Congressional Record, Volume 160 Issue 90 (Wednesday, June 11, 2014)

[Congressional Record Volume 160, Number 90 (Wednesday, June 11, 2014)]
[Senate]
[Pages S3564-S3593]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

MAKING CONTINUING APPROPRIATIONS DURING A GOVERNMENT SHUTDOWN

Mr. REID. Madam President, I ask unanimous consent that the Senate
proceed to the consideration of Calendar No. 206, H.R. 3230; that all
after

[[Page S3565]]

the enacting clause be stricken and the text of S. 2450 be inserted in
lieu thereof, which is the Sanders-McCain veterans bill; that there be
no other amendments, motions or points of order in order other than a
budget point of order against the bill and the applicable motion to
waive; that the time until 4 p.m. be equally divided between the two
leaders or their designees; that if a budget point of order is made and
the applicable motion to waive the point of order is made, then at 4
p.m. today, the Senate proceed to vote on the motion to waive; if the
motion to waive is agreed to, the bill, as amended, be read a third
time and the Senate proceed to vote on passage of the bill, as amended.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered.
The clerk will report the bill by title.
The assistant legislative clerk read as follows:

A bill (H.R. 3230) making continuing appropriations during
a government shutdown to provide pay and allowances to
members of the reserve components of the Armed Forces who
perform inactive-duty training during such period.

The amendment is as follows:

H.R. 3230

Resolved, That the bill from the House of Representatives
(H.R. 3230) entitled ``An Act making continuing
appropriations during a Government shutdown to provide pay
and allowances to members of the reserve components of the
Armed Forces who perform inactive-duty training during such
period.'', do pass with the following amendments:
Strike all after the enacting clause, and insert in lieu
thereof:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Veterans'
Access to Care through Choice, Accountability, and
Transparency Act of 2014''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.

TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS

Sec. 101. Independent assessment of the scheduling of appointments and
other health care management processes of the Department
of Veterans Affairs.
Sec. 102. Technology task force on review of scheduling system and
software of the Department of Veterans Affairs.

TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

Sec. 201. Treatment of staffing shortage and biannual report on
staffing of medical facilities of the Department of
Veterans Affairs.
Sec. 202. Clinic management training for managers and health care
providers of the Department of Veterans Affairs.
Sec. 203. Use of unobligated amounts to hire additional health care
providers for the Veterans Health Administration.

TITLE III--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF
VETERANS AFFAIRS PROVIDERS

Sec. 301. Expanded availability of hospital care and medical services
for veterans through the use of contracts.
Sec. 302. Transfer of authority for payments for hospital care, medical
services, and other health care from non-Department
providers to the Chief Business Office of the Veterans
Health Administration of the Department.
Sec. 303. Enhancement of collaboration between Department of Veterans
Affairs and Indian Health Service.
Sec. 304. Enhancement of collaboration between Department of Veterans
Affairs and Native Hawaiian health care systems.
Sec. 305. Sense of Congress on prompt payment by Department of Veterans
Affairs.

TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

Sec. 401. Improvement of access of veterans to mobile vet centers of
the Department of Veterans Affairs.
Sec. 402. Commission on construction projects of the Department of
Veterans Affairs.
Sec. 403. Commission on Access to Care.
Sec. 404. Improved performance metrics for health care provided by
Department of Veterans Affairs.
Sec. 405. Improved transparency concerning health care provided by
Department of Veterans Affairs.
Sec. 406. Information for veterans on the credentials of Department of
Veterans Affairs physicians.
Sec. 407. Information in annual budget of the President on hospital
care and medical services furnished through expanded use
of contracts for such care.
Sec. 408. Prohibition on falsification of data concerning wait times
and quality measures at Department of Veterans Affairs.
Sec. 409. Removal of Senior Executive Service employees of the
Department of Veterans Affairs for performance.

TITLE V--HEALTH CARE RELATED TO SEXUAL TRAUMA

Sec. 501. Expansion of eligibility for sexual trauma counseling and
treatment to veterans on inactive duty training.
Sec. 502. Provision of counseling and treatment for sexual trauma by
the Department of Veterans Affairs to members of the
Armed Forces.
Sec. 503. Reports on military sexual trauma.

TITLE VI--MAJOR MEDICAL FACILITY LEASES

Sec. 601. Authorization of major medical facility leases.
Sec. 602. Budgetary treatment of Department of Veterans Affairs major
medical facilities leases.

TITLE VII--VETERANS BENEFITS MATTERS

Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry
Scholarship.
Sec. 702. Approval of courses of education provided by public
institutions of higher learning for purposes of All-
Volunteer Force Educational Assistance Program and Post-
9/11 Educational Assistance conditional on in-State
tuition rate for veterans.

TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS

Sec. 801. Appropriation of emergency amounts.
Sec. 802. Emergency designations.

TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS

SEC. 101. INDEPENDENT ASSESSMENT OF THE SCHEDULING OF
APPOINTMENTS AND OTHER HEALTH CARE MANAGEMENT
PROCESSES OF THE DEPARTMENT OF VETERANS
AFFAIRS.

(a) Independent Assessment.--
(1) Assessment.--Not later than 30 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall enter into a contract with an independent third party
to assess the following:
(A) The process at each medical facility of the Department
of Veterans Affairs for scheduling appointments for veterans
to receive hospital care, medical services, or other health
care from the Department.
(B) The staffing level and productivity of each medical
facility of the Department, including the following:
(i) The case load of each health care provider of the
Department.
(ii) The time spent by each health care provider of the
Department on matters other than the case load of such health
care provider, including time spent by such health care
provider as follows:

(I) At a medical facility that is affiliated with the
Department.
(II) Conducting research.
(III) Training or overseeing other health care
professionals of the Department.

(C) The organization, processes, and tools used by the
Department to support clinical documentation and the
subsequent coding of inpatient services.
(D) The purchasing, distribution, and use of
pharmaceuticals, medical and surgical supplies, and medical
devices by the Department, including the following:
(i) The prices paid for, standardization of, and use by the
Department of the following:

(I) High-cost pharmaceuticals.
(II) Medical and surgical supplies.
(III) Medical devices.

(ii) The use by the Department of group purchasing
arrangements to purchase pharmaceuticals, medical and
surgical supplies, medical devices, and health care related
services.
(iii) The strategy used by the Department to distribute
pharmaceuticals, medical and surgical supplies, and medical
devices to Veterans Integrated Service Networks and medical
facilities of the Department.
(E) The performance of the Department in paying amounts
owed to third parties and collecting amounts owed to the
Department with respect to hospital care, medical services,
and other health care, including any recommendations of the
independent third party as follows:
(i) To avoid the payment of penalties to vendors.
(ii) To increase the collection of amounts owed to the
Department for hospital care, medical services, or other
health care provided by the Department for which
reimbursement from a third party is authorized.
(iii) To increase the collection of any other amounts owed
to the Department.
(2) Elements of scheduling assessment.--In carrying out the
assessment required by paragraph (1)(A), the independent
third party shall do the following:
(A) Review all training materials pertaining to scheduling
of appointments at each medical facility of the Department.
(B) Assess whether all employees of the Department
conducting tasks related to scheduling are properly trained
for conducting such tasks.
(C) Assess whether changes in the technology or system used
in scheduling appointments are necessary to limit access to
the system to only those employees that have been properly
trained in conducting such tasks.
(D) Assess whether health care providers of the Department
are making changes to their

[[Page S3566]]

schedules that hinder the ability of employees conducting
such tasks to perform such tasks.
(E) Assess whether the establishment of a centralized call
center throughout the Department for scheduling appointments
at medical facilities of the Department would improve the
process of scheduling such appointments.
(F) Assess whether booking templates for each medical
facility or clinic of the Department would improve the
process of scheduling such appointments.
(G) Recommend any actions to be taken by the Department to
improve the process for scheduling such appointments,
including the following:
(i) Changes in training materials provided to employees of
the Department with respect to conducting tasks related to
scheduling such appointments.
(ii) Changes in monitoring and assessment conducted by the
Department of wait times of veterans for such appointments.
(iii) Changes in the system used to schedule such
appointments, including changes to improve how the
Department--

(I) measures wait times of veterans for such appointments;
(II) monitors the availability of health care providers of
the Department; and
(III) provides veterans the ability to schedule such
appointments.

(iv) Such other actions as the independent third party
considers appropriate.
(3) Timing.--The independent third party carrying out the
assessment required by paragraph (1) shall complete such
assessment not later than 180 days after entering into the
contract described in such paragraph.
(b) Report.--
(1) In general.--Not later than 90 days after the date on
which the independent third party completes the assessment
under this section, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the results of such assessment.
(2) Publication.--Not later than 30 days after submitting
the report under paragraph (1), the Secretary shall publish
such report in the Federal Register and on an Internet
website of the Department accessible to the public.

SEC. 102. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING
SYSTEM AND SOFTWARE OF THE DEPARTMENT OF
VETERANS AFFAIRS.

(a) Task Force Review.--
(1) In general.--The Secretary of Veterans Affairs shall,
through the use of a technology task force, conduct a review
of the needs of the Department of Veterans Affairs with
respect to the scheduling system and scheduling software of
the Department of Veterans Affairs that is used by the
Department to schedule appointments for veterans for hospital
care, medical services, and other health care from the
Department.
(2) Agreement.--
(A) In general.--The Secretary shall seek to enter into an
agreement with a technology organization or technology
organizations to carry out the review required by paragraph
(1).
(B) Prohibition on use of funds.--No Federal funds may be
used to assist the technology organization or technology
organizations under subparagraph (A) in carrying out the
review required by paragraph (1).
(b) Report.--
(1) In general.--Not later than 45 days after the date of
the enactment of this Act, the technology task force required
under subsection (a)(1) shall submit to the Secretary, the
Committee on Veterans' Affairs of the Senate, and the
Committee on Veterans' Affairs of the House of
Representatives a report setting forth the findings and
recommendations of the technology task force regarding the
needs of the Department with respect to the scheduling system
and scheduling software of the Department described in such
subsection.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) Proposals for specific actions to be taken by the
Department to improve the scheduling system and scheduling
software of the Department described in subsection (a)(1).
(B) A determination as to whether an existing off-the-shelf
system would--
(i) meet the needs of the Department to schedule
appointments for veterans for hospital care, medical
services, and other health care from the Department; and
(ii) improve the access of veterans to such care and
services.
(3) Publication.--Not later than 30 days after the receipt
of the report required by paragraph (1), the Secretary shall
publish such report in the Federal Register and on an
Internet website of the Department accessible to the public.
(c) Implementation of Task Force Recommendations.--Not
later than one year after the receipt of the report required
by subsection (b)(1), the Secretary shall implement the
recommendations set forth in such report that the Secretary
considers are feasible, advisable, and cost-effective.

TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

SEC. 201. TREATMENT OF STAFFING SHORTAGE AND BIANNUAL REPORT
ON STAFFING OF MEDICAL FACILITIES OF THE
DEPARTMENT OF VETERANS AFFAIRS.

(a) Staffing Shortage.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, and not later than September 30
each year thereafter, the Inspector General of the Department
of Veterans Affairs shall determine, and the Secretary of
Veterans Affairs shall publish in the Federal Register, the
five occupations of health care providers of the Department
of Veterans Affairs for which there is the largest staffing
shortage throughout the Department.
(2) Recruitment and appointment.--Notwithstanding sections
3304 and 3309 through 3318 of title 5, United States Code,
the Secretary may, upon a determination by the Inspector
General under paragraph (1) that there is a staffing shortage
throughout the Department with respect to a particular
occupation of health care provider, recruit and directly
appoint highly qualified health care providers to serve as
health care providers in that particular occupation for the
Department.
(3) Priority in health professionals educational assistance
program to certain providers.--Section 7612(b)(5) of title
38, United States Code, is amended--
(A) in subparagraph (A), by striking ``and'' at the end;
(B) by redesignating subparagraph (B) as subparagraph (C);
and
(C) by inserting after subparagraph (A) the following new
subparagraph (B):
``(B) shall give priority to applicants pursuing a course
of education or training towards a career in an occupation
for which the Secretary has, in the most current
determination published in the Federal Register pursuant to
section 201(a)(1) of the Veterans' Access to Care through
Choice, Accountability, and Transparency Act of 2014,
determined that there is one of the largest staffing
shortages throughout the Department with respect to such
occupation; and''.
(b) Reports.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, and not later than December 31 of
each even numbered year thereafter until 2024, the Secretary
of Veterans Affairs shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report
assessing the staffing of each medical facility of the
Department of Veterans Affairs.
(2) Elements.--Each report submitted under paragraph (1)
shall include the following:
(A) The results of a system-wide assessment of all medical
facilities of the Department to ensure the following:
(i) Appropriate staffing levels for health care providers
to meet the goals of the Secretary for timely access to care
for veterans.
(ii) Appropriate staffing levels for support personnel,
including clerks.
(iii) Appropriate sizes for clinical panels.
(iv) Appropriate numbers of full-time staff, or full-time
equivalents, dedicated to direct care of patients.
(v) Appropriate physical plant space to meet the capacity
needs of the Department in that area.
(vi) Such other factors as the Secretary considers
necessary.
(B) A plan for addressing any issues identified in the
assessment described in subparagraph (A), including a
timeline for addressing such issues.
(C) A list of the current wait times and workload levels
for the following clinics in each medical facility:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary considers
appropriate.
(D) A description of the results of the most current
determination of the Inspector General under paragraph (1) of
subsection (a) and a plan to use direct appointment authority
under paragraph (2) of such subsection to fill staffing
shortages, including recommendations for improving the speed
at which the credentialing and privileging process can be
conducted.
(E) The current staffing models of the Department for the
following clinics, including recommendations for changes to
such models:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary considers
appropriate.
(F) A detailed analysis of succession planning at medical
facilities of the Department, including the following:
(i) The number of positions in medical facilities
throughout the Department that are not filled by a permanent
employee.
(ii) The length of time each position described in clause
(i) remained vacant or filled by a temporary or acting
employee.
(iii) A description of any barriers to filling the
positions described in clause (i).
(iv) A plan for filling any positions that are vacant or
filled by a temporary or acting employee for more than 180
days.
(v) A plan for handling emergency circumstances, such as
administrative leave or sudden medical leave for senior
officials.
(G) The number of health care providers of the Department
who have been removed from their positions, have retired, or
have left their positions for another reason, disaggregated
by provider type, during the two-year period preceding the
submittal of the report.
(H) Of the health care providers specified in subparagraph
(G) who have been removed from their positions, the
following:
(i) The number of such health care providers who were
reassigned to other positions in the Department.
(ii) The number of such health care providers who left the
Department.
(iii) The number of such health care providers who left the
Department and were subsequently rehired by the Department.

SEC. 202. CLINIC MANAGEMENT TRAINING FOR MANAGERS AND HEALTH
CARE PROVIDERS OF THE DEPARTMENT OF VETERANS
AFFAIRS.

(a) Clinic Management Training Program.--

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(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall commence a clinic management training program to
provide in-person, standardized education on health care
management to all managers of, and health care providers at,
medical facilities of the Department of Veterans Affairs.
(2) Elements.--The clinic management training program
required by paragraph (1) shall include the following:
(A) Training on how to manage the schedules of health care
providers of the Department, including the following:
(i) Maintaining such schedules in a manner that allows
appointments to be booked at least eight weeks in advance.
(ii) Proper planning procedures for vacation, leave, and
graduate medical education training schedules.
(B) Training on the appropriate number of appointments that
a health care provider should conduct on a daily basis, based
on specialty.
(C) Training on how to determine whether there are enough
available appointment slots to manage demand for different
appointment types and mechanisms for alerting management of
insufficient slots.
(D) Training on how to properly use the appointment
scheduling system of the Department, including any new
scheduling system implemented by the Department.
(E) Training on how to optimize the use of technology,
including the following:
(i) Telemedicine.
(ii) Electronic mail.
(iii) Text messaging.
(iv) Such other technologies as specified by the Secretary.
(F) Training on how to properly use physical plant space at
medical facilities of the Department to ensure efficient flow
and privacy for patients and staff.
(3) Sunset.--The clinic management training program
required by paragraph (1) shall terminate on the date that is
two years after the date on which the Secretary commences
such program.
(b) Training Materials.--
(1) In general.--After the termination of the clinic
management training program required by subsection (a), the
Secretary shall provide training materials on health care
management to each of the following employees of the
Department upon the commencement of employment of such
employee:
(A) Any manager of a medical facility of the Department.
(B) Any health care provider at a medical facility of the
Department.
(C) Such other employees of the Department as the Secretary
considers appropriate.
(2) Update.--The Secretary shall regularly update the
training materials required under paragraph (1).

SEC. 203. USE OF UNOBLIGATED AMOUNTS TO HIRE ADDITIONAL
HEALTH CARE PROVIDERS FOR THE VETERANS HEALTH
ADMINISTRATION.

(a) In General.--At the end of each of fiscal years 2014
and 2015, all covered amounts shall be made available to the
Secretary of Veterans Affairs to hire additional health care
providers for the Veterans Health Administration of the
Department of Veterans Affairs, or to carry out any provision
of this Act or the amendments made by this Act, and shall
remain available until expended.
(b) Priority in Hiring.--The Secretary shall prioritize
hiring additional health care providers under subsection (a)
at medical facilities of the Department and in geographic
areas in which the Secretary identifies the greatest shortage
of health care providers.
(c) Covered Amounts Defined.--In this section, the term
``covered amounts'' means amounts--
(1) that are made available to the Veterans Health
Administration of the Department for an appropriations
account--
(A) under the heading ``medical services'';
(B) under the heading ``medical support and compliance'';
or
(C) under the heading ``medical facilities''; and
(2) that are unobligated at the end of the applicable
fiscal year.

TITLE III--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF
VETERANS AFFAIRS PROVIDERS

SEC. 301. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL
SERVICES FOR VETERANS THROUGH THE USE OF
CONTRACTS.

(a) Expansion of Available Care and Services.--
(1) Furnishing of care.--
(A) In general.--Hospital care and medical services under
chapter 17 of title 38, United States Code, shall be
furnished to an eligible veteran described in subsection (b),
at the election of such veteran, through contracts authorized
under subsection (d), or any other law administered by the
Secretary of Veterans Affairs, with entities specified in
subparagraph (B) for the furnishing of such care and services
to veterans.
(B) Entities specified.--The entities specified in this
subparagraph are the following:
(i) Any health care provider that is participating in the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.).
(ii) Any Federally-qualified health center (as defined in
section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B))).
(iii) The Department of Defense.
(iv) The Indian Health Service.
(2) Choice of provider.--An eligible veteran who elects to
receive care and services under this section may select the
provider of such care and services from among any source of
provider of such care and services through an entity
specified in paragraph (1)(B) that is accessible to the
veteran.
(3) Coordination of care and services.--The Secretary shall
coordinate, through the Non-VA Care Coordination Program of
the Department of Veterans Affairs, the furnishing of care
and services under this section to eligible veterans,
including by ensuring that an eligible veteran receives an
appointment for such care and services within the current
wait-time goals of the Veterans Health Administration for the
furnishing of hospital care and medical services.
(b) Eligible Veterans.--A veteran is an eligible veteran
for purposes of this section if--
(1)(A) the veteran is enrolled in the patient enrollment
system of the Department of Veterans Affairs established and
operated under section 1705 of title 38, United States Code;
or
(B) the veteran is enrolled in such system, has not
received hospital care or medical services from the
Department, and has contacted the Department seeking an
initial appointment from the Department for the receipt of
such care or services; and
(2) the veteran--
(A)(i) attempts, or has attempted under paragraph (1)(B),
to schedule an appointment for the receipt of hospital care
or medical services under chapter 17 of title 38, United
States Code, but is unable to schedule an appointment within
the current wait-time goals of the Veterans Health
Administration for the furnishing of such care or services;
and
(ii) elects, and is authorized, to be furnished such care
or services pursuant to subsection (c)(2);
(B) resides more than 40 miles from the nearest medical
facility of the Department, including a community-based
outpatient clinic, that is closest to the residence of the
veteran; or
(C) resides--
(i) in a State without a medical facility of the Department
that provides--

(I) hospital care;
(II) emergency medical services; and
(III) surgical care rated by the Secretary as having a
surgical complexity of standard; and

(ii) more than 20 miles from a medical facility of the
Department described in clause (i).
(c) Election and Authorization.--
(1) In general.--If the Secretary confirms that an
appointment for an eligible veteran described in subsection
(b)(2)(A) for the receipt of hospital care or medical
services under chapter 17 of title 38, United States Code, is
unavailable within the current wait-time goals of the
Department for the furnishing of such care or services, the
Secretary shall, at the election of the eligible veteran--
(A) place such eligible veteran on an electronic waiting
list described in paragraph (2) for such an appointment; or
(B)(i) authorize that such care and services be furnished
to the eligible veteran under this section for a period of
time specified by the Secretary; and
(ii) send a letter to the eligible veteran describing the
care and services the eligible veteran is eligible to receive
under this section.
(2) Electronic waiting list.--The electronic waiting list
described in this paragraph shall be maintained by the
Department and allow access by each eligible veteran via
www.myhealth.va.gov or any successor website for the
following purposes:
(A) To determine the place of such eligible veteran on the
waiting list.
(B) To determine the average length of time an individual
spends on the waiting list, disaggregated by medical facility
of the Department and type of care or service needed, for
purposes of allowing such eligible veteran to make an
informed election under paragraph (1).
(d) Care and Services Through Contracts.--
(1) In general.--The Secretary shall enter into contracts
with health care providers that are participating in the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) to furnish care and services to
eligible veterans under this section.
(2) Rates and reimbursement.--
(A) In general.--In entering into a contract under this
subsection, the Secretary shall--
(i) negotiate rates for the furnishing of care and services
under this section; and
(ii) reimburse the health care provider for such care and
services at the rates negotiated pursuant to clause (i) as
provided in such contract.
(B) Limit on rates.--
(i) In general.--Except as provided in clause (ii), rates
negotiated under subparagraph (A)(i) shall not be more than
the rates paid by the United States to a provider of services
(as defined in section 1861(u) of the Social Security Act (42
U.S.C. 1395x(u))) or a supplier (as defined in section
1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare
program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) for the same care and services.
(ii) Exception.--The Secretary may negotiate a rate that is
more than the rate paid by the United States as described in
clause (i) with respect to the furnishing of care or services
under this section to an eligible veteran if the Secretary
determines that there is no health care provider that will
provide such care or services to such eligible veteran at the
rate required under such clause--

(I) within the current wait-time goals of the Veterans
Health Administration for the furnishing of such care or
services; and
(II) at a location not more than 40 miles from the
residence of such eligible veteran.

