elimination now is going to be shifted to different offices.
    Thank you. I yield back.
        The Chairman. Representative Van Orden, you are now
    recognized for 7 minutes.
        Mr. Van Orden. Thank you, Mr. Chairman. Mr. Secretary, I
    want to thank you for getting something accomplished in less
    than 100 days that I have been trying to do for 2 years, and
    that is to get rid of a program that has never existed since
    the time someone lent someone seashells to buy a cave. That is
    the VASP program. The Veterans Affairs Administration, under
    the previous administration, decided to take on $17 billion
    worth of debt without conferring with Congress. To me, that
    should be unlawful.
        Let me explain what the VASP program is for those people
    that are not on me and Chris's subcommittee. The Veterans
    Affairs Administration, in the previous administration, decided
    to start buying home loans, reducing the interest rate. If it
    was at 7.5 percent, the VA would buy the loan from a lending
    institution, lower the interest rate to 2.5 percent, and they
    spend an average of $360,000 per home. They did this up to the
    tune of $17 billion. The amount of money the average veteran
    was in arrears was $25,000. It was a $25,000 problem that was
    solved with a $360,000 solution. That is how the previous
    administration ran the VA. Doug, excuse me. Dennis McDonough
    was a friend of mine and I actually respect him tremendously,
    but that was just foolish and wrong.
        In 99 days, or whatever the heck it is, you got rid of
    that. I thank you tremendously for doing that. That showed
    really incredibly bold leadership. We are getting arrows from
    this, right? Well, guess what? I am going to give all of my
    Democrat colleagues the opportunity to help rectify what they
    are talking about today because H.R. 1815 will be on the floor
    next week. I would encourage everyone to put their money where
    their mouth is and vote for that partial claim thing. You do
    not want someone to get kicked out of their house. Vote for
    H.R. 1815 or stop talking. That is all I am going to say to
    everybody about that.
        Here is what happened, Mr. Secretary. I had my graphics
    team draw this up so I can explain to some people what is going
    on. Here it is, right there. That is the whole VA. This is the
    problem with the VA, okay? This is the increase in bureaucrats.
    These are the doctors. It is almost a flat line. Then we have
    an increase with the veterans because of the PACT Act. Right.
    When we are going to cut the VA, and I hope you do, sir, this
    is where you need to make the cut. Right there in this line.
    Right there, sir. Mr. Secretary, if you cut this, then this
    line with the doctors and stuff, the people that are actually
    touching our veterans and providing care, can go like this,
    right? Then we can match the increase with vets.
        Mr. Secretary, I am incredibly happy and looking forward to
    working with you and your administration. If there is anything,
    just if you have a top line item that we can do from the
    congressional side, power of the person, all that stuff, if you
    could, you know, rattle off one or two of them, would be great.
    We will write these down and we will take it for action. Mr.
    Secretary.
        Secretary Collins. Thank you, Congressman. I think one of
    the things you mentioned there at the end is something that is
    very important because it is also been one of the most
    misconstrued and also used to scare veterans and also scare
    employees concerning what we are looking at in regards to a
    reorganization of, of staff and how we look at this. As I
    stated earlier, we have 465,000 as of today in our total VA
    organization. What is interesting about that is in VHA, there
    is 409,000, there is 34,000 in VBA, and there is 2,400 in NCA,
    which is our cemetery account. You know what is interesting? We
    have 16,375 in the central office who are not, you know, are
    doing policy, doing other things. By the way, most of them are
    not actually showing up at 810 Vermont or somewhere else. They
    are, they are not showing. What the question becomes.
        Mr. Van Orden. Mr. Secretary, I am sorry, will you say that
    number again just so people can understand the scope of this,
    the ludicrousness of this bureaucracy?
        Secretary Collins. Just at central office. This has nothing
    also to do with some of the other levels that are built into
    these numbers that I have talked about is a 16,375. Yes. As we
    look at this, the question becomes, is not are we, you know,
    where are we at with our programs. As I stated earlier, we have
    28,000 physicians. We have 91,000 nurses. Also, one of the
    things I did not mention on the GAO report was this. Veteran
    numbers not changed. We are still looking at 9 million veterans
    every year. That is the enrollment, 9 million for the last 10
    years. It is been the same. Yes, PACT ACT shot up. PACT ACT
    gave us some more. Here is the interesting. We got total number
    985,000 that came to new enrollees in PACT Act. That is not
    just for PACT. That is all enrollees, 985,000 in the last
    couple of years. Our numbers still stayed at 9.1 million. The
    reason is, is because over 2 years, we also lose 400,000
    veterans in this country every year. You may add 900,000, but
    you are also decreasing 400,000 each year on 2 years. 404, you
    are basically drawing even here, our total veterans in this
    country have dropped from about 4 million in the last 10 years.
        We are dealing in a circumstance here in which you cannot
    really justify the layers of bureaucracy. Let me give an
    example, if you do not mind, Congressman, about this. One of
    the issues that we have, and just to show you where it is
    again, when somebody says, oh, you are going to cut dollars. I
    actually saw this article again today, and somebody thinks that
    in one hospital we are going to cut 15 percent of everybody in
    that hospital. That is just stupid, wrong, and I do not want to
    hear it again, okay? That is just not the way this goes about.
    You are looking at organizational structure. Here is the
    interesting issue. I told you earlier, when I first came in, I
    could not get an actual count of our employees because our HR
    system was not set up the way we could to get employee count.
    Nobody in here has been in the military could understand that
    concept, but that is what happened.
        The other issue that we had is we had then we went to
    payroll and said, payroll, how many people do we have? Payroll
    came back at central office, which is our centralized payroll
    system, which was supposed to be implemented. Again, this is
    all oversight stuff that has not been, you know, for the last
    few years, is looking at. It was supposed to be centralized.
    They said we had 230,000 employees. I said, and even our guy
    said, we got more than 230,000 employees. Come to find out that
    there was a permissive attitude that allowed 60 or roughly 60
    of our hospitals to continue to do their own payroll with
    multiple hundreds of people involved in that process. We have
    contracting. It is all over the country. None of it is
    centralized. All of it doing different things. You have
    differences of opinion between even hospitals on how they
    actually do purchasing. Again, tens of thousands of people. We
    also have human resources. It is all done in this.
        Mr. Van Orden. Mr. Secretary, I just have a couple seconds.
    I want to say one thing. I want every single person that has
    served this country, is serving this country or feels like they
    want to serve in the future, to have access to the Veterans
    Affairs Administration Home Loan Guarantee Program. By shutting
    down this disastrous, VASP program, you accelerated that. Thank
    you very much for that. Mr. Chairman, I yield back.
        The Chairman. Representative McGarvey.
        Mr. McGarvey. Thank you, Mr. Chairman. Thank you, Mr.
    Secretary, for being with us today. We have our differences on
    this committee like any committees, but the thing I love about
    this committee in particular is that it is mission centered.
    Despite those differences, we often come together and try to do
    what is best for our veterans. That is what we are here to do.
    That is what we try to do. Now, I can tell you as someone on
    this committee and from Louisville, Kentucky, I hear a lot of
    complaints from veterans. Those complaints are very rarely
    about the care they receive. They are far more about how long
    it takes to get that care, how far they have to go to get that
    care, how they access their benefits that they have earned.
    Earned by putting on the uniform. I will tell you we have to do
    better about that. I think everyone would agree we have to do a
    better job of doing that.
        I will also tell you that because of that, I am concerned
    about some of the things that I have heard you and this
    administration say over the last few weeks. Like the stated
    goal of cutting 15 percent of the VA's workforce, which is
    roughly 83,000 jobs, or possibly terminating nearly 600
    contracts, which no one can tell us what the contracts are or
    what the actual number is. Or even just ending the VASP program
    in such a way that it could leave a thousand veterans in my
    home State of Kentucky without a home. I personally believe the
    term homeless veteran should not exist. I want to use my
    questions today to focus on an issue that I actually hope we
    can agree on, because right now there is a part of VA that is
    decreasing wait times. It is improving medical outcomes, it is
    reducing costs, it is making the department more efficient. It
    is not DOGE, it is the VHA in house innovation ecosystem. I
    know you know about some of this, but let us just outline some
    of their work for everyone else.
        This is like VetText, which sends text reminders to
    veterans about upcoming appointments, decreasing missed
    appointments by 10 percent and reducing wait times for our
    veterans. The VHA Uber collaboration which has provided
    veterans with rideshares across 100 facilities, saving VA
    nearly 200 million dollars. There is a remote diabetic foot
    ulcer smart mat. I know that might not sound like the most
    exciting thing in the world, but it has cut hospitalizations in
    half, and it has saved the VA almost $100 million and again
    hospitalizations in half. It is saving veterans lives. Vital,
    Important, Optional, Not needed and Every (VIONE), it is a
    physician created initiative that helps VA in prescribing
    unnecessary medications and improving patient safety. It saved
    VA over $300 million annually. I say I think we can agree on
    this because I actually read your op-ed on May 2 with interest
    when you went to Michigan and talked about some of the
    cardiology care there and praised this high quality, high tech
    and veteran centered care. I want to keep this innovation going
    in the VA. What I would like to know from you today that with
    all the cuts that are ongoing is a commitment that while you
    are Secretary, the Trump Administration will not eliminate the
    VHA innovation ecosystem.
        Secretary Collins. Congressman, I am not sure where it got
    out there that anything that I have said or done or
    misconstrued by anybody that wants to is to take away anything
    good that the VA is doing. In fact, we are not going to do
    that. We are going to applaud that. I tell our employees all
    the time, go make mistakes. You are not going to get in trouble
    at the VA for making a mistake if you are trying to do good,
    because I am going to pick you up and put you back out there
    and try again. What we do not want to have is issues where we
    get in our own way. I think that is the biggest thing I am
    trying to emphasize, just as I emphasized just a second ago,
    things that take away time, effort and money from the very
    things that you are talking about are the things that I am
    looking at trying to change. Look, we are on the same page. You
    and I can agree on this. Believe me. When I was here, I was on
    Judiciary Committee. We did not come close to congeniality most
    of the time on the Judiciary Committee. This is actually good
    with it, with what we have here.
        Mr. McGarvey. I like the agreement, although that was not a
    yes or a no answer on whether the innovation ecosystem is going
    to stay. I hope it does.
        Secretary Collins. I agree with you.
        Mr. McGarvey. Okay, perfect. I mean, I say this, we have
    such possibility there. When you look at the VA, we have 9
    million patients, largest patient population by a multiple of
    any hospital system in the country. Nearly 75 percent of
    physicians do some of their training at the VA. We have the
    largest longitudinal data set of any hospital system in the
    country. We are not putting enough focus into research, into
    innovation. I really believe we have the ability not just to
    take care of our veterans, but forward our resources so that
    maybe we find a cure for PTSD or TBI or a spinal cord injury
    that then benefits everybody in America. Then of course, of
    course we know those are service connected injuries. What
    happens if somebody comes in with Parkinson's cancer, heart
    disease, and we find a cure for that? We could change
    healthcare not just for our veterans, but for everybody in this
    country.
        I want to switch gears a little bit while staying on
    healthcare though. The fastest growing group of veterans in
    this country are our women veterans. We know that they have
    different healthcare needs. On February 18th of this year, the
    President, who once referred to himself as the fertilization
    president, signed an executive order instructing the Domestic
    Policy Council to identify ways to reduce barriers to In Vitro
    Fertilization (IVF). We know that women veterans do not have as
    much access to the service. We also know that their infertility
    rates are higher than their civilian counterparts. Secretary
    Collins, are you and the VA right now working on a plan to
    improve IVF access for women veterans?
        Secretary Collins. Yes, we are fully implementing the
    Executive Order from the President. We fully intend to.
        Mr. McGarvey. When can we get an update on that?
        Secretary Collins. We will get with your office and tell
    you the updates that we have at this point. Again, working with
    administration as they roll out their positions as well.
        Mr. McGarvey. Thank you. Again, shifting topics on you
    again. I am not scared about technology. I think technology can
    be used for a lot of good things. We are advancing in
    Artificial Intelligence (AI) rapidly. One of the things I have
    heard from my veterans is they are worried about the AI systems
    potentially going into place, particularly in making the final
    decisions on benefits. I know you cannot forecast way into the
    future, but while you are Secretary of the VA can, you commit
    that there will always be a human who is making the final say
    on a veteran's eligibility for their claims?
        Secretary Collins. I think, yes, the issue there, because
    there is such differences in somehow these disability claims
    are actually adjudicated out. One of the things I think we both
    can agree on, though, using technology, is that there are
    simple claims that should not have to go through the long,
    tedious process that we have that we can automate and automize.
    It gets them their benefit quicker. I think that is the big
    thing. If there is always a concern about a disability
    diagnosis or something, we are going to have somebody
    adjudicating that.
        Mr. McGarvey. Thanks. Only because I have 13 seconds left.
    I want the claims resolved quicker. I want them faster. I do
    want to make sure that a veteran knows that it is another
    person who is ultimately making that determination for them.
    Thank you, Mr. Chairman. I yield back.
        The Chairman. Representative King-Hinds, you are next.
    Recognized for 7 minutes.
        Ms. King-Hinds. Thank you, Mr. Chair. Thank you, Secretary
    Collins, for your time today. I have the privilege and great
    pride actually of representing the CNMI Commonwealth of the
    Northern Mariana Islands. We have hundreds of veterans who lack
    essential VA health care and VA resources because we are a
    smote remote community. With your help and the help of my
    colleagues in this committee, I hope we can start affecting
    serious change and improvement for many of our veterans. One of
    whom is here today who flew 8,000 miles for some other
    business. He is back in the back row. Mr. Brad Rosala, who is
    the local Veterans of Foreign Wars of the United States (VFW)
    representative for Saipan.
        You know, with the help of the Chairman and his amazing
    team, I have been pushing to fill the only VA administrative
    role in the entire CNMI, a position that has been vacant for
    over 18 months. The administrative specialist position is a
    critical resource for our community of underserved veterans. It
    is the only person in the CNMI actually, that is responsible
    for assisting our vets by answering questions, providing
    information, giving guidance, and, you know, given your earlier
    statement about, you know, our veterans do not need to hire
    somebody or, you know, get somebody to be advocating for them.
    Right. That position has been very critical, a critical
    lifeline to getting our vets to be able to get the help they
    need. Is there any way you can provide us an update with that?
        Secretary Collins. I appreciate that and thank you for your
    work. I mean, you are in an area that is, again, remote. As you
    said, it is very difficult, but in working with you, and our
    folks have been talking about this, we recognize the vacancy in
    that position and have worked with that to make sure it was not
    affected in any hiring freeze or anything else. I am here also
    as your one who has traveled 8,000 miles that your new
    administrative specialist will be on the job June 16th of this
    year.
        Ms. King-Hinds. Oh, my gosh. That is amazing news. Very
    much welcome. You know, God forbid that you wake up a little
    late, right? A lot of times to be able to get the, for our vets
    to be able to get the service, they have to call Guam, and then
    Guam has to go through Honolulu. If you missed that time
    period, you just do not get the service at all for that day.
    Thank you, much appreciate it.
        Secretary Collins. Well, I want to thank you and the
    Chairman and the Ranking Member and all on this, who have
    actually helped through this and get this done, and I
    appreciate that work. Again, sometimes it just takes, you know,
    we got to push, and there is in just an area that is very
    difficult to find work in, but hopefully you will be able to
    have good success starting in June of this year.
        Ms. King-Hinds. Thank you very much. Just one other thing.
    In December 2023, the VA announced the establishment of a vet
    center, outstation in the CNMI, a smaller satellite office
    aimed at improving access to counseling services for veterans
    and service members. This was incredibly welcome as there is
    currently a significant lack of services available to the
    veterans in the CNMI. However, a year and a half later, the
    outstation has yet to be established. The most recent update we
    have is that the outstation is in the leasing phase with no set
    date for its opening. Can you please provide an update on the
    status of the VA's effort to open the Vet Center outstation in
    the CNMI? Specifically, at what stage is the process and when
    can we expect it to be operational? I know you have mentioned
    some challenges with procurement and leasing processes, so any
    update would be very welcome at this point.
        Secretary Collins. I wish I could go two for two here, but
    I cannot on this one. I can give you at least a little bit. 500
    is it least better than none? It is still in that lease
    process. As I said earlier, this is the part that I really wish
    we could have some change on. We have got to get this better.
    It is still in that leasing process. I want to go ahead and
    say, what are we doing to look ahead? That is that the
    readjustment counseling service is currently recruiting for
    counseling positions and expect selection and onboarding in the
    next several months, and it is dependent on available. We are
    actually already looking for folks to fill that position, and
    we will continue to look for a place to put them and, you know,
    to get your help that you need.
        Ms. King-Hinds. Alright, thank you. I yield the remainder
    of my time, Mr. Chairman. Thank you very much for your time.
        The Chairman. Thank you, Representative Ramirez.
        Ms. Ramirez. Thank you, Chairman and Ranking Member, and
    Secretary Collins it is good to meet you. As Ranking Member of
    the Oversight and Investigation Subcommittee, I made a
    commitment to honor the service of veterans in this country
    with action. That includes 20,727 veterans that live in my
    district. When I talk about veterans, I talk about all
    veterans. That includes women, that includes people of color.
    That includes first generation, low income, LGBTQ veterans and
    also deported veterans. I know we do not talk about it enough
    here, but there are veterans who have fought for this Nation,
    have now been deported. Because every veteran is entitled to
    the full benefit they earned and were promised, I want to make
    sure that we have a conversation today about where we are on
    diversity, equity, and inclusion.
        When you, Secretary Collins, and my Republican colleagues
    celebrate turning your backs on a commitment to diversity,
    equity, and inclusion at the VA, it feels like you are turning
    your back on veterans. I will tell you why I say that I do not
    believe that any administration and any secretary has the
    authority to decide which veteran is worthy of the services and
    care that they are entitled to and which is not. Secretary,
    given the VA's mission to serve every single veteran, is
    meeting veterans where they are a priority for you? Yes or no?
