[Congressional Record Volume 160, Number 89 (Tuesday, June 10, 2014)]
[House]
[Pages H5196-H5201]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   VETERAN ACCESS TO CARE ACT OF 2014

  Mr. MILLER of Florida. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 4810) to direct the Secretary of Veterans Affairs 
to enter into contracts for the provision of hospital care and medical 
services at non-Department of Veterans Affairs facilities for 
Department of Veterans Affairs patients with extended waiting times for 
appointments at Department facilities, and for other purposes.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4810

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Veteran Access to Care Act 
     of 2014''.

     SEC. 2. PROVISION OF HOSPITAL CARE AND MEDICAL SERVICES AT 
                   NON-DEPARTMENT OF VETERANS AFFAIRS FACILITIES 
                   FOR DEPARTMENT OF VETERANS AFFAIRS PATIENTS 
                   WITH EXTENDED WAITING TIMES FOR APPOINTMENTS AT 
                   DEPARTMENT FACILITIES.

       (a) In General.--As authorized by section 1710 of title 38, 
     United States Code, the Secretary of Veterans Affairs (in 
     this Act referred to as the ``Secretary'') shall enter into 
     contracts with such non-Department facilities as may be 
     necessary in order to furnish hospital care and medical 
     services to covered veterans who are eligible for such care 
     and services under chapter 17 of title 38, United States 
     Code. To the greatest extent possible, the Secretary shall 
     carry out this section using contracts entered into before 
     the date of the enactment of this Act.
       (b) Covered Veterans.--For purposes of this section, the 
     term ``covered veteran'' means a veteran--
       (1) who is enrolled in the patient enrollment system under 
     section 1705 of title 38, United States Code;
       (2) who--
       (A) has waited longer than the wait-time goals of the 
     Veterans Health Administration (as of June 1, 2014) for an 
     appointment for hospital care or medical services in a 
     facility of the Department;
       (B) has been notified by a facility of the Department that 
     an appointment for hospital care or medical services is not 
     available within such wait-time goals; or
       (C) resides more than 40 miles from the medical facility of 
     the Department of Veterans Affairs, including a community-
     based outpatient clinic, that is closest to the residence of 
     the veteran; and
       (3) who makes an election to receive such care or services 
     in a non-Department facility.
       (c) Follow-Up Care.--In carrying out this section, the 
     Secretary shall ensure that, at the election of a covered 
     veteran who receives hospital care or medical services at a 
     non-Department facility in an episode of care under this 
     section, the veteran receives such hospital care and medical 
     services at such non-Department facility through the 
     completion of the episode of care (but for a period not 
     exceeding 60 days), including all specialty and ancillary 
     services deemed necessary as part of the treatment 
     recommended in the course of such hospital care or medical 
     services.
       (d) Report.--The Secretary shall submit to Congress a 
     quarterly report on hospital care and medical services 
     furnished pursuant to this section. Such report shall include 
     information, for the quarter covered by the report, 
     regarding--
       (1) the number of veterans who received care or services at 
     non-Department facilities pursuant to this section;
       (2) the number of veterans who were eligible to receive 
     care or services pursuant to this section but who elected to 
     continue waiting for an appointment at a Department facility;
       (3) the purchase methods used to provide the care and 
     services at non-Department facilities, including the rate of 
     payment for individual authorizations for such care and 
     services; and
       (4) any other matters the Secretary determines appropriate.
       (e) Definitions.--For purposes of this section, the terms 
     ``facilities of the Department'', ``non-Department 
     facilities'', ``hospital care'', and ``medical services'' 
     have the meanings given such terms in section 1701 of title 
     38, United States Code.
       (f) Implementation.--The Secretary shall begin implementing 
     this section on the date of the enactment of this Act.
       (e) Construction.--Nothing in this section shall be 
     construed to authorize payment for care or services not 
     otherwise covered under chapter 17 of title 38, United States 
     Code.
       (g) Termination.--The authority of the Secretary under this 
     section shall terminate with respect to any hospital care or 
     medical services furnished after the end of the 2-year period 
     beginning on the date of the enactment of this Act, except 
     that in the case of an episode of care for which hospital 
     care or medical services is furnished in a non-Department 
     facility pursuant to this section before the end of such 
     period, such termination shall not apply to such care and 
     services furnished during the remainder of such episode of 
     care but not to exceed a period of 60 days.

     SEC. 3. EXPANDED ACCESS TO HOSPITAL CARE AND MEDICAL 
                   SERVICES.