(C) Limit on collection.--For the furnishing of care and
services pursuant to a contract under this section, a health
care provider may not collect any amount that is greater than
the rate negotiated pursuant to subparagraph (A)(i).
(3) Information on policies and procedures.--The Secretary
shall provide to any

[[Page S3568]]

health care provider with which the Secretary has entered
into a contract under paragraph (1) the following:
(A) Information on applicable policies and procedures for
submitting bills or claims for authorized care and services
furnished to eligible veterans under this section.
(B) Access to a telephone hotline maintained by the
Department that such health care provider may call for
information on the following:
(i) Procedures for furnishing care and services under this
section.
(ii) Procedures for submitting bills or claims for
authorized care and services furnished to eligible veterans
under this section and being reimbursed for furnishing such
care and services.
(iii) Whether particular care or services under this
section are authorized, and the procedures for authorization
of such care or services.
(e) Choice Card.--
(1) In general.--For purposes of receiving care and
services under this section, the Secretary shall issue to
each eligible veteran a card that the eligible veteran shall
present to a health care provider that is eligible to furnish
care and services under this section before receiving such
care and services.
(2) Name of card.--Each card issued under paragraph (1)
shall be known as a ``Choice Card''.
(3) Details of card.--Each Choice Card issued to an
eligible veteran under paragraph (1) shall include the
following:
(A) The name of the eligible veteran.
(B) An identification number for the eligible veteran that
is not the social security number of the eligible veteran.
(C) The contact information of an appropriate office of the
Department for health care providers to confirm that care and
services under this section are authorized for the eligible
veteran.
(D) Contact information and other relevant information for
the submittal of claims or bills for the furnishing of care
and services under this section.
(E) The following statement: ``This card is for qualifying
medical care outside the Department of Veterans Affairs.
Please call the Department of Veterans Affairs phone number
specified on this card to ensure that treatment has been
authorized.''.
(4) Information on use of card.--Upon issuing a Choice Card
to an eligible veteran, the Secretary shall provide the
eligible veteran with information clearly stating the
circumstances under which the veteran may be eligible for
care and services under this section.
(f) Information on Availability of Care.--The Secretary
shall provide information to a veteran about the availability
of care and services under this section in the following
circumstances:
(1) When the veteran enrolls in the patient enrollment
system of the Department under section 1705 of title 38,
United States Code.
(2) When the veteran attempts to schedule an appointment
for the receipt of hospital care or medical services from the
Department but is unable to schedule an appointment within
the current wait-time goals of the Veterans Health
Administration for delivery of such care or services.
(g) Providers.--To be eligible to furnish care and services
under this section, a health care provider must--
(1) maintain at least the same or similar credentials and
licenses as those credentials and licenses that are required
of health care providers of the Department, as determined by
the Secretary for purposes of this section; and
(2) submit, not less frequently than once each year,
verification of such licenses and credentials maintained by
such health care provider.
(h) Cost-sharing.--
(1) In general.--The Secretary shall require an eligible
veteran to pay a copayment to the Department for the receipt
of care and services under this section only if such eligible
veteran would be required to pay such copayment for the
receipt of such care and services at a medical facility of
the Department.
(2) Limitation.--The copayment required under paragraph (1)
shall not be greater than the copayment required of such
eligible veteran by the Department for the receipt of such
care and services at a medical facility of the Department.
(i) Claims Processing System.--
(1) In general.--The Secretary shall provide for an
efficient nationwide system for processing and paying bills
or claims for authorized care and services furnished to
eligible veterans under this section.
(2) Regulations.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall prescribe regulations for the implementation of such
system.
(3) Oversight.--The Chief Business Office of the Veterans
Health Administration shall oversee the implementation and
maintenance of such system.
(4) Accuracy of payment.--
(A) In general.--The Secretary shall ensure that such
system meets such goals for accuracy of payment as the
Secretary shall specify for purposes of this section.
(B) Annual report.--
(i) In general.--Not later than one year after the date of
the enactment of this Act, and annually thereafter until the
termination date specified in subsection (n), the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the goals for accuracy of such
system.
(ii) Elements.--Each report required by clause (i) shall
include the following:

(I) A description of the goals for accuracy for such system
specified by the Secretary under subparagraph (A).
(II) An assessment of the success of the Department in
meeting such goals during the year preceding the submittal of
the report.

(j) Medical Records.--The Secretary shall ensure that any
health care provider that furnishes care and services under
this section to an eligible veteran submits to the Department
any medical record related to the care and services provided
to such eligible veteran by such health care provider for
inclusion in the electronic medical record of such eligible
veteran maintained by the Department upon the completion of
the provision of such care and services to such eligible
veteran.
(k) Tracking of Missed Appointments.--The Secretary shall
implement a mechanism to track any missed appointments for
care and services under this section by eligible veterans to
ensure that the Department does not pay for such care and
services that were not furnished to an eligible veteran.
(l) Implementation.--Not later than 90 days after the date
of the enactment of this Act, the Secretary shall prescribe
interim final regulations on the implementation of this
section and publish such regulations in the Federal Register.
(m) Inspector General Report.--Not later than 540 days
after the publication of the interim final regulations under
subsection (l), the Inspector General of the Department shall
submit to the Secretary a report on the results of an audit
of the care and services furnished under this section to
ensure the accuracy and timeliness of payments by the
Department for the cost of such care and services, including
any findings and recommendations of the Inspector General.
(n) Termination.--The requirement of the Secretary to
furnish care and services under this section terminates on
the date that is two years after the date on which the
Secretary publishes the interim final regulations under
subsection (l).
(o) Reports.--
(1) Initial report.--Not later than 90 days after the
publication of the interim final regulations under subsection
(l), the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the furnishing of
care and services under this section that includes the
following:
(A) The number of eligible veterans who have received care
and services under this section.
(B) A description of the type of care and services
furnished to eligible veterans under this section.
(2) Final report.--Not later than 540 days after the
publication of the interim final regulations under subsection
(l), the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the furnishing of
care and services under this section that includes the
following:
(A) The total number of eligible veterans who have received
care and services under this section, disaggregated by--
(i) eligible veterans described in subsection (b)(2)(A);
and
(ii) eligible veterans described in subsection (b)(2)(B).
(B) A description of the type of care and services
furnished to eligible veterans under this section.
(C) An accounting of the total cost of furnishing care and
services to eligible veterans under this section.
(D) The results of a survey of eligible veterans who have
received care or services under this section on the
satisfaction of such eligible veterans with the care or
services received by such eligible veterans under this
section.
(E) An assessment of the effect of furnishing care and
services under this section on wait times for an appointment
for the receipt of hospital care and medical services from
the Department.
(F) An assessment of the feasibility and advisability of
continuing furnishing care and services under this section
after the termination date specified in subsection (n).
(p) Rules of Construction.--
(1) No modification of contracts.--Nothing in this section
shall be construed to require the Secretary to renegotiate
contracts for the furnishing of hospital care or medical
services to veterans entered into by the Department before
the date of the enactment of this Act.
(2) Filling and paying for prescription medications.--
Nothing in this section shall be construed to alter the
process of the Department for filling and paying for
prescription medications.

SEC. 302. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL
CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE
FROM NON-DEPARTMENT PROVIDERS TO THE CHIEF
BUSINESS OFFICE OF THE VETERANS HEALTH
ADMINISTRATION OF THE DEPARTMENT.

(a) Transfer of Authority.--
(1) In general.--Effective on October 1, 2014, the
Secretary of Veterans Affairs shall transfer the authority to
pay for hospital care, medical services, and other health
care through non-Department providers to the Chief Business
Office of the Veterans Health Administration of the
Department of Veterans Affairs from the Veterans Integrated
Service Networks and medical centers of the Department of
Veterans Affairs.
(2) Manner of care.--The Chief Business Office shall work
in consultation with the Office of Clinical Operations and
Management of the Department of Veterans Affairs to ensure
that care and services described in paragraph (1) are
provided in a manner that is clinically appropriate and
effective.
(3) No delay in payment.--The transfer of authority under
paragraph (1) shall be carried out in a manner that does not
delay or impede

[[Page S3569]]

any payment by the Department for hospital care, medical
services, or other health care provided through a non-
Department provider under the laws administered by the
Secretary.
(b) Budgetary Effect.--The Secretary shall, for each fiscal
year that begins after the date of the enactment of this
Act--
(1) include in the budget for the Chief Business Office of
the Veterans Health Administration amounts to pay for
hospital care, medical services, and other health care
provided through non-Department providers, including any
amounts necessary to carry out the transfer of authority to
pay for such care and services under subsection (a),
including any increase in staff; and
(2) not include in the budget of each Veterans Integrated
Service Network and medical center of the Department amounts
to pay for such care and services.

SEC. 303. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF
VETERANS AFFAIRS AND INDIAN HEALTH SERVICE.

(a) Outreach to Tribal-Run Medical Facilities.--The
Secretary of Veterans Affairs shall, in consultation with the
Director of the Indian Health Service, conduct outreach to
each medical facility operated by an Indian tribe or tribal
organization through a contract or compact with the Indian
Health Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) to raise
awareness of the ability of such facilities, Indian tribes,
and tribal organizations to enter into agreements with the
Department of Veterans Affairs under which the Secretary
reimburses such facilities, Indian tribes, or tribal
organizations, as the case may be, for health care provided
to veterans eligible for health care at such facilities.
(b) Metrics for Memorandum of Understanding Performance.--
The Secretary of Veterans Affairs shall implement performance
metrics for assessing the performance by the Department of
Veterans Affairs and the Indian Health Service under the
memorandum of understanding entitled ``Memorandum of
Understanding between the Department of Veterans Affairs (VA)
and the Indian Health Service (IHS)'' in increasing access to
health care, improving quality and coordination of health
care, promoting effective patient-centered collaboration and
partnerships between the Department and the Service, and
ensuring health-promotion and disease-prevention services are
appropriately funded and available for beneficiaries under
both health care systems.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs and
the Director of the Indian Health Service shall jointly
submit to Congress a report on the feasibility and
advisability of the following:
(1) Entering into agreements for the reimbursement by the
Secretary of the costs of direct care services provided
through organizations receiving amounts pursuant to grants
made or contracts entered into under section 503 of the
Indian Health Care Improvement Act (25 U.S.C. 1653) to
veterans who are otherwise eligible to receive health care
from such organizations.
(2) Including the reimbursement of the costs of direct care
services provided to veterans who are not Indians in
agreements between the Department and the following:
(A) The Indian Health Service.
(B) An Indian tribe or tribal organization operating a
medical facility through a contract or compact with the
Indian Health Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).
(C) A medical facility of the Indian Health Service.
(d) Definitions.--In this section:
(1) Indian.--The terms ``Indian'' and ``Indian tribe'' have
the meanings given those terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603).
(2) Medical facility of the indian health service.--The
term ``medical facility of the Indian Health Service''
includes a facility operated by an Indian tribe or tribal
organization through a contract or compact with the Indian
Health Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).
(3) Tribal organization.--The term ``tribal organization''
has the meaning given the term in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C.
450b).

SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF
VETERANS AFFAIRS AND NATIVE HAWAIIAN HEALTH
CARE SYSTEMS.

(a) In General.--The Secretary of Veterans Affairs shall,
in consultation with Papa Ola Lokahi and such other
organizations involved in the delivery of health care to
Native Hawaiians as the Secretary considers appropriate,
enter into contracts or agreements with Native Hawaiian
health care systems that are in receipt of funds from the
Secretary of Health and Human Services pursuant to grants
awarded or contracts entered into under section 6(a) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C.
11705(a)) for the reimbursement of direct care services
provided to eligible veterans as specified in such contracts
or agreements.
(b) Definitions.--In this section, the terms ``Native
Hawaiian'', ``Native Hawaiian health care system'', and
``Papa Ola Lokahi'' have the meanings given those terms in
section 12 of the Native Hawaiian Health Care Improvement Act
(42 U.S.C. 11711).

SEC. 305. SENSE OF CONGRESS ON PROMPT PAYMENT BY DEPARTMENT
OF VETERANS AFFAIRS.

It is the sense of Congress that the Secretary of Veterans
Affairs shall comply with section 1315 of title 5, Code of
Federal Regulations (commonly known as the ``prompt payment
rule''), or any corresponding similar regulation or ruling,
in paying for health care pursuant to contracts entered into
with non-Department of Veterans Affairs providers to provide
health care under the laws administered by the Secretary.

TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET
CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS.

(a) Improvement of Access.--
(1) In general.--The Secretary of Veterans Affairs shall
improve the access of veterans to telemedicine and other
health care through the use of mobile vet centers of the
Department of Veterans Affairs by providing standardized
requirements for the operation of such centers.
(2) Requirements.--The standardized requirements required
by paragraph (1) shall include the following:
(A) The number of days each mobile vet center of the
Department is expected to travel per year.
(B) The number of locations each center is expected to
visit per year.
(C) The number of appointments each center is expected to
conduct per year.
(D) The method and timing of notifications given by each
center to individuals in the area to which such center is
traveling, including notifications informing veterans of the
availability to schedule appointments at the center.
(3) Use of telemedicine.--The Secretary shall ensure that
each mobile vet center of the Department has the capability
to provide telemedicine services.
(b) Reports.--Not later than one year after the date of the
enactment of this Act, and not later than September 30 each
year thereafter, the Secretary of Veterans Affairs shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report on the following:
(1) The use of mobile vet centers to provide telemedicine
services to veterans during the year preceding the submittal
of the report, including the following:
(A) The number of days each mobile vet center was open to
provide such services.
(B) The number of days each mobile vet center traveled to a
location other than the headquarters of the mobile vet center
to provide such services.
(C) The number of appointments each center conducted to
provide such services on average per month and in total
during such year.
(2) An analysis of the effectiveness of using mobile vet
centers to provide health care services to veterans through
the use of telemedicine.
(3) Any recommendations for an increase in the number of
mobile vet centers of the Department.
(4) Any recommendations for an increase in the telemedicine
capabilities of each mobile vet center.
(5) The feasibility and advisability of using temporary
health care providers, including locum tenens, to provide
direct health care services to veterans at mobile vet
centers.
(6) Such other recommendations on improvement of the use of
mobile vet centers by the Department as the Secretary
considers appropriate.

SEC. 402. COMMISSION ON CONSTRUCTION PROJECTS OF THE
DEPARTMENT OF VETERANS AFFAIRS.

(a) Establishment of Commission.--
(1) Establishment.--There is established an Independent
Commission on Department of Veterans Affairs Construction
Projects (in this section referred to as the ``Commission'').
(2) Membership.--
(A) Voting members.--The Commission shall be composed of 10
voting members as follows:
(i) Three members to be appointed by the President from
among members of the National Academy of Engineering who are
nominated under subparagraph (B).
(ii) Three members to be appointed by the President from
among members of the National Institute of Building Sciences
who are nominated under subparagraph (B).
(iii) Four members to be appointed by the President from
among veterans enrolled in the patient enrollment system of
the Department of Veterans Affairs under section 1705 of
title 38, United States Code, who are nominated under
subparagraph (B).
(B) Nomination of voting members.--The majority leader of
the Senate, the minority leader of the Senate, the speaker of
the House of Representatives, and the minority leader of the
House of Representatives shall jointly nominate not less than
24 individuals to be considered by the President for
appointment under subparagraph (A).
(C) Nonvoting members.--The Commission shall be composed of
the following nonvoting members:
(i) The Comptroller General of the United States, or
designee.
(ii) The Secretary of Veterans Affairs, or designee.
(iii) The Inspector General of the Department of Veterans
Affairs, or designee.
(D) Date of appointment of members.--The appointments of
the members of the Commission under subparagraph (A) shall be
made not later than 14 days after the date of the enactment
of this Act.
(3) Period of appointment; vacancies.--Members shall be
appointed for the life of the Commission. Any vacancy in the
Commission shall not affect its powers, but shall be filled
in the same manner as the original appointment.
(4) Initial meeting.--Not later than five days after the
date on which all members of the Commission have been
appointed, the Commission shall hold its first meeting.
(5) Meetings.--The Commission shall meet at the call of the
Chairperson.
(6) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.

[[Page S3570]]

(7) Chairperson and vice chairperson.--The Commission shall
select a Chairperson and Vice Chairperson from among its
members.
(b) Duties of Commission.--
(1) Review.--The Commission shall review current
construction and maintenance projects and the medical
facility leasing program of the Department of Veterans
Affairs to identify any problems experienced by the
Department in carrying out such projects and program.
(2) Reports.--
(A) Commission report.--Not later than 120 days after the
date of the enactment of this Act, the Commission shall
submit to the Secretary of Veterans Affairs, the Committee on
Veterans' Affairs of the Senate, and the Committee on
Veterans' Affairs of the House of Representatives a report
setting forth recommendations, if any, for improving the
manner in which the Secretary carries out the projects and
program specified in paragraph (1).
(B) Department report.--Not later than 60 days after the
submittal of the report under subparagraph (A), the Secretary
of Veterans Affairs shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
the feasibility and advisability of implementing the
recommendations of the Commission, if any, included in the
report submitted under such subparagraph, including a
timeline for the implementation of such recommendations.
(c) Powers of Commission.--
(1) Hearings.--The Commission may hold such hearings, sit
and act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable
to carry out this section.
(2) Information from federal agencies.--The Commission may
secure directly from any Federal agency such information as
the Commission considers necessary to carry out this section.
Upon request of the Chairperson of the Commission, the head
of such agency shall furnish such information to the
Commission.
(d) Commission Personnel Matters.--
(1) Compensation of members.--Each member of the Commission
who is not an officer or employee of the Federal Government
shall be compensated at a rate equal to the daily equivalent
of the annual rate of basic pay prescribed for level IV of
the Executive Schedule under section 5315 of title 5, United
States Code, for each day (including travel time) during
which such member is engaged in the performance of the duties
of the Commission. All members of the Commission who are
officers or employees of the United States shall serve
without compensation in addition to that received for their
services as officers or employees of the United States.
(2) Travel expenses.--The members of the Commission shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of
business in the performance of services for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission may,
without regard to the civil service laws and regulations,
appoint and terminate an executive director and such other
additional personnel as may be necessary to enable the
Commission to perform its duties. The employment of an
executive director shall be subject to confirmation by the
Commission.
(B) Compensation.--The Chairperson of the Commission may
fix the compensation of the executive director and other
personnel without regard to chapter 51 and subchapter III of
chapter 53 of title 5, United States Code, relating to
classification of positions and General Schedule pay rates,
except that the rate of pay for the executive director and
other personnel may not exceed the rate payable for level V
of the Executive Schedule under section 5316 of such title.
(4) Detail of government employees.--Any Federal Government
employee may be detailed to the Commission without
reimbursement, and such detail shall be without interruption
or loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services.--
The Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5,
United States Code, at rates for individuals that do not
exceed the daily equivalent of the annual rate of basic pay
prescribed for level V of the Executive Schedule under
section 5316 of such title.
(e) Termination of Commission.--The Commission shall
terminate 30 days after the date on which the Commission
submits its report under subsection (b)(2)(A).

SEC. 403. COMMISSION ON ACCESS TO CARE.

(a) Establishment of Commission.--
(1) In general.--There is established the Commission on
Access to Care (in this section referred to as the
``Commission'') to examine the access of veterans to health
care from the Department of Veterans Affairs and
strategically examine how best to organize the Veterans
Health Administration, locate health care resources, and
deliver health care to veterans during the 10- to 20-year
period beginning on the date of the enactment of this Act.
(2) Membership.--
(A) Voting members.--The Commission shall be composed of 10
voting members who are appointed by the President as follows:
(i) At least two members who represent an organization
recognized by the Secretary of Veterans Affairs for the
representation of veterans under section 5902 of title 38,
United States Code.
(ii) At least one member from among persons who have
experience as senior management for a private integrated
health care system with an annual gross revenue of more than
$50,000,000.
(iii) At least one member from among persons who are
familiar with government health care systems, including those
systems of the Department of Defense, the Indian Health
Service, and Federally-qualified health centers (as defined
in section 1905(l)(2)(B) of the Social Security Act (42
U.S.C. 1396d(l)(2)(B))).
(iv) At least two members from among persons who are
familiar with the Veterans Health Administration but are not
current employees of the Veterans Health Administration.
(v) At least two members from among persons who are
veterans or eligible for hospital care, medical services, or
other health care under the laws administered by the
Secretary of Veterans Affairs.
(B) Nonvoting members.--
(i) In general.--In addition to members appointed under
subparagraph (A), the Commission shall be composed of 10
nonvoting members who are appointed by the President as
follows:

(I) At least two members who represent an organization
recognized by the Secretary of Veterans Affairs for the
representation of veterans under section 5902 of title 38,
United States Code.
(II) At least one member from among persons who have
experience as senior management for a private integrated
health care system with an annual gross revenue of more than
$50,000,000.
(III) At least one member from among persons who are
familiar with government health care systems, including those
systems of the Department of Defense, the Indian Health
Service, and Federally-qualified health centers (as defined
in section 1905(l)(2)(B) of the Social Security Act (42
U.S.C. 1396d(l)(2)(B))).
(IV) At least two members from among persons who are
familiar with the Veterans Health Administration but are not
current employees of the Veterans Health Administration.
(V) At least two members from among persons who are
veterans or eligible for hospital care, medical services, or
other health care under the laws administered by the
Secretary of Veterans Affairs.

(ii) Additional nonvoting members.--In addition to members
appointed under subparagraph (A) and clause (i), the
Commission shall be composed of the following nonvoting
members:

(I) The Comptroller General of the United States, or
designee.
(II) The Inspector General of the Department of Veterans
Affairs, or designee.