    Thank you. If that is the case, why has the VA paused all
    outreach efforts? Let me explain to you. We have been
    attempting to work with the VA to do outreach services with the
    veterans and meet veterans. Sometimes veterans cannot make it
    to a VA center, sometimes they cannot make it to a Veterans
    Service Organization (VSO). There is outreach, there are fares.
    We have been told that outreach services have been put on
    pause. My question has been, how has halting outreach improved
    access for veterans?
        Secretary Collins. That is not true. We have been at
    events, and I can give your office plenty of events. I was just
    in Detroit where we are doing outreach events in bus stations,
    we are doing outreach events, at sporting events, we are doing
    outreach events all over.
        Ms. Ramirez. Secretary, I am really glad you said that,
    because now I am more concerned. I am going to tell you why. On
    March 6th, I sent a letter asking about Paul's outreach
    programs on behalf of veterans in my district who were confused
    and frustrated. We invited the VA to participate in some of the
    fairs and events that we do in outreach, and they told us that
    services had been paused. Did you receive the letter that we
    sent on March 6th?
        Secretary Collins. I am sure we did.
        Ms. Ramirez. We have not heard back from your office. When
    can I expect an answer?
        Secretary Collins. You are going to expect an answer right
    now because what you have just described is malicious
    compliance, and it is not tolerated. That is not what is
    happening. For a VA employee to tell you that they could not
    come to a fair or outreach is taking what was done and said. I
    have had to already face this, so I appreciate your question. I
    am as upset about it as you are. That is malicious compliance.
    What they wanted to be able to do was say we could not do
    outreach, although they can do outreach.
        Ms. Ramirez. Well, Secretary, let me just tell you then for
    the record here in the letter that you have from March 6th. On
    Wednesday, March 5th, 2025, we received correspondence from
    Chicago community leaders of the Jesse Brown VA Medical Center
    noticed that they were temporarily pausing any comprehensive
    outreach programs, effective March 7th. I am going to make sure
    that we enter this into the record, Secretary, after you and I
    can have a conversation about it, because obviously there are
    concerns there that I know you want to address.
        Secretary Collins. Could I have a, could I get a copy of
    that letter as well?
        Ms. Ramirez. Yes, actually, we have a letter for the copy
    of the letter here. We will be sure to get it to you.
        Secretary Collins. Look, I am. This is something that
    frustrates me. Even if I had to pause and wait for this, I do
    not want you to feel like you are losing time, Mr. Chairman,
    because this one is upsetting to me, because I am having to
    deal with this a lot.
        Ms. Ramirez. That is why we bring this here. That is why
    members of.
        Secretary Collins. I am so happy you did. Thank you so much
    for bringing it, because that is exactly. Malicious compliance
    right now is hurting our veterans. If our VA employees are
    doing that, it is wrong.
        Ms. Ramirez. Thank you for saying that, Secretary, because
    outreach, making sure we are meeting veterans where they are,
    is so incredibly important, making sure that they access the
    resources they need. You and I agree, necessity to ensure that
    outreach is being done in every part of the country is
    critical. I will say to you, I find it even more critical
    because sometimes I know that there are veterans that can make
    it to certain places. Black and brown veterans are placed in
    housing at lower rates. We know that by fact. We know that
    women veterans face greater barriers to care, and we know that
    trans veterans are living authentically, still face
    discrimination inside the very system meant to serve and honor
    them.
        Secretary, just this morning I heard from diverse veterans
    who said going after diversity, equity and inclusion programs
    feels like an excuse to not to serve all veterans. You said
    earlier you are committed to our veterans, but I did not hear
    you clarify when my colleague asked you about the Office of
    Equity, how these disparities are going to be confronted and
    how you are going to make sure that disparities are addressed.
    Can you talk a little bit more about it?
        Secretary Collins. Yes, I am happy to. It does not need an
    Office of Equity Inclusion to actually make sure that veterans
    are treated properly. That is something that we have developed
    and I understand something, there are offices for you, me,
    anybody, no matter where their service is, if, if they have
    earned the service, if they have earned the benefit, they are
    going to come.
        Ms. Ramirez. Secretary, where would they go if they have
    experienced discrimination? Who should they be calling?
        Secretary Collins. The same place you would, in the same
    Office of Whistleblower Protection. They can call their
    Congressman, they can call. There is several outlets for them
    to do that. I will tell you right now, no matter what
    background they are, male, female, gender, it does not matter
    if they have earned a benefit and they have something at the VA
    that they feel like they are not getting, then you personally
    call me, and I will walk into the clinic.
        Ms. Ramirez. I am glad you say that, Secretary. I have a
    follow-up question to that. Trans veterans are veterans. They
    wore the uniform. They serve this country. Gender affirming
    care is health care. It is suicide prevention. It is dignity.
    Last time I raised this with your team, the responses were
    unsatisfactory. Mr. Secretary, gender affirming care is shown
    to reduce suicide risk and ends veteran suicide. Ending veteran
    suicide is a VA priority. Will you defend and expand access to
    gender affirming care, yes or no?
        Secretary Collins. We are going to continue those that are
    in the VA system to receive the care that they were currently,
    but we are not adding sex change in the VA. That is just not
    what we are going to do. They will get every benefit they have
    earned.
        Ms. Ramirez. Thank you, Secretary. I just have 47 seconds
    left. I am disappointed in hearing that, but I am not
    surprised. This administration and my colleagues keep
    supporting a divisive agenda for the VA that harms our
    veterans. American veterans are diverse and we do not get to
    decide who is worthy of a promise to honor their service with
    action. The reality is that in this moment, we have veterans
    who do not believe they will be able to get care under this
    administration. I want to make sure, for the record and in the
    work that we do in oversight, that when we talk about every
    single veteran, we mean every single veteran. That means gender
    affirming care as well. With that, Chairman, I yield back.
        The Chairman. Representative Barrett, you are recognized
    for 7 minutes.
        Mr. Barrett. Thank you, Mr. Chairman and Secretary, great
    to see you again. I want to start by thanking you for coming to
    Michigan last month, spending time with veterans in my
    district. We deeply appreciated that and appreciate your
    commitment to fulfilling the mission we have to every single
    one of our veterans across the country and the interest you
    took to come to Michigan. We really appreciate and appreciate
    your willingness to step up and serve in this role. I know that
    it is not always easy to step into the management role of such
    a large organization with a lot of political pressure and a lot
    of spotlight on you. Thank you for being willing to do that.
        I wanted to ask you specifically about the electronic
    health record modernization (EHRM) and the increased funding in
    the budget proposal before us and wanted to ask how this
    enhancement and funding is going to be used to ensure that we
    have a success in the electronic health record rollout, knowing
    that we have had challenges with the program in the past.
        Secretary Collins. Thank you, Congressman. I do appreciate
    the commitment, especially in your area, because of, you know,
    April next year, the four sites will be going live in Michigan.
    I think it is just a restart is what we have to sort of look at
    here. This was a system that had been broken in the sense that
    nobody was working with it. They were not. They just sort of
    went to their corner and just held the ball and money was being
    wasted all the time. What we did is restarted the system from
    minute one. One of the biggest issues that I would heard that
    was a concern not only from a perspective of patient safety,
    patient quality, dealing with these health records. It did put
    my understanding, at least looking back on some of the stuff in
    Washington State and Oregon, is that it was not working
    properly and was actually giving some bad results. That is just
    an issue there.
        Most of that came from the situation in which we did not
    standardize what we were doing. They just sort of were allowed
    to do whatever they wanted to do. One of the ways going forward
    is, is we are holding accountable on a very short timeline on
    our end to make sure that all of our employees are trained.
    Everybody is going to be up to speed, and we are expediting up
    that integration process. We are also holding Oracle
    accountable for realistic time--time limits and also bidding
    the equipment in and also adding things such as AI and others
    on top of that to help our doctors in their treatments and the
    nurses as well, practitioners going forward, which is something
    they see in the private sector right now if they just walked
    across the street and went into a private care facility.
        We believe that we are putting in the safeguards to make
    sure that going forward, this is going to be something that can
    actually work, but also giving it the tools to expand in a
    quicker fashion.
        Mr. Barrett. Thank you. I appreciate that. I chair the
    Technology Modernization Subcommittee here, and one of the
    issues we have taken up is the external provider scheduling
    (EPS) program. One thing that was clear throughout that hearing
    we had recently is that provider participation is really
    critical in making sure that EPS works for veterans and
    reducing that community care appointment wait time in the
    seamless integration there. I personally had an experience with
    the community care scheduling that was fraught with challenges
    and problems. Can you tell us what steps the VA is taking to
    encourage community care providers to participate in EPS and
    educate them about the program and not delay the implementation
    or discourage its use?
        Secretary Collins. Yes, and this is something I think that
    anybody sitting in my position right now would have this
    problem and I do not care which administration it could be
    going forward because frankly, the third-party administrating
    of this has been a problem in struggle and I am not saying
    completely their fault. I think there is a VA component to this
    as well on things that we have done to exacerbate the problem
    going forward. One of the things, and I do not think I have
    mentioned this is my second hearing, but if I have not
    mentioned it already, I want to at least emphasize this again
    is that when about the second week that I was on the job, I was
    brought, it was brought to my attention that we could not put
    out the contract Request For Information (RFI) for the third
    party administrators this year as we were supposed to because
    the work was supposed to have been. Please do not hear me just
    trying to say blame, but this is just an honest assessment.
    They did not do it last year. They basically, it was supposed
    to been done in the fall of last year in the previous
    administration. They just did not do it. The groundwork,
    legwork to work up to this was, was not done. We had to put it
    off a year.
        What has given us the ability to do now is spend time
    looking at the qualifications for these contracts. Looking at
    these things, we. I think one of the latest conversations I
    have had with some of our folks on looking at this system is
    there is going to be literally hundreds of changes to the RFI
    proposal so that we get better work with our community care
    doctors and with our VA. Just to let you know on this
    committee, if you have not understood this issue, one of the
    problems is, and some of the doctors have alluded to this, is
    that you have doctors who cannot communicate with our system
    and our system does not communicate to them. They are waiting
    weeks with, I kid you not, we are faxing information, we are
    putting it on compact disc and sending it up. This is something
    all of us could, you know, hold hands and say why are we doing
    this? This is what is been going on and that is what is
    delaying care for our veterans.
        Mr. Barrett. Yes, no, I appreciate that. It felt like there
    was a bit of a, you know, dragging of feet to get this
    integrated and to expand it. One thing I raised in committee
    that I am hopeful we can look at is if we are doing the change
    management around the electronic health record, modernization
    and upgrade and roll out to these facilities, it might be the
    appropriate time to put them onto this scheduling program at
    the same time so that we are doing that kind of comprehensively
    or with some thought there. I am not in your position to kind
    of discern that practicality or not, but I do think that we
    need to do a far better job of rolling this out in a much more
    aggressive fashion to kind of achieve the benefit of getting
    these things scheduled in a timely way for our veterans.
        Secretary Collins. I agree. It is not just the issue of
    inside of our own facilities. It is also the veteran using it
    as well. It is a twofold purpose of how we are training and how
    we are also rolling this out. I feel good about where we are
    now and anything that we can add on. I have already experienced
    to Oracle that, you know, we expect compliance, we expect this
    to go forward. Fortunately, about 3 weeks ago, the Senate
    confirmed my deputy, Paul Lawrence, to be our Deputy Secretary.
    That is statutorily under his purview, and I have turned him
    loose to do that. He is getting involved now heavily on a
    weekly basis and even a daily basis on it. Anything we can add
    will be definitely looking forward.
        Mr. Barrett. We look forward to working together through
    the subcommittee in that effort and appreciate you being here
    today. With that, Mr. Chairman, I will yield back. Thank you.
        The Chairman. Gentlemen yields back. Dr. Conaway, you are
    recognized for 5 minutes or 7 minutes. I am sorry.
        Mr. Conaway. Thank you, Mr. Chairman. Thank you, Secretary
    Collins, for being here today and answering questions. In the
    interest of time, I am going to ask you a series, series of yes
    or no questions just in the interest of time. I am very
    concerned about what this administration is doing to safety net
    programs such as the Supplemental Nutrition Assistance Program,
    otherwise called SNAP and Medicaid. The cuts to those programs
    that are proposed are, in my mind, completely unacceptable and
    will put many people at risk. Many of our veterans rely on
    these services to put food on the table and to access
    healthcare coverage. If any veteran loses their Medicaid
    coverage during this administration, would you allow those
    veterans to be eligible for VA health care under Priority Group
    6 to receive health care coverage? Yes or no? If you would.
        Secretary Collins. At this point in time, I do not foresee
    any of that happening. I would have to take it as it came and
    look at it as if it happened. If that was an understanding,
    that is not something that we have dealt with so far.
        Mr. Conaway. I will take that as a no for the moment.
        Secretary Collins. Take it any way you need to.
        Mr. Conaway. If any veteran loses their nutrition benefit
    during this administration due to changes in the law, as you
    know, there are some drastic proposals out there, in my view.
    Would you be open to directing the VA to provide cash subsidies
    for those veterans who have lost that important food security
    program?
        Secretary Collins. Veterans are exempt from the SNAP work
    requirements. They are not included in these issues.
        Mr. Conaway. Well, but if the SNAP or the work requirements
    are a separate issue on the SNAP, as you know, the SNAP program
    itself, if it is cut, that means people are not going to be
    able to get the SNAP benefit at all. My, my question is, and I
    will ask it again, would you be open to directing to replace
    that money? You have the authority to do this with cash
    subsidies to make sure that veterans are not food insecure.
        Secretary Collins. Veterans are not a part of the program.
    That is been described as what is passed.
        Mr. Conaway. Yet they are on SNAP. I will move on.
        Secretary Collins. They said they will continue to get
    their SNAP program.
        Mr. Conaway. Well, not if the program is cut by $230
    billion. Let me just move on.
        Secretary Collins. I appreciate it.
        Mr. Conaway. What do you intend to do about veterans who
    cannot--let me move on. I have significant concerns regarding
    DOGE's access to VA data. Specifically, I am worried about
    their access to sensitive personal veteran data. Secretary
    Collins, can you ensure this committee that DOGE personnel who
    have had access to VA data have not retained any copies of that
    data?
        Secretary Collins. Yes, and they follow all the personnel
    and all strategic information as any employee would at the VA.
        Mr. Conaway. Can you commit to this committee that no
    personnel, excuse me, or sensitive veteran data such as Social
    Security numbers, driver's licenses, medical records, or
    financial records have been retrieved or will be retrieved by
    DOGE after, I guess, their time in service ends and that those
    employees have not stored that data elsewhere or have used it
    for personal gain?
        Secretary Collins. There is no even resemblance of anything
    that would happen in that regard.
        Mr. Conaway. The VA is a major player in medical research
    and innovation. How many researchers have been fired or
    dismissed from the VA?
        Secretary Collins. None.
        Mr. Conaway. How many research projects and studies have
    been impacted due to the firing of researchers? We have a lot
    of reports about clinical trials being disrupted or being
    canceled or otherwise postponed or paused.
        Secretary Collins. Dr. Conaway, I am not trying to evade
    your question, but I do need to draw a distinction here. Are we
    discussing research trials or are we discussing clinical
    trials?
        Mr. Conaway. Clinical trials.
        Secretary Collins. Clinical trials. This is, there is no
    clinical trials has been halted. Now, if there have been other
    issues that may have done it, but none has been canceled. The
    research trials, I mean the clinical trials. Let me also say
    something and I want to get this out because it is important.
    There is over 1,500 clinical trials going on right now and of
    which this is not, hopefully not going to shock you. Did you
    realize that we have no centralized control over those clinical
    trials? I have no idea. No one person is overseeing those. To
    get those information and to find out what is going on, on some
    of those, we have nobody that is actually over those, but yet
    we have 1500 that are actually going on currently.
        Mr. Conaway. I suspect many of those trials, because I work
    in this area, have worked in this area, are probably being done
    through research grants from universities that are testing
    various new proposed new drugs and the like and they are being
    run there. I take your point that you might not have knowledge
    of them within the VA itself.
        Some of the information, just for the record, I would
    provide you with some of the estimates stakeholders have given
    us. Since the hiring freeze by the President and that continues
    to be in effect. 370 extramural studies and clinical trials
    will be suspended or canceled at the VA. 10,000 veterans that
    are relying on these clinical trials and studies will be denied
    care and the VA will lose $35 million in research funding due
    to delays and cancellations. During earlier today during a
    hearing at MILCON-VA Appropriations Subcommittee, you stated
    that clinical trials are not health care for veterans, that
    they are above and beyond health care. I must tell you that I
    completely disagree with that statement. If you wish to correct
    it, that is fine. Clinical trials are health care and for those
    veterans, as has been mentioned earlier by my colleague, might
    be a lifeline for a veteran who has cancer and is in a trial or
    perhaps has a neurodegenerative disease and is in a trial.
    Those potential discoveries that treatment that is given during
    a clinical trial and it is treatment because I have been an
    investigator, I know that is treatment that any pause or delay
    in cancellation of such trials is a delay in cancellation of
    treatment. Are you taking any steps to ensure that veterans who
    lost access to clinical trials will still receive the care that
    they need?
        Secretary Collins. Yes. I would appreciate the opportunity
    to clarify because my words were taken out of context and I
    think when you have to have proper context, what I said was
    because I am having to also deal with a lot doctor about people
    who are lying about what doing in all honesty. When you get to
    the point where it is I have had many people come up and say
    dealing with research or dealing with clinical trials saying
    they have lost all access to healthcare. This was their
    wording. All access to healthcare. That is just. I am with you
    on this. It is not. It is a part of healthcare, but it is not.