       (a) In General.--To the extent that appropriations are 
     available for the Veterans Health Administration of the 
     Department of Veterans Affairs for medical services, to the 
     extent that the Secretary of Veterans Affairs is unable to 
     provide access, within the wait-time goals of the Veterans 
     Health Administration (as of June 1, 2014), to hospital care 
     or medical services to a covered veteran who is eligible for 
     such care or services under chapter 17 of title 38, United 
     States Code, under contracts described in section 2, the 
     Secretary shall reimburse any non-Department facility with 
     which the Secretary has not entered into a contract to 
     furnish hospital care or medical services for furnishing such 
     hospital care or medical services to such veteran, if the 
     veteran elects to receive such care or services from the non-
     Department facility. The Secretary shall reimburse the 
     facility for the care or services furnished to the veteran at 
     the greatest of the following rates:
       (1) VA payment rate.--The rate of reimbursement for such 
     care or services established by the Secretary of Veterans 
     Affairs.
       (2) Medicare payment rate.--The payment rate for such care 
     or services or comparable care or services under the Medicare 
     program under title XVIII of the Social Security Act.
       (3) TRICARE payment rate.--The reimbursement rate for such 
     care or services furnished to a member of the Armed Forces 
     under chapter 55 of title 10, United States Code.
       (b) Covered Veterans.--For purposes of this section, the 
     term ``covered veteran'' means a veteran--
       (1) who is enrolled in the patient enrollment system under 
     section 1705 of title 38, United States Code; and
       (2) who--
       (A) has waited longer than the wait-time goals of the 
     Veterans Health Administration (as of June 1, 2014) for an 
     appointment for hospital care or medical services in a 
     facility of the Department;
       (B) has been notified by a facility of the Department that 
     an appointment for hospital care or medical services is not 
     available within such wait-time goals after the date for 
     which the veteran requests the appointment; or
       (C) who resides more than 40 miles from the medical 
     facility of the Department of Veterans Affairs, including a 
     community-based outpatient clinic, that is closest to the 
     residence of the veteran.
       (c) Definitions.--For purposes of this section, the terms 
     ``facilities of the Department'', ``non-Department 
     facilities'', ``hospital care'', and ``medical services'' 
     have the meanings given such terms in section 1701 of title 
     38, United States Code.
       (d) Implementation.--The Secretary shall begin implementing 
     this section on the date of the enactment of this Act.
       (e) Construction.--Nothing in this section shall be 
     construed to authorize payment for care or services not 
     otherwise covered under chapter 17 of title 38, United States 
     Code.
       (f) Termination.--The authority of the Secretary under this 
     section shall terminate with respect to care or services 
     furnished after the date that is 2 years after the date of 
     the enactment of this Act.

     SEC. 4. INDEPENDENT ASSESSMENT OF VETERANS HEALTH 
                   ADMINISTRATION PERFORMANCE.

       (a) Independent Assessment Required.--Not later than 120 
     days after the date of the enactment of this Act, the 
     Secretary of Veterans Affairs shall enter into a contract or 
     contracts with a private sector entity or entities with 
     experience in the delivery systems of the Veterans Health 
     Administration and the private sector and in health care 
     management to conduct an independent assessment of hospital 
     care and medical services furnished in medical facilities of 
     the Department of Veterans Affairs. Such assessment shall 
     address each of the following:
       (1) The current and projected demographics and unique care 
     needs of the patient population served by the Department of 
     Veterans Affairs.
       (2) The current and projected health care capabilities and 
     resources of the Department, including hospital care and 
     medical services furnished by non-Department facilities under 
     contract with the Department, to provide timely and 
     accessible care to eligible veterans.
       (3) The authorities and mechanisms under which the 
     Secretary may furnish hospital care and medical services at 
     non-Department facilities, including an assessment of whether 
     the Secretary should have the authority to furnish such care 
     and services at such facilities through the completion of 
     episodes of care.
       (4) The appropriate system-wide access standard applicable 
     to hospital care and medical services furnished by and 
     through the Department of Veterans Affairs and 
     recommendations relating to access standards specific to 
     individual specialties and standards for post-care 
     rehabilitation.

[[Page H5197]]