(C) Date.--The appointments of members of the Commission
shall be made not later than 60 days after the date of the
enactment of this Act.
(3) Period of appointment; vacancies.--Members shall be
appointed for the life of the Commission. Any vacancy in the
Commission shall not affect its powers, but shall be filled
in the same manner as the original appointment.
(4) Initial meeting.--Not later than 15 days after the date
on which seven voting members of the Commission have been
appointed, the Commission shall hold its first meeting.
(5) Meetings.--The Commission shall meet at the call of the
Chairperson.
(6) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.
(7) Chairperson and vice chairperson.--The Commission shall
select a Chairperson and Vice Chairperson from among its
members.
(b) Duties of Commission.--
(1) Evaluation and assessment.--The Commission shall
undertake a comprehensive evaluation and assessment of access
to health care at the Department of Veterans Affairs.
(2) Matters evaluated and assessed.--The matters evaluated
and assessed by the Commission shall include the following:
(A) The appropriateness of current standards of the
Department of Veterans Affairs concerning access to health
care.
(B) The measurement of such standards.
(C) The appropriateness of performance standards and
incentives in relation to standards described in subparagraph
(A).
(D) Staffing levels throughout the Veterans Health
Administration and whether they are sufficient to meet
current demand for health care from the Administration.
(E) The results of the assessment conducted by an
independent third party under section 101(a), including any
data or recommendations included in such assessment.
(3) Reports.--The Commission shall submit to the President,
through the Secretary of Veterans Affairs, reports as
follows:
(A) Not later than 90 days after the date of the initial
meeting of the Commission, an interim report on--
(i) the findings of the Commission with respect to the
evaluation and assessment required by this subsection; and
(ii) such recommendations as the Commission may have for
legislative or administrative action to improve access to
health care through the Veterans Health Administration.
(B) Not later than 180 days after the date of the initial
meeting of the Commission, a final report on--
(i) the findings of the Commission with respect to the
evaluation and assessment required by this subsection; and
(ii) such recommendations as the Commission may have for
legislative or administrative action to improve access to
health care through the Veterans Health Administration.
(c) Powers of the Commission.--
(1) Hearings.--The Commission may hold such hearings, sit
and act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable
to carry out this section.
(2) Information from federal agencies.--The Commission may
secure directly from any Federal department or agency such
information as the Commission considers necessary to carry

[[Page S3571]]

out this section. Upon request of the Chairperson of the
Commission, the head of such department or agency shall
furnish such information to the Commission.
(d) Commission Personnel Matters.--
(1) Compensation of members.--Each member of the Commission
who is not an officer or employee of the Federal Government
shall be compensated at a rate equal to the daily equivalent
of the annual rate of basic pay prescribed for level IV of
the Executive Schedule under section 5315 of title 5, United
States Code, for each day (including travel time) during
which such member is engaged in the performance of the duties
of the Commission. All members of the Commission who are
officers or employees of the United States shall serve
without compensation in addition to that received for their
services as officers or employees of the United States.
(2) Travel expenses.--The members of the Commission shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of
business in the performance of services for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission may,
without regard to the civil service laws and regulations,
appoint and terminate an executive director and such other
additional personnel as may be necessary to enable the
Commission to perform its duties. The employment of an
executive director shall be subject to confirmation by the
Commission.
(B) Compensation.--The Chairperson of the Commission may
fix the compensation of the executive director and other
personnel without regard to chapter 51 and subchapter III of
chapter 53 of title 5, United States Code, relating to
classification of positions and General Schedule pay rates,
except that the rate of pay for the executive director and
other personnel may not exceed the rate payable for level V
of the Executive Schedule under section 5316 of such title.
(4) Detail of government employees.--Any Federal Government
employee may be detailed to the Commission without
reimbursement, and such detail shall be without interruption
or loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services.--
The Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5,
United States Code, at rates for individuals that do not
exceed the daily equivalent of the annual rate of basic pay
prescribed for level V of the Executive Schedule under
section 5316 of such title.
(e) Termination of the Commission.--The Commission shall
terminate 30 days after the date on which the Commission
submits its report under subsection (b)(3)(B).
(f) Funding.--The Secretary of Veterans Affairs shall make
available to the Commission from amounts appropriated or
otherwise made available to the Secretary such amounts as the
Secretary and the Chairperson of the Commission jointly
consider appropriate for the Commission to perform its duties
under this section.
(g) Executive Action.--
(1) Action on recommendations.--The President shall require
the Secretary of Veterans Affairs and such other heads of
relevant Federal departments and agencies to implement each
recommendation set forth in a report submitted under
subsection (b)(3) that the President--
(A) considers feasible and advisable; and
(B) determines can be implemented without further
legislative action.
(2) Reports.--Not later than 60 days after the date on
which the President receives a report under subsection
(b)(3), the President shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives and such
other committees of Congress as the President considers
appropriate a report setting forth the following:
(A) An assessment of the feasibility and advisability of
each recommendation contained in the report received by the
President.
(B) For each recommendation assessed as feasible and
advisable under subparagraph (A) the following:
(i) Whether such recommendation requires legislative
action.
(ii) If such recommendation requires legislative action, a
recommendation concerning such legislative action.
(iii) A description of any administrative action already
taken to carry out such recommendation.
(iv) A description of any administrative action the
President intends to be taken to carry out such
recommendation and by whom.

SEC. 404. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE
PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.

(a) Prohibition on Use of Scheduling and Wait-time Metrics
in Determination of Performance Awards.--The Secretary of
Veterans Affairs shall ensure that scheduling and wait-time
metrics or goals are not used as factors in determining the
performance of the following employees for purposes of
determining whether to pay performance awards to such
employees:
(1) Directors, associate directors, assistant directors,
deputy directors, chiefs of staff, and clinical leads of
medical centers of the Department of Veterans Affairs.
(2) Directors, assistant directors, and quality management
officers of Veterans Integrated Service Networks of the
Department of Veterans Affairs.
(b) Modification of Performance Plans.--
(1) In general.--Not later than 30 days after the date of
the enactment of this Act, the Secretary shall modify the
performance plans of the directors of the medical centers of
the Department and the directors of the Veterans Integrated
Service Networks to ensure that such plans are based on the
quality of care received by veterans at the health care
facilities under the jurisdictions of such directors.
(2) Factors.--In modifying performance plans under
paragraph (1), the Secretary shall ensure that assessment of
the quality of care provided at health care facilities under
the jurisdiction of a director described in paragraph (1)
includes consideration of the following:
(A) Recent reviews by the Joint Commission (formerly known
as the ``Joint Commission on Accreditation of Healthcare
Organizations'') of such facilities.
(B) The number and nature of recommendations concerning
such facilities by the Inspector General of the Department in
reviews conducted through the Combined Assessment Program
(CAP), in the reviews by the Inspector General of community
based outpatient clinics and primary care clinics, and in
reviews conducted through the Office of Healthcare
Inspections during the two most recently completed fiscal
years.
(C) The number of recommendations described in subparagraph
(B) that the Inspector General of the Department determines
have not been carried out satisfactorily with respect to such
facilities.
(D) Reviews of such facilities by the Commission on
Accreditation of Rehabilitation Facilities.
(E) The number and outcomes of administrative investigation
boards, root cause analysis, and peer reviews conducted at
such facilities during the fiscal year for which the
assessment is being conducted.
(F) The effectiveness of any remedial actions or plans
resulting from any Inspector General recommendations in the
reviews and analyses described in subparagraphs (A) through
(E).
(3) Additional leadership positions.--To the degree
practicable, the Secretary shall assess the performance of
other employees of the Department in leadership positions at
Department medical centers, including associate directors,
assistant directors, deputy directors, chiefs of staff, and
clinical leads, and in Veterans Integrated Service Networks,
including assistant directors and quality management
officers, using factors and criteria similar to those used in
the performance plans modified under paragraph (1).
(c) Removal of Certain Performance Goals.--For each fiscal
year that begins after the date of the enactment of this Act,
the Secretary shall not include in the performance goals of
any employee of a Veterans Integrated Service Network or
medical center of the Department any performance goal that
might disincentivize the payment of Department amounts to
provide hospital care, medical services, or other health care
through a non-Department provider.

SEC. 405. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE
PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.

(a) Publication of Wait Times.--
(1) Goals.--
(A) Initial.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs
shall publish in the Federal Register, and on an Internet
website accessible to the public of each medical center of
the Department of Veterans Affairs, the wait-time goals of
the Department for the scheduling of an appointment by a
veteran for the receipt of health care from the Department.
(B) Subsequent changes.--
(i) In general.--If the Secretary modifies the wait-time
goals described in subparagraph (A), the Secretary shall
publish the new wait-times goals--

(I) on an Internet website accessible to the public of each
medical center of the Department not later than 30 days after
such modification; and
(II) in the Federal Register not later than 90 days after
such modification.

(ii) Effective date.--Any modification under clause (i)
shall take effect on the date of publication in the Federal
Register.
(C) Goals described.--Wait-time goals published under this
paragraph shall include goals for primary care appointments,
specialty care appointments, and appointments based on the
general severity of the condition of the veteran.
(2) Wait times at medical centers of the department.--Not
later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall publish on an
Internet website accessible to the public of each medical
center of the Department the current wait time for an
appointment for primary care and specialty care at the
medical center.
(b) Publicly Available Database of Patient Safety, Quality
of Care, and Outcome Measures.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall develop and
make available to the public a comprehensive database
containing all applicable patient safety, quality of care,
and outcome measures for health care provided by the
Department that are tracked by the Secretary.
(2) Update frequency.--The Secretary shall update the
database required by paragraph (1) not less frequently than
once each year.
(3) Unavailable measures.--For all measures that the
Secretary would otherwise publish in the database required by
paragraph (1) but has not done so because such measures are
not available, the Secretary shall publish notice in the
database of the reason for such unavailability and a timeline
for making such measures available in the database.
(4) Accessibility.--The Secretary shall ensure that the
database required by paragraph (1) is accessible to the
public through the primary Internet website of the Department
and

[[Page S3572]]

through each primary Internet website of a Department medical
center.
(c) Hospital Compare Website of Department of Health and
Human Services.--
(1) Agreement required.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall enter into an agreement with the Secretary of
Health and Human Services for the provision by the Secretary
of Veterans Affairs of such information as the Secretary of
Health and Human Services may require to report and make
publicly available patient quality and outcome information
concerning Department of Veterans Affairs medical centers
through the Hospital Compare Internet website of the
Department of Health and Human Services or any successor
Internet website.
(2) Information provided.--The information provided by the
Secretary of Veterans Affairs to the Secretary of Health and
Human Services under paragraph (1) shall include the
following:
(A) Measures of timely and effective health care.
(B) Measures of readmissions, complications of death,
including with respect to 30-day mortality rates and 30-day
readmission rates, surgical complication measures, and health
care related infection measures.
(C) Survey data of patient experiences, including the
Hospital Consumer Assessment of Healthcare Providers and
Systems or any similar successor survey developed by the
Department of Health and Human Services.
(D) Any other measures required of or reported with respect
to hospitals participating in the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.).
(3) Unavailable information.--For any applicable metric
collected by the Department of Veterans Affairs or required
to be provided under paragraph (2) and withheld from or
unavailable in the Hospital Compare Internet website, the
Secretary of Veterans Affairs shall publish a notice in the
Federal Register stating the reason why such metric was
withheld from public disclosure and a timeline for making
such metric available, if applicable.
(d) Comptroller General Review of Publicly Available Safety
and Quality Metrics.--Not later than three years after the
date of the enactment of this Act, the Comptroller General of
the United States shall conduct a review of the safety and
quality metrics made publicly available by the Secretary of
Veterans Affairs under this section to assess the degree to
which the Secretary is complying with the provisions of this
section.

SEC. 406. INFORMATION FOR VETERANS ON THE CREDENTIALS OF
DEPARTMENT OF VETERANS AFFAIRS PHYSICIANS.

(a) Improvement of ``Our Providers'' Internet Website
Links.--
(1) Availability through department of veterans affairs
homepage.--A link to the ``Our Providers'' health care
providers database of the Department of Veterans Affairs, or
any successor database, shall be available on and through the
homepage of the Internet website of the Department that is
accessible to the public.
(2) Information on location of residency training.--The
Internet website of the Department that is accessible to the
public shall include under the link to the ``Our Providers''
health care providers database of the Department, or any
successor database, the location of residency training of
each licensed physician of the Department.
(3) Information on physicians at particular facilities.--
The ``Our Providers'' health care providers database of the
Department, or any successor database, shall identify whether
each licensed physician of the Department is a physician in
residency.
(b) Information on Credentials of Physicians for Veterans
Undergoing Surgical Procedures.--
(1) In general.--Each veteran who is undergoing a surgical
procedure by or through the Department shall be provided
information on the credentials of the surgeon to be
performing such procedure at such time in advance of the
procedure as is appropriate to permit such veteran to
evaluate such information.
(2) Other individuals.--If a veteran is unable to evaluate
the information provided under paragraph (1) due to the
health or mental competence of the veteran, such information
shall be provided to an individual acting on behalf of the
veteran.
(c) Comptroller General Report and Plan.--
(1) Report.--Not later than two years after the date of the
enactment of this Act, the Comptroller General of the United
States shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report setting forth an assessment
by the Comptroller General of the following:
(A) The manner in which contractors under the Patient-
Centered Community Care initiative of the Department perform
oversight of the credentials of physicians within the
networks of such contractors under the initiative.
(B) The oversight by the Department of the contracts under
the Patient-Centered Community Care initiative.
(C) The verification by the Department of the credentials
and licenses of health care providers furnishing hospital
care and medical services under section 301.
(2) Plan.--
(A) In general.--Not later than 30 days after the submittal
of the report under paragraph (1), the Secretary shall--
(i) submit to the Comptroller General, the Committee on
Veterans' Affairs of the Senate, and the Committee on
Veterans' Affairs of the House of Representatives a plan to
address any findings and recommendations of the Comptroller
General included in such report; and
(ii) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a request for additional amounts, if any,
that may be necessary to carry out such plan.
(B) Implementation.--Not later than 90 days after the
submittal of the report under paragraph (1), the Secretary
shall carry out such plan.

SEC. 407. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON
HOSPITAL CARE AND MEDICAL SERVICES FURNISHED
THROUGH EXPANDED USE OF CONTRACTS FOR SUCH
CARE.

The materials on the Department of Veterans Affairs in the
budget of the President for a fiscal year, as submitted to
Congress pursuant to section 1105(a) of title 31, United
States Code, shall set forth the following:
(1) The number of veterans who received hospital care and
medical services under section 301 during the fiscal year
preceding the fiscal year in which such budget is submitted.
(2) The amount expended by the Department on furnishing
care and services under such section during the fiscal year
preceding the fiscal year in which such budget is submitted.
(3) The amount requested in such budget for the costs of
furnishing care and services under such section during the
fiscal year covered by such budget, set forth in aggregate
and by amounts for each account for which amounts are so
requested.
(4) The number of veterans that the Department estimates
will receive hospital care and medical services under such
section during the fiscal years covered by the budget
submission.
(5) The number of employees of the Department on paid
administrative leave at any point during the fiscal year
preceding the fiscal year in which such budget is submitted.

SEC. 408. PROHIBITION ON FALSIFICATION OF DATA CONCERNING
WAIT TIMES AND QUALITY MEASURES AT DEPARTMENT
OF VETERANS AFFAIRS.

Not later than 60 days after the date of the enactment of
this Act, and in accordance with title 5, United States Code,
the Secretary of Veterans Affairs shall establish policies
whereby any employee of the Department of Veterans Affairs
who knowingly submits false data concerning wait times for
health care or quality measures with respect to health care
to another employee of the Department or knowingly requires
another employee of the Department to submit false data
concerning such wait times or quality measures to another
employee of the Department is subject to a penalty the
Secretary considers appropriate after notice and an
opportunity for a hearing, including civil penalties, unpaid
suspensions, or termination.

SEC. 409. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF
THE DEPARTMENT OF VETERANS AFFAIRS FOR
PERFORMANCE.

(a) Removal or Transfer.--
(1) In general.--Chapter 7 of title 38, United States Code,
is amended by adding at the end the following new section:

``Sec. 713. Senior Executive Service: removal based on
performance

``(a) In General.--The Secretary may remove any individual
from the Senior Executive Service if the Secretary determines
the performance of the individual warrants such removal. If
the Secretary so removes such an individual, the Secretary
may--
``(1) remove the individual from the civil service (as
defined in section 2101 of title 5); or
``(2) transfer the individual to a General Schedule
position at any grade of the General Schedule for which the
individual is qualified and that the Secretary determines is
appropriate.
``(b) Notice to Congress.--Not later than 30 days after
removing or transferring an individual from the Senior
Executive Service under subsection (a), the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate
and House of Representatives notice in writing of such
removal or transfer and the reason for such removal or
transfer.
``(c) Procedure.--(1) The procedures under section 7543 of
title 5 shall not apply to a removal or transfer under this
section.
``(2)(A) Subject to subparagraph (B), any removal or
transfer under subsection (a) may be appealed to the Merit
Systems Protection Board under section 7701 of title 5.
``(B) An appeal under subparagraph (A) of a removal or
transfer may only be made if such appeal is made not later
than 7 days after the date of such removal or transfer.
``(d) Expedited Review by Merit Systems Protection Board.--
(1) The Merit Systems Protection Board shall expedite any
appeal under section 7701 of title 5 of a removal or transfer
under subsection (a) and, in any such case, shall issue a
decision not later than 21 days after the date of the appeal.
``(2) In any case in which the Merit Systems Protection
Board determines that it cannot issue a decision in
accordance with the 21-day requirement under paragraph (1),
the Merit Systems Protection Board shall submit to Congress a
report that explains the reason why the Merit Systems
Protection Board is unable to issue a decision in accordance
with such requirement in such case.
``(3) There is authorized to be appropriated such sums as
may be necessary for the Merit Systems Protection Board to
expedite appeals under paragraph (1).
``(4) The Merit Systems Protection Board may not stay any
personnel action taken under this section.
``(5) A person who appeals under section 7701 of title 5 a
removal under subsection (a)(1) may not receive any pay,
awards, bonuses, incentives, allowances, differentials,
student loan repayments, special payments, or benefits from
the Secretary until the Merit Systems Protection Board has
made a final decision on such appeal.
``(6) A decision made by the Merit Systems Protection Board
with respect to a removal or

[[Page S3573]]

transfer under subsection (a) shall not be subject to any
further appeal.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by adding at the end the
following new item:

``713. Senior Executive Service: removal based on performance.''.
(b) Establishment of Expedited Review Process.--
(1) In general.--Not later than 30 days after the date of
the enactment of this Act, the Merit Systems Protection Board
shall establish and put into effect a process to conduct
expedited reviews in accordance with section 713(d) of title
38, United States Code.
(2) Inapplicability of certain regulations.--Section
1201.22 of title 5, Code of Federal Regulations, as in effect
on the day before the date of the enactment of this Act,
shall not apply to expedited reviews carried out under
section 713(d) of title 38, United States Code.
(3) Report by merit systems protection board.--Not later
than 30 days after the date of the enactment of this Act, the
Merit Systems Protection Board shall submit to Congress a
report on the actions the Board plans to take to conduct
expedited reviews under section 713(d) of title 38, United
States Code, as added by subsection (a). Such report shall
include a description of the resources the Board determines
will be necessary to conduct such reviews and a description
of whether any resources will be necessary to conduct such
reviews that were not available to the Board on the day
before the date of the enactment of this Act.
(c) Temporary Exemption From Certain Limitation on
Initiation of Removal From Senior Executive Service.--During
the 120-day period beginning on the date of the enactment of
this Act, an action to remove an individual from the Senior
Executive Service at the Department of Veterans Affairs
pursuant to section 713 of title 38, United States Code, as
added by subsection (a), or section 7543 of title 5, United
States Code, may be initiated, notwithstanding section
3592(b) of title 5, United States Code, or any other
provision of law.
(d) Construction.--Nothing in this section or section 713
of title 38, United States Code, as added by subsection (a),
shall be construed to apply to an appeal of a removal,
transfer, or other personnel action that was pending before
the date of the enactment of this Act.

TITLE V--HEALTH CARE RELATED TO SEXUAL TRAUMA

SEC. 501. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA
COUNSELING AND TREATMENT TO VETERANS ON
INACTIVE DUTY TRAINING.

Section 1720D(a)(1) of title 38, United States Code, is
amended by striking ``or active duty for training'' and
inserting ``, active duty for training, or inactive duty
training''.

SEC. 502. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL
TRAUMA BY THE DEPARTMENT OF VETERANS AFFAIRS TO
MEMBERS OF THE ARMED FORCES.

(a) Expansion of Coverage to Members of the Armed Forces.--
Subsection (a) of section 1720D of title 38, United States
Code, is amended--
(1) by redesignating paragraph (2) as paragraph (3);
(2) by inserting after paragraph (1) the following new
paragraph (2):
``(2)(A) In operating the program required by paragraph
(1), the Secretary may, in consultation with the Secretary of
Defense, provide counseling and care and services to members
of the Armed Forces (including members of the National Guard
and Reserves) on active duty to overcome psychological trauma
described in that paragraph.
``(B) A member described in subparagraph (A) shall not be
required to obtain a referral before receiving counseling and
care and services under this paragraph.''; and
(3) in paragraph (3), as predesignated by paragraph (1)--
(A) by striking ``a veteran'' and inserting ``an
individual''; and
(B) by striking ``that veteran'' each place it appears and
inserting ``that individual''.
(b) Information to Members on Availability of Counseling
and Services.--Subsection (c) of such section is amended--
(1) by striking ``to veterans'' each place it appears; and
(2) in paragraph (3), by inserting ``members of the Armed
Forces and'' before ``individuals''.
(c) Inclusion of Members in Reports on Counseling and
Services.--Subsection (e) of such section is amended--
(1) in the matter preceding paragraph (1), by striking ``to
veterans'';
(2) in paragraph (2)--
(A) by striking ``women veterans'' and inserting
``individuals''; and
(B) by striking ``training under subsection (d).'' and
inserting ``training under subsection (d), desegregated by--
``(A) veterans;
``(B) members of the Armed Forces (including members of the
National Guard and Reserves) on active duty; and
``(C) for each of subparagraphs (A) and (B)--
``(i) men; and
``(ii) women.'';
(3) in paragraph (4), by striking ``veterans'' and
inserting ``individuals''; and
(4) in paragraph (5)--
(A) by striking ``women veterans'' and inserting
``individuals'' ; and
(B) by inserting ``, including specific recommendations for
individuals specified in subparagraphs (A), (B), and (C) of
paragraph (2)'' before the period at the end.
(d) Effective Date.--The amendments made by this section
shall take effect on the date that is one year after the date
of the enactment of this Act.