    They did not lose their access to their primary care physician.
    They did not lose their access to anything else. Even if it is
    true, we did not cancel any of the clinical trials. As we move
    forward on that, we are going to continue to do that because
    they have actually provided a great deal of service to not only
    our veterans, but outside that veteran organization as well.
    The same is true with that. No research trials have been
    canceled. That is one of the reasons we put the pause in that
    we did as well for that.
        Mr. Conaway. Thank you, Mr. Secretary. Thank you, Mr.
    Chairman.
        The Chairman. Representative Hamadeh, you are recognized
    for 7 minutes.
        Mr. Hamadeh. Thank you. Thank you, Mr. Chairman. Secretary
    Collins, it is good to have you here.
        Secretary Collins. I believe happy birthday.
        Mr. Hamadeh. Thank you. It is. I have turned 68 today. I am
    just doubling my age. I can fit in with my other colleagues
    over here.
        Secretary Collins. Well, that is it for me, Mr. Chairman. I
    am gone.
        Mr. Hamadeh. As we all know, the number of veterans in
    America has declined over the past two decades. Yet VA spending
    continues to skyrocket, and this trend is simply unsustainable.
    Mr. Secretary, under your leadership, the VA is finally taking
    long overdue steps to increase accountability, eliminate waste
    and refocus the department's mission of serving veterans and
    not preserving bureaucracy for bureaucracy's sake. As my
    Democrat colleagues fearmonger, the reality is more than
    300,000 jobs have been exempted from the hiring freeze. The
    focus is on eliminating the administrative fat, not doctors and
    nurses. Veterans need the VA bureaucracy to work for them, not
    the other way around. It should not have taken the VA's Chief
    Financial Officer (CFO) 2 weeks to give a simple set of basic
    budget accounting information to you. That is what we had until
    recently. With more than 60 disparate HR systems, outrageous
    tales of corruption and chronically broken veterans integrated
    services networks, we have lacked fiscal accountability for
    decades.
        Now Phoenix's Carl Hayden VA Medical Center, which is quite
    infamous, failed so many veterans that it became ground zero
    for reform efforts. I know there has been a lot of progress
    being made over there. Veterans in my district and across
    Arizona expect the VA's budget to directly support their care,
    not layers of administrators removed from the mission. I look
    forward to assisting your continued efforts to refocus the VA
    on its high-minded mission, taking care of Veterans. The Trump
    Administration's reforms aspire to accomplish this by providing
    greater oversight, less bureaucracy and a culture of nonstop
    effectiveness.
        Now, Mr. Secretary, we have heard a lot of scare tactics,
    but I want you to talk about once more. List the services and
    jobs excluded from the hiring freeze.
        Secretary Collins. Thank you for, you know, offering the
    question. One of the things is I can, I want. There is
    something you said in your, in your question that I want to
    address if I could, and I will get to that part. You talked
    about our Chief Financial Officer. I wish I had one right now.
    Right now, our Chief Financial Officer, our lead general
    counsel and our national cemeteries Undersecretary are being
    held up in the Senate. These are three veterans who have all
    served one who is going to be Sam Brown, who is going to be
    head of our mortuary affairs, our cemeteries, gave some of his
    own body to service of this country after being blown up and
    yet is right now being held hostage in the U.S. Senate by the
    same people who actually want to say we want you to hire
    veterans and not fire veterans. Well, now I just got a sense,
    and I have told the Senators this as well. It is time to stop
    that. If you want to hire veterans. I got three of them that
    need to be approved and need to get on the job working for
    veterans. When you say I have a CFO, I do not have one because
    I cannot get the Senate to approve them.
        Do not tell me they want to help veterans when they got
    three of them sitting right there, one who was grievously
    injured in wartime that they refused to approve. That is what I
    am dealing with right now. In addition to what you are saying
    and what we are looking at, we are not looking at doctors, we
    are not looking at nurses, we are not looking at this. You just
    look at the numbers in general and you have your poster there.
    I mean, we are looking at issues that I talked about earlier
    where we have payroll that is being done at 60 locations, which
    was supposed to been centralized a long time ago with hundreds
    of employees that we are now having to look to see how we can
    consolidate to make sure we are running it efficiently and more
    cost effective.
        We do not need them all over the place. We do not need the
    issues that we have of human resources being run in every
    location again with hundreds of employees. We have a system of
    a vision system which many of you may understand is was put in
    the 90's to give general oversight over our hospitals. Did you
    realize that? I talked to some folks from that timeframe when
    they actually put this in, that they were supposed to be
    minimally staffed. 10 to 20 people will be in the, look at our
    VISNs right now, our VISN structure with everything we have
    added onto it. Instead of having at number, most of them have
    full time staff between 60 and 100, but added staff of nearly
    16,000 in the VISN structure.
        These are not also some of them, by the way, someone said,
    well, they are impacting healthcare because you have some
    doctors, I have one of my VISN directors actually tell me. They
    said, yes, we have some of ours who are, quote, dual hatted.
    They do 4 hours a week in a clinic. That is not helping us with
    our veteran backlog. That is not helping with our wait times.
    It is still being done from a level that is far up. We have 200
    plus call centers in the VA. You want to talk about that one
    for a second? These are, I mean, every one of our VBOs, our
    business have one of their own call centers for their mortgage
    issue. It is like, why do we have this? This is the part that
    has just grown over time and it is not affecting healthcare. We
    are going to make it easier for a veteran to call on one of
    these lines and get to talk to somebody on the other end of the
    line. We are also going to make it to where we have people who
    are actually working in these, our clinics, working in our
    disabilities and working in our cemeteries that actually have
    firsthand touch.
        The last thing that I have to say is, you can say what you
    want about where we are at and how we got here, but in 10
    years, GAO has said, we got a problem. We have increased money,
    we have increased. By the way, before we get into it, some will
    say, well, the PACT Act was why we had the money. Okay, you are
    right. If you look at the numbers, we are basically giving some
    of the same money to the same people that were already there,
    just in a different capacity. I respect that. They have earned
    it. As I said before, I am a veteran who served under a burn
    pit for almost 5 months. I think these are the areas that we
    have got to look at. For anybody out there, giving. Again, I go
    back to the assessment where you are cutting 15 percent of
    doctors, 15 percent of nurses is frankly just not helpful to do
    what we need to do, because that is not what we are looking at.
    Frontline workers should be the happiest at the VA right now
    because we are going to be freeing them up to do their job and
    not get bogged down with paperwork.
        Mr. Hamadeh. Absolutely. I hope to see your CFO Senate
    confirmed very soon. You need that. You have a tough job right
    now ahead of you and I just want to thank you for your service
    to our Nation's veterans and I appreciate your laser focused
    outcomes over optics. Now, please know that you have my full
    support in refocusing the VA on its founding principle,
    delivering the best care for those who born the battle. With
    that, Chairman, I yield back.
        The Chairman. Thank you, Representative Budzinski, you are
    recognized for 7 minutes.
        Ms. Budzinski. Thank you, Chairman Bost. Thank you, Ranking
    Member Takano. Thank you, Mr. Secretary, for being here today.
    Appreciate your time. I do want to take a minute to just
    address the claims that you have made about the VA's
    performance has gotten worse from the previous administration
    by many measures. I want to highlight the great work of the
    VEO, the Veterans Experience Office within the VA that has been
    measuring specifically Veteran Trust Scores. They have come up
    with a Veteran Trust Score which is at an all time high at 80.4
    percent in 2024, which was an increase of 25 percent since 2016
    when we first started recording this metric. VA employees, many
    of them veterans, as you know, have been stepping up to meet
    the demands.
        You referenced the PACT Act, which was a historic expansion
    of care. Now with more staffing cuts on the horizon, these
    public servants are being asked to do more with less is my
    concern. Almost four in five VA employees are members of unions
    and collective bargaining rights give them a process to address
    their concerns in the workplace and ensure sound working
    conditions. I believe this helps both the employee and the
    veteran being served. Mr. Secretary, when you endorse President
    Trump's executive order stripping VA employees of their labor
    rights, I believe you devalue their work. Coupled with the
    threat of significant staff downsizing, I hear from
    constituents working at the VA in my district that they have
    increased fear and stress and there are deep morale issues at
    the workplace where they deeply believe in the mission of
    serving our Nation's heroes.
        Of course we agree that improvements can and should be made
    at the VA. I want to say that despite testimony, none of us on
    this committee believe that the VA is perfect. Improvements and
    changes, I really do believe need to be done in a manner that
    is thoughtful, legal and based on the input of stakeholders,
    which includes us in Congress. I am going to shift gears and
    talk about one area that you have touched on and I am really
    honored to be the ranking member on the Tech Modernization
    Subcommittee with our chairman, Mr. Barrett. I want to spend a
    little time talking about the EHRM as well, which I think is
    one area that we can all agree is a place that could use
    improvement.
        Your remarks mention an accelerated rollout of this system.
    I too really do want to see EHRM be successful and can
    acknowledge that there have definitely been stalls and not a
    lot of success seen to date. I think it is worth taking a
    minute to say, you know, talk about the program and where it
    started and then where it is today. This program actually was
    started during the first Trump Administration. In 2017, the VA
    signed a $10 billion sole source, no bid contract with Cerner,
    which some have said the GAO has mentioned that, you know,
    influenced by so called Mar-a-Lago crowd as Cerner struggled
    with the implementation. Then Oracle acquired them in 2022.
        As you know, there is a total of 170 VA sites that need to
    implement the new EHR system. Since 2020, VA has rolled out and
    I think we can acknowledge only six sites, which is not, that
    is not great. Now VA has announced plans to roll out EHRM at 13
    sites by 2026, which is, which is progress. My concern is that
    that leaves about 151 sites left. If we are accelerating that
    to 20 by 2031, how are we going to get there?
        This is going to be a major undertaking and I am just very
    concerned with the staffing levels in particular if we are not
    fully staffed, how we are going to meet this metric. In the
    midst of what I think is a massive reduction in force and then
    a bare bones IT budget, I am really worried that this is going
    to set up the VA for failure. I completely agree with you. You
    mentioned standardization. That is something we have talked
    about on our subcommittee and something we should be moving to.
    Some of the unique challenges, as you know, is that every VA
    has their own unique system and trying to get all of them to
    standardize is a challenge. I agree with you that is something
    we should be committed to looking to. One of my first questions
    for you, Secretary Collins, is to better understand how
    workforce cuts will help you achieve that. What is your target
    reduction for Office of Information and Technology (OIT)
    workforce?
        Secretary Collins. At this point in time, it is not been,
    there is no quota or anything else looking for OIT or any other
    workforce. It is looking at total picture of who we have where
    and we are going through that process right now.
        Ms. Budzinski. Have there been cuts to the OIT workforce?
        Secretary Collins. Not at this time, no. No. There has
    been. No. We let less than one half of 1 percent of employees
    that were here in January that have let them let go.
        Ms. Budzinski. Okay. There is no plan in the future to
    reduce the OIT workforce?
        Secretary Collins. I think when you overlook it, you know,
    are there areas of the OIT workforce that may or may not be
    essential to what is happening? That is. I am not going to say
    there is not, but I am also going to say that it is essential
    to us going forward as we look forward in this.
        Ms. Budzinski. Okay.
        Secretary Collins. I just, I mean, I am just, I understand
    what you are trying to say. I do not mean to be evasive in this
    and I just. You are not going to go that granular.
        Ms. Budzinski. Yes, I understand. I think some, you know, I
    complete. I hear what you are saying about the medical staff of
    the VA, but I think the OIT is a great example of those are not
    medical staff, but they are really critical to being mission
    driven into getting a program like the EHRM system really
    successfully off the ground. These are not doctors or nurses.
    These are technicians. These are tech folks. I just. That is
    why I am asking.
        Secretary Collins. No, no, it is a great question because
    you have actually opened it up a little bit because also
    neither are people who clean our rooms and neither are the
    plumbers and neither are electricians which we have all, we
    have all. We have protected. We protected them as well. They
    are part of that 300,000.
        Ms. Budzinski. Okay. I guess one of the. During your
    testimony last week before the Senate, before my Senate
    colleagues, you indicated that technologies would help VA to
    improve efficiencies in the face of work workforce cuts. It
    sounds like in one of my concerns is that we might be using
    technology to replace people, which is a concern of mine
    because I think quite frankly the VA is not, you know, we do
    not want to be installing McDonald's kiosks here. These are
    actual people we want serving our veterans person to person. I
    just want to make sure. Can you respond to that and how
    technology is potentially going to be used.
        Secretary Collins. I think technology is working how we are
    taking first time claims into the-a lot of this is in our BA
    benefit side-We can actually take things that we have seen over
    and over and over again that we can get a benefit that could
    take several months under a system we are actually getting new
    claim benefits done within literally days so that they are not
    waiting for these things. I think you use them in ways that it
    helps you do not use it. You know, technology is not going to
    solve every issue that you ever have, but it can get us more
    efficiently as far especially in ways that are more not hands
    off, but they are more of a the transaction with our like
    mortgage benefits, you know, the education benefits, things
    like that. That could work in that way.
        Ms. Budzinski. Okay, we would love to keep talking. I have
    time for maybe one more quick question. I did want to ask the
    VA Chief Information Officer, the OIT, if you that position I
    do not think has been filled. If you could respond to when you
    think that position will be filled.
        Secretary Collins. We are working on that as we speak. I
    mean, we are still interviewing some folks. It is hard to fill
    some positions and we are still working to get that filled.
    Thank you. I yield back, Mr. Chairman.
        The Chairman. The votes have been called and it is the
    intent of the Chair to go to recess for the votes we will have.
    I would like to get everybody back here as quickly as possible.
    Ten minutes after the last vote. There is only two votes and we
    will carry on. I know that many of you might have flights or
    whatever, but we will try to get through to everybody. We will
    come back, and as I said, Mr. Luttrell, you will be first one
    up when we get back. We will be in recess until the call of the
    Chair.
        [Recess]
        The Chairman. We will come back to order. We will be
    continuing with the 7-minute questions. Mr. Luttrell, you are
    up. You are recognized for 7 minutes.
        Mr. Luttrell. Thank you, Mr. Chairman. Mr. Secretary,
    welcome back. I am sure you are used to the kind of the ebb and
    flow of this place. I need to kind of lay out my question. So.
    Not--hold. Everybody. He is from Georgia. Just take notes.
    Okay, sorry. I digress. Alright, we good? Alright. Alright. We
    have 9 million veterans. We have roughly about 1.3, 1.5 plus or
    minus service members currently. Of course, recruiting is up,
    recruiting is down. The transition will inevitably happen from
    active duty to our veteran space. Now, one of the challenges
    that I often hear about, see about as a veteran myself and have
    gone through, when the veteran enters into the VA space, then
    the process starts.
        Now, as easy as that can be for some veterans or as
    painstaking a process as that can be for veterans, I will
    always say it seems to be problematic. Once the veteran
    initiates the claim, if you will, then he goes into the VSOs,
    goes in the rating system, goes up the national work queue, it
    disappears into the metaverse. Sometimes it gets lost,
    sometimes it gets found. I will not get into the national work
    queue with you today. Then we run into systematic problems
    along the way. Not for every veteran, but for veterans,
    nonetheless. I truly and honestly believe if there was a
    transitional period between leaving active duty service, where
    the service members record is buttoned up top to bottom, inside
    and out, take the veteran more or less out of the equation,
    almost all the way out of the equation in the record, however,
    that may transition from this active service to veteran
    service, and then it starts the process on its own.
        Now, I know we can do that. My question is, will you not
    have you. It is too early. Will you, will you consider, or will
    you please engage with U.S. Secretary of Defense (SECDEF),
    start these conversations? I have had this conversation with
    him. I do not know if you have or not, but everyone understands
    the problem. Everyone understands that the transition between
    the two should be seamless. For decades and decades and
    decades, we hear about this. This would be the greatest
    opportunity that we could have to catch people on the wrong
    trajectory that may be suicidal ideologies, may have a
    healthcare problem, something that we miss. When you are in
    this service and you are on the train, you are front sight
    focused, laser focused on the problem set that exists in front
    of you and that bullet train is traveling down the track, 1,000
    miles an hour, and it does not stop for us to get off.
        We jump, and everything that we jump with goes in a
    thousand different directions. Then it is our responsibility to
    try to find it somewhere in every place that we were stationed
    to put it together to give to the VA. Then the VA has that. It
    is their responsibility to help the veterans with it. We know
    how painstaking of a process that can be. My question is, will
    you, sir, please engage with the DoD and start baseline
    assessment from the time that we come in through the time that
    we transition out into time into the veteran space so our
    veterans are better taken care of.
        Secretary Collins. You know, in looking at it in oversight.
    What we are talking about right here is probably one of the
    most pertinent questions I think we have had, and I appreciate
    all the questions we have today. You have hit it something that
    is very important to me because it is the trigger mechanism
    that for many of the bad outcomes that we see, either not
    getting care, having a bad experience with care, then leaving
    the care, or not getting the benefits that they have. Just
    recently, I was at McDill Air Force Base, and we had their
    medical side there, the Air Force medical side, and we had our
    veteran benefits office personnel there, some of their senior
    leadership. I asked the question just because we were talking
    about how this was transitioning out. They said, I asked our
    benefits coordinator, I said, how many of you get people coming
    in who have no experience or no knowledge of what their
    benefits are? To almost to a person, they said, most everybody.
        I have already started that conversation with SECDEF. In
    fact, we started it before either one of us were confirmed.
    Here is the bigger issue that we got to deal with TAPS. This is
    our transition assistance program. It is. I say this in a
    generic form, so any reporter here, please listen to what I am
    saying. TAPS is owned by DoD, in which they do not really have
    a good plan, because the way it is positioned, as you well
    know, you know, to give 12 months, 18 months, however you
    transition out. It goes through this contract, not deporting
    them, but this is just their issue. DoD owns TAPS and I am