       (5) The current organization, processes, and tools used to 
     support clinical staffing and documentation.
       (6) The staffing levels and productivity standards, 
     including a comparison with industry performance percentiles.
       (7) Information technology strategies of the Veterans 
     Health Administration, including an identification of 
     technology weaknesses and opportunities, especially as they 
     apply to clinical documentation of hospital care and medical 
     services provided in non-Department facilities.
       (8) Business processes of the Veterans Health 
     Administration, including non-Department care, insurance 
     identification, third-party revenue collection, and vendor 
     reimbursement.
       (b) Assessment Outcomes.--The assessment conducted pursuant 
     to subsection (a) shall include the following:
       (1) An identification of improvement areas outlined both 
     qualitatively and quantitatively, taking into consideration 
     Department of Veterans Affairs directives and industry 
     benchmarks from outside the Federal Government.
       (2) Recommendations for how to address the improvement 
     areas identified under paragraph (1) relating to structure, 
     accountability, process changes, technology, and other 
     relevant drivers of performance.
       (3) The business case associated with making the 
     improvements and recommendations identified in paragraphs (1) 
     and (2).
       (4) Findings and supporting analysis on how credible 
     conclusions were established.
       (c) Program Integrator.--If the Secretary enters into 
     contracts with more than one private sector entity under 
     subsection (a), the Secretary shall designate one such entity 
     as the program integrator. The program integrator shall be 
     responsible for coordinating the outcomes of the assessments 
     conducted by the private entities pursuant to such contracts.
       (d) Submittal of Reports to Congress.--
       (1) Report on independent assessment.--Not later than 10 
     months after entering into the contract under subsection (a), 
     the Secretary shall submit to the Committees on Veterans' 
     Affairs of the Senate and House of Representatives the 
     findings and recommendations of the independent assessment 
     required by such subsection.
       (2) Report on va action plan to implement recommendations 
     in assessment.--Not later than 120 days after the date of 
     submission of the report under paragraph (1), the Secretary 
     shall submit to such Committees on the Secretary's response 
     to the findings of the assessment and shall include an action 
     plan, including a timeline, for fully implementing the 
     recommendations of the assessment.

     SEC. 5. LIMITATION ON AWARDS AND BONUSES TO EMPLOYEES OF 
                   DEPARTMENT OF VETERANS AFFAIRS.

       For each of fiscal years 2014 through 2016, the Secretary 
     of Veterans Affairs may not pay awards or bonuses under 
     chapter 45 or 53 of title 5, United States Code, or any other 
     awards or bonuses authorized under such title.

     SEC. 6. OMB ESTIMATE OF BUDGETARY EFFECTS AND NEEDED TRANSFER 
                   AUTHORITY.

       Not later than 30 days after the date of the enactment of 
     this Act, the Director of the Office of Management and Budget 
     shall transmit to the Committees on Appropriations, the 
     Budget, and Veterans' Affairs of the House of Representatives 
     and of the Senate--
       (1) an estimate of the budgetary effects of sections 2 and 
     3;
       (2) any transfer authority needed to utilize the savings 
     from section 5 to satisfy such budgetary effects; and
       (3) if necessary, a request for any additional budgetary 
     resources, or transfers or reprogramming of existing 
     budgetary resources, necessary to provide funding for 
     sections 2 and 3.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Florida (Mr. Miller) and the gentleman from Maine (Mr. Michaud) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Florida.


                             General Leave

  Mr. MILLER of Florida. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks H.R. 4810.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. MILLER of Florida. Mr. Speaker, I yield myself such time as I may 
consume.

                              {time}  1230

  Mr. Speaker, I rise today amidst a growing crisis amongst America's 
veterans. Just over 2 months ago, at a committee oversight hearing, we 
disclosed that the committee investigation had in fact uncovered 
evidence suggesting that at least 40 veterans had died while waiting 
for care at the Phoenix Department of Veterans Affairs health care 
system. We now know, and VA has in fact confirmed, that almost 60 
veterans have died while facing delays in care at Phoenix and other 
locations, and that the data manipulation efforts that the committee 
has uncovered are in fact systemic throughout the entire Department.
  I cannot state it strongly enough, Mr. Speaker, this is a national 
disgrace. For our veterans, it is something more. It is a national 
emergency.
  An internal audit that was released just yesterday found that more 
than 57,000 veterans had been waiting for care, for their first medical 
appointment, and an additional 64,000 veterans who have enrolled in the 
health care system over the last 10 years never received the 
appointment that they requested.
  Now, correcting the many failures of the VA health care system is 
going to take diligent and focused work for a long time to come. This 
committee, both Republicans and Democrats, is committed to seeing this 
through. However, our first priority must be making sure that those 
121,000 veterans--and the thousands more I fear that are out there that 
have yet to be identified--receive the long overdue care that they need 
without any further delay.
  This is why we have introduced H.R. 4810, the Veteran Access to Care 
Act. This bill would require VA to provide non-VA care authorization to 
any enrolled veteran who resides more than 40 miles from a VA medical 
facility and has waited longer than VA's stated wait time goals for a 
medical appointment, or has been notified by the Department of Veterans 
Affairs that an appointment is not available within the stated wait 
time goals.
  Now, to ensure continuity of care, the bill would require VA to 
utilize existing contracts to the greatest extent possible. It would 
also ensure that the non-VA care authorization encompasses the entire 
episode of care needed by the veteran during a 60-day period.
  To ensure providers are willing to accept veteran patients, the bill 
requires the Department to reimburse non-VA providers at the greater of 
the following rates: the rate of reimbursement under VA, the rate of 
reimbursement under Medicare, or the rate of reimbursement under 
TRICARE. These authorities would remain in place for 2 years.
  To ensure that we are addressing both the short-term access 
challenges facing our veterans as well as the long-term need for a 
proactive solution, H.R. 4810 would further require the VA to enter 
into a contract with an independent entity or entities to conduct an 
assessment of the health care provided by the VA medical facilities and 
to submit its findings and recommendations of the assessment as well as 
an action plan and a timeline for full implementation to the Congress.
  Importantly, the bill would also eliminate bonuses and performance 
awards for all VA employees for fiscal years 2014 through 2016 and 
require the Office of Management and Budget to transmit to Congress an 
estimate of the authority's budgetary effects, to include any transfer 
authority needed to utilize savings and, if necessary, a request for 
additional budgetary resources. Our latest estimate suggests that a 
temporary elimination of bonuses and other incentives will free up 
roughly $400 million per year that can be immediately utilized for the 
expanded patient choice options under this bill.
  VA has a well-established authority to send veterans outside of the 
VA health care system to receive care through non-VA providers. 
However, right now, the decision of if and when a veteran is sent to 
non-VA care lies with a VA bureaucrat.
  H.R. 4810 would require that the VA use the authority the Department 
has been given to assure that veterans waiting for an appointment or 
residing far from VA medical facilities are left in the control of 
their own care and able to choose for themselves where, when, and how 
they receive the care that the veteran themselves need. This authority 
would ensure that no veteran waiting for an appointment today would 
receive what one veteran, during a recent committee hearing, determined 
``a death sentence.''
  Mr. Barry Coates is a gulf war era veteran who waited almost a year 
in increasing pain to receive a colonoscopy from the Dorn VA Medical 
Center in Columbia, South Carolina.