SEC. 503. REPORTS ON MILITARY SEXUAL TRAUMA.

(a) Report on Services Available for Military Sexual Trauma
in the Department of Veterans Affairs.--Not later than 630
days after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
the treatment and services available from the Department of
Veterans Affairs for male veterans who experience military
sexual trauma compared to such treatment and services
available to female veterans who experience military sexual
trauma.
(b) Reports on Transition of Military Sexual Trauma
Treatment From Department of Defense to Department of
Veterans Affairs.--Not later than 630 days after the date of
the enactment of this Act, and annually thereafter for five
years, the Department of Veterans Affairs-Department of
Defense Joint Executive Committee established by section
320(a) of title 38, United States Code, shall submit to the
appropriate committees of Congress a report on military
sexual trauma that includes the following:
(1) The processes and procedures utilized by the Department
of Veterans Affairs and the Department of Defense to
facilitate transition of treatment of individuals who have
experienced military sexual trauma from treatment provided by
the Department of Defense to treatment provided by the
Department of Veterans Affairs.
(2) A description and assessment of the collaboration
between the Department of Veterans Affairs and the Department
of Defense in assisting veterans in filing claims for
disabilities related to military sexual trauma, including
permitting veterans access to information and evidence
necessary to develop or support such claims.
(c) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the Committee on
Armed Services of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on
Armed Services of the House of Representatives.
(2) Military sexual trauma.--The term ``military sexual
trauma'' means psychological trauma, which in the judgment of
a mental health professional employed by the Department,
resulted from a physical assault of a sexual nature, battery
of a sexual nature, or sexual harassment which occurred while
the veteran was serving on active duty or active duty for
training.
(3) Sexual harassment.--The term ``sexual harassment''
means repeated, unsolicited verbal or physical contact of a
sexual nature which is threatening in character.
(4) Sexual trauma.--The term ``sexual trauma'' shall have
the meaning given that term by the Secretary of Veterans
Affairs for purposes of this section.
(d) Effective Date.--This section shall take effect on the
date that is 270 days after the date of the enactment of this
Act.

TITLE VI--MAJOR MEDICAL FACILITY LEASES

SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

The Secretary of Veterans Affairs may carry out the
following major medical facility leases at the locations
specified, and in an amount for each lease not to exceed the
amount shown for such location (not including any estimated
cancellation costs):
(1) For a clinical research and pharmacy coordinating
center, Albuquerque, New Mexico, an amount not to exceed
$9,560,000.
(2) For a community-based outpatient clinic, Brick, New
Jersey, an amount not to exceed $7,280,000.
(3) For a new primary care and dental clinic annex,
Charleston, South Carolina, an amount not to exceed
$7,070,250.
(4) For the Cobb County community-based Outpatient Clinic,
Cobb County, Georgia, an amount not to exceed $6,409,000.
(5) For the Leeward Outpatient Healthcare Access Center,
Honolulu, Hawaii, including a co-located clinic with the
Department of Defense and the co-location of the Honolulu
Regional Office of the Veterans Benefits Administration and
the Capel Vet Center of the Department of Veterans Affairs,
an amount not to exceed $15,887,370.
(6) For a community-based outpatient clinic, Johnson
County, Kansas, an amount not to exceed $2,263,000.
(7) For a replacement community-based outpatient clinic,
Lafayette, Louisiana, an amount not to exceed $2,996,000.
(8) For a community-based outpatient clinic, Lake Charles,
Louisiana, an amount not to exceed $2,626,000.
(9) For outpatient clinic consolidation, New Port Riche,
Florida, an amount not to exceed $11,927,000.
(10) For an outpatient clinic, Pence, Puerto Rico, an
amount not to exceed $11,535,000.
(11) For lease consolidation, San Antonio, Texas, an amount
not to exceed $19,426,000.
(12) For a community-based outpatient clinic, San Diego,
California, an amount not to exceed $11,946,100.
(13) For an outpatient clinic, Tyler, Texas, an amount not
to exceed $4,327,000.
(14) For the Arere Community Care Center, West Haven,
Connecticut, an amount not to exceed $4,883,000.
(15) For the Worcester community-based Outpatient Clinic,
Worcester, Massachusetts, an amount not to exceed $4,855,000.
(16) For the expansion of a community-based outpatient
clinic, Cape Girardeau, Missouri, an amount not to exceed
$4,232,060.
(17) For a multi specialty clinic, Chattanooga, Tennessee,
an amount not to exceed $7,069,000.

[[Page S3574]]

(18) For the expansion of a community-based outpatient
clinic, Chico, California, an amount not to exceed
$4,534,000.
(19) For a community-based outpatient clinic, Chula Vista,
California, an amount not to exceed $3,714,000.
(20) For a new research lease, Haines, Illinois, an amount
not to exceed $22,032,000.
(21) For a replacement research lease, Houston, Texas, an
amount not to exceed $6,142,000.
(22) For a community-based outpatient clinic, Lincoln,
Nebraska, an amount not to exceed $7,178,400.
(23) For a community-based outpatient clinic, Lubbock,
Texas, an amount not to exceed $8,554,000.
(24) For a community-based outpatient clinic consolidation,
Myrtle Beach, South Carolina, an amount not to exceed
$8,022,000.
(25) For a community-based outpatient clinic, Phoenix,
Arizona, an amount not to exceed $20,757,000.
(26) For the expansion of a community-based outpatient
clinic, Redding, California, an amount not to exceed
$8,154,000.

SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS
AFFAIRS MAJOR MEDICAL FACILITIES LEASES.

(a) Findings.--Congress finds the following:
(1) Title 31, United States Code, requires the Department
of Veterans Affairs to record the full cost of its
contractual obligation against funds available at the time a
contract is executed.
(2) Office of Management and Budget Circular A-11 provides
guidance to agencies in meeting the statutory requirements
under title 31, United States Code, with respect to leases.
(3) For operating leases, Office of Management and Budget
Circular A-11 requires the Department of Veterans Affairs to
record up-front budget authority in an ``amount equal to
total payments under the full term of the lease or [an]
amount sufficient to cover first year lease payments plus
cancellation costs''.
(b) Requirement for Obligation of Full Cost.--
(1) In general.--Subject to the availability of
appropriations provided in advance, in exercising the
authority of the Secretary of Veterans Affairs to enter into
leases provided in this Act, the Secretary shall record,
pursuant to section 1501 of title 31, United States Code, as
the full cost of the contractual obligation at the time a
contract is executed either--
(A) an amount equal to total payments under the full term
of the lease; or
(B) if the lease specifies payments to be made in the event
the lease is terminated before its full term, an amount
sufficient to cover the first year lease payments plus the
specified cancellation costs.
(2) Self-insuring authority.--The requirements of paragraph
(1) may be satisfied through the use of a self-insuring
authority consistent with Office of Management and Budget
Circular A-11.
(c) Transparency.--
(1) Compliance.--Subsection (b) of section 8104 of title
38, United States Code, is amended by adding at the end the
following new paragraph:
``(7) In the case of a prospectus proposing funding for a
major medical facility lease, a detailed analysis of how the
lease is expected to comply with Office of Management and
Budget Circular A-11 and section 1341 of title 31 (commonly
referred to as the `Anti-Deficiency Act'). Any such analysis
shall include--
``(A) an analysis of the classification of the lease as a
`lease-purchase', `capital lease', or `operating lease' as
those terms are defined in Office of Management and Budget
Circular A-11;
``(B) an analysis of the obligation of budgetary resources
associated with the lease; and
``(C) an analysis of the methodology used in determining
the asset cost, fair market value, and cancellation costs of
the lease.''.
(2) Submittal to congress.--Such section 8104 is further
amended by adding at the end the following new subsection:
``(h)(1) Not less than 30 days before entering into a major
medical facility lease, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and the House
of Representatives--
``(A) notice of the Secretary's intention to enter into the
lease;
``(B) a detailed summary of the proposed lease;
``(C) a description and analysis of any differences between
the prospectus submitted pursuant to subsection (b) and the
proposed lease; and
``(D) a scoring analysis demonstrating that the proposed
lease fully complies with Office of Management and Budget
Circular A-11.
``(2) Each committee described in paragraph (1) shall
ensure that any information submitted to the committee under
such paragraph is treated by the committee with the same
level of confidentiality as is required by law of the
Secretary and subject to the same statutory penalties for
unauthorized disclosure or use as the Secretary.
``(3) Not more than 30 days after entering into a major
medical facility lease, the Secretary shall submit to each
committee described in paragraph (1) a report on any material
differences between the lease that was entered into and the
proposed lease described under such paragraph, including how
the lease that was entered into changes the previously
submitted scoring analysis described in subparagraph (D) of
such paragraph.''.
(d) Rule of Construction.--Nothing in this section, or the
amendments made by this section, shall be construed to in any
way relieve the Department of Veterans Affairs from any
statutory or regulatory obligations or requirements existing
prior to the enactment of this section and such amendments.

TITLE VII--VETERANS BENEFITS MATTERS

SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY
SCHOLARSHIP.

(a) Expansion of Entitlement.--Subsection (b)(9) of section
3311 of title 38, United States Code, is amended by inserting
``or spouse'' after ``child''.
(b) Limitation and Election on Certain Benefits.--
Subsection (f) of such section is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
(2) by inserting after paragraph (1) the following new
paragraphs:
``(2) Limitation.--The entitlement of an individual to
assistance under subsection (a) pursuant to paragraph (9) of
subsection (b) because the individual was a spouse of a
person described in such paragraph shall expire on the
earlier of--
``(A) the date that is 15 years after the date on which the
person died; and
``(B) the date on which the individual remarries.
``(3) Election on receipt of certain benefits.--A surviving
spouse entitled to assistance under subsection (a) pursuant
to paragraph (9) of subsection (b) who is also entitled to
educational assistance under chapter 35 of this title may not
receive assistance under both this section and such chapter,
but shall make an irrevocable election (in such form and
manner as the Secretary may prescribe) under which section or
chapter to receive educational assistance.''.
(c) Conforming Amendment.--Section 3321(b)(4) of such title
is amended--
(1) by striking ``an individual'' and inserting ``a
child''; and
(2) by striking ``such individual's'' each time it appears
and inserting ``such child's''.

SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC
INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES OF
ALL-VOLUNTEER FORCE EDUCATIONAL ASSISTANCE
PROGRAM AND POST-9/11 EDUCATIONAL ASSISTANCE
CONDITIONAL ON IN-STATE TUITION RATE FOR
VETERANS.

(a) In General.--Section 3679 of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(c)(1) Notwithstanding any other provision of this
chapter and subject to paragraphs (3) through (6), the
Secretary shall disapprove a course of education provided by
a public institution of higher learning to a covered
individual pursuing a course of education with educational
assistance under chapter 30 or 33 of this title while living
in the State in which the public institution of higher
learning is located if the institution charges tuition and
fees for that course for the covered individual at a rate
that is higher than the rate the institution charges for
tuition and fees for that course for residents of the State
in which the institution is located, regardless of the
covered individual's State of residence.
``(2) For purposes of this subsection, a covered individual
is any individual as follows:
``(A) A veteran who was discharged or released from a
period of not fewer than 90 days of service in the active
military, naval, or air service less than three years before
the date of enrollment in the course concerned.
``(B) An individual who is entitled to assistance under
section 3311(b)(9) or 3319 of this title by virtue of such
individual's relationship to a veteran described in
subparagraph (A).
``(3) If after enrollment in a course of education that is
subject to disapproval under paragraph (1) by reason of
paragraph (2)(A) or (2)(B) a covered individual pursues one
or more courses of education at the same public institution
of higher learning while remaining continuously enrolled
(other than during regularly scheduled breaks between
courses, semesters or terms) at that institution of higher
learning, any course so pursued by the covered individual at
that institution of higher learning while so continuously
enrolled shall also be subject to disapproval under paragraph
(1).
``(4) It shall not be grounds to disapprove a course of
education under paragraph (1) if a public institution of
higher learning requires a covered individual pursuing a
course of education at the institution to demonstrate an
intent, by means other than satisfying a physical presence
requirement, to establish residency in the State in which the
institution is located, or to satisfy other requirements not
relating to the establishment of residency, in order to be
charged tuition and fees for that course at a rate that is
equal to or less than the rate the institution charges for
tuition and fees for that course for residents of the State.
``(5) The Secretary may waive such requirements of
paragraph (1) as the Secretary considers appropriate.
``(6) Disapproval under paragraph (1) shall apply only with
respect to educational assistance under chapters 30 and 33 of
this title.''.
(b) Effective Date.--Subsection (c) of section 3679 of
title 38, United States Code (as added by subsection (a) of
this section), shall apply with respect to educational
assistance provided for pursuit of programs of education
during academic terms that begin after July 1, 2015, through
courses of education that commence on or after that date.

TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS

SEC. 801. APPROPRIATION OF EMERGENCY AMOUNTS.

There is authorized to be appropriated, and is
appropriated, to the Secretary of Veterans Affairs, out of
any funds in the Treasury not otherwise appropriated, for
fiscal years 2014, 2015,

[[Page S3575]]

and 2016, such sums as may be necessary to carry out this
Act.

SEC. 802. EMERGENCY DESIGNATIONS.

(a) In General.--This Act is designated as an emergency
requirement pursuant to section 4(g) of the Statutory Pay-As-
You-Go Act of 2010 (2 U.S.C. 933(g)).
(b) Designation in Senate.--In the Senate, this Act is
designated as an emergency requirement pursuant to section
403(a) of S. Con. Res. 13 (111th Congress), the concurrent
resolution on the budget for fiscal year 2010.

Mr. REID. Madam President, we will have one or two rollcall votes
starting at 4 p.m. this afternoon.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. McCAIN. Madam President, we have not completed this legislation,
and we may be subject to a budget point of order. It is not clear yet
whether there will be one, but according to this unanimous consent
agreement, there will be no amendments filed prior to a vote on final
passage either with or without a budget point of order being considered
by the body. We will have time between now and then to have an indepth
discussion of the provisions of this legislation.
In the meantime, I thank the Senator from Vermont for his willingness
to make very difficult compromises. I also thank many of my colleagues
who have forgone the amending process in order that we may expedite
this legislation, which if there is a definition for emergency, I would
say this legislation fits that appellation. It is an emergency. What is
happening to our veterans and the men and women who have served this
country needs to be addressed, and we need to pass this legislation and
get it to conference with the House as soon as possible.
I especially mention two people who are really responsible for this
legislation, and I say--with not typical modesty--that they were the
ones who were really responsible for the provisions of this bill; that
is, Senator Burr, ranking member of the Veterans' Affairs Committee,
and Senator Coburn, whom I view, in many respects, as the conscience of
the Senate. Those two individuals were largely responsible for this
legislation, and I am obviously very proud to be a part of it.
Again, we will have time to discuss this legislation, but I extend my
appreciation to the Senator from Vermont whose chairmanship of the
Veterans' Affairs Committee has been conducted with patriotism and with
the needs of our veterans uppermost in his priorities.
I thank the Senator from Vermont, and I look forward to our passing
this legislation and getting it to conference in as short a period of
time as is possible so we can bring it back to this body and then to
the President's desk for signature.
I yield the floor.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. SANDERS. Madam President, the Senator from Arizona has been too
modest. He deserves a great deal of credit for stepping to the plate
when we needed him to step to the plate. He understands that we have an
emergency, and it is imperative that the veterans of this country get
quality care in a timely manner. He and I were both determined to make
sure that something happened.
I thank Senator McCain and his staff for their hard work on this
bill. We will discuss this issue more on the floor. He was absolutely
right when he said that we have an emergency. We have to pass this
legislation today. We have to get it to conference as soon as possible,
and we have to get a good bill on the President's desk next week.
Again, I thank Senator McCain.
With that I yield the floor.
Mr. McCAIN. Madam President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll. The assistant
legislative clerk proceeded to call the roll.
Mr. COONS. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Climate Change

Mr. COONS. Madam President, I come to the floor of the Senate to
speak about an issue that is of urgent concern to me and should be of
urgent concern to all of us. That issue is global warming or climate
change.
This is a personal issue for me. As the father of three, along with
any other parent, my kids are never far from my mind and my heart. This
is true for me as a father as well as a Senator, where every day I have
to ask the question: What kind of example am I setting? What kind of a
world are my actions going to lead to? What sort of a world will I
leave my children, and will it be better than the one my parents left
to me?
Last summer I experienced one of the great joys of parenthood--a
family trip. My wife Annie and I took our three children Maggie,
Michael, and Jack on a visit to one of our Nation's most spectacular
places: the mountains and glaciers of Glacier National Park in Montana.
There was one hike in particular on our summer trip that I will never
forget. It was our hike up to visit historic Grinnell Glacier. If we
had taken this hike more than 60 years ago, here is what we would have
seen, as this picture shows: mountains deep in glaciers, thick with ice
and snow, covered in the glaciers that gave this national park its
name. Yet last year as we took a long and winding hike up the trails,
we came up and over the last rise, and what we saw was noticeably
different--strikingly so--because most of what is left of the iconic
Grinnell Glacier in the summer is a chilly pool of water in a largely
empty valley pool. We can see the difference in these two pictures, and
this is just in one lifetime.
Since 1966, Grinnell Glacier has lost half its total acreage, and as
we continue to warm our planet, these changes will only accelerate. My
children--our children--will not just lose the chance to see beautiful
glaciers and an iconic national park but the chance to live in a world
as robust and safe and healthy and vibrant as the one their parents
were born into. As our global population keeps growing toward 9 billion
and developing nations keep seeking higher living standards and climate
change accelerates, this is the foundational challenge of the 21st
century.
Climate change impacts everything: human health, agriculture,
national security, migration patterns for animals and fish and birds.
As parents and as a nation, I think it is our responsibility, our
challenge, and our opportunity to lead the way, to show that prosperity
does not need to mean doom for our future.
I also think in my view that, simply put, there is no alternative to
action. The world where we don't act isn't a world of vibrant economic
growth, it is a world with more frequent and extreme natural disasters,
with increased droughts and famine, with displaced populations and
cities--even regions and in a few cases even nations--plunged under
water.
I represent the lowest mean elevation State in America, the State of
Delaware. It has been documented in a broad study led by our Governor's
Department of Natural Resources and Environmental Control that rising
sea levels could put up to 11 percent of my home State of Delaware
under water by the end of the century. We know these changes are
coming. They are slow. They are gradual. They are cumulative. At times
they are hard to perceive, but they have already started and will only
get more extreme and more expensive the longer we wait to act. The cost
of our inaction will be borne by our children and generations to come.
We are not the only ones seeing these impacts, and although the
debate over science raged for many years, and I think is settled, I
have also had an opportunity to hear from folks who live well outside
the Western scientific world but have a profound insight into what
these impacts are and how they are seen in the world.
Several years ago, along with the senior Senator, a friend of mine,
our President pro tempore, Senator Leahy, I visited the Kogi tribe in
the remote Santa Marta Mountains of Colombia. These equatorial
mountains have massive glaciers up at the very top of very high
mountains but are also right at the edge of the Caribbean Sea. The
folks who make up this pre-Colombian tribe, the Kogi tribe, don't have
sophisticated technology that monitors and tracks climate change, but
as they sat with us they shared with us what they see as starkly as our
best weather-monitoring satellites. By observing changes in migratory
patterns and weather and the snowpack on the glacial mountains they
worship, they see,