    blamed for it.
        I think this is the part that we have got to look at as we
    go forward. There is got to be a more seamless transition for
    that, and we have already started. I think you are going to see
    something pretty soon about that. I just wanted to let you know
    that Secretary of Defense and I have talked about it. The last
    part on that is that question that I think no matter what we
    do, one of my priorities is going to be is those that have
    issues coming out having warm handoffs basically straight into
    VHA, especially those who are having issues with mental health
    issues, TBI, PTS, and those kind of things, because.
        Mr. Luttrell. DoD has absolute authority to gather all that
    information and share that with the VA. Just the complexities
    of the global threat currently that is developing, our
    generation is coming into the VA, our older generation, we are
    losing them. If, worst case scenario, if we have to go all in
    again. The wave is just going to. I need the VA to be ready.
        Secretary Collins. Yes, exactly. That is also one of the
    emphasis of the President as well, is that fourth mission of
    the VA, which is our disaster and natural response. Also our.
    We are the actual backstop. There is not a--without going into
    classified information, which we would never do here. The VA is
    always a part of any national contingency that would come up in
    any, any type of scenario that we have. We have got to be ready
    for that, make sure our workforce is developed.
        I want to real quick enough, if I could. One of the issues
    that bothers me most about our transition part right now is
    statistics show us that a shorter time of service, a three to 6
    year or three to 7 year time of service is a drastically higher
    propensity for death by suicide from not just when they get
    out, not just three or 4 years later, but upwards of 40 years
    later, they are seeing statistics to say that shorter
    timeframe. That is why transition is so important. Correct.
        Mr. Luttrell. There is no difference with somebody that
    served 6 months to somebody who served 60 years, period. Thank
    you. I yield, sir.
        The Chairman. Mr. Kennedy, you are recognized for 11
    minutes.
        Mr. Kennedy. Thank you.
        The Chairman. 7 minutes.
        Mr. Kennedy. Thank you, Mr. Chairman. I will take whatever
    I can get here.
        The Chairman. Seven.
        Mr. Kennedy. Secretary Collins, first of all, thank you for
    being here today. Thank you for your service to our country. I
    represent the Buffalo Niagara region in New York, home of the
    western New York VA system, including the Buffalo VA Medical
    Center and one of the Nation's two GI Bill processing centers.
    During my time in office, I have had the privilege of meeting
    with many VA employees, often veterans themselves, who take
    immense pride in continuing their service to support their
    fellow veterans. Unfortunately, in these meetings, VA staff at
    every level have raised serious concerns, including plummeting
    morale and an increased stress due to the threat of sudden
    firings and what they feel is a climate of fear, PTSD and
    mental health strains stemming from constant job insecurity,
    the rollback of collective bargaining rights and attempts to
    strip employees of their voice, rigid and poorly thought out,
    return to office mandates without adequate infrastructure or
    workspace to carry out mission critical duties, and worsening
    understaffing, which is leaving teams stretched even thinner
    than they were to begin with.
        That list does not stop there. Those are just a few. The
    issues demand urgent attention from you and your team, Mr.
    Secretary. Your testimony claims improvements to veterans'
    care, yet you are eliminating positions essential to handling
    the increased PACT Act cases, cutting these roles removed
    skilled, experienced staff who directly assist our veterans.
    Outside consultants and political appointees obviously cannot
    do this work. Neither can AI. VA employees in my district work
    tirelessly to deliver care and benefits. They are not faceless
    bureaucrats. They are honoring our promise to our veterans.
    Your testimony states that VA aims to place employees where
    they are needed, reduce unnecessary overhead and strategically
    cut staff. Now, I have asked this question repeatedly of this
    administration. Still have not received a clear answer. How do
    you plan to reduce staff without affecting care? Who exactly
    are you planning to let go? What are their roles? What
    qualifies as unnecessary overhead and what safeguards are in
    place to ensure that these cuts do not further strain an
    already short-staffed system or reduce access to vital services
    for our veterans?
        Secretary Collins. Congressman, I appreciate the
    thoughtfulness of the question and the overall expansiveness of
    it. Let me just answer in the best way possible. As I have said
    before and I have made several comments already on concerning
    consolidation, we have seen areas of work that being payroll in
    our HR systems, those kind of things. The people that you are
    speaking to actually handle disability claims, who actually
    move forward. These processes are not the people that are
    involved. We have exempted 300,000 plus positions to make sure
    that those are actually the positions we need that we are going
    to keep and that we are hiring. Right now, in any one time we
    look at this and going forward, and there is been something
    that is been said a couple of times and I want to address it
    here. There is no, especially going forward in our look at our
    reorganization process, there is no such thing as a sudden
    firing because this is a process that is going through and as
    we get to the level of where we are able to say here is what
    our structure looks like, here is how we are trying to look at
    this and here is how we are going to be maybe rolling this out.
    There is going to be the notice to the employees. There is
    going to be notice as we go forward in this.
        It is not an issue of sudden firings. I would hope that
    that would get through to especially our employees who are on
    front lines. Again, they are not part of what we are looking
    at, especially in the duplicative services in looking at this.
    I do have one other question if you do not mind for your
    second. I appreciate the question. I want to be able to answer
    it. The adequate office space----
        Mr. Kennedy. You got to move quick. I have more. Please.
        Secretary Collins. No, I will. One last thing. Adequate
    office space issue. Anybody that is brought back from our work
    processes that are not in spaces that fulfill their duty, the
    supervisor in that position is not fulfilling the role because
    it stated clearly that no one is being brought back into a
    position in which they are not able to do their job. If that is
    happening, then we will hold supervisors accountable and make
    sure that is happening. They are not going to be able to. I
    hope that answers.
        Mr. Kennedy. The consolidation of space. I will just say
    when it comes especially to dealing with our veterans and
    mental health services, when you are in confined spaces and you
    have practitioners that are providing those services oftentimes
    via a virtual space, that is a problem when they are in a
    consolidated space. These veterans are not feeling comfortable
    sharing privileged, confidential, very personal information.
    That is something that has to be dealt with.
        I want to also go back because look, we have heard from so
    many different veterans that are concerned. I want to just
    clarify. You know, in the first week of this administration
    there were cuts. There was 1,000 cuts at first, then another
    1,400. Then there was your memo talking about going back to
    pre-pandemic 2019 levels. I know you have discussed this was
    just a goal. 83,000 people would be cut. That is all concerning
    all pre-PACT Act as well when those people were hired
    specifically to deal with our veterans that have had these
    horrific injuries fighting for our country. I think there needs
    to be a consistent message. I am very concerned. I know our
    veterans are worried, they are fearful and those that are
    employees as well.
        Mr. Secretary, you talk about over in the Senate those
    service-disabled veterans that are waiting to be approved by
    the Senate. There are service-disabled veterans that have
    served this country and are serving in in the hospitals and the
    VA system today that are getting cut and are losing their jobs
    because of this administration that is not treating them with
    the dignity and the respect that they have earned and they
    deserve. You visited multiple VA facilities, Mr. Secretary, and
    spoken with non-healthcare staff like VBA employees,
    electricians, maintenance workers.
        I know we discussed this earlier today. I think we agree
    these roles face similar challenges across the country. Why did
    the Milwaukee VA preserve these collective bargaining rights
    for nurses and facility workers while employees in the Buffalo
    VA and Buffalo VA VBA lost theirs even though their job
    functions are identical? I will just say that the clear
    difference to me is that there is union affiliation and it is
    seems like retaliation. The Buffalo VA employees are
    represented by three different unions that have filed lawsuits.
    Can you please elaborate and discuss how these determinations
    were made?
        Secretary Collins. I think from that perspective I will be
    very simple here because it is going through a process right
    now of legal issues. Well, as they were made following the EO
    from the President to go forward on this and we are following
    that and of course are going through any of the issues that are
    currently in under litigation.
        The Chairman. Mr. Ciscomani.
        Mr. Ciscomani. Thank you, Mr. Chairman. Thank you,
    Secretary Collins, for being here. I first want to thank you
    for your visit to Arizona and Tucson just a few weeks ago. I
    think we had a great time there. You got to see what the VA is
    all about there and their needs and the things that we can work
    together on. Thank you for spending the time to visit our
    districts. I know that is mine is not the first one that you
    have done that with. I think you have a very hard job ahead of
    you with, with a lot of cleanup to do. Plethora of issues that
    I think we have heard about from both sides here. You are
    getting to them as fast as you can. At the same time
    dismantling a lot of the misinformation and lies that are
    coming out regarding the VA and what, what your efforts are and
    the President's as well. Thank you for all that you do there.
        Now I want to focus on the issue of veteran suicide. You
    and I have talked about this. I know that is a passion of
    yours. During our meeting in March and then again your visit
    last in April, we discussed the Arizona Be Connected program
    that I mentioned, which serves my veterans with their mental
    health needs and works diligently to forward the goals of the
    VA suicide prevention strategy. That was cut under the previous
    administration. I was and still am looking forward to working
    with you to find a solution to ensure our veterans, and
    particularly the ones in Arizona who benefit from this program,
    who have told me they personally rely on it for their mental
    health needs, continue to receive the assistance. Now,
    unfortunately, we do not have full clarity on the status and
    the future of the program.
        Now I know that this is an important issue to you. It is
    your passion as well. We did receive some information last
    night from the department in terms of some of our questions and
    the answers that you provided there, but still no real clarity
    there. I want to talk a little bit on that. Just before I give
    it back to you so you can talk about that, I want to make sure
    that we all understand, especially the Department, you and your
    team, that we are not talking about frivolous partnerships
    here. This is a program that specifically serves veterans and
    their families, that specializes in mental health and in
    suicide prevention for the veterans. Because of the VA scandals
    a decade ago that resulted in the creation of this program,
    veteran suicide rates in Arizona were 3, 3 to 4 times the
    national average with 260 deaths estimated in 2024 alone. This
    is a huge issue for Arizona, even more than in other states.
        When I was told that the previous administration was
    canceling funding for suicide prevention services without
    communication or justification, what I hear is that I
    potentially have thousands of constituents in the highest
    caliber and need being left without care and without the
    support that we were promised. I know you agree that veteran
    suicide is absolutely the last issue that should experience
    delays in communication and care. Can we commit together to
    work on this and maybe getting more clarity on the specific
    future of the program?
        Secretary Collins. Yes, and I think that is the, in the Be
    Connected program, Non-Service Connected (NSC), what we are
    wanting to do, and I think we talked about this before, is
    making sure the programs that we are going through have key
    deliverables, things that actually can be measured so that we
    can get this done. I am committed to working with you and I
    know we sent the response back to you. We are going to continue
    to work to make these programs such as Be Connected, have the
    measurables that we can make sure that we are getting the
    results that you have expressed how those are working. I
    appreciate that we also have to look at it as an overview
    program, how we are reaching out. It may be something as we put
    more emphasis on and more accountability on, that we can expand
    as we go forward.
        Mr. Ciscomani. Yes, I remember you mentioning how much
    money was being spent on suicide prevention and the results
    overall of that investment were not yielding the results that
    they should based on the amount that is being there. This one
    is a public partnership, public-private partnership. It is
    yielding results. We love to provide, you know, again, the
    information on this because it is something that I think can
    serve as an example not only to keep promoting it in Arizona
    because our veterans are calling for it, because it has worked,
    but maybe even the model for other states as well. I would,
    that is really my top priority in terms of comments this
    morning. I mean this, what are we afternoon, evening, what
    time?
        Secretary Collins. I am not sure. I am not sure.
        Mr. Ciscomani. Yes, evening, almost. Thank you for being
    here that long. That, that I am really passionate about that
    because again, Arizona is getting hit at a higher rate with
    this. I know this is your passion as well. I hope we can, we
    can get even more clarity on answers and then even the last
    letter we got last night. Let me just move on to a quick one as
    well. I was proud to see some of the recent changes that were
    made on the Officers of Survivors' Assistance that I have been
    advocating for since last Congress, such as moving Office of
    Survivors Assistance (OSA) within the Office of the Secretary
    to be direct advising body. Can you speak to the impacts your
    reforms for survival survivors will have?
        Secretary Collins. Yes, I think that is. I appreciate your
    H.R. 1228 on the Prioritizing Act. We just went ahead and
    basically moved it. Look forward to you moving the legislation
    through. We went ahead and moved that back to the Secretary's
    office. These are ways that we can make these things go
    quicker. They can go be more compassionately handled in others.
    I make the statement as someone who has been a pastor and also
    been a chaplain now for many years in the military. One of the
    biggest things is how we handle these issues of death and end
    of life and how we go from there. I have sort of described it
    this way as you have a medical examiner's perspective and you
    have a funeral home director's perspective. I do not mean to, I
    am not making light of this, but it is really true. You have
    the more clinical aspect of a medical examiner says, you know,
    your loved one is deceased, they are no longer here, and they
    just sort of leave it at that. A funeral home director takes
    that same situation and says, how can I help you and how can I
    get you through this time, which is so difficult for you and
    your family?
        What my goal here is bringing this in as sort of the, the
    white glove survivor outreach item is to make sure that we are
    giving them the due concern that they have in a time of
    trouble, in a time of need, but also doing it in a way that
    conforms to the law and conforms to the benefits that have
    earned. Bringing it back into the office, setting this
    structure up actually gives them the ability to feel needed,
    feel wanted and feel heard, even if the answers that they may
    get are not what they expected. We are making it here where it
    is less what I think is less clinical and more compassionate.
        Mr. Ciscomani. Excellent. Love to hear that. Again, thank
    you for all that you are doing for our veterans. It has been a
    little over 100 days and I think that we are seeing this move
    in a very sharp, great direction. Keep up the good work and
    again, I look forward to working with you specifically on the
    suicide preventionsite on the Be Connected program in Arizona.
    We will talk more about that. Thank you so much, Chairman. I
    yield back with 28 seconds left.
        The Chairman. Thank you, Dr. Morrison.
        Ms. Morrison. Thank you, Mr. Chair. Mr. Secretary, welcome.
    I want to begin by thanking you both for your military service,
    for your service in this role as Secretary, and for being here
    to testify today. Before I begin, I just want to preface my
    questions by sharing with you that my husband is an army combat
    veteran and I care deeply about our Nation's veterans, as I
    know you do. While we belong to different political parties, I
    want you to know that I genuinely want you to succeed in this
    role because that is what is in our veterans' best interest.
        Now, I know you had the opportunity to visit the
    Minneapolis VA earlier this week. I hope you enjoyed your time
    there. We are incredibly proud of our VA, which as you know, is
    a Centers for Medicare and Medicaid Services (CMS) rated five-
    star hospital, one of only two such hospitals in the greater
    Twin Cities metro area. I believe that Minneapolis VA can be a
    model for the whole system. I have to be honest with you, Mr.
    Secretary. The conversations I have had with veterans in my
    district and caregivers at our VA have me concerned about its
    direction under this administration's leadership. I know there
    is been a lot of talk today about Reduction In Force (RIF)
    efforts at VA, and I apologize if this feels redundant, but I
    just think it is so important. I know you do not want to talk
    specifics, but consistent with your testimony, can you commit
    to us that any reduction in force at VA will not threaten
    veterans' care and benefits?
        Secretary Collins. Yes, that has been my goal all of the
    long and can I also say this? Minneapolis is great and is a
    really an example and for just and I do not mean to say this,
    but one of the reasons we have it is we have some longevity of
    leadership there. That is something that is I am looking across
    our hospitals and others. We have up and down leadership.
    Leadership is so important there. I appreciate what is
    happening. Leadership, after we had our conversation, was very
    frank. They said before hearing we were concerned, and now
    hearing it straight from me and hearing what we are trying to
    do, I think it gave them a renewed sense of purpose.
        Ms. Morrison. I am really glad to hear that. So. I know
    this has been asked, but I have to repeat it. Can you commit
    that no doctors or nurses will be fired as any part of the RIF?
        Secretary Collins. We are not going to fire any. We are not
    going to be riffing anybody that is actually taking care of
    employees. Not employees, but anybody that is taking care of
    our profession in direct care.
        Ms. Morrison. Okay. Patient support employees. Sir, can you
    commit to us that no housekeepers or environmental health
    technicians?
        Secretary Collins. No, they are all part of the. In fact,
    they are already exempt.
        Ms. Morrison. They are pest control and laundry workers.
        Secretary Collins. They are part of the 300,000 that we
    have already exempted.
        Ms. Morrison. I am very relieved to hear that. You know, my
    point really is that, you know, I am a physician, and after
    more than 20 years of practicing medicine, I can tell you that
    it is very much a team sport. The whole team plays a role in
    patient care, the physicians and nurses, of course, but the
    support staff is incredibly important as well. These people are
    mission critical to the delivery of care, and firing them would
    affect veteran care. These are people who help ensure their
    operating rooms are sterile, the patient's bed sheets are
    clean, the medicine and equipment are delivered in a timely
    fashion. You have mentioned that you want clinicians returning
    to the bedside to provide care. Obviously, if we fire the
    support staff, then the clinicians are going to have to fill in
    those roles. I am relieved to hear that they will not be
    impacted.
        I think we will want to hold you to that because I am
    concerned that there is a crisis of morale right now at VA. I
    was actually really shocked when I spoke with some frontline VA
    workers at our Minneapolis VA just the other day. I was pretty
    shocked when they said. Two of them said, I question whether
    the secretary actually cares about veterans. I was really
    devastated to hear that, Mr. Secretary, and I would assume that
    you would be, too, because despite our political differences, I