[[Page H5198]]

That colonoscopy revealed that Mr. Coates had stage IV colon cancer 
that had metastasized to his lungs and his liver. Members, he is 
terminally ill today. Mr. Coates called his experience attempting to 
access care through the Department long, painful, emotional, and 
unnecessary. He testified:

       I am here to speak for those to come so that they might be 
     spared the pain I have already endured and know that I have 
     yet to face.

  Mr. Speaker, the problems the Department of Veterans Affairs is now 
facing represents failure on at least two fronts: failure of 
accountability and failure of access. Over the last several weeks, the 
House has addressed VA's lack of accountability through the passage of 
two pieces of legislation: H.R. 4031, the Department of Veterans 
Affairs Management Accountability Act, and H.R. 2072, the Demanding 
Accountability for Veterans Act.
  Today, with the passage of H.R. 4810, we will address the 
Department's access failures for Barry Coates and, as he so eloquently 
said, for all those veterans still yet to come.
  Mr. Speaker, I urge all of my colleagues to join me in supporting 
this legislation, and I reserve the balance of my time.
  Mr. MICHAUD. Mr. Speaker, I yield myself as much time as I may 
consume.
  I rise in support of H.R. 4810, the Veteran Access to Care Act of 
2014. I want to thank the chairman for bringing this bill forward. I 
also want to thank the chairman and the staff on both the majority and 
minority side for all the work that they have been doing to get to the 
bottom of this crisis within the Department.
  Access to timely, quality health care for veterans is a top priority 
for the Veterans' Affairs Committee. We often hear that the care that 
veterans receive at the VA facilities is second to none--that is, if 
you can get in. As we have recently learned, tens of thousands of 
veterans are not getting in, having to wait weeks and even months to 
access VA medical centers throughout the country.
  The gravity of the delay in care that veterans from all areas are 
experiencing cannot be overstated and is totally unacceptable. This 
legislation would help to alleviate the backlog of veteran patients 
waiting to be seen at VA medical facilities both for specialty care and 
primary care appointments.
  Specifically, it requires the VA to provide access to non-VA care to 
any enrolled veteran who lives more than 40 miles from a VA medical 
facility, has waited longer than the wait time goals for a medical 
appointment, or has been notified by the VA that an appointment is not 
available within the wait time goals. More importantly, it gives the 
veteran the option to elect to receive care at a non-VA facility or, if 
the veteran chooses, to wait to be seen at the VA medical center.