[[Page S3576]]

more every year, that there is a fundamental change happening in our
environment, in our climate. Their purpose in calling us to meet with
them was to warn us that climate change is impacting the way of life
that has passed down from generation to generation for centuries in
their people, and it has moved them to speak out to the world, to tell
their story, and to urge the rest of us not to hurt Mother Earth and to
understand the consequences of the changes we are making.
Whether the voices we listen to come from our own children, from our
science community or from remote corners of the world, all of them call
us to act, to act in a way that prevents the worst from happening and
to ensure that the benefits outweigh the costs.
This isn't just wild-eyed or rosy thinking. It is possible for us to
make meaningful change in a bipartisan way. We have done it before.
Back in 1990, when acid rain was a real and pressing challenge that was
threatening the vitality and the vibrancy of many of the lakes and the
mountain places in the American West, I remember well that under then-
Republican President George H.W. Bush, Congress came together in a
bipartisan way and passed the Clean Air Act amendments. These were
designed to reduce the contributing elements to acid rain: powerplant
emissions that produce sulfur dioxide and nitrogen dioxide that in
combination caused acid rain, damaging historic property, monuments,
injuring forests and lakes and ecosystems all over our country.
So Congress came together to create a novel, market-based, flexible
cap-and-trade program that allowed powerplants to find cost-effective
alternatives, solutions to limit pollution. Rather than tanking our
economy, that cap-and-trade plan to fight acid rain ended up finding
new ways to power our country and to improve energy efficiency without
so much pollution. We adapted, we changed, and in some ways we thrived.
As a study done 13 years later shows, those standards adopted in 1990
have saved lives at a cost well worth it: $70 billion in health
benefits every year, cumulatively, compared to $1.7 billion in costs--a
40-to-1 tradeoff that I think most Americans would take any day of the
week as a return on their investment.
More recently, in my own State of Delaware and eight of our
northeastern neighbors, we showed how we can act together to begin to
curb climate change and grow our economies at the same time. In 2003, a
bipartisan group of regional leaders, this time led by New York State's
Republican Gov. George Pataki, built a regional cap-and-trade system,
similar to the Acid Rain Prevention Program I just referenced. But the
one in our region was called the Regional Greenhouse Gas Initiative, or
RGGI for short. It is flexible, market-based, and it has been
effective. States choose to cut pollution in a number of ways, from
closing older coal-fired powerplants or opening renewable energy
projects to investing in important and valuable energy efficiency.
As the New York Times reported just last week, since that program
started in 2009, our economies in these regional States have actually
grown more than the 41 other States that are not part of RGGI--by
several percentage points--while we have cut our emissions over four
times more than the rest of the Nation.
We have created jobs, we have invested in innovation, we have cut
pollution, and we saved millions of families money on their energy
bills. That is why I think we should feel optimistic about the
important steps the administration has just taken. The President's
strong standards for vehicle fuel efficiency were a great start. At
first many argued that pushing car companies to make cleaner, more
efficient cars would end up costing a huge amount of money with little
to show for it. But the opposite has happened.
We set more aggressive national standards. Engineers have gotten to
work. They have innovated. They have invented. America's leading car
companies have met the challenge, and the improvement in fuel
efficiency has been dramatic. Although there is a cost in upfront
research and development, it is well worth it, as drivers save money at
the pump, America becomes less dependent on foreign oil, and we all get
to breathe cleaner air.
Just last week the Obama administration took another step and
proposed our Nation's first rules to limit carbon pollution from
existing powerplants. Although they will not be finalized for another
year, these limits represent the most significant action that any
country has taken to halt the devastating warming of our planet.
They will have real and lasting health benefits. By cutting
powerplant pollution over the next 15 years, we will be able to prevent
100,000 asthma attacks in children, 2,100 heart attacks, and thousands
of premature deaths. That will mean nearly 500,000 fewer missed days of
school and work and will save $7 in health costs for every $1 required
of new investment.
Over the long term, curbing climate change will make large, lasting,
and meaningful differences--from reduced hunger and heat waves, to
reducing the spread of infectious diseases or conflicts over scarce
resources.
Cynics will argue that even with these limits we will not stop
climate change, and that is true. They will point out that renewable
energy technology is not yet ready to fully replace fossil fuels. They
will say that America acting alone cannot solve the problem, and that
is true. We need global action, especially from large developing
nations such as China and India that are on pace to pollute the most
going forward.
As an exercise in cynicism, they get a lot of things wrong. These
rules alone, yes, will not halt our rising seas. But, then again, no
one is claiming they will alone. But they are a crucial step, and we
owe it to posterity, to our country, to our future to take what action
we can to send a powerful signal to America's entrepreneurs and
engineers, our innovators and inventors, that this is a challenge we
intend to take on. By acting now, we can begin to birth the innovations
that will be at the heart of our planet's clean energy future.
Innovation in America has never stood still. We have done incredible
things that even a few years before we might not have predicted.
Remember, just a few years ago, natural gas prices were volatile,
unreliable, and solar power was too expensive for most households. Yet
in just the last few years new technologies have flipped those on their
head and we are seeing remarkable changes. Solar prices have fallen 60
percent in just the last 3 years, and natural gas is today cheaper than
coal. There are dramatic changes in our energy future going on because
of a huge resurgence in natural gas production in this country. We have
every reason to believe that by focusing our greatest minds on this
challenge, American ingenuity can change and even save the world.
If the United States is going to lead the 21st century, we have to be
at the forefront of combating climate change. Although we know meeting
this challenge will take global action, the United States needs to lead
the way. This is our responsibility. We cannot expect other poor
nations to act if a leading, wealthy nation such as the United States
is not willing to take even the most minimal responsible actions. We
are the second largest polluter of greenhouse gases on the planet, only
just eclipsed by the Chinese in the last decade.
For more than a century our economic growth and our strong middle
class--built on American industry and innovation--made us the envy of
the world, but they have also contributed to putting our planet in a
dangerous position.
As developing nations work to lift hundreds of millions of people out
of desperate poverty, they are looking at us to show that it is
possible. Also, a great but urgent opportunity here lies before us. We
have a moral obligation to lead because others are looking at competing
examples and are not waiting around.
China, our greatest economic competitor, now and into the future, is
itself choking on the byproducts of coal and investing heavily in
cleaner air and cleaner energy. The country that figures out how to
prosper without deadly pollution is the country that will dominate the
technologies that our world uses and depends on in the decades to come.
Are we really going to miss out on this chance to be the country that
makes the clean cars, the

[[Page S3577]]

clean powerplants, the clean technologies of the future? I hope not.
We in Congress have the opportunity and the obligation to pull
together and to act responsibly as well. We can pass the bipartisan
Shaheen-Portman energy efficiency bill today, create great jobs, and
make it easy for families to spend less on energy and save money while
doing it. We can put clean energy on a level playing field by passing
the bipartisan Master Limited Partnership Parity Act, of which I am a
cosponsor, to stop giving coal, oil, and natural gas a leg up without
an even playing field for renewables and energy efficiency. We can
invest in the research that will unlock the energy innovations of the
future.
These are actions we could take today. There will be costs. But if we
act now, they will be far outweighed by the benefits today and into the
future. If we wait, these costs will only grow.
I understand this is a difficult issue politically for us to take on.
Many of the most dire consequences of global warming are still into the
future. As I know, as a person who struggles to make long-term, delayed
decisions--whether it is investing for retirement or losing the weight
my doctor keeps suggesting would help improve my long-term health--
humans are not really good at taking the small but powerful steps today
that over time will lead to a healthier, more secure future. Even if
the costs are low, when the benefits are farther out, it is so hard for
us to take action.
What will we say--what will we say--when our children ask, what did
we do, when the science was clear, when the options were before us, and
when we had the chance? Just as we rightly worry in this Chamber about
the financial debts we are going to leave to future generations,
leaving this debt, leaving the burdens of unaddressed, unresolved
global warming and climate change to our children and future
generations is a debt too deep for us not to address.
We are in danger--if we do not act--of leaving behind not only a
worse off world but of leaving ourselves a future where we cannot look
our children in the eye and say that we stepped up to the greatest
global challenge of this century.
What will it mean when my own daughter, at some point in the future,
goes to Glacier National Park with her future family? Will it even have
glaciers? How will she explain to them how that amazing national park
has changed? And what will she say about what this Senate and her own
father did to take action? It is my hope, my prayer, that on that
future trip they will reflect on how we found the will, how we found
the determination, to act together to change the trajectory of our
future and to save it for everyone's future.

With that, I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. BOOKER. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

College Affordability

Mr. BOOKER. Madam President, I rise today to express my
disappointment that earlier today this Chamber could not even proceed
to the consideration of the Bank on Students Emergency Loan Refinancing
Act. This would have allowed those with outstanding student loan debt
to refinance at the lower interest rates currently offered to new
borrowers. This is deeply disappointing to me, and it should be to the
American public--that we could not even get on to the bill to debate
it.
This is why it is particularly disappointing: Our Nation's young
people and their families are burdened with extraordinary debt--$1.2
trillion of student loan debt. This exceeds the aggregate--the total--
auto loan, credit card, and home equity debt balances in America,
making student loans the second largest debt of U.S. households,
following mortgages.
Today, the average student graduates from college with around $29,000
in loans. In New Jersey, that is up from an average of $27,600 in 2011
and $23,792 in 2010. More than 16 percent of my constituents now have
student debt. That is over 1 million New Jerseyans who are weighed down
by a significant financial obligation that limits the amount of money
they are able to put back into the economy--in buying homes and in
investing in their futures, in pursuing their American dream.
Reduced purchasing power due to high student loan debts not only
holds back a family's day-to-day spending but it keeps them from making
those large investments.
I believe it is irresponsible and shortsighted for us to think that
we can saddle young people--the true engines of our economy--with this
burden and maintain our position as the world's most powerful economy.
Historically, the United States has done things differently. We were
the leader in expanding college opportunity. From the GI bill following
World War II to Pell grants in 1980, we have taken bold steps to ensure
that Americans have access to college regardless of their ability to
pay their way entirely on their own. We created these programs because
we understood that an educated workforce is essential to our Nations's
economic competitiveness. The most valuable natural resource any nation
on the planet has is the genius and mental acuity of its people.
Without highly skilled workers, without trained minds, without that
opportunity that comes with higher education, America simply will not
be able to compete as well in the global economy.
The cost of college in America puts our young people at a
disadvantage compared to their peers. We are not leading; we are
lagging. These obstacles to a college education deny a level playing
field. We are disadvantaging our young people in their fight to compete
and lead against other nations that are doing so much more.
Take this important data point: More than 51 percent of the median
income is the cost of college in the United States, while the cost of
college in Germany is just 4.3 percent of that country's income. In
Canada it is about 5 percent. In England it is about 6 percent. Compare
that to us--51 percent of median income in the United States. It is
less than 7 percent in Canada, in England, in Germany--our competitors.
We should be doing everything in our power to encourage forthcoming
generations to pursue higher education so that we do not slide further
in global rankings and compromise our ability to compete. Where we used
to lead the globe in percentage of population with a college education,
now we lag. We cannot be the leading economy if we are the lagging
nation in education.
I commend my colleagues, including Senators Harkin, Reed, Warren, and
Gillibrand, who have been so active even before I came to this body in
calling attention to this issue. I urge my colleagues to step up and be
a part of preserving this grand American tradition of college access,
which is so essential to the other grand tradition in our Nation of
social mobility, that no matter where you are born, no matter what your
economic status, no matter what your color or your creed, this is the
Nation where, if you have grit and toughness, discipline and hard work,
you can make it. We are a country that will remove those obstacles and
allow genius to be made manifest.
I hope we can begin to get bills like this that are so common sense--
this idea that we can refinance student debt--to the point where we can
discuss the bills on the floor and they can escape the trap of the
filibuster.

Truck Safety

Before yielding the floor, I wish to take this moment to express my
deepest condolences to the family of victims involved in a tragic
tractor trailer accident Saturday night on the New Jersey Turnpike. My
thoughts and prayers go out to the several individuals who were injured
in the crash. I obviously wish them a full recovery.
We owe many thanks to the emergency personnel who responded to this
weekend's accident and countless others who worked tirelessly along our
highways to keep them safe. During times like these, though, we must
ask ourselves whether this tragedy and so many others in New Jersey and
across our Nation along our highways could have been prevented with
common sense. It is too early to tell, but I am grateful to the
National Transportation Safety Board for investigating

[[Page S3578]]

this particular accident thoroughly. I eagerly await their findings,
but in the meantime, it is worth reviewing what we do know.
Larger and heavier trucks cause greater damage when collisions occur.
It is just physics. That is why there are rules governing truck size
and weight limitations on our highways. I have concerns about any
attempts to increase truck size and weight limits. I hope that sound
data and science will inform our decisions, the decisions this body
must make on that issue.
Another major highway problem--one that I know is affecting the lives
of families from coast to coast--is the problem with driver fatigue.
Studies show that fatigue contributes to 30 to 40 percent of all major
accidents--all major truck accidents. Thirty to forty percent of truck
accidents are contributed to by fatigue. When drivers do not get enough
rest, when they are more tired, they are much more likely to get into
an accident. That is why there are limitations in place on the number
of hours truckdrivers may work in any given week. I am concerned about
any efforts to weaken those rules, which would allow people to push the
limit of human exhaustion even further and would therefore create an
environment where more accidents are possible.
The bottom line is that truck accidents and the deaths and injuries
caused by them are actually increasing in America. I look forward to
working with my colleagues in the Senate to take a serious look at what
we can do to improve the safety of our highways.
I yield the floor.
The PRESIDING OFFICER (Ms. Hirono). The Senator from Oregon.
Mr. WYDEN. Madam President, I come to the floor today as we get ready
to vote on the veterans bill to make several points and would like to
begin by commending Senators Sanders and McCain. They have obviously
acted quickly. They have acted responsibly. They are taking up some of
the most extraordinary concerns that really have come to light in the
last few weeks regarding the access our veterans have to medical care.
I think it would be fair to say that every single Senator--every
Senator--is grateful for the immeasurable sacrifices veterans make for
the Nation. These are men and women who give up years of their lives to
serve our country and willingly head into harm's way. They suffer
physical and mental wounds all too often. Many of the veterans of the
wars in Iraq and Afghanistan--and I have seen this in my home State--
have volunteered for three, four, and five tours of duty.
What is undisputable is this: The Senate understands that when our
veterans come home, the health care services they receive must be
second to none. I believe that strongly. I believe it is a concern
widely shared here in the Senate. That is why the reports of long wait
times and falsified records are so appalling.
The VA audit that came out this week showed, for example, how hard
veterans in my home State of Oregon have been hit. More than 3,000
Oregon veterans could not be seen by a doctor within 90 days at the
Portland VA facility, and nearly 3,500 faced the same wait times at the
Roseberg VA facility. Many Oregon veterans who rely on the Boise and
Walla Walla facilities got similar treatment. Moreover, an
investigation is underway to determine how things deteriorated so
rapidly. It is pretty obvious that these kinds of findings are
inexcusable and they are unconscionable.
Veterans deserve the best. Senators Sanders and McCain deserve credit
for working in a bipartisan way--a way that is too rare here in
Washington, DC--to address this challenge. It is never easy to work in
a bipartisan way. I commend them.

I wish to also raise today one part of the bill that I believe has to
be resolved and can be resolved before the legislation gets to the
President's desk. The legislation currently directs many of our
veterans to Medicare's doctors and specialists. At first glance that
might not raise questions, but I wanted to bring up the possibility of
some unintended consequences.
Right now there is a mandated 2-percent cut on payments for Medicare
services because of across-the-board sequestration. That is still in
effect. However, that particular spending cut, that spending reduction,
does not apply to treatment for veterans. So, in effect--and I know
this was completely unintended--this could create an incentive for
physicians--we already do not have enough of them caring for seniors
who rely on Medicare--it could create an incentive for doctors to take
the veteran patients over our Nation's seniors. I think no Senator
wants that to happen. I have talked about this with Chairman Sanders
and with Senator McCain, and they certainly do not want that false
choice. I think it would be fair to say that no one wants to see
seniors pitted against veterans. All Senators want the best possible
care for both our older people and our veterans.
The problem, however--and all Senators are familiar with this--
Medicare patients often are already waiting in line to see their
doctors. In fact, many of the underperforming VA facilities are located
in communities that have difficulty meeting the current demand for
care. This is especially true in some medical fields that are
absolutely crucial for our veterans, particularly primary care and
mental health.
It is important to note that the other body--the House--has picked up
on an idea that I and others have advanced in order to resolve this
matter. So this is an opportunity for the Senate and the House, in a
bipartisan way, to work together. I have talked to leaders of the
veterans committee in the House. My sense is that we now have the House
fully supportive of a way to resolve this issue and ensure that despite
the fact that the veterans funds are not sequestered and the seniors
funds--the Medicare funds--are, there would be a way to resolve this,
and that would simply be to stipulate that any credentialed provider
could contract with the VA to treat veterans. That way, in effect, we
would ensure that both seniors and veterans would get the care they
need. In effect, it would put the Senate and the other body on the same
wavelength.
It is a simple fix. We just allow our veterans to meet with any
licensed clinical provider, not just the Medicare provider.
In closing, I commend again Chairman Sanders and Senator McCain for
first-rate work, accomplished at truly land-speed record timing.
As chairman of the Finance Committee, which has jurisdiction and a
long history with respect to Medicare, I want them and our colleagues
in the other body to know the Finance Committee is very anxious to work
with all concerned to make sure the final version of this legislation--
the bill we hope goes to the President's desk as soon as possible--
addresses what is best for both veterans and seniors.
I am confident that by working together--Democrats and Republicans in
the Senate and the House--we can achieve that resolution before the
bill gets to the President's desk.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Washington.

Student Loan Debt

Ms. CANTWELL. Madam President, I rise to express my disappointment in
today's earlier vote, that we weren't able to pass the student
refinancing legislation.
I thank my colleague Senator Warren for sponsoring that bill and for
my colleagues who did support it. I hope we will have a chance to bring
up this legislation again, get bipartisan support, and get it passed.
We can agree education is the gateway to opportunity. I was first in
my family to go to college and went to school with the help of
financial aid, and I know how important it is to many in the State of
Washington that we help them make education more affordable.
Student debt in this Nation quadrupled over the past 10 years, so the
total amount of debt is $1.2 trillion. Many students in my State are
anxious about this situation and they want to do something about it.
Over the past 4 years student debt has even surpassed credit card
debt. So when we think about that, the fact that student debt is enough
to pay every American's credit card balance and still have $450 billion
left over tells us how much debt is being accumulated on behalf of
students just to get an education, just to basically make their way in
a changing economy.
We do live in an information age, and it means that everybody having
a good

[[Page S3579]]

base education and being able to adapt--as new information comes along
that changes industry--is going to be critically important.
The fact that student debt is now the second source of personal debt
in America, only behind mortgages, puts a drag on our economy. Those
who are suffering under this are real individuals.
We just had a roundtable in the State of Washington last weekend with
some of the best and brightest at the University of Washington. These
students talked about how they were trying to invest in their own
skills so they could advance in their education, and many of the
stories they told were not out of the ordinary, but I think it is
something we don't think about.
In a lot of these cases, these individuals were talking about how
they were trying to get an education. Other people in their family,
their brothers and sisters, were trying to get an education, and their
parents were also trying to upgrade their skills, because in an
information age economy, that is what happens, everybody has to upgrade
their skills.
So these students are trying to do everything. But I was truly moved
by one student who said: I have a debt that seems to be the size of a
mortgage for me, but I don't have a house that goes along with it.
He was trying to say: I am coming out of college with incredible debt
and how am I going to even afford the basic things people look forward
to--maybe not right after graduation but as they start their careers
and start to move forward. These are individuals who contribute to our
economy. They buy cars, they buy homes, everything. But this
individual, a graduate of Central Washington University, told me he
pays the same amount for rent as he does for student loans every month.
In Washington State the average student borrower owes more than
$23,000 before they graduate. That is an increase of 22 percent over
the last 5 years, $4,000 for the average student borrower at the
University of Washington.
So over the next weeks thousands of students in Washington State will
walk across and get their diploma, but when they accept this diploma
and go into the world of opportunity, they will also be going with a
lot of debt. We also heard from another student at the University of
Washington, how at this point in her career, as she graduates, the debt
will be almost $100,000. She wants to pursue a career, but when she
thinks about how much she has to pay on that student loan, that is
going to affect that. In fact, during her time at the University of
Washington there were points at which she worked 60 hours a week. I
don't know how anybody can continue their education and work 60 hours a
week.
So these are students who want to be able to refinance and pay down.
In this case, with somebody who has a 6-percent or 7-percent loan, this
bill and legislation would allow them to refinance.
With the legislation, an undergraduate with $30,000 in student loans,
for example, would save almost $5,000 over the life of their loan by a
refinancing of that interest rate, if it was 6.8 percent, to the
current direct undergraduate interest rate of 3.86. Those are real
dollars to these individuals.
That means much needed help for 25 million borrowers across the
country. It could save, on average, for all those borrowers, about
$2,000 per loan. In my State it would mean relief for 451,000 students,
just like the ones we spoke to last week.
The University of Washington in the Pacific Northwest took matters
into its own hands and produced a report. The report showed that the
typical University of Washington student would have to work 54 hours a
week for a full year to pay for 1 year of student education.
I am so proud of these students. They did their own report and got it
on the front page of the Seattle Times because it spells out what we
have already known, that the days when students could raise the amount
of money they needed to pay for education by doing summer jobs is gone.
The burden of debt and the amount of money owed is impacting
students. There is no way they can work their way through college at 54
hours or 60 hours a week and be able to do their academic work.
Entrepreneurial activity among 20- to 34-year-olds is challenged. The
Federal Reserve Bank of New York has found that for the first time
people with student loan debt are less likely to buy a house than those
without, so it is showing up in our economy.
If you think about it, if this is what a generation of Americans are
going to be faced with for the next decade or two, then that is going
to have a ripple effect through our economy for several years.
A recent study by the Brookings Institution found that student loan
borrowers are 60 to 70 percent less likely to apply for graduate school
than those without student debt. So again now we have another
complexity.
I look at this issue and I look at the fact that we have a worldwide
demand for 35,000 new airplanes. We need 20,000 new workers in the
aerospace industry. We have demands for computer scientists, something
like 300,000 a year. We only graduate 70,000.