    genuinely believe that every person in this room cares about
    serving our veterans, including and especially you.
        You know what it means to be put on the uniform and serve
    our country, Mr. Secretary. I have immense respect for that. I
    have to say it is troubling to me that VA providers caring for
    my constituents feel this way. These are your employees, Mr.
    Secretary. These are the people we trust to care for our
    veterans. They are scared right now. If we continue to go down
    this road of firings and what they feel like is intimidation,
    we are going to lose good people and it is going to be veterans
    that pay the price. I know neither one of us wants that. My
    question for you is, what are you going to do to improve morale
    at VA?
        Secretary Collins. Well, first and foremost, being here.
    Being in every interview that I have. I have spent 100 days in
    which we have tried. We have been, instead of working many
    times on issues that we have found, looking at how we can
    improve and do this, I have been fighting rumor and innuendo.
    This is the problem that I have from day one. There are reasons
    that people are scared, and it is not coming from my office, is
    coming from folks who actually talk about the things that I
    have talked about earlier. When we have reports saying you are
    going to fire 15 percent of the doctors at Minneapolis, that is
    just a lie.
        Ms. Morrison. Well, but Mr. Secretary, respectfully, that
    15 percent, 83,000 number came from your people.
        Secretary Collins. It did come from my people, but it has
    no context to actually firing frontline employees of which I
    have talked about. Here is the deal. I have said it many times,
    I repeat it every time, that healthcare providers who provide
    that frontline care, even the ones that you mentioned earlier,
    are not included in this. Yet every time I turn around, there
    is another article or there is another someone in the community
    or a Member of Congress or otherwise, they are saying these
    radical cuts, these radical things. I am having to sit here and
    fight about this the whole time when I have actually said it.
    My question is, why is the voices of those who say this is
    going to hurt being processed and amplified when the very one
    from the Secretary of VA who is sitting right before you is
    saying, this is the process that we are going through?
        Ms. Morrison. Mr. Secretary, we would welcome you to this
    committee anytime. Please brief us, give us some transparency
    so that we can reassure VA employees. I do want to ask one
    other question. The VA center for Women Veterans sent out an
    email blast just last night that said it was embarking on an
    ambitious goal to enroll 1 million new women veterans in VA. I
    think that is commendable. We have discussed today that women
    veterans are the largest growing group of veterans and of
    course support the effort to bring more women veterans into VA.
    Could you share a little bit more about your strategy for doing
    so. Surely a significant increase in demand will require more
    clinical staff and space, will not it? What is VA's plan for
    reaching this milestone that you have set?
        Secretary Collins. One I think the milestone is great. I am
    glad you recognize that we are looking at that. Encouraging.
    Again, it is, this is hard to overcome at this point. I mean,
    because without going through the process here of where we are
    actually looking at cuts and putting people back in places
    where they need to be in which we could actually increase
    capacity in some of our clinics and some of our hospitals,
    which will not affect and actually would welcome these going
    forward. I think that is the fundamental issue that we are
    dealing with here, is there is an understanding of what we are
    trying to do and how that is actually playing out.
        Ms. Morrison. Mr. Secretary, I hope you will come back to
    our committee and testify about all of these issues. We would
    love to know what your process is. Thank you so much for being
    here. Mr. Chair, yield back.
        The Chairman. Representative Kiggans.
        Ms. Kiggans. Mr. Secretary, it is great to see you. Thank
    you so much for being with us. A special thank you for coming
    down to Hampton Roads, home to a lot of Navy veterans, a lot of
    military veterans. I really appreciate your time, not just
    visiting my district, but so many. You have been doing such an
    amazing job and, and you are starting to sound like a broken
    record, which I guess is good. Over and over again about how we
    are not cutting staff and how you are looking out for
    physicians and nurses and allied health partners. I think that
    is important just to repeat that, and we will try to repeat
    that as well on your behalf.
        I know that one of the VA's statutory missions is training
    for health professionals, and that includes nurses. We have a
    nursing shortage right now across the board, not just in the
    VA, but on the civilian sector. I am thankful for the VA's
    investment in educational opportunities, including residency
    programs and clinical opportunities. You have 68 nurse
    residency or clinical programs, including 34 primary care
    slots, 26 mental health slots, and you have expanded that to
    eight geriatric and extended care slots. As a geriatric nurse
    practitioner, I am certainly thankful for that. I think that we
    have a lot of older veterans, and I know that with aging of
    America, just in general, we need to be focused more on
    providing geriatric specific health care. Thank you for
    recognizing that.
        I wanted to offer some comments on behalf of what I
    consider to be an underutilized resource. It is no secret that
    sometimes physicians sometimes feel encroached upon when we
    integrate advanced practice nurses, but their superb care
    cannot be overlooked. I think we have talked about that even a
    little bit today. Just to present some evidence-based research,
    I know that patient safety outcomes are identical regardless of
    whether for example, anesthesia is provided by a physician or a
    Certified Registered Nurse Anesthetist (CRNA). There is no
    secret that we have a shortage of anesthesiologists. We have
    nurse anesthetists who are available and there is a lot of
    debate about integrating them into VA healthcare. CRNAs are
    often the sole anesthesia provider in rural hospitals, ensuring
    safe obstetric outcomes. Then we have got 31 facilities in the
    last VA Office of Inspector General (OIG) report that cited a
    severe shortage of physicians and anesthesiologists, including
    my Hampton VA Medical Center. The Trump Administration has
    consistently supported the removal of barriers for CRNAs and
    other advanced practice Registered Nurses (RNs).
        During the pandemic, the administration went even further,
    suspending Medicare supervision requirement for CRNAs to allow
    them to practice to the full training, their full training to
    provide critical care when the Nation needed it the most. At
    the same time, the VHA put out a memo calling for facilities to
    remove restrictions on CRNAs. These recommendations are all
    supported by the National Academies of Sciences, Engineering
    and Medicine. Calls to remove restrictions on CRNAs are well
    supported by data. I am just a little bit, I would love some
    clarification on what your plans are as the new VA secretary to
    integrate advanced practice nurses especially we have this lack
    of anesthesiologists. We have a group of people that can
    provide that care. Just would love to hear from you what your
    plans for integration are.
        Secretary Collins. Thank you Councilwoman, I appreciate it.
    I have enjoyed working with you and also working with, you
    know, opening facilities. I think it was really interesting
    that one of the issues that we had to deal with early on was in
    actually your district in which there was a discussion about
    opening a facility and was said because of hiring freezes and
    everything else, it was not opening as it should. The reality
    was it was opening just as all the others have opened and that
    is with a gradual rollout. I appreciate your work there. We are
    looking at our scope of practice issues on many fronts. This
    was a project that was began a lot before me a couple of
    secretaries ago. We are still continuing to look at that as you
    have heard even today on this, there is a lot of disagreement,
    especially when it comes to certain areas. We are trying to
    find what is the best balance, not only for VA, but also for
    our employees as well. We are still looking at that issue and
    we will be getting more input as we go forward.
        Ms. Kiggans. We would love to work with you on that. As one
    of two nurse practitioners here in Congress, we fill critical
    health care shortages and gaps where I think our care is
    valued. I know that the VA is always on the forefront of
    wanting to provide the best patient care. Just please do not
    overlook advanced practice nurses and the role that we play.
        Then just to say, switch gears from healthcare a little
    bit. I know we have talked a lot about healthcare and VA
    medical centers, but there is a lot of other veteran benefits
    that you will oversee now, including GI Bill benefits and even
    healthcare. VA home loans, you know what exactly veterans are
    entitled to. I know as a veteran with a veteran family, it has
    been frustrating sometimes to actually access my benefits and
    to understand what that looks like. You and I spoke at a
    roundtable briefly just about what that online component looks
    like. For example, MIL Connect does not talk to the VA website,
    and I feel like there is some technology challenges there. It
    creates a lot of frustration on the part of veterans. When I
    share with my veteran friends, how hard is it for you to access
    your GI Bill benefits or to transfer those to your children?
    All of us share the same level of frustration.
        With our VA budget that we have, can we or do you have any
    plans to dedicate a portion of that into upgrading this
    probably outdated technology? I think that investment of trying
    to make it a little more user friendly, that website piece, so
    veterans can log on in one place, can see their benefits, can
    understand how to transfer their GI Bill benefits to their
    kids, what even that paper trail looks like. I got a 15-page
    letter about my, you know, my son's, it was my husband's GI
    Bill benefit, but transferred to my son and that I could not
    really decipher. That was frustrating to me, and I am sure I am
    not alone. Just would love to hear your plans about that
    technology upgrade and if you could add that to your list of
    things to do to maybe make that website just a little more user
    friendly.
        Secretary Collins. Yes, we are looking at every opportunity
    we can to streamline our online access, online portals, to make
    it easier to understand. It goes back to something in your
    comment just now reminded me that when I actually was able to
    access my benefit, I used it for my transferred it to my kids
    was I did not even know it existed. This, it came to me when I
    was at home base 1 day and I had another officer, we were just
    talking about it in general and he said, well, you know that
    you can use that money. I said, what are you talking about?
    Okay, this just shows you that there is an understanding that
    needs to happen even more as we go forward.
        Yes, anything we can do in that realm, we are going to
    continue to do. It is about putting, this is probably as clear
    as I can say, it is about putting that veteran first and saying
    how can we make that happen for all of our veterans and make it
    easier. I said this earlier this morning. I will say it again
    and I may have partially said it here. When the VA, when a
    veteran has to call any one of Your offices and 60 percent of
    your caseload is VA caseload, when they have to call your
    office, it is a fail. It is a mission fail for us, it is a
    mission fail for VA. It should not be this hard to get benefits
    that are already earned, no matter what the bureaucracy says or
    anything else.
        Ms. Kiggans. Thank you for that. All those benefits are
    important health care, but even the education benefits, et
    cetera, et cetera. Thank you for prioritizing that as well. I
    appreciate your time. I yield back.
        The Chairman. Dr. Dexter.
        Ms. Dexter. Thank you, Mr. Chair. Secretary Collins, thank
    you for joining us and thank you for your endurance. Like many
    physicians, I was trained in VA facilities and proudly cared
    for veterans at the Denver VA for 7 years. As a critical care
    physician for nearly 20 years, I have cared for far too many
    families grappling with post suicide attempt repercussions.
    They are looking for answers, support and hope. I know you know
    and you have expressed your support for our veterans in dealing
    with the fact that they are amongst the most vulnerable people
    in our communities. Risk for suicide is very high amongst our
    veteran population, and it sounds from your multiple comments
    today that this is a top priority for you and you have stated
    that multiple times. I just want to verify that we are in that
    together.
        Secretary Collins. We are definitely in that together and
    thank you for your word there. One of the things, if I could
    just interject here, most people do not realize it is not just
    75 percent, it is closer to 80 or 90 percent on 60 some baby
    docs who all come through the VA. What I would love to have and
    have your help and the other doctors help. How can we keep
    them? Some of that is actually, by the way, if you want a bill
    recommendation that you might want to carry, let us raise the
    caps. Yes, get my caps raised so I can actually hire doctors at
    a rate that is better than what we got right now.
        Ms. Dexter. Love to work with you on that. Former Inspector
    General Michael Missal was dedicated in his work to end
    veterans suicide as well. Under his leadership, the Inspector
    General's office issued, and I just brought a few report after
    report after report laying out steps to better protect veterans
    who are at risk for suicide. If we are committed to expanding
    with every effort, every dollar to prevent veteran suicide, you
    would think our administration would have wanted to keep him
    around. Instead, he was fired by President Trump along with at
    least 16 other Inspectors General against across the Federal
    Government, just days after his taking office. Secretary
    Collins, why did President Trump fire Inspector General Missal?
        Secretary Collins. I have no idea. You would have to ask
    him.
        Ms. Dexter. Okay. Since Missal's firing, we have been
    without a permanent inspector general to hold your department
    accountable. It is, as you know from oversight, it is an
    important role. You, Secretary of Collins, have taken actions
    that have inadvertently put veterans at risk with the firing of
    24 direct support line veteran crisis line support staff. I
    know it was not the direct answerers of the calls. I know you
    have rehired those VA workers, but can you tell me, did you
    approve those initial firings?
        Secretary Collins. The probationary firings were approved
    in my office. I mean, that is what we went forward, is
    following the directions that we were given.
        Ms. Dexter. Okay.
        Secretary Collins. Also, frankly, the way it also the
    trigger mechanisms for those that needed to be exempted.
    Actually, the crisis line showed that they actually worked
    because once notified and that that got caught up, it was
    actually put back in place.
        Ms. Dexter. Yes. No. Their hiring back is important,
    clearly. I think that true to what Congresswoman Morrison was
    talking to, there is a lack of trust right now in the VA and a
    fear that many of us are hearing about. Nearly 4 months now
    after that firing, the President has now nominated a
    replacement, Cheryl Mason and Secretary Collins, Ms. Mason is a
    current political appointee at the VA who reports directly to
    you, is that correct?
        Secretary Collins. Yes.
        Ms. Dexter. What concerns me, Mr. Secretary, is that we
    have reason to believe that Ms. Mason helped transition
    President Trump into office and has played a role in cutting
    VA's workforce, blocking staff from contacting agency
    attorneys. As my colleague Ms. Brownley pointed out earlier,
    suggesting or forcing that VA staff sign on to non-disclosure
    agreements. When considering her track record, it is clear that
    there is a conflict of interest here. She has been part of
    executing the Trump agenda and now theoretically will hold that
    same administration accountable in an oversight role. Secretary
    Collins, veterans and their families deserve leaders who put
    them first, especially when stakes of life and death are at
    play. Do you agree that we must have someone who can be seen as
    impartial and without conflict in this role of Inspector
    General?
        Secretary Collins. I think the President has nominated
    someone who will actually do that, who has actually worked
    through two administrations. She actually worked under the
    Biden Administration in the VA. She has worked inside the
    system for many, many years. If you look at her total work
    experience and how she goes about it, I think she will be a
    great candidate for that.
        Ms. Dexter. Without question, she is a good candidate. I
    think the concern for me is her role with the administration
    and also as a political appointee serving the people that she
    actually is going to be appointed to oversee. Regardless of
    whether or not she can do that without partisanship or favor,
    the potential conflicts exist or at least people the premise or
    the suggestion of conflict exists. For the record, our shared
    commitment to advancing an inspector general who can fulfill
    their statutory obligation to be independent and objective in
    executing their duties is something that we share. Is that
    true?
        Secretary Collins. Yes. I believe the President's choice,
    Ms. Mason is, will fulfill that.
        Ms. Dexter. Okay, great. I also appreciate that members of
    this committee know from direct outreach, including what we
    just heard again from Dr. Morrison, that VA employees have
    concerns about the culture of the VA and have shared that there
    is a fear of retaliation for people who speak out. Members of
    this committee have also experienced a lack of responsiveness
    when asking to visit a local VA, which is really quite
    unprecedented. Mr. Secretary, how are you going to rebuild
    trust in the VA for the employees as well as the veterans that
    you serve?
        Secretary Collins. Continuing Congresswoman, exactly what I
    am trying to do right now is I look, I have freely come up and
    talked about issues that are hard and also say just judge what
    is actually happening and not what is being talked about. This
    has been the issue that I have had to deal with from the day
    one that I got in was actually dealing with many times not
    accurate information.
        Now we can disagree about how some of this is to go about
    and there may be some things that we could do differently. Also
    having to deal with just the blatant disregard for reporter and
    other backlog actually hurts the problem. For me, it is just
    having to go forward and tell the truth as I have it, as we are
    actually working it and work to just rebuild that visit by
    visit by visit that I go to. What is interesting though, and I
    was not joking with Dr. Morrison as well, is in Minneapolis and
    in other places as well. Once I am there and able to talk to
    our hospital staff, talk to our senior leaders, leadership and
    see them, they are actually understanding what my heart is. I
    just got to do this one at a time and with every member here.
        Ms. Dexter. I appreciate that. I certainly appreciate that
    showing up is what builds trust and clearly you are doing that
    in good honor and spirit. I appreciate that. We will be
    watching. We certainly are looking for our veterans to be
    served to the best of our ability as a Nation. I hear your
    commitment, and we look forward to further conversations. Thank
    you, Mr. Secretary
        The Chairman. Congressman Self.
        Mr. Self. Thank you, Mr. Chairman, and thank you, Mr.
    Secretary, for spending so much time with us. First of all, I
    have a--I want to thank you personally for, for deciding that
    chaplains would be able to minister in the conscience of their
    particular dogma in the Coatesville, Pennsylvania VA clinic.
    You personally made that decision that they will be able to do
    that across the VA, and I appreciate that very much.
        I am glad that you are refocusing the VA from an employment
    agency and a mortgage company back to veterans. I will tell you
    that we are used to in this committee, the VA coming to us and
    telling us what inputs they have put, what they have done, what
    they have spent, but very little results, very little outcomes.
    It is been a breath of fresh air today for you to tell us what
    you are actually achieving. I know that you have responded to
    what we call the lies of the left multiple times today. They
    have used the word fear, they use the word lack of trust, and
    you have responded every time to it. You have also had to tell
    us what the laws is because we have heard it seems to be an
    issue that my colleagues across the aisle have it hard to
    understand that there are laws of this land that you are going
    to obey as you provide for our veterans. The complexity of the
    VA is not worthy of a yes or no answer in most cases, and I
    applaud you for working through that with them.
        The only question I have for you, and take as much time as
    you would like, is you have answered several questions on the
    electronic health records, but we have been told that it was
    going to be 50 billion versus the 9 billion that we have
    already spent. Can you just share with us the plans going ahead