  When our young men and women sign up to serve their country, we 
promise them quality, accessible health care. Thanks to many caring 
frontline clinicians, we have achieved the first, high-quality medical 
care. Now we must work on the second timely, and that is access issues. 
I encourage my colleagues to support this very important piece of 
legislation.
  I reserve the balance of my time.
  Mr. MILLER of Florida. Mr. Speaker, I yield 2 minutes to the 
gentleman from Colorado (Mr. Lamborn), who has been at the forefront of 
the investigation on this scandal.
  Mr. LAMBORN. Mr. Speaker, I rise today in support of the chairman's 
H.R. 4810, the Veteran Access to Care Act.
  Recent reports from within the VA have confirmed that the 
manipulation of scheduling data and unacceptable wait times first 
highlighted in Phoenix are systemic throughout the VA system. 
Unfortunately, we have seen some of this in Colorado--at Colorado 
Springs, in particular. I am really upset about that.
  These findings prompted me to author a letter last week that was 
signed by 35 of my colleagues urging Acting Secretary of the VA Gibson 
to expand the use of fee-based care in order to clear the current 
backlog and address any capacity shortfalls.
  H.R. 4810 takes the next steps in addressing these shortfalls by 
mandating that the VA expand access to fee-based care and defines the 
parameters under which this care will be administered.
  ``Fee-based'' means that the veteran can get private health care 
providers to step in and take care of his health care needs when the VA 
doesn't have the capacity at that time to take care of him or her.
  In order to ensure this timely delivery of quality care, H.R. 4810 
also requires the VA to have an independent assessment conducted on the 
Veterans Health Administration to evaluate the Department's performance 
and to provide recommendations for improvement. Also, I would like to 
mention, bonuses will not be available to VA bureaucrats until 2016 
under this bill, until this problem gets solved.
  Mr. Speaker, I fully support H.R. 4810. I appreciate the chairman's 
leadership on this issue, and I ask my colleagues to support this 
important piece of legislation as well.
  Mr. MICHAUD. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Brownley).
  Ms. BROWNLEY of California. Mr. Speaker, I thank the ranking member 
for yielding, and I thank the chairman for introducing this bill.
  I chose to join the House Veterans' Affairs Committee even knowing 
the many challenges that have plagued the VA for decades because I want 
to do all I can to make sure our veterans receive the care they have 
earned and deserve for the sacrifices they have made for our great 
Nation.
  If the VA cannot see a veteran in a timely manner, then that veteran 
should be able to seek care outside of the VA. That is why I have 
cosponsored this bill and I intend to vote for it today.
  This bill will not fix everything, but it will absolutely help and it 
is an important step forward. However, for those of us who represent 
urban areas like southern California, we all know that 40 miles can 
take the better part of a day to traverse back and forth. That is why I 
believe that we must take into account not only the distance traveled, 
but also the amount of time that it takes for veterans to travel to the 
VA so that the intention of this bill reaches all of our veterans. As a 
consequence, I ask the chairman and the ranking member to work with me 
to improve this bill and include time traveled as a factor as the bill 
continues to move forward.
  I ask my colleagues to support this bill. I ask them to continue our 
work until we live up to the promise this country has made to our 
veterans and their families.
  Mr. MILLER of Florida. Mr. Speaker, I understand Ms. Brownley's 
concern, and I have heard that from Members on our side of the aisle as 
well.
  At this point, I would like to yield 2 minutes to the gentleman from 
Florida (Mr. Bilirakis), the vice chairman of the House Committee on 
Veterans' Affairs, a stalwart supporter of our veterans.
  Mr. BILIRAKIS. Thank you, Mr. Chairman, for your leadership on behalf 
of our true American heroes, and thank you for filing this bill. I also 
want to thank the ranking member. He does an outstanding job, as well, 
on behalf of our heroes.
  Mr. Speaker, as a proud original cosponsor, I rise in strong support 
for H.R. 4810, the Veteran Access to Care Act. In upholding our promise 
to our Nation's heroes, this legislation will provide necessary relief 
for thousands of veterans who have waited far too long within the VA 
health system. Many of these veterans are forced to wait months, even 
years.

                              {time}  1245

  This is beyond unacceptable and represents a disservice for their 
sacrifice and service.
  H.R. 4810 empowers the veterans with choice. It will address an 
immediate problem, allowing veterans to access non-VA care or stay 
within the VA system if they desire.
  Our colleagues in the Senate have introduced similar legislation, 
which includes, again, a very similar provision. Mr. Speaker, I hope 
that this needed solution to care for our veterans will move quickly 
and be presented before the President without delay.
  Long term, the VA's systemic failures that promote a culture of 
mediocrity and discourage transparency and accountability must be 
addressed.
  However, our first priority is to ensure veterans are receiving 
timely quality care, but we must also continue our oversight to root 
out this culture of corruption.