I look at it and say: Why aren't we helping to finance everybody who
wants to get an engineering degree and a computer science degree? Why
aren't we figuring out a way to make that more affordable? Because in
an information age economy, that is exactly what we need to do, make an
investment in education, but we can't make an investment in education
on the backs of these students when they are coming out of college with
this much debt or trying to struggle even to learn these careers that
are so vital to our economy and they have to choose between working and
actually studying. We would rather they commit themselves to these
careers and these educations so we can have the workforce of the
future.
I know some of my colleagues on the other side of the aisle didn't
support this legislation, but the Congressional Budget Office projects
that the bill would actually reduce the deficit by about $14 billion
over the next decade.
That is important because we want to see policies that are going to
help our economy in the short run and in the long run, but they have to
be fiscally responsible.
So I say to those critics who say: Oh, well, if we make the interest
rate lower, then students are going to borrow more money, I don't think
students are looking to borrow more to add to their debt.
I don't think students whom I talked to who had loans as high as
$180,000 want to borrow more money just because we are going to reduce
the interest rate. They want to refinance, reduce their obligation, and
get back to studying.
There is much more we need to do to mitigate the cost of higher
education. I know my colleagues and I are going to be working on that,
but the Bank on Student Loans Emergency Refinancing Act was a very good
step to help students and to focus them on their careers and education.
Again, I hope my colleagues on the other side of the aisle will look
again at this issue and get back to it. We need to make sure college
education is more affordable. It is time for us to extend the same
benefits we do for businesses and mortgages to students so they can
refinance and that 25 million students in America could refinance their
student loans.
I thank Senator Warren for bringing up this issue. I hope we will get
back to it again.
I yield the floor and I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Ms. CANTWELL. I ask unanimous consent that the order for the quorum
call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. CANTWELL. I ask unanimous consent that the time in quorum be
equally divided between both sides.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. CANTWELL. I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. HATCH. I ask unanimous consent that the order for the quorum call
be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

[[Page S3580]]

Federal Employee Unions

Mr. HATCH. Madam President, I rise to speak on a matter of great
importance that seems to have slipped through the cracks of the
public's consciousness. However, with the growing furor over the recent
scandal at the Veterans' Administration, I expect more and more people
will be made aware of it.
I don't think it is unreasonable to argue that most Americans would
be outraged to learn the Federal Government pays tens of millions of
dollars every year to pay hundreds, if not thousands, of government
employees not to work. This practice used to be called featherbedding.
``The term `featherbedding' originally referred to any person who is
pampered, coddled, or excessively rewarded.''
It was later used to describe certain labor relations practices.
According to Wikipedia:
The modern use of the term in the labor relations setting began in
the United States railroad industry, which used feathered mattresses in
sleeping cars. Railway labor unions, confronted with changing
technology which led to widespread unemployment, sought to preserve
jobs by negotiating contracts which required employers to compensate
workers to do little or no work or which required complex and time-
consuming work rules so as to generate a full day's work for an
employee who otherwise would not remain employed.
Congress tried to put an end to the practice in the 1947 Taft-Hartley
Act amendments, which defined and outlawed featherbedding. However, the
U.S. Supreme Court has narrowly defined the terminology, leaving most
practices undisturbed.
The featherbedding-like practice I am referring to today is most
often called official time, wherein government employees--who are
highly compensated, often including overtime pay--are paid to perform
no work for the government, only work for the benefit of their unions.
These ``employees'' are not union employees, nor are they paid by the
union. Instead, they are union members paid by the taxpayers to work
full time for the union while working for the Federal Government.
Of course, this practice also goes on in the private sector. However,
in the private sector, the featherbedding comes off of the bottom line
and is negotiated as a measure of ensuring labor peace and in exchange
for other union concessions. In the Federal Government, where the
bottom line is the taxpayer and where unions are not permitted to
strike, this practice is a way for weak managers to use government
funds to reward public sector union political supporters and financial
contributors, passing the costs along to the unknowing taxpayer for
services not rendered. In the private sector, official time is
carefully monitored and controlled. In the Federal sector, managers
generally look the other way.
According to the Office of Personnel Management, or OPM, during
fiscal year 2011 unions represented 1,202,733 nonpostal Federal civil
service bargaining unit employees--an increase of more than 17,000
employees compared to fiscal year 2010. In that same year agencies
reported that bargaining unit employees spent nearly 3.4 million hours
on official time--an increase of nearly 10 percent compared to the
previous year. How much money are we talking about, and why should
American taxpayers shoulder the entire burden if the official time is
only for union work?
Some may wonder what this has to do with the VA scandal. I don't
think it is a coincidence that the VA--which is plagued by
incompetence, dishonesty, and bureaucratic ineptitude--utilizes the
practice of official time more than any other Federal agency, according
to OPM. In 2011 the VA reported paying out nearly 1 million hours in
official time--an increase of more than 23 percent over the previous
year. The cost of official time in 2011 amounted to nearly $43 million.
That is $43 million paid out to VA ``employees'' to do union work full
time. Wall Street Journal Editorial Board writer Kimberley Strassel
noted a few weeks back:

The VA boasts one of the largest federal workforces, and VA
Secretary Eric Shinseki bragged in 2010 that two-thirds of it
is unionized. That's a whopping 200,000 union members,
represented by the likes of the American Federation of
Government Employees and the Service Employees International
Union.

I ask unanimous consent that the article be printed in the Record
following my remarks.
Union supporters often lament that under Federal law Federal employee
unions are relatively toothless, especially when compared to the very
powerful State employee unions. However, as Ms. Strassel noted, given
its size and influence, the VA union may be an exception to that rule.
Once again, two-thirds of the VA workforce is unionized, and the
agency has paid more than $40 million in salaries to full-time union
workers in a single year. That has to have an impact on the VA's
efficiency. And that is for workers who don't even work--except for the
union.
Obviously, the inefficiency of the VA has recently been the subject
of a very high-profile public debate. However, the impact unions have
had on the VA's operation was being talked about well before news of
the recent scandal broke. For example, Senators Portman and Coburn sent
a letter to former VA Secretary Shinseki in 2013 noting that the vast
majority of VA employees on official time were trained nurses,
instrument technicians, pharmacists, dental assistants, or therapists.
In other words, these were employees hired specifically to fulfill
roles in direct support of veterans. Yet, instead of caring for
veterans, processing claims, and helping to eliminate the horrendous
backlog, these employees were being paid to do union work full time--
all at the expense of taxpayers. On top of that, union-negotiated work
rules over things such as seniority and job classification have
contributed to the bureaucratic nightmare at the VA. In addition, the
unions have been the most vocal opponents of any reform proposals that
would give veterans access to outside health care.
While it may be overstating the unions' influence to assign to them
the blame for the entire VA scandal, it is clear that these unions have
at least contributed to the problems we are now seeing at the agency.
They are at least partially to blame for the backlog in veterans'
claims. They are at least partially to blame for the failed VA
bureaucracy. They are at least partially to blame for the failure of
reasonable attempts to reform the agency in the past, and it is almost
impossible to reform it the way it is currently run.
I wish I could say this problem is isolated at the VA. Unfortunately,
there is at least one other scandal-plagued agency with a similar union
problem. I am talking, of course, about the IRS.
We are all pretty familiar with the IRS targeting scandal. By its own
admission, the agency was targeting Tea Party groups in the runup to
the elections in both 2010 and 2012.
Like the VA, the IRS consists of a heavily unionized workforce. About
66 percent of IRS employees belong to the National Treasury Employees
Union, or NTEU.
It shouldn't surprise anyone to learn that the NTEU is extremely
active in politics, having twice endorsed President Obama. During the
2010 election cycle, when the IRS first began targeting conservative
groups, the NTEU raised over $600,000 through its PAC, almost all of
which went to Democrats. In the next election, in 2012, the NTEU PAC
raised more than $700,000, 94 percent of which went to Democrats. In
other words, during the same campaign cycles in which the IRS was
targeting conservative organizations--organizations that were critical
of the President, his administration, and in many cases the IRS
itself--for harassment and extra scrutiny, the union that represents
nearly two-thirds of IRS employees was busy raising and donating well
over $1 million to Democratic candidates. And we wonder why the IRS--
which should not be partisan in any way, shape, or form--is filled with
partisanship. We should not have unions at the IRS or at the VA. Is it
any surprise that the agency found itself predisposed toward harming
conservative organizations or their causes?
Of course, the IRS has its own issues with the practice of paying out
official time. Indeed, as of 2011 there were at least 200 IRS employees
working full time for their union--all at taxpayers' expense. In that
same year, the agency paid out more than 625,000 hours of official
time. The total cost of these union activities was roughly around $27
million. But that is only the beginning. That is $27 million in a
single year paid

[[Page S3581]]

to ``employees'' of the Federal Government who did nothing but union
work. That is simply preposterous.
As I said, if the American people understood that this type of
fleecing of the taxpayers goes on every day, they would be outraged.
Current law allows most Federal employees to be represented by a
union. There are, however, some exceptions--and good reasons for these
exceptions. Most of these exceptions are for agencies that perform a
national security function or other highly sensitive work. One would
think the IRS would fit in that category. One would think the VA would
fit in that category. For example, we don't allow employees at the FBI,
the CIA, or the Secret Service to be unionized. There is good reason
for that: We don't need partisan political activities in those
agencies. But we don't need them in the IRS or the Veterans'
Administration either. We also don't allow employees at the GAO or the
Federal Labor Relations Authority to unionize.
In days to come, Congress is going to have to take a hard look at
reforming both the Veterans' Administration and the IRS. One of the
questions we are going to have to ask ourselves is whether these
agencies, with their important and sensitive missions and their poor
performance in the recent past, should be added to the list of agencies
not permitted to unionize, not permitted to be partisan. And anybody
who doesn't understand that doesn't understand anything about politics.
In addition, as we continually look for ways to improve the
efficiency of our government, we will need to examine the overall
practice of official time and determine whether it should be eliminated
entirely. I, for one, don't believe taxpayers ought to be footing the
bill for union work. I think the majority of the American people, if
given an opportunity to fully understand this practice and the abuse it
entails, would agree with me.
One thing is for sure: If what we have seen at the VA and the IRS is
in any way representative of the influence unions have on government
agencies, drastic changes are going to be necessary. How can any
American citizen feel the IRS is above politics when it is run by a
union? And we all know that unions support almost 100 percent one party
over the other. How can we feel the VA is going to be handled right
when it has a union representing it and determining all the workloads?
I have talked to the IRS Commissioners since I have been on the
Finance Committee, and they admit that to try to correct or punish an
IRS employee who is out of control and not doing what is right takes
upward of a year if you are lucky. That is why there are all kinds of
politics in these agencies and they act with impunity in advancing what
really are liberal causes.
If there are any two agencies that should not have unions in them,
one ought to be the IRS and the other ought to be the Veterans'
Administration.
I was raised in the union movement. I learned a trade. I went through
a formal apprenticeship program, and I became a journeyman. I am proud
of that. I believe unions have a place in our society, but they have
become more and more partisan. It is reported that 40 percent of union
members are Republicans. Yet almost 100 percent of every dime that is
given in politics is given to Democrats. So by any measure we have to
say that these folks are partisan, which I think is their right. But
should we have partisan control of agencies such as the IRS, which
everybody has to deal with at one time or another in their life, and
the Veterans' Administration, which is in dire jeopardy right now
because of the way it is being run?
I have been very much trying to do a straightforward investigation of
the IRS and these accusations that have been thrown at it, many of
which are true. The more I get into it, the more I realize it is being
run in a partisan way for one party when it should be run in a
nonpartisan way--for neither party. I am going to do something about
it, and I hope the American people pay attention to it because I think
most people, including younger Members, would be outraged to know that
there is partisanship at these agencies that is not just average
partisanship. It is blatant partisanship. The more I get into it, the
more I realize that is true.

Madam President, I ask unanimous consent to have printed in the
Record the Wall Street Journal article that I previously referred to.
There being no objection, the material was ordered to be printed in
the Record, as follows:

[From the Wall Street Journal, May 29, 2014]

Big Labor's VA Choke Hold

(By Kimberley A. Strassel)

We know with certainty that there is at least one person
the Department of Veterans Affairs is serving well. That
would be the president of local lodge 1798 of the National
Federation of Federal Employees.
The Federal Labor Relations Authority, the agency that
mediates federal labor disputes, earlier this month ruled in
favor of this union president, in a dispute over whether she
need bother to show up at her workplace--the Veterans Affairs
Medical Center in Martinsburg, W.Va. According to FLRA
documents, this particular VA employee is 100% ``official
time''--D.C. parlance for federal employees who work every
hour of every work day for their union, at the taxpayer's
expense.
In April 2012, this, ahem, VA ``employee'' broke her ankle
and declared that she now wanted to do her nonwork for the VA
entirely from the comfort of her home. Veterans Affairs
attempted a compromise: Perhaps she could, pretty please,
come in two days a week? She refused, and complained to the
FLRA that the VA was interfering with her right to act as a
union official. The VA failed to respond to the complaint in
the required time (perhaps too busy caring for actual
veterans) and so the union boss summarily won her case.
The VA battle is only just starting, but any real reform
inevitably ends with a fight over organized labor. Think of
it as the federal version of Wisconsin, Indiana, Michigan and
other states where elected officials have attempted to rein
in the public-sector unions that have hijacked government
agencies for their own purpose. Fixing the VA requires first
breaking labor's grip, and the unions are already girding for
that fight.
Federal labor unions are generally weak by comparison to
state public-sector unions, though the VA might be an
exception. The VA boasts one of the largest federal
workforces and VA Secretary Eric Shinseki bragged in 2010
that two-thirds of it is unionized. That's a whopping 200,000
union members, represented by the likes of the American
Federation of Government Employees and the Service Employees
International Union. And this is government-run health care--
something unions know a lot about from organizing health
workers in the private sector. Compared with most D.C. unions
(which organize for better parking spots) the VA houses a
serious union shop.
The Bush administration worked to keep federal union
excesses in check; Obama administration officials have viewed
contract ``negotiations'' as a way to reward union allies.
Federal unions can't bargain for wages or benefits, but the
White House has made it up to them.
Manhattan Institute scholar Diana Furchtgott-Roth recently
detailed Office of Personnel Management numbers obtained
through a Freedom of Information Act request by Rep. Phil
Gingrey (R., Ga.). On May 25, Ms. Furchtgott-Roth reported on
MarketWatch that the VA in 2012 paid 258 employees to be 100
percent ``full-time,'' receiving full pay and benefits to do
only union work. Seventeen had six-figure salaries, up to
$132,000. According to the Office of Personnel Management,
the VA paid for 988,000 hours of ``official'' time in fiscal
2011, a 23 percent increase from 2010.
Moreover, as Sens. Rob Portman (R., Ohio) and Tom Coburn
(R., Okla.) noted in a 2013 letter to Mr. Shinseki, the vast
majority of these ``official'' timers were nurses, instrument
technicians pharmacists, dental assistants and therapists,
who were being paid to do union work even as the VA tried to
fill hundreds of jobs and paid overtime to other staff.
As for patient-case backlogs, the unions have helped in
their creation. Contract-negotiated work rules over job
classifications and duties and seniorities are central to the
``bureaucracy'' that fails veterans. More damaging has been
the union hostility to any VA attempt to give veterans access
to alternative sources of care--which the unions consider a
direct job threat. The American Federation of Government
Employees puts out regular press releases blasting any
``outsourcing'' of VA work to non-VA-union members.
The VA scandal is now putting an excruciating spotlight on
the most politically sensitive agency in D.C., and the unions
are worried about where this is headed. They watched in alarm
as an overwhelming 390 House members--including 160
Democrats--voted on May 21 to give the VA more power to fire
senior executives, a shot over the rank-and-file's bow. They
watched in greater alarm as Mr. Shinseki said the VA would be
letting more veterans seek care at private facilities in
areas where the department's capacity is limited.
This is a first step toward a reform being drafted by Sens.
Coburn, John McCain (R., Ariz.) and Richard Burr (R., N.C.),
which would give veterans a card allowing them health
services at facilities of their choosing. The union fear is
that Democrats, in a tough election year, will be pressured
toward reforms that break labor's VA stronghold.
Not surprisingly, Sen. Bernie Sanders (D., Vt.), chairman
of the Veterans Affairs Committee, has promised his own
``reform.'' Odds

[[Page S3582]]

are it will echo the unions' call to simply throw more money
at the problem. Any such bill should be viewed as Democrats
once again putting the interests of their union allies ahead
of veterans.

Madam President, I yield the floor.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. COATS. Madam President, last week our Nation commemorated the
70th anniversary of D-day. Leo Scheer of Huntington County, IN, is one
of those courageous veterans who survived the outlying assault on the
beaches of Normandy, and last month he made the trip to Washington, DC,
through the Honor Flight Network to receive a hero's welcome from a
grateful Nation.
My office had the honor of greeting Leo and this group of heroes upon
their arrival to the World War II Memorial, and Leo made an
unforgettable impression with his humility, demeanor, and strength of
character. Leo is a member of what we have come to know as the
``greatest generation.'' They easily deserve that title, where duty
comes as second nature, where braggadocio is not present, where simply
standing up and serving your country in a time of crisis is responded
to overwhelmingly without complaint and with true honor and dignity.
Sadly, there are a dwindling number of those not only who arrived on
the shores of D-day in Normandy but those who served throughout the
world's largest military conflict in history. While those great service
men and women are still here to share their stories--at least a few--we
must remember the sacred promise that we as a Nation made to them to
give them the care they deserve when they come back home.
As a veteran myself, my hope is that our Nation will carry out this
promise not only to our World War II vets but to all who have served in
conflicts from that point forward--from Korea, Vietnam, Iraq,
Afghanistan, and other places. We must live up to the promise for all
who were called to serve and answered that call.
Regrettably, in recent months we have seen this promise broken and
shattered. Just this week an internal audit by the Department of
Veterans Affairs revealed that the department's problems have affected
76 percent of VA facilities. Nearly 100,000 veterans continue to wait
for medical appointments. These are staggering figures.
In my home State of Indiana confirmed audit findings show that
veterans endured unacceptably long wait times. Some Hoosier veterans
never even received an appointment. This is unacceptable. That is why
today I stand here to support the bipartisan Sanders-McCain veterans
bill that would implement key changes to the existing VA health care
system.
This is not a perfect bill, and there are parts of it that I wish
were different. I hope that we can manage some needed changes as it
moves over to the House of Representatives and then to conference. I
hope the final bill will make our veterans proud and begin the process
of reform that the VA so desperately needs.
Let me address three key reforms in this legislation that I think are
essential to moving forward and the primary reason why I have agreed to
support this. First, giving veterans more choices in care--perhaps the
most important provision in this legislation--is allowing veterans who
cannot be scheduled within a reasonable time the option to receive care
from non-VA facilities or private sector facilities outside of the VA.
This also applies to veterans that reside more than 40 miles away from
a VA facility, many of them not in a condition to be able to secure the
transportation they need for that care, so they don't have to endure
long drives to get care. We must ensure that veterans receive timely
care, and if the VA cannot provide it, then our veterans should be free
to go elsewhere for care, including Medicare providers.
Second, the removal of bad actors--there are a lot of good people
working at VA. Their hearts are in the right place. They are talented
and provide good care and good service. I don't mean to demean their
contributions to veterans' health care, but we do know that there have
been mistakes, mismanagement, and there has been some outright fraud,
it appears. We will have to prosecute that. This reform would authorize
the Secretary of the VA to demote or fire senior executive service
employees based on their performance. That is not present now, and if
we are going to change the management it takes more than just asking
the first top person to resign as has happened. We need to look at the
management team and those that oversee those that are providing the
care and what their responsibility is in that role. Passage here would
shake up the leadership of the VA so those people can be held
accountable for their actions.
The third provision I want to mention is providing more VA locations.
It is clear that some of our veterans have to travel very long
distances. Also it is clear that the facilities currently in place are
short of help and there are not enough to address the needs of the many
veterans that are entering the system. So this bill would establish 26
new VA medical facilities around the country. As I said, while this
legislation is not perfect, it is an important start but it should not
and will not be the end of our work to live up to our promises to
veterans.
Ultimately, as I stated before to our body of Senators, the VA needs
a change of culture. Too many bureaucrats view our veterans as a list
of numbers rather than the heroes worthy of our very best care. We have
to look at our veterans through a different lens, one that sees them
clearly as defenders of our freedom and as the heroes they are.
We must continue to investigate and reform the culture within the VA
and ensure that this crisis doesn't happen again. That is why I called
for an independent investigation. This bill authorizes the process of
beginning these independent evaluations. Also the committee has
provided additional funding to specifically allow the inspector general
to conduct an independent investigation into the VA, and I join my many
colleagues to ask the Department of Justice to join in this
investigation. Now, unfortunately, this culture of indifference at the
VA is not new. For years veterans have faced excessively long waits for
disability claims. When I returned to the Senate in 2011, these waits
were over 600 days in Indianapolis. Veterans were waiting over 2 years
to have their claims adjudicated. Once we shined a light on the
problem, the situation improved somewhat, but our veterans still face
waits that are far too long both for medical visits and to receive
their disability benefits.
My staff in Indianapolis currently have over 550 active cases that we
are working on for Hoosier veterans who are seeking help and have not
gotten satisfactory responses from the VA. So they call us and say: Can
you help? We do everything that we can to help expedite the process. In
many cases these veterans are just trying to assess the benefits that
they have rightfully earned and they just want an answer.
Reflecting on Leo Scheer's service to our Nation on D-day reminded me
of the opportunity that I had to visit the beaches of Normandy while I
was Ambassador to Germany. It was, to say the least, a powerful and
extremely emotional experience standing on the bluffs overlooking the
spread of beaches from Utah to Omaha, and it made me reflect on the
countless lives lost in service to our Nation.
I was standing there on a perfectly calm day. The water was gently
lapping on the shore. The beaches were empty. A soft warm breeze was
blowing. The sun was shining--just a beautiful day--and I was
overwhelmed by the violence that must have taken place that I could
only have imagined. We have all seen the movie ``Saving Private Ryan,''
and I give Mr. Spielberg great credit for making that a very realistic
picture of what happens. But I don't think Hollywood, or those of us
who weren't there, could imagine the violence that was taking place on
that beach when our troops went ashore. The silence was not there.
There must have been a cacophony of noise with hundreds of ships
offshore unloading our soldiers into landing vehicles. Many of them
were shot down by the German bunkers up in the bluffs, built-in
concrete fortifications--an almost impossible task. Many of them never
even got out of their landing craft. When the doors opened, many were
shot before they reached the water. The water was red with the blood
from our soldiers who never

[[Page S3583]]

made it to the beach. The beach was littered with bodies of those who
never made it to the edge of the cliff. And the sacrifice that was made
in climbing those cliffs and getting to those German bunkers took many,
many hundreds if not thousands of more lives.
So visiting the graves of soldiers afterwards, pausing to say a
prayer of gratitude for their sacrifice leads us to this point where we
have to understand what it is we are trying to provide and why we need
to provide it. That is in a response to those who put their lives on
the line and sacrificed those lives--and many ended up with lifelong
disabilities--a commitment to those that we would take care of them
when they came back.
They have come back and run into a government-run bureaucracy that
has run amuck. If it proves anything, it proves that government just
simply doesn't do big stuff very well, without confusion, without
bureaucracy, without duplication, without excessive costs. It is not
efficient and not effective, nowhere near what the private sector can
offer. That is why there is the provision for veterans who cannot get
care at the VA on a timely basis to have the opportunity to use our
private system.
They deserve our utmost care. They served on the frontline, but when
they go for benefit decisions and when they go for health care, they
are not in the front of the line, they are at the back of the line, and
that is not right.
We cannot let the sun set today, and I am glad we are not, because we
are voting to move this legislation forward. In doing so we are going
to make a statement that we are going to try to live up to that promise
and do the best that we possibly can. As I said, as a veteran I expect
my country to fulfill the promises to my fellow service men and women,
and as a Senator I will seek to hold the Veterans' Administration
accountable and to do everything I can to help in the reform of the
system. That reform is so desperately needed.
The leader of the D-day effort, GEN Dwight D. Eisenhower called the
invasion of Normandy ``a fight in which we would accept nothing less
than full victory.'' It is in that spirit that I call upon my Senate
colleagues to immediately take up and pass this legislation on behalf
of our veterans and then to continue the work of changing the culture
of the VA so that we don't have to come back years from now and repeat
this process all over again.
Let's get it right this time. The fight to restore trust to our
veterans is one we are waging, and to paraphrase General Eisenhower, we
should accept nothing less than victory.
Mr. President, I yield the floor.
The PRESIDING OFFICER (Mr. King). The Senator from Texas.