    and take whatever time you would like Mr. Secretary.
        Secretary Collins. I appreciate that. I wish I could go
    into the entire because we are now looking at out years of a
    contract that should have been finished in 28 as it was
    originally done and that is frankly not going to happen. I do
    not think anybody on this committee would take issue with that.
    What we are looking at is finishing up the contract under the
    terms we have now and we are actually actively renegotiating
    and trying to get more out of Oracle and others from their side
    to see how we can do it. Actually so far they have stepped up
    and agreed to many things as we go forward. Yes, there will be
    a time as we look forward in how to implement this past that 28
    timeframe as we go forward. I am not at a position right now to
    say what those numbers would be, but they will be something
    that we will share with the Committee as we go forward.
        I really wish we was not here at this point. This is an
    issue that it could have been handled a lot differently. I
    cannot comment. There was, I know, some discussion that we had
    earlier, which I respected on the history of this program. I
    had no involvement in that. It may have gotten started bad, but
    I have been given the task of finishing it. I have been, I have
    been given the task of taking the mess and cleaning the stall.
    That is what we are going to do. I appreciate the work. Again,
    what was really also very disturbing to me, Congressman, is,
    and this probably emphasized more than anything what I am
    facing as we try to make change at the VA. That is what I have
    always known, is that we have always done it this way before
    syndrome, and I have seen it across the board. They come in and
    when I ask questions, I feel like that I am have basically
    reverted back to childhood. I ask why about everything because
    when I see stuff come in like why do we do this? Why is this
    happening? Why is this person not held accountable? Finally I
    think our folks are getting to realize that I am not just going
    to accept the answer that, you know, this is what we need to
    do.
        We have had issues ranging from West LA. We have had issues
    ranging from, you know, how we deal with our community care,
    how we actually put in processes to make sure that our
    survivors are actually getting the care that they need. All
    this may not seem like the health records management system,
    but it is combined. When I came into this, we had a VA who was
    basically, and I remember my first meeting on this, and I am
    trying to be as transparent as I can be here. Like I said, I
    just want you to know that when I first sat down with our
    people, it was basically, we cannot move forward. We are not in
    a position, and we are not going to make changes, and it is,
    you know, everything is bad. I said, well, that is not a
    workable position. It is not workable for this committee. It is
    not workable for the President. It is not working for anybody.
    We are wasting billions of dollars here on a program that is
    not helping our veterans, and also right now is actually
    hurtful in some ways in the original rollout.
        It took getting over that hump. I am very pleased to say
    that after the initial meetings, our staff and Dr. Evans, who I
    cannot speak well enough about because he took on the mantle
    and he had been sort of, unfortunately, having to ride this
    through the storms, if you would, many times when nobody would
    listen, and he was having trouble trying to get it through. He
    actually has taken that on. I do appreciate his willingness to
    sort of redirect the team to say, how can we now get this to
    happen? Your question sort of overlaps everything we have tried
    to do at the VA is to say, look, let us take a fresh look at
    what we are doing and fresh look at how we are doing it and why
    we are doing it. Some things may change, other things may not
    change.
        Years ago, an older gentleman who was in the church that I
    used to pastor made a comment. He said, Preacher, he said, I do
    not want you to change. He said, we are making some changes. He
    said, just always remember, he said, I will support you and we
    will change. He said, but before you move a fence, know why it
    was put up? I thought to myself at the time, I was not sure
    about what he meant by that. Then it made sense, is, you know,
    sometimes you do not know what is on the other side of the
    fence. We have tried to do that all along. This EHRM process is
    something that, why did we not get to where we are? Why was it
    at and what. We are now knowing why the fence was put up, and
    we are moving the fence to get it really where it needs to go.
    It is an endemic not just to this, but to other things as well.
        Mr. Self. Thank you for that, Mr. Secretary. Mr. Chairman.
    I yield back.
        The Chairman. Representative Mace.
        Ms. Mace. Thank you, Mr. Chairman. I would thank the
    Ranking Member and Secretary Collins. Welcome. I look forward
    to working with you as we refocus the VA on what is always
    meant to do serve veterans and not push social experiments. For
    the past 4 years, veterans took a back seat to identity
    politics, gender ideology, DEI dogma. Every dollar wasted on
    the woke agenda was a dollar stolen from real care for real
    heroes. President Trump has given you a clear mandate in the
    circus, restore the mission. Let us talk biological reality,
    something the last administration ignored. President Trump has
    made it clear there are two sexes, male and female. They are
    assigned at birth, they cannot be changed and taxpayers should
    not foot the bill for surgical or chemical mutilation. How is
    the VA implementing President Trump's directives to restore
    biological reality and end taxpayer funded sex changes?
        Secretary Collins. By doing exactly what the EOs call for.
    We are no longer doing that. We stopped care. If they were
    currently in hormonal treatment, which is or they are coming
    off of it for from DoD, they are going to continue that because
    there is some health issues associated with that. That is now
    being taken care of. We are not starting and we are also not
    getting into sex change operations. Those are just not
    something that is the VA is going to be doing.
        Ms. Mace. Yes, what we do, what these people do to
    themselves or doctors is it is crazy and it harms them
    physically and mentally. What steps has the VA taken to
    redirect money previously spent on gender ideology back toward
    actual letter and care?
        Secretary Collins. Well, I think where we are redirecting
    money back is to our, you know, paralyzed veterans, amputees,
    moving the moneys to where it can be best spent. Again, I think
    that is the overall function of everything that we do is making
    sure that our healthcare system has is just my priorities is
    making sure our veterans have the benefits that they have
    earned.
        Ms. Mace. DEI is out, equal opportunity is in, equity
    politics and racial discrimination disguises virtue and virtue
    signaling have no place in the VA. How many DEI related
    contracts has the VA canceled and what was the price tag on
    those savings?
        Secretary Collins. There were a number of contracts and the
    total value we saw on those contracts was about $6.1 million.
        Ms. Mace. How has that freed up resources to be reallocated
    to improve veteran care?
        Secretary Collins. As we said, it went back toward
    allocation toward community care and prosthetics as we were
    looking for.
        Ms. Mace. As an animal lover, I applaud the VA for ending
    painful, unnecessary area experiments on dogs and cats. This is
    a bold step under President Trump. Congress has since required
    the VA to phaseout primate testing by 2026. What is the current
    status on phasing out animal testing, particularly on primates?
        Secretary Collins. We are on track to make sure that that
    directive is met. In fact, in some instances, we may be even
    able to meet that goal sooner.
        Ms. Mace. Is the VA exploring any innovative non animal
    research methods to replace outdated and inhumane testing on
    animals?
        Secretary Collins. Yes, we are always looking for ways to
    do, to make the research as valuable to those that need it.
    Also, the again, we are in an area in which prosthetics and
    that kind of information with amputees is something very
    central to the VA. It is something we are looking at.
        Ms. Mace. Then what can other agencies learn from the VA's
    leadership in ending these cruel and obsolete animal
    experiments, do you think?
        Secretary Collins. Well, I think, you know, judging from
    the reaction to Congress also, what the President has also
    stated and laid out, I think is just following the rules as we
    go forward here.
        Ms. Mace. Thanks to your leadership and President Trump's
    direction, the VA is finally being restored to its rightful
    purpose, delivering world class care to those who serve their
    country. I look forward to continuing this mission with you. We
    wish you a lot of luck and many blessings to get the job done
    and we believe in you. I yield back. Mr. Chairman. Thank you.
        The Chairman. Representative Deluzio.
        Mr. Deluzio. Thank you, Mr. Chairman. Secretary, long day.
    Good to see you here.
        Secretary Collins. Good to see you as well.
        Mr. Deluzio. Want to talk about clinical trials and some of
    the reporting on the impacts of whether it is hiring freeze,
    contract terminations, firings, or some combination of those
    things. Two Pittsburgh clinical trials, according to reports,
    had not started as of May 6th. These were to treat veterans
    with advanced head and neck cancers. Have either of those
    resumed or started?
        Secretary Collins. Well, one, they never started before,
    and they are starting now because we are now actually reaching
    out to veterans to be a part of this trial. Those were not,
    they had not been started before any at this point. You cannot
    stop anything that had not started.
        Mr. Deluzio. They have started since May 6th.
        Secretary Collins. They started in the last little bit.
    They are getting ready right now. They are recruiting veterans
    this month.
        Mr. Deluzio. Okay, so both of those have started. When were
    they originally planned to start, because the reporting here is
    that these were delayed or stalled because of some combination
    of firings, contract terminations, probationary impairments.
        Secretary Collins. Yes, not that we are aware of. I think
    the interesting thing is here is before any of these other
    things got involved is they had not recruited patients for
    these trials.
        Mr. Deluzio. Just to be clear, when were these supposed to
    start? Do you know?
        Secretary Collins. I would assume they have been around
    before the hiring freeze. It was supposed to start probably
    earlier. I would have to get a direct date on that. I am not
    going to try and guess.
        Mr. Deluzio. I would appreciate a response on that.
        Secretary Collins. Okay, no problem.
        Mr. Deluzio. There are others that were identified in some
    of this reporting, specifically at VA Pittsburgh. I think seven
    in total, including those two that I have asked about that the
    impact again of whether it was firings, contract terminations,
    on and on were that they stopped enrollment in several of these
    clinical trials, and these were to treat veterans suffering
    from advanced lung cancer, kidney transplantation,
    cardiovascular disease and others. The reporting here is that
    the planned enrollment was 500, but as of again this reporting
    in May, only 75 veterans had been enrolled. Have that, has that
    enrollment now continued and are additional veterans being
    enrolled?
        Secretary Collins. No clinical trials have been stopped. We
    have been no cancellations from our decision on clinical
    trials. Those are still going on. Any issues in those clinical
    trials will be specific to that issue. One of the things is to,
    Representative, and I think to understand here we have over
    1500 clinical trials going on in the country through the VA, of
    which there is no centralized management of that from the VA.
    Getting sometimes information about our clinical trials has
    been difficult when we started asking these questions because
    the VA, as much as we do these clinical trials are working on
    them. We have no management of those and how they are started
    and where they go forward.
        Mr. Deluzio. Secretary so you said they had not been
    stopped, which is a little different than what I asked you,
    though what I asked you was whether enrollment had been paused.
    That is the reporting that 75 folks, 75 of my fellow veterans
    have been enrolled rather than the planned 500. Again, the
    reporting is that enrollment was stalled during this period of
    firings, hiring freeze, contract terminations. Is that true?
        Secretary Collins. They have not started, as far as I know.
    They are still recruiting people for those trials.
        Mr. Deluzio. I understand that, but was the recruitment of
    enrollment stalled during this period?
        Secretary Collins. Not that I am aware of.
        Mr. Deluzio. Okay. I would like to know if you could find
    that out for us.
        Secretary Collins. I will find out.
        Mr. Deluzio. Because my concern, as you can imagine, is
    whether it is those first two clinical trials on head and neck
    cancer being delayed to start or these other at least five that
    I am aware from reporting being stalled. Some veterans may not
    have gotten an access to that kind of care in these clinical
    trials, some of those veterans may have gotten sicker. God
    forbid somebody may have died. We should know whether any of
    those things happened. I do not want to guess. I do not want to
    put you in the spot to guess, but we should know that.
        Secretary Collins. I appreciate the concern there. Also
    remember one of the things that I want to make very clear here
    is we have talked about this a little bit in going forward. The
    clinical trials are used to assess new treatments and new ways
    to going about it. These veterans were not, and I say this
    simply not because of what you said and I will be frank with
    you, but what I have heard from others and they saying these,
    that they were kept away from all health care, that is just not
    true. They were still getting the health care through the
    Pittsburgh. The clinical trials that had not been started,
    especially in the head and neck cancer had not started. I think
    that is. There is two distinctions here we have. I am willing
    to work with you to look at whatever.
        Mr. Deluzio. Great. I would love to know for each of those
    trials and as you say, you are still getting healthcare. It
    might be that that clinical trial could be a life-or-death
    outcome. It might not be. I think it is important that someone
    is got a chance who is in a horrible situation. Advanced head
    or neck cancer.
        Secretary Collins. Yes, I would hope that also.
    Congressman, I would love to work with anyone on this committee
    also as we go forward how we can actually streamline this is
    something I am looking at now as we have gotten into these
    conversations more and more on clinical trials that we actually
    need to have in my opinion a better sort of command and control
    system so that we know where these are going on and if there
    are any issues that we can help with as we go forward. As you
    said, some may have gotten help but also some may not have
    worked. Are we making sure that that information is available
    across the system wide so that we know this actually worked,
    but this did not. We do not have that information.
        Mr. Deluzio. Look, and we all know this, the research VA
    does has led to some really groundbreaking interventions and
    treatments for veterans. We have to continue that. I want to
    spend the last minute and a half or so about morale. I have and
    my team have heard from physicians and other folks who work at
    the VA have heard from veterans. There is been plenty of
    reporting and discussion here today about mental health care in
    particular and some of the reports of impacts on the return to
    work and clinicians being placed in an environment where they
    cannot have a confidential discussion with patients. I have
    talked to physicians myself and heard some of those concerns. I
    will throw out an example of someone being put in a room where
    there is another VA employee that would betray confidentiality
    with a patient seeking mental health care, asking for
    headphones or a headset to be able to have some confidentiality
    being told, no. Should that happen? If not, what are you doing
    to fix that?
        Secretary Collins. No, it should not happen. I think one of
    the things is to remember is all of VA centers are secure
    facilities and they should not be put back in. If they are
    coming back into work, it would go against. I said, I made this
    statement earlier, if they are being brought back in an
    environment in which they were not supposed to be, then that is
    a failure of the leadership to bring them back in because it is
    also a direct violation of the policy of bringing people back
    to work. This is not something that we have looked at and many
    times we have asked for incidences when it is been reported and
    then gotten back to it, and it worked.
        Let me just be very clear. If they are coming, if there is
    an issue, we would love to hear about that. Also, also, it is a
    direct violation of the policy coming back to work to not be in
    an environment in which they are not supposed to be in. If we
    have a supervisor who is doing that.
        Mr. Deluzio. In the 10 seconds I have left, Secretary, if
    someone is raising those concerns, I would love a commitment
    from you that they will not face any consequence for voicing
    objection.
        Secretary Collins. No. I think that we need to know, and I
    think this is what we have proven, and there is been areas in
    which there were some concerns and we have actually made
    exceptions to say no. The telework continue off with premise
    can do.
        Mr. Deluzio. Mr. Chairman. I yield back.
        The Chairman. Thank you, Ranking Member.
        Mr. Takano. Thank you, Mr. Chairman. Thank you, Mr.
    Secretary for being here today, Mr. Secretary, you have
    testified that, quote, no one has discussed firing doctors or
    firing nurses, end quote. No one has discussed this. That the
    15 percent figure floating around is just a goal, not a
    directive. Then I need you to explain this spreadsheet that I
    have behind me. We are handing you a copy of this spreadsheet.
    It was circulated by your own Reorganization Implementation
    cell. It asks VA staff to calculate the savings from a 15
    percent cut to every VHA position, including frontline clinical
    roles and it says cutting nearly 4,000 nurses, for example,
    would save a billion dollars. Cutting 400 psychologists another
    $110 million. The list goes on. Health aides, pharmacists,
    housekeepers, et cetera. Now, if your testimony is true that no
    one is looking at plans to cut these jobs, why did your team
    ask for this analysis?
        Secretary Collins. Ranking Member, looking at this right
    here, this is exactly why we are here. This is a leaked pre-
    decisional document that is not helpful. It is not working
    because here is the end of the day--no, no, I am going to
    answer this
        Mr. Takano. No claiming my time. Mr. Secretary, it is my
    time.
        Secretary Collins. Well, it is my answer.
        Mr. Takano. You have said publicly that no one has
    discussed that would be interpreted. No one has discussed this
    at all. We have a document, whether leaked or not, that
    establishes that these cuts are being discussed.
        Secretary Collins. I said that I have made clear we will
    not be cutting frontline health care.
        Mr. Takano. Your subordinates are discussing this. They
    must have gotten the directions from somebody.
        Secretary Collins. They did. Well, I have been very public.
    It is just like your staff if they talk about something you do
    not know about.
        Mr. Takano. You understand why there is a lack of
    credibility from the public on this sort of.
        Secretary Collins. There is a lack of credibility.
        Mr. Takano. This is not speculation, Mr. Secretary. It is a
    VA document. We have asked your head of HR, Mark Engelbaum for
    answers. We have actually asked your subordinates about this.
    He promised a follow up and we never got it. I am asking you
    now on the record, why did your team request this analysis and
    what are you preparing for?
        Secretary Collins. Well, if I have to explain this in a way
    that makes sense, let me just say this, if you----
        Mr. Takano. Do not talk down to me, sir, I am just asking
    you a question.
        Secretary Collins. I am just answering your question. If
    you let me answer it, I will answer it.
        Mr. Takano. Please. Time is ticking.
        Secretary Collins. This right here is an overlook of our
    entire organization. To see what they did here is fine.
    Whatever they are looking at is fine. When it comes to the
    Secretary of VA, which is me, and the direction that we have
    given to make sure that health care is prioritized, to make
    sure that our veterans are getting the desire that they need.
    When I have told you that when we are talking about this and
    exempted 300,000 positions, that is what happens at the VA. Can
    they have other conversations that involve other things?
    Possibly. Coming from me, it is not.
        Mr. Takano. Okay. Well, thank you. Let us move on. I would
    like to point out that you have set a goal of 83,000 VA
    employees. I know it is not a fact. It is a goal. I just want
    to make sure we go over this and we have some agreement without
    cutting clinical staff. There simply are not 80,000, 83,000
    employees elsewhere in the department. If you look at this
    chart over here, you have already cited these numbers yourself.