[[Page H5199]]

  I want to thank again the chairman for filing this bill, and I urge 
my colleagues to support it.
  Mr. MICHAUD. Mr. Speaker, at this time, I yield 2 minutes to the 
gentlewoman from Nevada (Ms. Titus).
  Ms. TITUS. Mr. Speaker, I thank the ranking member for yielding to 
me.
  As a member of the House Veterans' Affairs Committee, I rise in 
support of H.R. 4810. This important legislation will allow our 
Nation's heroes to access health care outside the VA for the next 2 
years.
  If even one veteran who has been waiting a long time for an 
appointment through the VA is able to receive care more quickly in the 
private sector, then we should give him or her that opportunity.
  But this alone won't solve the problem. More must be done. We have 
known for a while that the VA facilities across the United States do 
not have enough doctors and nurses on staff to meet the growing demand 
for care. This is not a problem that is just isolated to the VA.
  As I discussed in our hearing last night, allowing veterans to access 
care in the private sector will help in some areas of the United 
States, but in many cities and rural areas across the country there is 
also a shortage of care in the private sector.
  In Nevada, for example, we have for a long time had a chronic 
shortage of doctors, both in primary care and among specialists. When 
comparing the number of health care workers relative to State 
population, Nevada ranks 46th in the Nation for general and family 
practitioners, 50th for psychiatrists, and 51st for general surgeons. 
So, as a result, veterans aren't the only ones who are waiting for 
health care. Everyone is affected.
  Adding more patients to an already burdened system will not be a 
panacea.
  That is why I am working with members of the committee on legislation 
that will shore up our VA health care system by increasing the number 
of medical residency programs at VA hospitals in areas that are facing 
a physician shortage. By increasing our investment in physician 
training, we will not only help our veterans in the short run, but we 
will be taking a step toward addressing the long-term nationwide 
physician shortage.
  I hope that I will find support for that as we move forward, and I 
thank the chairman for his work on this important issue.
  Mr. MILLER of Florida. Mr. Speaker, I yield 2 minutes to the 
gentleman from the First District of Tennessee, Dr. Roe, a veteran 
himself.
  Mr. ROE of Tennessee. Mr. Speaker I thank the chairman.
  I rise in support of H.R. 4810, the Veteran Access to Care Act.
  As a physician, veteran, and member of the House Veterans' Affairs 
Committee, words cannot express my outrage over the VA's blatant 
disregard for the lives of those who served their country honorably and 
earned timely access to quality care.
  I have helped run a hospital and am fully aware of how wait times and 
performance goals work. When the VA set a 14-day goal for scheduling 
appointments, it should have become immediately apparent that this was 
unattainable and could only be realized by cooking the books. Even in 
the private sector, a 14-day wait time is quite ambitious.
  This bipartisan legislation offers a simple solution to a deadly 
problem. The needs of the vast majority of VA patients across the 
country can and will continue to be met through the existing VA system. 
But it is outrageous that veterans could die awaiting for care that is 
readily available in the private sector, so this is a commonsense 
solution and, frankly, the least we should do to help our veterans.
  As I said last night in the committee hearing, there is something the 
VA could do today to change the culture of the VA. If you asked someone 
who works on a VA campus where do they work, Mr. Speaker, they will say 
I work for the VA. They should say, the answer to that question should 
be, I work and serve veterans.
  I applaud the work that Chairman Miller, Ranking Member Michaud, and 
the committee staff have undertaken to hold the VA accountable.
  Mr. MICHAUD. Mr. Speaker, at this time, I yield 2 minutes to the 
gentleman from Georgia (Mr. Barrow), a former member of the Veterans' 
Affairs Committee.
  Mr. BARROW of Georgia. Mr. Speaker, I thank the chairman for yielding 
and for his leadership on this issue.
  I am proud to be an original cosponsor of this bill because it offers 
a way out for so many veterans who are stuck in the VA bureaucracy.
  Over a year ago, I joined Chairman Miller at the VA in Atlanta when 
this problem first arose. Just this year, he was gracious enough to 
come to my district in Georgia, where we are encountering similar 
problems. The audit released yesterday underscores the necessity of 
this legislation.
  In my district alone, 130 veterans who requested appointments have 
never been seen. Sadly, they are only a small portion of the 57,000 who 
have waited more than 90 days to see a physician. We can do better.
  This bill addresses the immediate critical needs of our veterans, but 
for too long veterans have been denied access to the care we promised 
them, too often because of simple inefficiency and incompetence at the 
VA.
  I urge my colleagues to support this bill. I look forward to 
continuing to work together toward comprehensive reform of the VA 
services that our veterans have earned.
  Mr. MILLER of Florida. Mr. Speaker, many Members have been very 
involved in this issue. Certainly the chairman of the Subcommittee on 
Health has been at the forefront. I yield 2 minutes to the gentleman 
from Michigan, Dr. Benishek.
  Mr. BENISHEK. Thank you, Mr. Chairman.
  Mr. Speaker, today I rise in support of H.R. 4810, the Veteran Access 
to Care Act.
  This bill simply says to our veterans, you will receive the care you 
earned in a timely manner, whether it is at a VA facility or at your 
local hospital. I am proud to be an original cosponsor.
  By passing this legislation, we give a helping hand to those veterans 
stuck in a broken bureaucracy. We will not allow them to sit and wait 
for an appointment that they should have gotten immediately. They 
fought to defend our right to freedom. Today we defend their right to 
the care they were promised.