Immigration

Mr. CORNYN. Mr. President, I thank my friend from Indiana for his
remarks about our military service men and women and our obligation to
provide them the care they have earned for their service. I look
forward to voting, along with everyone in this Chamber, on this
bipartisan legislation this afternoon, which represents the first
step--not the last step but the first step--toward the systemic
failures that have been disclosed as a result of the comprehensive VA
audit.
I come to the floor to speak again about a growing humanitarian
crisis in South Texas, the State I represent, where authorities are
struggling with waves of unaccompanied minors--children--coming through
Mexico into the United States. The numbers are pretty staggering. So
far 47,000 minors have been detained at the southwestern border since
October. The Department of Homeland Security and Border Patrol estimate
that there could be as many as 60,000 unaccompanied minors, mostly from
Central America. If we look at the map from Guatemala City to McAllen,
TX, it is roughly 1,200 miles.
Unfortunately, this influx is a direct consequence of the perception
that this administration will not enforce our immigration laws.
Interviews with more than 200 of the migrants who comprise some of
these individuals confirm their impression, which is reinforced by
Central American news media outlets--primarily newspapers--that if
children can get to the United States, they will have a free ticket and
be able to stay.
We had a chance to question and discuss this humanitarian crisis with
Secretary Johnson, the Secretary of Homeland Security, this morning
before the Judiciary Committee, and to his credit, he has taken an all-
hands-on-deck attitude, but the truth is the Federal Government's
resources are overwhelmed by this humanitarian crisis.
By creating a powerful incentive for people to come to the United
States illegally, we have effectively encouraged children and their
parents to make a treacherous and threatening journey from Central
America, one of the most dangerous parts of the world today, through
Mexico--large swaths of Mexico are controlled by drug cartels--and then
all the way into Texas.
Secretary Johnson conceded this morning that somehow we are
schizophrenic about this issue. When we look at the victims of human
trafficking and other people, we all agree we need to do more on a
bipartisan basis to deal with this scourge of human trafficking, but
the fact is that the transnational criminal organizations--trafficking
people for economic reasons, such as for sex, drugs, and weapons--will
do anything for money. They are criminals, and that is what they do.
Unfortunately, we have a lot of innocent children who are now being
swept up in this humanitarian crisis, as I said, committed by their
parents to take this trek across Mexico into the United States. We have
no idea how many children start that journey and how many simply drop
off along the way because they have been kidnapped, injured, murdered
or perhaps they just become ill as a result of exposure and die during
this long trek.
It is a journey that often begins in cities, towns, and villages
scattered throughout Honduras, Guatemala, and El Salvador. The first
major checkpoint is the Mexican border with Guatemala. It is about 500
miles long. Before arriving there, many families and children pass
through regions of northern Guatemala that are controlled by the Zetas
cartel, one of the most violent criminal organizations in the world.
When they reach Mexico, many illegal immigrants jump onto a network
of freight trains known by the ominous nickname ``The Beast.''
I encourage anyone who is listening to me to go online and Google or
Bing or use some other search engine and type in ``The Beast'' and read
some of the horrific stories about transportation from southern Mexico
up to northern Mexico on The Beast. NPR, National Public Radio,
repeatedly reported The Beast train is ``just as likely to spit them
out as it is to shepherd them safely to the border.''
Indeed, people riding on The Beast are frequently robbed, raped or
killed by the drug traffickers and gang members who control the
smuggling corridors. This is organized criminal activity by
transnational criminal organizations. As one former Beast passenger
told CNN, ``almost everyone gets assaulted.''
If there is anybody who thinks illegal immigration and trafficking
involves some sort of benign experience of traveling from a country
where people don't have an opportunity to a country where people do
have an opportunity, that part is true, but what they don't tell you is
the horrific, life-threatening, and sometimes life-destroying
experience of getting to the United States because people are
committing themselves to the tender mercies of some of the most violent
criminal organizations on the planet.
In recent years, Mexican authorities have discovered mass graves
containing the bodies of Central American migrants--those who did not
make it to our southern border. Among those who are not murdered by the
cartels, many passengers on The Beast simply fall off the train. For
example, they try to jump on it while it is moving. If they are lucky,
they might just end up with a few broken bones, but if they are not
lucky, they might end up losing a limb or being crushed to death
underneath its wheels.
In short, no one should be traveling to the United States this way
and least of all young children, some of whom, according to published
newspaper reports, are as young as 3 and 5 years old. Can any parent
comprehend the idea of a 3- or 5-year-old coming unaccompanied or
perhaps en masse with drug cartels and criminal organizations
transporting them from their home country to the United States?

[[Page S3584]]

The Border Patrol reported that 180 convicted sex offenders have been
arrested since October while coming across the southwestern border. Can
you imagine this trip with convicted sex offenders mixed into the mass
of humanity coming across the border?
Some children who ride The Beast are kidnapped or forced to become
drug mules or forced into sexual slavery. In fact, some who make it all
the way to Texas and north remain prisoners of organized crime after
crossing the U.S. border.
I remember talking to one young woman. About 1 year ago I had the
chance to visit with her. She came from Central America. She was
brought by a coyote, they called him--a human smuggler--into Houston,
TX. She had family in New Jersey, but that didn't work out, so she came
back to Houston where she was essentially held as an indentured servant
and prostituted and forced to turn over the proceeds of that money to
the coyote--the smuggler.
When people operate in the shadows of the law, they have no
protection of the law, and the people who are the most likely to get
hurt are the immigrants themselves or certainly the immigrant
community. We need to keep that in mind. We have to remember that
Mexico's biggest and most violent drug cartels are heavily involved in
this trafficking, as I mentioned earlier.
Time magazine reported last year: ``Cartels control most of Mexico's
smuggling networks through which victims are moved, while they also
take money from pimps and brothels operating in their territories.''
The cartels, gangs, and sex traffickers are only too happy to prey on
the poor, vulnerable migrants, including children, transiting through
their terrain. Experts believe the Mexican drug cartels may earn as
much as $10 billion a year from sex trafficking and sex slavery alone.
These are not nice people.
According to Amnesty International: ``Some human rights organizations
and academics estimate that as many as six in 10 women and girl''--and
one-quarter of these unaccompanied minors are girls--``migrants
experience sexual violence during the journey'' through Mexico--6 out
of 10.
A new CRS--Congressional Research Service--memo reports that based on
apprehension data provided by Customs and Border Protection, ``there
has been an increase in the number of [accompanied alien children] who
are girls and the number of [unaccompanied alien children] who under
the age of 13.''
They are not exactly able to defend themselves against the
monstrosities they encounter along the way.
I hope it is clear to everyone listening and to the President and
every other person of good will, that we should be doing everything
possible to discourage people from risking their lives in the first
place, and especially their children's lives, on such a dangerous
journey.
Before I came to the Senate, I happened to be the Attorney General of
Texas, and before that I had a career in law and the judiciary. It is
standard criminal jurisprudence that not only should law enforcement
enforce the laws in order to maintain the law, but the law serves
another important function; that is, deterrence.
In other words, it stops people from doing things they know they
should not do in the first place rather than just catching them after
they do it. This is one of the elements that is missing and
unfortunately was encouraged by the impression that you got a free
ticket if all you had to do was get on the train and show up in South
Texas. As I have said, this is very dangerous stuff, and it has
backfired in unexpected ways.
Yesterday, I listed five simple suggestions to the President that he
could take to start fixing the problem. I was glad to hear Secretary
Johnson talk about some of the ad hoc measures he has begun to
implement, but the truth is they are struggling to catch up.
I urged the President, No. 1, to publicly declare that his 2012
deferred action program will not apply to children currently arriving
at the border. Let me stop there to say that this morning some of my
colleagues on the Judiciary Committee could not resist the temptation
to take a partisan shot. They said if the House had just passed
immigration reform, this never would have happened.
My point is the President's deferred action program doesn't even
apply to these children, so it is still against the law for them to
enter. But they realize, as a practical matter, although the resources
and capacity of the Federal Government are overwhelmed, there is no way
we can turn them back, and they will have to be handled compassionately
and in a humane sort of way.
It would help if, No. 1, the President would make clear he has not
issued a free ticket to anyone who wants to enter the country
illegally.
No. 2, I encouraged him to publicly discourage people from attempting
the journey through Mexico, and it would help if our Mexican
counterparts would do a better job--maybe with our help and
assistance--securing their southern border, since that would stop a lot
of people from coming from Central America through Mexico on this
dangerous journey which I have tried to describe.
I also encouraged the President to enforce all of our immigration
laws regardless of political needs or any frustration he might feel or
anyone else might feel on the current stalemate in which we find
ourselves. Sometimes these things take a little time.
My hope is, if not before, then by next year, Congress--the Senate
and the House--can begin to move a series of smaller pieces of
legislation that are more transparent, consensus based, and begin to
repair the broken immigration system. I don't think anybody believes on
the right or the left that the status quo is acceptable, and indeed it
is dangerous to the people I have described.

So I mentioned the fourth item, which is to work with the Mexican
Government to improve security at the border with Guatemala. I was
recently in Juarez, Mexico, right across the river from El Paso, which
used to be one of the most dangerous places on the planet because of
all of the conflict between the drug cartels. Things are getting
better. It is still pretty rough, but things are getting better thanks
to strong leaders, such as the mayor, whom I met with there, and thanks
to the assistance the U.S. Government is providing through the Merida
Initiative to help train law enforcement and to provide equipment and
the like. So we could step up our work with the Mexican Government to
help them secure their own southern border, which would eliminate more
than half of this migration from Central America.
Finally, I urge the President to take the step of making sure that
Texas and other U.S. border States and communities have the resources
they need to address the ongoing crisis.
Today I reiterate those calls, and I also call on the President to
please act as soon as possible. Make no mistake. The actions we take
and sometimes the actions we don't take have unintended consequences.
But in the days and weeks ahead, there will be life-or-death
consequences to an untold number of vulnerable children, perhaps in the
misperception that they can come to the United States if they can just
get here, without understanding the treacherous journey that will
befall them. We are doing no one a service by allowing that.
Because the impression created by the President has resulted in this
problem, at least in substantial part, I believe he has the unique
authority and power to begin to fix it. But first he will have to send
the message that I mentioned a moment ago, which is that there is no
free ticket into the United States. We have to deal with the
humanitarian crisis of these children and make sure they are safe, but
then we need to get about the business of enforcing our laws and not
just giving the impression that anybody and everybody who wants to come
to the United States can come here.
Perhaps in a perfect world everybody could live in America. But the
fact is that we need to have our immigration laws for our protection
and for the protection of legal immigrants. We need to do everything we
can to send a message that we are a caring country, but we are also a
country that believes in the rule of law. We need to restore order out
of this chaos, while dealing with the immediate humanitarian crisis of
this wave of children that is overwhelming the capability of the
Federal Government to deal with it. We need to do everything we can
together to address all of these issues.
Mr. President, I yield the floor.

[[Page S3585]]

The PRESIDING OFFICER. The Senator from Illinois.
Mr. DURBIN. Mr. President, the Senator from Texas just spoke on the
floor about the number of children coming across the border into the
United States, and the numbers are frightening, they are so large.
We had a hearing today with Jeh Johnson, who is the Secretary of the
Department of Homeland Security. A lot of questions were asked, such as
if actions by our government or statements by our President are luring
these children into the United States. Let me make the record clear.
There is nothing--nothing--about the President's Executive order
involving those we call DREAMers--children brought to the United
States--which would lead any of these families of the children to
believe they could qualify to be treated as qualified for docket--that
is, deferred deportation--because they would be eligible DREAMers.
None--none--of these children would be eligible, period. So the
suggestion that this Executive order has anything to do with luring
these children to the United States is wrong.
Second, there is turmoil in Mexico and Central America. That is a
fact. I am sure that is a factor in decisions being made by some to
leave. But there is an issue that has been overlooked here time and
again which needs to be addressed. There is a Pulitzer Prize-winning
book entitled ``Enrique's Journey.'' The author is an L.A. Times writer
named Sonia Nazario. She started following the paths of children--
children--coming into the United States from Mexico and Central America
and even South America. Here is what she found after her investigation:
48,000 children a year coming across the border into the United States,
some as young as 7 years old, half of them without any escort. How do
they get in? Well, many of them jump on freight trains. Can my
colleagues imagine, 7-, 8-, 9-, 10-year-olds jumping on a freight train
to come into the United States, trying to get here by themselves--half
of them by themselves? Why? Seventy-five percent gave the same reason:
To find my mother. To find my father.
That is what is bringing so many of them into the United States. What
happened? Mother left that village in Mexico or somewhere in Central
America and came to the United States. She works hard now and sends
money home and occasionally will send toys at birthdays and Christmas
and exchange photographs. And heartbroken children get on these trains
and try to find them.
They found a 9-year-old boy walking around Los Angeles. They asked
him why and where he was going. He said: Where is San Francisco? He was
trying to find his mother.
That is the reality and the heartbreak of what is happening at our
border when it comes to children, so many times over. The lucky ones
make it. Many don't. A survey done by the University of Houston found
over and over these kids on their way are starving, they are beaten,
they are robbed, they are raped over and over. Some are pushed off of
the train. Some die. Some are maimed. That is the reality.
What does it tell us? As we step back and look at this, what does it
tell us? It tells us what we already know: Our immigration system in
America is broken. It is flat-out broken. I know this, and everyone
else does too. Twelve million people living amongst us, some of whom
have been here for decades, worried about being deported tomorrow, with
a household where the wife and mother may be a citizen, the children
may all be citizens, but one person in the household is not--that is
our broken immigration system.
Well, Congress, stop talking about it. Do something about it. So we
did. We did. And the Presiding Officer was here. It was a little over a
year ago. We put together a bipartisan coalition of Senators--four
Democrats, four Republicans, and I was one of them--and we sat down and
for months worked out comprehensive immigration reform to finally fix
this broken immigration system and start to end some of the tragedies
we know are happening to children and to their parents all across
America. We worked on it for months.

It was a pretty interesting coalition. It included John McCain, a
well-known Republican Senator from Arizona; Lindsey Graham, Republican
Senator from South Carolina; Marco Rubio, a Republican Senator from
Florida; Jeff Flake, a Republican Senator from Arizona; and on our
side, Chuck Schumer of New York, Bob Menendez of New Jersey, Michael
Bennet of Colorado, and myself.
We worked on it for months, and we produced a comprehensive
immigration reform bill that was endorsed by virtually every major
labor organization and the U.S. Chamber of Commerce. We go through the
list of virtually every religion in America, and major religions
endorsed it. It was an amazing bipartisan product, and I was proud to
be a part of it and even more proud when the day came that we passed it
on the floor of the Senate with 68 votes--Republicans and Democrats. We
did it.
What happened to it? We sent it to the U.S. House of Representatives,
where it has languished for over a year. For over a year they have
refused to call this bill.
Now Senators who come to the floor, who voted against the reform, who
don't acknowledge the obvious--that the Republican House will not even
call this bill for debate and a vote--and who criticize the current
immigration system in America, aren't telling us the whole story. The
whole story is that we need to fix this system top to bottom--yes, a
path to citizenship but a path to citizenship that eliminates those
with serious criminal records--we don't want them--makes those who want
to enter this path pay a fine and learn English and make sure as well
that they are paying their taxes to our country. Then we will put them
on a path to citizenship, where they can be at the back of the line.
Under our bill, it would take a person 13 years before they become a
citizen. All that time they are paying their fines, they are learning
English, they are doing what they are supposed to do, and they are
subject to regular questioning as to any problems that might be in
their lives that we should know about. That is what the bill does.
So when I hear people come to the floor and say this immigration
system is broken, I agree completely. It is a tragedy to think
thousands of children are crossing the border in search of their
parents, as young as 7, 8, 9, 10 years old, and teenagers, being preyed
upon.
I just had in my office the Ambassador of Ecuador to the United
States of America. We talked about this issue. She told me the story of
a 12-year-old girl whose mother and father were in New York, and this
heartbroken girl decided she had to at any cost be reunited with them.
She jumped on one of those trains, and she was apprehended by Mexican
authorities. The parents found out about it and tried to find her. They
put her in an orphanage. She was going through the Mexican legal
system. The next thing: It was announced that this 12-year-old girl had
committed suicide--questionable but still a tragedy. And this
Ambassador from Ecuador said: I can't tell you what that did to our
country. It broke our hearts to think that little girl was just trying
to find her mom and dad.
We can do better. We can be better. All of the excuses in the world
don't count when it comes to this issue because we are a nation of
immigrants, my friends, all of us. We may have to go back several
generations--in my case, not very far. My mother was an immigrant to
this country. I am lucky to be standing on the floor of the Senate
representing a great State such as Illinois. That is my story. That is
my family's story. That is America's story. That is who we all are.
Why can't we, in our generation, embrace the reality of immigration
and fix this broken system, make sure we have security on the border to
stop, as much as we physically can, the flow of illegal immigration,
and make sure those who are here are reporting to our government so we
know who they are, where they are, and where they work? All of these
things will make us a better and stronger nation.
Let me tell my colleagues something else about these immigrant folks,
and I speak with some authority. The first wave of immigrants to this
country, by and large, take the toughest, hardest jobs available--
anything--and they will work hard on those jobs. But they are also
looking over their shoulder at their kids and they are saying to their
kids: We expect more from you. We

[[Page S3586]]

want you to stay in school. We want you to succeed.
That dynamic of the hard-working immigrant and the first-generation
American, striving to prove they can succeed, gives our country the
energy it needs. It gives our economy the energy it needs.
I see my friend has come to the floor, Senator McCain, and I
mentioned his name earlier in a positive way because we worked together
so closely on immigration reform. He has a special challenge I don't
have. Yes, we have many undocumented in Illinois, but being a border
State, Arizona has tougher challenges than most. We tried in our bill
to be sensitive to both States and all States in what we were putting
together.
So I wanted to come to the floor and say a word about children coming
across the border. I see two of my colleagues here, and I will yield
the floor in just a second.
We need to acknowledge the obvious. These children are vulnerable.
They are being exploited. Many of them are being hurt. Some are being
raped. Others are being killed. And that has to come to an end. To
bring it to an end in a sensible, thoughtful, American way, we ought to
pass comprehensive immigration reform. No more excuses in the U.S.
House of Representatives. Call the bill. For goodness' sake, call the
bill. Debate it. Vote on it. I will accept whatever comes, but what I
won't accept is ignoring these problems, blaming them on someone else,
and putting off to some time in the future the reality of the
responsibility we should face today.
I yield the floor.
The PRESIDING OFFICER. The Senator from Arkansas.
Mr. BOOZMAN. Mr. President, as the son of an Air Force master
sergeant and a member of the Senate Committee on Veterans' Affairs, I
take very seriously my responsibility to represent the interests of
those who have served our country in uniform. When it comes to our
Nation's veterans, their commitment to country is without question, and
our country's commitment to them should be the same.
Put simply, our veterans deserve better. That is why I am pleased to
see that we have come together to address this crisis in the Senate.
These men and women have served and sacrificed on behalf of a grateful
nation. We need to ensure that they are getting the high-quality
services they have earned. Our veterans deserve a system that proves
their care is our top priority.
Unfortunately, the VA is struggling to meet the health demands for
our veterans. The VA inspector general is currently investigating
misconduct throughout the VA health system. In order to ensure
accountability, we have to give the VA the ability to fire and demote
senior executive service employees who are responsible for these types
of abuses.
Under current law, senior VA employees are nearly untouchable. That
means the very people responsible for hiding the true extent of wait
times, for instance, and other abuses cannot be fired. That is
incredible when you think about it.
We cannot tolerate bad actors who abuse their power and put our
veterans in danger. That is why a key component of this bill gives the
Secretary of Veterans Affairs the authority to fire or demote senior VA
employees for poor performance.
Accountability is the goal here. However, that goes beyond individual
employees. The Department itself needs to be held accountable for its
shortcomings. So it is time we shine a light on the VA.
This bill would also establish an electronic waiting list that would
be made available to veterans on the Department's Web site so everyone
can see the average waiting time for an appointment at each VA medical
center for specific types of care and services. New wait time goals
would also be published on the Department's Web site and in the Federal
Register within 90 days of the bill's enactment.
Earlier this week we saw an audit which revealed that veterans
seeking care for the first time waited an average of 60 days in the
Little Rock VA hospital and 52 days in the Fayetteville hospital.
Clearly, these results need to be improved and indicate the failure of
the VA to meet its goal of seeing new patients within 14 days.
I am committed to ensuring that the VA uses every available option it
has to deliver on its mission for all veterans who have earned this
care. And if it cannot, this bill gives our veterans the ability to
seek that care elsewhere.
The bill we are considering today would establish a 2-year program
that allows veterans who have been unable to obtain care from the VA
for providing service to seek care from private providers. This option
would also be provided to those who live more than 40 miles from a VA
facility, including a community-based outpatient clinic. The government
would be obligated to reimburse the non-VA health care provider for the
services provided to the veteran.
Wait times and secret lists are not the only problem within the VA
health system. We are learning now that quality-of-care issues on a
range of critical care outcomes, including mortality and infection
rates, are willingly being ignored by senior VA management.
We need to restore faith in the VA health care system, and that
begins with accountability and following through with our promises.
The crisis surrounding the VA health care system shows an immediate
need to improve timely access to medical care for our veterans. The VA
needs to correct the systemic problems that are preventing our veterans
from accessing the high-quality health care services offered.
I am pleased we are taking action on this important issue, and I
encourage my colleagues to support this legislation before us because
we need to improve the health services our veterans earned and deserve.
The PRESIDING OFFICER. The Chair welcomes the Senator from Arkansas
back to the floor.
Mr. BOOZMAN. I thank the Chair.
The PRESIDING OFFICER. The Senator from Washington.
Mrs. MURRAY. Mr. President, I come to the floor today to say that
this compromise is really an excellent example of what Congress can do
when we work together to put our veterans first and work toward
substantive solutions to the challenges they face.
Passing this legislation this afternoon is a critical step toward
addressing some of the immediate accountability and transparency
concerns that are plaguing the VA and fixing its deep-seated structural
and cultural challenges. Each new report seems to paint a more serious
and more disturbing picture of the VA's systemwide failure to provide
timely access to care for our Nation's heroes. I am especially
concerned by the number of facilities that serve Washington State
veterans that have been flagged for further review and investigation.
The VA has promised to get to the bottom of this, and I expect them to
do so immediately.
However, these new reports are not only consistent with what I hear
so often from veterans and VA employees but also with what the
inspector general and GAO have been reporting on for more than a
decade. These are not new problems, and Congress must continue to take
action on them while addressing the inevitable issues that will be
uncovered as ongoing investigations and reviews are completed.
I expect this Chamber to come together, as the House did yesterday--
twice, in fact--to move this bill forward so we can work on our
differences with the House and send this legislation to the President's
desk as soon as possible.
As we all know, there are serious problems at the VA that will not be
solved through legislation alone or by simply replacing the Secretary.
However, I am very hopeful these steps that are in this legislation
will spark long-overdue change--from the top down--in order to ensure
that our veterans are given the care and support they expect and
deserve.
So I wanted to come today to commend the Senator from Arizona and the
Senator from Vermont for their commitment to bipartisanship and putting
the needs of our veterans first. This is an important compromise, and I
urge our colleagues to continue the bipartisan collaboration that made
this bill possible. Let's get it passed and in place so these reforms
can begin to get started. And then we must keep working to address the
management, resource, and personnel shortcomings that we all know exist
at the VA.
I yield the floor.

