[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
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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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