    If we add up all the VBA, NCA, and all the other positions, it
    hardly adds up to 83,000. You are going to have to cut deeply
    out of the VHA column there.
        You know, there is just simply no way that that can be done
    without that. I would also like to move on and say it is also
    our understanding that on the VA Human Resources SharePoint
    there is a document that lists every employee hired since 2019
    with their name and occupation. Will you get that document to
    us in digital form?
        Secretary Collins. I am not familiar with the document you
    are talking about.
        Mr. Takano. If it does exist, I mean, we know it exists,
    would you get it to us? It just.
        Secretary Collins. I do not know what you are talking
    about. Also, if I can answer your other question.
        Mr. Takano. Okay, no, I would like to move on to that. I
    would like to move on to the Deferred Resignation Program
    (DRP). There is been a lot of confusion about the Deferred
    Resignation Program.
        Secretary Collins. Okay.
        Mr. Takano. It is my understanding that you have made
    employees who are in positions that provide direct care exempt
    from this program unless there is an additional review by VA
    leadership. How many employees who directly provide care or
    support or support the provision of direct care have submitted
    requests for DRP, early retirement or retirement?
        Secretary Collins. The last number I had on that was about
    2,500. About 2,500 of which all of them will be probably, all
    of them are going to be denied.
        Mr. Takano. You are going to deny them. You are telling me
    today that you are going to deny all of the clinicians who
    applied for DRP?
        Secretary Collins. That is what we are looking to do. I
    will say this. As we look at this, one of the issues of DRP is
    making sure that employees who want to be here are not. We are
    not looking to get rid of any clinicians. We are not looking to
    get anybody. In fact, we are taking.
        Mr. Takano. That is fine. I got it. 2500 clinicians have
    applied for DRP. You are going to deny those.
        Secretary Collins. We are denying clinicians. That is been
    done.
        Mr. Takano. Have you thought about why frontline staff are
    requesting DRP in the first place? To me, it is an indictment
    of your leadership that valuable clinicians that are hard to
    recruit, hard to onboard, that that staff who loved serving
    veterans now want to leave.
        Secretary Collins. Well, have you looked at actually the
    ones who may want to leave and how close they are to retirement
    to start with? Have you actually looked at where they may be? I
    have not looked at those, but we are going to keep them in the
    system. Your question may sound like it is ominous, but also
    you have not answered the other questions. Who are these people
    actually are.
        Mr. Takano. Okay, well, so fine, let us move on. Mr.
    Secretary, are medical center directors exempt from the hire
    and freeze? Medical center directors?
        Secretary Collins. Yes.
        Mr. Takano. They are? So to be.
        Secretary Collins. They are part of the clinician side.
    Yes.
        Mr. Takano. Okay, well, to be clear, the list you have
    provided to Congress does not include medical center directors
    as exempt positions. That is not.
        Secretary Collins. It is been updated.
        Mr. Takano. Now it is. Now, according to a report that VA
    just submitted to Congress last week, there are 12 medical
    center director vacancies, eight of which cannot be hired due
    to the freeze. The chart behind me shows a page from the report
    with those vacancies listed and the status, which is that
    quote, recruitment is on hold due to hiring freeze, end quote.
        Secretary Collins. We are working to fill all those. When
    we find those, we are working to get them hired. Those are many
    of those were actually predecessor to me.
        Mr. Takano. All right, well, this document shows that they
    are not. They are empty because of a freeze. You will commit to
    exempting medical center directors from the hiring freeze and
    prioritize finding leaders for those facilities as soon as
    possible.
        Secretary Collins. Already have.
        Mr. Takano. Wonderful. Well, Mr. Secretary, I just want to
    know, can we get a RIF plan before you execute it and not
    execute it for 30 days so that the public veterans in Congress
    can examine it before it is put into force? 83,000 is a lot of
    people to cut.
        Secretary Collins. We are going to provide everything we
    are supposed to under RIF to make sure you have every
    notification you have.
        Mr. Takano. Well, that is not the same as providing us with
    the draft plan so that we all can discuss it together. That is
    83,000 is a huge change.
        Secretary Collins. Again, I was not able to answer your
    question because you did not allow me to discuss the 83,000.
        Mr. Takano. I will take that as non-responsive.
        Secretary Collins. I will take yours as not wanting the
    answer
        Mr. Takano. I yield back.
        The Chairman. The gentleman yields back. One thing I have
    discovered about today is that normally the Ranking Member and
    myself, we ask our questions first. What has happened is I
    think we have questioned you to the point that I think we got a
    lot of answers of what my questions were going to be. Maybe I
    am going to ask you this. What is something that has not been
    asked that you feel is vitally important to put on the record?
        Secretary Collins. Mr. Chairman, I think it is not what
    necessarily has been asked, but I think it is from the
    perspective of how it was asked. This is the fight that I, that
    you and I have spoken about and I have spoken to many. We just
    got through with it. Please hear me. To everyone here, I
    consider the Ranking Member a friend. We came in, we vehemently
    disagree on this. I think the problem we have here is something
    that I refuse to talk about in a setting like this or where we
    actually have living proof of pre-decisional documents being
    leaked at the, basically even against section. You know, the,
    the law of Atlanta. These are not supposed to be leaked. We see
    this. If they want to go to Inspector General, whistleblower,
    those are all there for them. This is the exact reason I was
    asked earlier about NDAs. Okay.
        Now what is happening as you sit here and we put up forms,
    we are continuing to fester this idea that there is no way we
    can do what needs to be done without hurting veteran
    healthcare. I refuse to accept that because one thing that was
    not accepted and I was not, you know, able to continue. There
    are 409 positions in VHA. When we look at that and you look at
    some of the areas that we have in VHA, which also includes call
    centers, which also includes staffing issues, they also include
    procurement, they also include HR. They also include, include
    processing of payroll, which these hospitals were not supposed
    to be doing. By the way, those numbers add up to significant
    amounts.
        What was not said just a minute ago is that just last year
    the Biden VA in the VHA in their own internal documents stated
    that they could get rid of 28,000 people. This is the Biden VA
    6 months ago. Have not heard that. 28,000. Now, if you go by
    the numbers that I have been told today, oh, you cannot do that
    without hurting healthcare. Then we are saying Biden's going to
    hurt. The Biden administration will not hurt healthcare. No, I
    think they actually looked at the same numbers we did, Mr.
    Chairman, and determined that of the frontline healthcare,
    frontline disability workers and all, there is a lot of
    interest in looking at are we being as efficient as we should
    be. I believe that as we look at this, you are going to find
    those answers. That is why we have to do this in a very
    methodical way.
        Everybody wants to run forward and say, here, give me your
    plan, because you know what? Then they want to go out and say,
    you are going to cut here, you are going to cut here. They are
    going to put fear in my employees, and they are going to put
    fear in my veterans. That is wrong. It is wrong. You see no
    other industry in this country who are making decisions about
    their workforce, who do it in a way that we are talking about
    being told here. We are doing it in a methodical way, using
    career employees who have been there forever. We are actually
    looking at-actually using consultants. We are actually using
    our political folks to get this into the record to say, here is
    how we look at this, looking at the examples of private
    industry and knowing that we are not private industry. We are a
    veteran's organization that gets to treat the best people in
    the world, and that is our veterans. We only have one mission,
    the veteran. Over time, we have gotten away from that.
        When you look at these numbers, I have a question for
    anybody that wants to look at this. Why do we have a middle
    management if you order a structure system that keeps our
    clinicians out from seeing patients and then saying that if we
    look at anything of a doctor or nurse who is not seeing
    patients, that we are going to affect healthcare if for some
    reason they was not around or if they quit on their own? I
    think what we are saying here is there is a large understanding
    gap that unfortunately has become political. I could go along
    almost every member except the new ones, because there is a lot
    of new on this committee, Mr. Chairman. I can go from Ranking
    Member to you to everybody else and find quotes on the Senate
    side as well. VA needs reform. VA needs efficiencies. VA needs
    cost cutting. VA needs all these things, both Democrat and
    Republican. Then all of a sudden you have somebody like myself
    who is just. I say this in knowing that somebody will use it
    against me. I am just a simple country lawyer from North
    Georgia who simply says, maybe we actually ought to look at
    this and maybe we actually ought to ask the questions on why we
    have this and why do the VSOs and why do others always seem to
    have issues that they want to get fixed at the VA? All we do is
    continually to perpetuate the problem.
        I am not willing to do that anymore. We can disagree. The
    President told me to do one thing and that is take care of our
    veterans. Yet in this timeframe, which was not brought up and
    we are going to bring it up even again by the Biden
    Administration, they changed the wait time issue to make it
    more transparent so that we. In fact, I got this last week when
    I said the primary care days. Let me just repeat this, it is
    worth repeating. Primary care rose from 15.7 to 24.3. Mental
    health rose from 14.7 to 20.4. 24 days for specialty care rose
    to 38. The backlog, by the way, interestingly enough in 2019
    before the COVID was under 60,000 on the backlog. Of course, it
    went up during COVID because we could not get our appointments.
    It is still at 260,000. When I came in, in less than 100 days,
    we have actually brought that down 21 percent to 200,000 and it
    is heading south now.
        I was actually accused the other day of, well, you are
    using flawed numbers, and the VA wait times flawed because the
    VA changed the way it does its wait times. Here is the problem.
    It was changed under the Biden Administration to better reflect
    calculations because the data reinforced above did not reflect
    the adjusted change. It plainly shows that the wait times
    increased because here is what you need to hear. Wait time
    clocks started only after a veteran was contacted by a
    scheduler for appointment under the prior administration. In
    other words, we did not even start the clock till we reached
    out to them. The veteran may be looking to get their help, but
    they did not get it. The new method, which was again done under
    the previous administration and adjusted through every number
    beforehand so there is no apples to oranges here. This came
    from Dr. Lieberman, who is our top doctor by the way, at the
    VHA.
        The method is now calculated on when the schedulers are
    called to reduce so that we actually make a queer time. As we
    look at this, Mr. Chairman, I appreciate you allowing me the
    time. I appreciate the Ranking Member, I appreciate all the
    Committee wanting to do good work. What I cannot have is
    spending another hundred days as we go forward here because as
    Dr. Morrison and many others say, yes there is from people who
    have morale issues because they are having to sit here and
    listen through wrong answers out of that yield.
        Mr. Takano. Yes, I do. Thank you, Mr. Secretary. You know
    you are opining about a so-called leaked document. It is
    obvious. It is obvious. We are not mushrooms, we are going to
    hear stuff. We are going to hear stuff from employees who are
    alarmed about the huge, massive changes that are occurring.
    That document. We do not get answers to our questions. When we
    do not, when there is no transparency, we are going to rely on
    whistleblowers telling us the truth. Look, private industry,
    sir, would not have fired 2,400 employees and then hired back
    1,000. That was indiscriminate firing. Indiscriminate firing of
    probationary employees. A memo went out signed by Tracy Theriot
    that said they were being fired because of their performance. I
    questioned her, and she could not really cop to the fact that
    they were fired because of their performance.
        I am not even sure really that you personally authorized
    all of that or whether it was someone from the Office of
    Personnel Management (OPM). She, in fact, said that, that that
    memo was actually not, even though she signed it, was actually
    not written by her, but was written by OPM, which does not seem
    like it came from the Secretary's office. That, sir, was
    entered into evidence, into a Federal court. That judge did
    indeed rule that they had to be restored. Those probationary
    employees. That 28,000 employee cut that you were talking about
    from the Biden Administration, the VHA, you know, is related,
    not, not due to necessity, but because of a, a shortfall in the
    budget. There was a huge shift and acceleration of expense in
    the community care, the community care account.
        We need to have some space for some straight talk here. We
    are not getting it here. Mr. Secretary, I must say I was
    pleased to hear you say that you want to make the disability
    claims process easier to veterans. I was listening carefully to
    your response. I personally do not want to see claim sharks
    legitimized. I am not saying you are taking a side on that
    gentleman's bill, but I think we have some meat of the mind
    here. We do need to. Maybe we need to talk about some
    presumptives that would make the process easier and more
    veterans would get through that red tape. I am all for cutting
    that bureaucratic red tape. We share that goal. We do need to
    make it simpler for veterans to get care and benefits. There
    are two really good ways to do that.
        One is to increase the number of presumptive illnesses, and
    the other is to automatically enroll transitioning service
    members into VA health care, as my legislation in the Ensuring
    Veterans' Smooth Transition (EVEST) act does. I look forward to
    your considering supporting that bill and to VA increasing the
    number of presumptions of Service connections. I also think it
    is possible for us to work together and help veterans and
    ensure that VA is a world class institution. I cannot emphasize
    enough that VA's unresponsiveness to my questions and letters
    is not acceptable. VA's recent habit of canceling long standing
    briefings at the last minute is also not acceptable. VA's
    refusal to provide briefing materials to staff is not
    acceptable. We cannot have a productive relationship if we do
    not have the information we need for our Constitutional
    oversight responsibilities.
        Now, when you told Ranking Member Ramirez that canceling
    outreach was not your intended policy, I take you at face
    value. I expect that our follow-up questions about this
    outreach problem will receive responses with the same candor
    and attention. This research issue is, this outreach issue is
    not limited to just one district or facility. Now you blame the
    issue on quote unquote, malicious compliance. Sir, the buck
    does stop with you. I know that is a phrase that you embrace.
    If policy is not being implemented correctly, then I say it is
    on you. If veterans and employees are scared and feel like they
    have to overcomply with a policy that is on you, that should
    cause you to re examine the policy as well, not just black the
    staff. If you truly want to lead VA, accountability is where
    leadership begins. You cannot expect your employees to be
    accountable if you will not be yourself.
        Now another thing I just want to say is I have gotten
    concerns from my colleagues about this directive that any
    Member of Congress wanting to visit their VA facility has to
    get it cleared through your Chief of Staff. They are having to
    take that very literally. They are taking it very literally
    based on all that we are seeing coming out of your first 100
    days or so in office, that cannot stand. Members of Congress
    need to be able to visit their facilities, talk to their
    medical center directors and be able to see what is going on.
    My job as an elected official and the Ranking Member of this
    Committee is to represent the interest of veterans. We cannot
    answer questions from veterans or get them information if we
    cannot get answers from VA. We cannot represent veteran
    interests if we do not have the full picture of how their
    interests will be affected. That is why veterans are scared.
        Now let me be clear. Veterans are not scared because I or
    any other Member of Congress asks a question. They are scared
    because you have made massive changes with no plan, no details,
    no accountability and no transparency. You have truly, if you
    truly believe it is, quote unquote, fearmongering to ask a
    question then you should ask yourself why you, Mr. Secretary,
    fear answering our questions?
        Now, I am proud of the employees who have bravely shared
    their stories with us. We are relying on the courage of
    whistleblowers now more than ever. I am grateful to the
    veterans who have shared their concerns and I will continue to
    fight to ensure that their worries are heard and addressed.
    Now, Mr. Secretary, if you want to accuse VA employees of,
    quote, unquote, malicious compliance, I say you need to examine
    your role in creating a culture where VA employees feel like
    your directives to require them to implement policies that harm
    veterans. Reconsider the cruelty in your treatment of minority
    veterans. Reconsider your termination of collective bargaining
    rights for the hard working public servants. Reconsider your
    role in ending critical programs like VASP because veterans
    will now lose their homes to foreclosure unless you put a
    moratorium on those foreclosures until we can ramp up the
    partial claims legislation.
        Reconsider your pause of clinical trials leaving sick
    veterans without the lifeline of hope. Reconsider how you will
    have, how you have indiscriminately fired employees only to
    hire them back again. Mr. Secretary, I truly hope that you will
    go back to the central office today and chart a plan to course
    correct. That plan should include complete and truthful answers
    to all of the questions you were unable to answer today and a
    path to true partnership with both sides of this committee.
    With that, I yield back.
        The Chairman. Thank you, Ranking Member, for yielding back.
    I want to actually thank the Secretary for being here and
    joining us today and answering every question that was put
    before him. I want to say that, you know, we do stand for our
    veterans here and we all talk how we want to stand for our
    veterans and that we respect our veterans. Some of us in this
    room understand that quite often you do not get the birds on
    your shoulder unless you know how to be a leader. I appreciate
    you for both jobs that you are doing, especially when people
    that question it have never even had a stripe on theirs.
        I do want to thank you, and I appreciate the responses and
    your leadership during this transition. While this budget
    request shows real progress, I remain concerned that the VA is
    still working through the consequences of poor budget decisions
    made under the Biden Administration. The alleged shortfall last
    year was not the result of inadequate funding. It was the
    result of poor internal controls and a lack of transparency
    around how VA managed its accounts. Congress has always
    provided VA with the resources it needs, and we will continue
    to do so. We need to understand that the money is being used,
    where the money is being used, and we need to be able to
    explain to the veterans that are taxpayers how it is being
    used.
        Some of those budget practices that we have seen in recent
    years, terrible account coverage, shifting obligations, have
    made it harder, not easier, to figure out where we are at as
    far as Congress. In the end, it hurts trust in the system. I
    look forward to working with you. I thank you for your service.
    I thank the colleagues, for the most part that actually dealt
    with the questions at hand. Let you answer. I think a lot has
    been explained over things that we have heard in rumors that
    have flown around, and you've been able to answer them very
    well.
        We look forward to continuing to work with you and we want
    to make sure. One thing that you say is the same thing I say
    with this committee. Remember, our VA Is not about the
    bureaucracy of the VA it is about providing for the veterans.
    With that, that is the best way to ensure that we can continue
    with the care for our veterans. With that, this hearing is
    adjourned.
        [Whereupon, at 6:08 p.m., the committee was adjourned.]