  The 2-year authorization for private care in this bill will give 
Congress time to work with the VA to overhaul the system. As a former 
VA doctor, I pledge to you that the VA that emerges from this process 
will be leaner, smarter, and far more responsive to the needs of our 
veterans.
  We know 35 veterans have died while awaiting care in the Phoenix area 
alone. We know the recent deaths of at least 23 veterans have been 
linked to delayed VA medical care. The time for excuses is over. The 
time for action is now.
  I support, and I urge all my colleagues to support, H.R. 4810.
  Mr. MICHAUD. Mr. Speaker, at this time, I yield 2 minutes to the 
gentleman from Texas, Dr. Cuellar.
  Mr. CUELLAR. Mr. Speaker, I first want to thank my good friend, the 
chairman, for the great work that he and his staff have been doing, and 
certainly the ranking member and his staff, who have worked so hard, 
along with the Members, to get this piece of legislation.
  I have always said, as my fellow colleagues have said, that when one 
of our men and women go out and fight on a foreign battlefield, they 
should not come back and fight the bureaucracy of the VA. This is why 
this legislation is very, very important, that we address some of the 
issues.
  As one of the original cosponsors, I think providing an alternative 
with this emergency bill, H.R. 4810, which is at the top of an 
emergency, will provide an alternative to those veterans.
  I represent part of San Antonio, go through a lot of rural areas, go 
down to Laredo, then go through a lot of rural areas, and then go into 
the McAllen area, the Valley area. In that area, I think this 
legislation will be very, very useful in the sense that if somebody has 
to wait or somebody lives more than 40 miles away from the VA facility, 
then they should be able to go to one of the local providers in their 
home area to get that assistance. I think this will save the veterans a 
lot of trouble, time, and provide them care in their home area.
  I believe also when they are provided services at a non-VA facility 
where

[[Page H5200]]