    ?

    =======================================================================

                             A  P  P  E  N  D  I  X

    =======================================================================

                         Prepared Statement of Witness

                                  ----------

                     Prepared Statement of Douglas Collins

        Chairman Bost, Ranking Member Takano, and distinguished members of
    the Committee, thank you for the opportunity to testify today on the
    state of the Department of Veterans Affairs (VA).
        Since becoming VA Secretary, I've met many of the men and women who
    show up to work every day at the Department with a deep dedication to
    our mission - delivering health care and benefits to millions of
    Veterans who've served our Nation. They have my sincere thanks, and I
    can't wait to meet more of them in the months ahead.
        In this same period, I've come to learn what many of you on this
    sub-committee also realize: VA is in need of reform. We must do a
    better job delivering timely care to Veterans, getting to ``yes'' so
    Veterans can get the benefits they've earned, and making sure the money
    Congress appropriates to VA is not diverted to non-mission-critical or
    even wasteful programs.
        In the old days, way back in 2024, discussions in Congress about
    the need to reform VA were often just a thinly veiled request for more
    employees. But the Department's history shows that adding more
    employees to the system doesn't automatically mean better results.
        The Biden Administration's record is a perfect example. During
    those 4 years, VA failed to address nearly all of its most serious
    problems, such as benefits backlogs and rising health care wait times.
    The numbers speak for themselves:
        The number of VA employees grew by more than 52,000 full-time
    equivalents from Fiscal Year 2021 to Fiscal Year 2024. Did all those
    extra people make things better for Veterans? No. In fact, VA's
    performance got worse, as health care wait times and the disability
    benefits backlog increased.
        Something has to change, and it's up to us to make that change.
    Under President Trump, we are working to solve problems that have
    persisted at VA for decades. Our goal is to create a Department that
    works better for the Veterans, families, caregivers and survivors that
    we serve.
        I've never been shy when it comes to addressing tough issues head-
    on, and I won't ignore the elephant in the room here today. As everyone
    here is aware, we're conducting a thorough review of the Department's
    structure and staffing across the enterprise.
        As I've said countless times, this review is aimed at finding ways
    to improve care and benefits for Veterans without cutting care and
    benefits for Veterans. Our goal is to increase productivity and
    efficiency, eliminate waste and bureaucracy, and improve the delivery
    of health care and benefits to Veterans.
        We're going to maintain VA's mission-essential jobs like doctors,
    nurses, and claims processors, while phasing out non-mission essential
    roles like interior designers and Diversity Equity and Inclusion (DEI)
    officers. The savings we achieve will be redirected to Veteran health
    care and benefits.
        Our goal is to ensure we have employees where they are needed, cut
    unnecessary overhead, and strategically reduce staff to ensure VA's
    budget is mostly going directly to Veterans. We will accomplish this
    without making cuts to health care or benefits to Veterans or VA
    beneficiaries.
        Year after year, calls for VA reform come from every corner -
    lawmakers, the media, watchdogs like Inspectors General and the
    Government Accountability Office, Veterans Service Organizations, and
    individual Veterans across the country.
        This year, finally, we have embarked on a historic effort to reform
    VA. We've been emphatic that we won't be cutting benefits and health
    care - only improving them. And we're engaging career subject matter
    experts, senior executives, and political leadership to restructure the
    Department so it works better for Veterans.
        We are doing what literally all VA stakeholders agree needs to be
    done. So, what has the reaction been? We've been met with a barrage of
    false rumors, innuendo, disinformation, and speculation implying we're
    firing doctors and nurses, forcing staff to work in closets and
    showers, and that there is ``chaos'' across the Department.
        Why? Because we canceled some duplicative contracts for work VA can
    and should be doing in-house, and we let go of one half of 1 percent of
    non-mission critical employees.
        To hear our critics tell it, the Department was absolutely perfect
    until we started making changes in January 2025. Everyone knows that's
    not true.
        The fact is that VA health care has been on the Government
    Accountability Office's high-risk list for more than a decade. GAO even
    says VA faces ``system-wide challenges in overseeing patient safety and
    access to care, hiring critical staff, and meeting future
    infrastructure needs.'' We are working hard to fix these and other
    issues, and we need your help. We want to work with Congress to fix VA.
    But our shared goal needs to be making things better for Veterans
    rather than protecting the Department's broken bureaucracy.
        The Department of Veterans Affairs is not a Federal jobs program.
    It is an organization whose sole purpose is to serve Veterans. We must
    never lose sight of that.
        We're just over 100 days into the second Trump Administration, and
    despite major opposition from many in the media, union bosses, and some
    in Congress, we're already making significant progress to better serve
    Veterans, including:

          We are refocusing on our core mission, which is providing
    the best possible care and benefits to Veterans, families, caregivers,
    and survivors.

          That means we're making sure Veterans get the health care
    choices they were promised under the MISSION Act.

          We're taking thousands of employees off remote work and
    bringing them back to the office, where we can work as a team to better
    serve Veterans.

          We're phasing out treatment for gender dysphoria.

          We're accelerating the deployment of our modern
    electronic health record system, after the program was nearly dormant
    under the Biden Administration.

          We're processing record numbers of disability claims.

          We're redirecting hundreds of millions of dollars from
    non-mission-critical efforts to health care, benefits, and services
    that directly support VA beneficiaries.

          We're creating a better system to more quickly and
    effectively provide survivors the services, support, and compassion
    they've earned.

          And we've ended DEI at the department, reversing the
    divisive Biden-era policies and stopping more than $14 million in DEI
    spending.

        But we're just getting started. We have an obligation to make VA
    work better for the Veterans, families, caregivers, and survivors that
    we are charged with serving. That is exactly what we have been doing
    and exactly what we will continue to do.
        President Trump sent his Fiscal Year 2026 budget request to
    Congress on May 2, 2025. President Trump is committed to balancing the
    budget while providing adequate funding for critical nondefense
    discretionary priorities--securing our borders, caring for our
    Veterans, and continued infrastructure investment. Reaching balance
    requires:

          resetting the proper balance between Federal and State
    responsibilities with a renewed emphasis on federalism;

          eliminating the Federal Government's support of woke
    ideology;

          protecting the American people by deconstructing a
    wasteful and weaponized bureaucracy; and

          identifying and eliminating wasteful spending.

        The budget levels reflect the reforms necessary to enable VA to
    fulfill its statutory responsibilities in the most cost-effective
    manner possible.
        The budget provides increased funding for health care services
    tailored to Veterans' needs, both at VA medical centers and in the
    community. The budget ensures that the Nation's Veterans are provided
    with the world-class health care that they deserve. In addition,
    Veterans who qualify for access to care with local community providers
    would be empowered to make the choice to see them, rather than having
    to drive, in some cases, hours to access the nearest VA facility.
        The VA discretionary budget request for Fiscal Year (FY) 2026 is
    $134.6 billion, and $52.6 billion for Toxic Exposures Fund (TEF), for a
    total request of $187.2 billion. This is an increase of $27.6 billion
    (+17 percent) above the Fiscal Year 2025 enacted level.
        VA is committed to ending Veteran homelessness. The budget includes
    a new effort, Rental Assistance to Homeless Veterans, which will
    provide $1.1 billion to support the President's commitment to end
    Veteran homelessness. VA will be directly responsible for programs and
    financial support to provide rental assistance and other support
    services.
        The budget request also includes $3.5 billion for the Electronic
    Health Record Modernization (EHRM) program. VA's EHRM effort is moving
    the Department from a decades-old legacy system to a modern system that
    is interoperable with systems at the Department of Defense and other
    Federal partners, as well as participating community care providers,
    allowing clinicians to easily access a veteran's full medical history
    anywhere they seek care. Acceleration of the EHRM rollout is now a top
    VA priority effort. The Fiscal Year 2026 funding will enable VA to
    complete planned deployments in Fiscal Year 2027.
        Further details on the full VA budget request will be available
    when OMB releases the complete Fiscal Year 2026 budget.
        Thank you for your time and attention, and I look forward to your
    questions.

                           Statements for the Record

                                  ----------

     Prepared Statement of National Association of Veterans' Research and
                             Education Foundations
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

      Housing Policy Council Data for the Record Submitted by Chris Pappas
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     [all]