they can be reimbursed at the rate of the VA, TRICARE, Medicare, 
whatever is greater, that is, again, another good alternative. The only 
thing I would caution my friends on is, let's be careful, because I 
have been pushing the alternative to work with the local providers, and 
there has been a problem with the VA where they don't provide the 
reimbursement to those providers on a timely basis, and we have got to 
make sure that we provide the oversight that if a provider comes in, a 
private provider, that they are reimbursed and paid promptly. Otherwise 
we are going to lose those providers.
  Again, I certainly want to thank the chairman for the great work that 
he has been doing, the ranking member, the staff, and the other 
Members. This is a good piece of legislation, a good step forward, and 
I urge my colleagues to support H.R. 4810.
  Mr. MILLER of Florida. Mr. Speaker, I yield 2 minutes to the 
gentleman from Kansas (Mr. Huelskamp).
  Mr. HUELSKAMP. Mr. Speaker, I rise in strong support of the Veteran 
Access to Care Act of 2014.
  I want to thank the chairman for his leadership not only on this 
bill, but investigating the current situation at the VA. This is a long 
overdue, proactive, multipronged solution I have been advocating for 
since coming to Congress.
  On the committee in the last 3 years, we have been investigating 
lavish conference spending at the VA, millions of dollars of outrageous 
bonuses, billions of dollars of cost overruns. These are all 
significant scandals in and of themselves.
  But what we are discussing here today is much bigger. It is about 
life and death. It is about dozens of veterans who lost their lives 
because of what happened at the VA; a systemic, nationwide problem, 
along with coverups, corruption, and, yes, criminality. It is shameful.
  Instead of fighting to preserve the status quo, it is time to ensure 
that veterans receive quality health care closer to home. H.R. 4810 is 
a proactive solution. It involves veterans choice, independent review 
of VA performance, eliminating those outrageous bonuses, and holding 
the administration and holding the VA accountable.
  Whether it is the veteran I met in Syracuse, Kansas, who was told he 
had to drive 10 hours round-trip three times in 10 days for care he 
could have gotten down the street at his local hospital, and he was 
told to drive to a facility that had a secret waiting list in Wichita, 
or the veteran Jack in Liberal, Kansas, who has waited 2 years for a 
doctor that was promised by the VA, or Larry in Oberlin, who I just 
learned a few weeks ago was told again to drive 10 hours to get a 
shingles vaccination that was just down the road, these are veterans 
who have been denied access to quality care.
  H.R. 4810 deserves to be passed. These veterans deserve quality care 
close to home. The answer is pretty simple, Mr. Speaker. I do not 
believe there will be a rush to the exits of VA, but it will meet the 
needs of Larry, it will need the needs of Jack, it will meet the needs 
of Joe, and hopefully millions of other veterans that deserve quality 
access to care.
  Mr. MILLER of Florida. Mr. Speaker, we have no further speakers at 
this time so we are prepared to close.
  Mr. MICHAUD. Mr. Speaker, I have a couple of speakers, but they are 
not here so I will close.
  Once again, Mr. Speaker, I urge my colleagues to support H.R. 4810, 
the Veteran Access to Care Act of 2014.
  I want to thank the chairman once again for bringing this bill before 
the Chamber so we can vote on it.
  Good quality health care is important for our veterans, but it 
doesn't do any good unless they can have access to that quality care. 
This legislation will definitely provide that access through non-VA 
care that our veterans need in certain areas.
  I encourage my colleagues to support it. I once again want to thank 
you, Mr. Chairman, for working in a bipartisan manner to bring this 
bill before us today for a vote.
  With that, I yield back the balance of my time.
  Mr. MILLER of Florida. Mr. Speaker, without a doubt there are 
thousands of veterans across this country that are waiting for care 
that VA should be providing for them today. That is a national 
disgrace.
  It is a national crisis when veterans die, as VA has already 
admitted: 23 preventable deaths due to delayed care, and maybe more on 
the way.
  Let me assure the Members of this body, this will not end here. There 
are problems, systemic problems, throughout the entire Department of 
Veterans Affairs. We will work day and night, as we did last night, 
going until 11:30 p.m., making sure that VA tells this Congress, a 
coequal branch of this Federal Government, the truth.
  With that, I urge my colleagues to vote in favor of H.R. 4810, and I 
yield back the balance of my time.
  Mr. RYAN of Wisconsin. Mr. Speaker, the Veteran Access to Care Act of 
2014 is critical to ensuring that our nation's veterans have timely 
access to quality health care. Recent reports from the VA's internal 
audits have revealed that thousands of veterans are still waiting for 
their first medical appointments at VA medical centers after waiting 
for at least 90 days. This is much longer than the agency's wait-time 
policy of 14 days or less. And it is simply unacceptable.
  Further, the VA inspector general has confirmed that VA medical 
centers were deliberately hiding treatment delays and waiting times to 
make it seem that they were meeting the agency's wait-time goals. The 
Veteran Access to Care Act would address the wait-time issue by 
allowing veterans to receive private-sector health care if they have 
waited longer than the Veterans Health Administration's wait-time 
targets or if they reside more than 40 miles from the nearest VA 
medical facility or community-based outpatient clinic. The Access to 
Care Act gives the secretary authority to enter into contracts with 
non-Department medical facilities to provide health care to veterans 
and, if the secretary is unable to provide timely health-care access 
using contracted care, the act provides authority for the secretary to 
reimburse any non-Department medical facility for health care provided 
to a veteran.
  Funding for implementing this act will come from funds that have 
already been appropriated, or will in the future be appropriated, to 
the Veterans Health Administration for medical services in the normal 
course of the discretionary appropriations process. This bill provides 
no new budget authority to the Department of Veterans Affairs and does 
not violate the budget enforcement regime.
  Mrs. KIRKPATRICK. Mr. Speaker, I rise today in support of H.R. 4810, 
the Veterans Access to Care Act. This common-sense bill will help the 
veterans in my district get access to the care they deserve.
  As many of you may know, my district is mostly rural. Many of the 
veterans in Arizona's district one wait too long to receive care, and 
they drive over 200 miles one way for an appointment.
  This is difficult not only for the veterans, but for their families--
and it's unrealistic for veterans requiring frequent treatment for 
things like mental health services or post-traumatic stress.
  This bill helps our rural veterans by giving them a choice. Veterans 
will now be able to see a healthcare provider outside of the VA system 
if they live at least 40 miles from the closest VA medical facility and 
cannot get an appointment with a VA provider within a reasonable period 
of time.
  This choice works for the veterans in my district. On the Navajo 
Nation, we realized that it was too difficult for our veterans to 
travel great distances to VA providers--and we pushed for a partnership 
with the Indian Health Service.
  Now veterans on the Navajo Nation have the option of seeing a 
provider at the Indian Health Service without having to wait an 
unreasonable amount of time or travel great distances.
  Mr. Speaker, I urge my colleagues to support H.R. 4810 so that 
veterans in rural communities in Arizona and across the country can go 
to a local doctor, clinic or hospital when the VA wait time is just too 
long.
  Our veterans deserve timely care, and this will address one part of 
the VA access problem.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Florida (Mr. Miller) that the House suspend the rules 
and pass the bill, H.R. 4810.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. MILLER of Florida. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

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