[[Page S3587]]

The PRESIDING OFFICER. The Senator from Louisiana.
Mr. VITTER. Mr. President, I stand in strong support of the veterans
bill we are about to vote on as well. I commend everyone who worked on
it on both sides of the aisle, certainly including Senator McCain, who
was here a minute ago, Senator Sanders, who is on the floor, and
Senator Burr, who is the ranking Republican member of the committee.
I am strongly supporting it, mostly with three key provisions in
mind--one I have been working on since well before this scandal and
this crisis that has engulfed the VA broke; that is, to dislodge, to
get moving on crucial expanded VA outpatient clinics in 18 States
around the country, including Louisiana. Mr. President, 26 clinics; 2
of those are in Louisiana, in Lafayette and Lake Charles. Those should
have been built by now. They have been on the books, they have been in
the VA plan for years. Through what the VA readily admits was a
bureaucratic glitch--a complete screw-up at the VA--they were delayed
for a significant period of time.
There was another glitch in terms of the so-called scoring of these
clinics. That required legislation, which the House passed. But that
legislation, which I was spearheading in the Senate, has been balled up
in the Senate.
Finally, the corrective legislation, to get moving, to get these
clinics done--including in Lafayette and Lake Charles, LA--is in this
bill. So I have been committed to that for months--since well before
this scandal erupted.
The other two provisions I want to highlight in this bill do go
directly to this scandal. One is the need to give veterans choice when
they are locked into a dysfunctional system. So for the first time ever
we are mandating the unparalleled choice that if a veteran is either
over 40 miles from a VA facility or he or she cannot get care--an
appointment--in a reasonable timeframe, then that veteran can go to a
Medicare provider or another provider who is delineated in the bill to
get the care he or she needs in a timely way. That is a really
important reform to expand choice and really competition that I think
will make the VA system better and offer veterans, when need be,
important care outside the strict VA system.
The third provision I wish to highlight is to give the leadership of
the VA the tools it needs to clean house, to get rid of incompetence
or, worse, to fire people who clearly merit that in the cases we have
been reading about in the last several months.
We have had so many protections heaped on the civil service system
over 100-plus years that it has become virtually impossible to fire or
demote or punish someone who is deserving of that because of
incompetence or worse. We need to change that because unless and until
we do, bureaucracies such as the VA will remain broken. This bill has
important provisions in that regard.
Those are the three top reasons I will be strongly supporting the
bill.
I thank the Chair.
Mr. MARKEY. Mr. President, Massachusetts is the Bay State, but we are
also the ``Brave State.'' But being first in freedom is not enough if
we don't put our veterans, their families, and the families of the
fallen first as well.
There are more than 388,000 veterans in Massachusetts. But too many
of our bravest return home unable to find a job. They suffer from
homelessness, mental health, and substance abuse. Too often, they end
their lives in suicide. Twenty-two veterans kill themselves every day.
This March, not one servicemember died in action in Afghanistan or
Iraq, but almost 700 veterans took their own lives. Of the 8,500
Massachusetts National Guard, six of them have committed suicide in the
last year and a half.
We need to treat these unseen wounds, and give our veterans a better
life, where they are employed, appreciated, and supported.
We have a sacred obligation to honor and care for our service men and
women for their bravery and sacrifice.
On the battlefield, the military pledges to leave no soldier behind.
As a nation, we must ensure that when warriors return home, we leave no
veteran behind.
In recent years, we have provided historic budget increases for
veterans, expanded access to VA health care, improved health services
for all veterans, and modernized benefits earned by America's
servicemembers.
But what is clear today is that hasn't been enough. The problems at
the VA are unacceptable and they dishonor our veterans and their
families who have sacrificed so much.
Anyone who contributed to the careless treatment of our veterans
should be held fully accountable, and I mean anyone.
And so our work must continue. We must address the emerging needs of
veterans, as well as those needs that have lingered for years.
Our returning veterans, and those who served in previous wars, always
should get the best services, including medical care.
Unfortunately, the U.S. Department of Veterans Affairs, VA, is facing
a crisis. The Department of Veterans Affairs inspector general reports
showed that thousands of veterans have been trying to see a doctor but
were never on the VA list to see a doctor. These veterans were
forgotten and lost in the scheduling process. VA leadership
significantly understated the time new patients waited for their
primary care appointment in their performance appraisals in part
because that affected their bonuses and salary increases. Mr.
President, 57,000 veterans have been waiting 90 days or more for their
first VA appointment. Mr. President, 64,000 veterans have fallen
through the cracks and have never received an appointment after
enrollment.
These deficiencies at the VA are unacceptable.
What is clear is that we need a full-scale reform of how the VA does
business. Too many men and women are falling through the cracks. We
need to fully fund the VA and modernize the agency and its facilities
to appropriately address the new needs of returning soldiers and their
families.
All veterans are heroes, but sometimes heroes need help.
The Veterans' Access to Care through Choice, Accountability, and
Transparency Act of 2014 allows the immediate firing of incompetent
high-level officials who broke the trust of our veterans by leaving
them behind. It also includes appropriate provisions to prevent the
abuse of these new powers.
The bill allows VA to lease 26 new medical facilities that would
expand access to care, including $4.8 million for the VA Worcester
community-based Outpatient Clinic.
It authorizes the hiring of new medical personnel for hospitals and
clinics that are facing a shortage of doctors and other health
professionals.
It would allow veterans living more than 40 miles from a VA hospital
or clinic to go to a private doctor.
It develops an independent commission to update the VA's scheduling
appointments process and another to help spur the construction of new
VA facilities.
It would allow all recently separated veterans taking advantage of
the post-9/11 GI bill to get instate tuition at public colleges and
universities. Finally, it would extend post-9/11 GI bill education
benefits to surviving spouses of veterans who have died in the line of
duty.
This bill is an important first step to dealing with the crisis at
the VA. However, more needs to be done. We need to make sure the
Massachusetts VA hospitals in Brockton, West Roxbury, Jamaica Plain,
Bedford, and Northampton can continue to provide the care that our
veterans deserve, including the latest in health care for traumatic
brain injury, post-traumatic stress disorder, and other injuries.
Mr. CARDIN. Mr. President, I rise today on behalf of the 470,000
Maryland veterans in order to thank my colleagues for making veterans
health care a priority by passing S. 2450, the Veterans' Access to Care
through Choice, Accountability, and Transparency Act of 2014. I
specifically applaud the chairman of the Veterans' Affairs Committee,
Senator Sanders, and Senator John McCain for developing this bipartisan
agreement and demonstrating to the Nation that the Congress can work
together to meet our greatest challenges.
I want to thank President Obama and Acting Secretary Gibson for
taking preliminary action and holding senior Department of Veterans
Affairs, VA,

[[Page S3588]]

leadership accountable. Now the hard work begins of renewing and
meeting our commitments to our veterans, who have sacrificed so much
for our Nation. I support this bill's efforts to provide immediate
authority to refer veterans to non-VA care and its provisions
addressing commonsense long-term reform. Much of the treatment our
veterans need is already provided in world-class facilities that are
closer to their homes than the nearest VA Hospital, and they stand
ready to support them today.
I am concerned that the expedited firing provision for Senior
Executive Service employees creates a separate process for VA staff
employee. Let me be clear: Anyone guilty of fraud, malfeasance or
criminal negligence must be held accountable. But current law and
Office of Personnel Management policy provide measures to address such
acts. Federal employees deserve the appropriate due process.
This bill is an exceptional step in the right direction and will
begin to address some of the concerns we all have with respect to the
VA, beginning with access to care. But there is still much work to do
to help our veterans return to civilian life after they have served. A
mere thank you is of little comfort to a veteran who cannot find
meaningful employment, who is struggling to provide for his or her
family or who is dealing with post-traumatic stress. Their sacrifices
are often made in stressful, frustrating, and dangerous conditions. Yet
these brave men and women do not shy away from committing themselves to
serving our country.
Disability claims at the VA are continuing to take far too long to be
processed, and the backlog is denying support to veterans who are in
critical need due to service-related injuries. I will continue to push
for an amendment that will make the Fully Developed Claims Program
permanent. The Fully Developed Claims Program is an optional new
initiative that offers veterans and survivors faster decisions from the
VA on compensation, pension, and survivor benefit claims. Veterans and
survivors must simply submit all relevant records in their possession
and those records which are easily obtainable, such as private medical
records, at the time they make their claim and certify that they have
no further evidence to submit. Then the VA can review and process the
claims more quickly. This program is realizing much improved processing
time due to the extraordinary partnership with numerous Veterans
Service Organizations, but I propose we make a guarantee to our
veterans that if they utilize this program, the VA will provide their
final rating in an expedited manner or they will receive a provisional
rating at 180 days. This is the level of commitment from Congress that
the American people expect and our veterans deserve.
A true marker of our Nation's worth is our willingness to serve those
who have served us. As we continue to wind down our commitments in
Afghanistan after 13 years of war, we need to gear up our commitment to
our veterans. Our veterans deserve every possible tool we can provide
to help ease their transition to civilian life. I am committed to
making sure that our veterans receive the services and benefits they
have earned and the support they were promised and deserve. The United
States is the strongest Nation in the world because of our veterans,
and we owe them and their families our gratitude and our respect and,
most important, our support.
Mrs. McCASKILL. Mr. President, today I rise in strong support of S.
2450, a bill I have proudly cosponsored that would make critically
needed reforms to the Department of Veterans Affairs. As we all know,
revelations from whistleblowers, reports from the Government
Accountability Office, an internal review by the VA, and an interim
report from the VA's inspector general, an independent watchdog, have
all revealed problems within the VA that have caused the system to fail
many of our veterans. This is simply unacceptable.
As the daughter of a World War II veteran, I understand the
extraordinary debt we owe to the men and women who have served this
Nation in defense of our freedoms. I thank my colleagues, Senator
Sanders and Senator McCain, for working to forge a bipartisan bill to
address some of the most serious shortcomings in the VA health care
system that have been identified in recent weeks. The bill would
provide for greater transparency at the VA by requiring an independent
assessment of the scheduling system used at every VA medical center,
along with the staffing levels and workloads at each facility. It would
also task the VA inspector general to identify on an annual basis the
health provider occupations with the largest staffing shortages, which
will give both the VA and Congress a better understanding of the
Department's needs. In order to address what has been identified as a
shortage in health care providers within the VA, the bill would expand
opportunities for veterans to seek care outside of the VA system,
including allowing veterans who qualify to seek care at Department of
Defense health facilities. The bill would also empower the Secretary of
Veterans Affairs to immediately hold senior VA officials accountable if
they have failed to do their jobs.
The credibility of the VA has taken a serious blow, and it will take
years for the Department to regain the trust it has lost among veterans
and among the American people. My strong support for this legislation
is based on my belief that it will make critical and fundamental
changes to the VA that will result in significant improvements to the
quality of care our veterans receive and their ability to access that
care. The VA is facing significant challenges, but with the passage of
this legislation the Senate is taking an important step in helping to
restore trust in a system that has provided tremendous care for
generations of veterans. Our Nation's veterans deserve no less.
Mrs. FEINSTEIN. Mr. President, I rise today to state my strong
support for the legislation on the floor that addresses the current
healthcare crisis facing our nation's veterans. This bill, the
Veterans' Access to Care through Choice, Accountability, and
Transparency Act of 2014, is the product of excellent bipartisan work
done by Senator Sanders and Senator McCain. I want to thank both of my
colleagues for their efforts on drafting this legislation and finding a
path to bring it to the Senate floor today. I believe their legislation
will give our veterans access to the healthcare they deserve and that
it will invest in the Department of Veterans Affairs' health care
system.
While Senator Sanders' and McCain's legislation contains many good
measures that will improve the healthcare our veterans receive at the
Department of Veterans Affairs, VA, I would like to highlight three
provisions in the bill that I believe are especially important for
Congress to pass.
First, I am strongly supportive that the legislation contains a
provision to allow the Secretary of the Department of Veterans Affairs
to immediately terminate senior executives for poor performance. It is
my opinion that the current scandal was largely a result of ineffective
and disgraceful mismanagement. As a first step, the Department must be
able to terminate any managers who directed or pressured staff to
falsify or cover up wait times for veterans seeking health care. It is
time for a new culture of management in the VA, and I look forward to
providing this authority to the Department.
Second, I am grateful the legislation provides the authority for the
VA to quickly hire new clinical staff, such as physicians and nurses,
when there is a shortage of medical providers within the VA. The
legislation allows the VA to use any unobligated funds at the end of
each fiscal year to do such hiring. The audit released by the
Department of Veterans Affairs this week clearly indicated that many
medical facilities had a shortage of clinical providers. The
legislation on the floor also authorizes the VA to enter into medical
leases the Department has requested in previous years, but that
Congress has not funded. These include four community outpatient
clinics in California, which are in San Diego, Chico, Chula Vista, and
Redding. Thus, I am confident the authority to hire new clinical staff
and the authority to enter into much needed medical leases are critical
measures that Congress must pass if we expect the VA to meet the
growing demand of medical care our Nation's veterans need and deserve.
I am also glad the legislation the Senate is considering contains
measures to beef up how VA hospitals are

[[Page S3589]]

evaluated for the quality of health care they provide, and that this
information will be made public for veterans. The legislation contains
a provision that would require the Department of Health and Human
Services to complete evaluations of VA hospitals and to post this
information publically. It also requires the Government Accountability
Office to look at the metrics the VA is using to evaluate patient care
and hospital quality. Finally, the bill will require the VA to publish
its appointment wait times, which will increase the transparency of how
quickly our veterans can access health care. Thus, I want to thank both
Senator Sanders and Senator McCain for including such important
provisions that will improve accountability, transparency, and health
care quality at the VA.
Recently, the Department of Veterans Affairs released the results of
its nation-wide Access Audit detailing the breadth of its struggle to
responsibly manage waiting lists for care at its medical facilities
across the country. The allegations of false record-keeping and other
inappropriate scheduling practices were further substantiated. The
audit made it clear that many staff members--13 percent interviewed
nationally--were instructed to use inappropriate scheduling actions by
their supervisors. The audit also revealed that at least one scheduler
at 76 percent of all VA facilities indicated they received direction to
enter inaccurate or misleading appointment data. The result is that
some veterans were forced to wait an egregious amount of time for
medical appointments, and surely many of these veterans suffered
negative health effects as a result of these delays.
After the press reports of secret wait lists at the Phoenix VA
Medical Center, I wrote a letter to the VA's acting inspector general
urging him to expand the scope of his investigation in order to
determine if similar problems were occurring elsewhere. On May 28,
2014, the VA's Office of the Inspector General released an interim
report of the ongoing review at the Phoenix VA Health Care System. This
independent review verified that deliberate action was taking to
falsify wait times and to keep some veterans--1,700 in Phoenix--off
official wait lists. In response to this report, on June 2, I wrote to
Acting Secretary Sloan Gibson requesting an immediate review of medical
appointment wait times at all California VA medical facilities, and
that the VA take action to expedite appointments for veterans in my
State waiting an excessive amount of time to receive health care.
California is home to 8 major Department of Veterans Affairs, VA,
health care systems which include 66 medical centers and outpatient
clinics. According to the latest data from the U.S. Census Bureau, of
the nearly 22 million veterans in the United States, nine percent, or
roughly 2 million, live in California; a figure greater than that of
any other State. California's large population of veterans, many of
which are concentrated in southern California, creates a substantial
demand for medical care at California's VA Medical Centers.
The VA's Access Audit, released this week, validated the national
extent of lengthy wait times and potential falsification of appointment
records. It also makes it clear that California is not exempt from the
recent VA scandal. The data collected shows that over 20,000 veterans
in California are having to wait more than 30 days for a medical
appointment. Nearly 3,000 are waiting more than 90 days for their
appointment. Furthermore, nearly 7,000 California veterans are on
electronic wait lists who have not been able to schedule any
appointment. This lack of urgency to provide care to our Nation's
veterans is not only appalling, it is also irresponsible.
In addition, I am deeply troubled that the recent audit identified
that five VA health care facilities in my State had some evidence of
falsifying or hiding wait times. They are the Livermore Medical Center,
the Yuba City Outpatient Clinic, the Sepulveda Ambulatory Care Center,
the Escondido Outpatient Clinic, and the Imperial Valley Outpatient
Clinic. The VA recommended the Office of the Inspector General conduct
investigations at these facilities in order to determine if any
fraudulent or criminal activity occurred, and I eagerly await the
results of these investigations.
It is clear to me that excessive wait times for medical appointments
negatively impacts the health of our veterans. So, fixing the VA is not
only about fixing the systemic management problems that led to a cover-
up of appointment wait times at certain VA facilities across the
Nation. The fix also must be about improving the VA's ability to
provide high caliber health care to all of our Nation's veterans.
The VA must radically alter how it manages health care. It is my
opinion that the VA's performance should be tied to the health outcomes
of our veterans. The VA has played number games with appointment wait
times in order to evaluate their performance for too long, and that
must end today. I hope the new leadership at the Department will work
to develop better measures of performance that are based on how well
our veterans do in terms of health and wellbeing as a result of the
care they receive at the VA.
For example, the VA should strive to reduce preventable drug
resistant infections acquired in medical facilities. Deadly drug
resistant infections are linked to poor infection control and the
overuse of antibiotics in hospitals. These infections, like Methicillin
Resistant Staphylococcus aureus, MRSA, and Clostridium difficile are
deadly, difficult to treat, and largely preventable. VA hospitals that
provide high quality medical care, that use antibiotics prudently, and
that practice good hygiene will have lower rates of these infections,
faster recovery times for hospitalized patients, and reduced health
care costs. VA hospitals that have clear data that they use antibiotics
appropriately, have fewer deadly hospital acquired infections, and have
veterans who can be discharged faster should be noticed for their
performance. I truly believe that a greater focus on health care
quality and outcomes is critical for improving the VA's health care
system.
The delays in access to health care and the culture of cover-ups that
emerged within the Department of Veterans Affairs are absolutely
unacceptable. Our Nation's veterans served and sacrificed for our
country, and they deserve better. I truly believe the legislation
introduced by Senators Sanders and McCain is the solution our veterans
need and deserve. This is not a partisan issue, this is an issue of
doing what is right by those who defended our freedom.
Thus, I urge my colleagues to vote for this bill.
Ms. MIKULSKI. Mr. President, I come to the floor today in support of
S. 2450, the Veterans' Access to Care through Choice, Accountability,
and Transparency Act of 2014.
The preliminary VA inspector general's report of delayed care at the
Phoenix Hospital uncovered serious and systemic failures in our VA
system. The internal audit by the Veterans Health Administration
confirmed these delays. These problems have dragged on long enough and
must be addressed and corrected. I believe we must keep the promises we
have made to our veterans. We can do this by giving them the same
quality of service they gave us, and by providing them with the care
they deserve. That is why I support this bill.
This bill contains a number of provisions that will improve veterans
access to care when they need it the most by:
Sending care into the community and ensuring veterans do not have to
wait more than 14 days to see a doctor or physician;
expeditiously hiring new doctors, nurses and other health care
providers in locations that have shortages;
requiring the VA to upgrade their electronic scheduling software;
authorizing the VA to enter into 27 major medical leases that will
increase access to care for thousands of veterans who currently have to
travel long distances to get the care they need;
requiring the President to create a commission to evaluate access
issues in the VA Health Care system;
and, creating a commission on capital planning for VA medical
facilities to look at the processes to ensure our veterans are being
treated in safe facilities.
There is also a provision that would allow the Secretary of the VA to
terminate VA senior executives for poor performance. This provision
would also require the Secretary to provide Congress a justification
for any removal

[[Page S3590]]

within 30 days. I also support giving SES employees the ability to
appeal to the Merit System Protection Board within 7 days of
termination, providing them the protections from retaliation and
discrimination they deserve.
In addition to supporting this bill, as the chairwoman of the Senate
Appropriations Committee, I have put money in the Federal checkbook to
improve the veterans health care system so that wounded and disabled
warriors get the care and benefits they need. I have worked to ensure
veterans suffering from post-traumatic stress disorder, PTSD, or a
traumatic brain injury, TBI receive better diagnosis and treatment
through the Defense Department and the VA.
I have also led the charge to reduce the backlog in processing
veterans disability claims. I brought Secretary Shinseki to Baltimore
to create a sense of urgency to end the backlog by 2015. I used my
power as chairwoman of the Appropriations Committee to convene a
hearing with the top brass in the military and members of the committee
to identify challenges and get moving on solutions. I cut across
agencies to break down smokestacks and developed a 10-point checklist
for change enacted as part of the FY-2014 omnibus appropriations bill.
This plan includes better funding, better technology, better training
and better oversight of the VA.
The Veteran's Administration needs a new attitude from the bottom up
in every facility across the Nation. It is time to turn the VA around.
Veterans who have fought on the front lines should not have to stand in
line for the care they have earned and deserve.
This legislation is a significant step in the right direction, and I
urge my colleagues to support it.
Mr. McCAIN. Mr. President, parliamentary inquiry: How much time is on
both sides?
The PRESIDING OFFICER. The Republican side has 6 minutes, the
Democrats just under 13 minutes.
Mr. McCAIN. Mr. President, I ask unanimous consent for the Senator
from Alabama to have 6 minutes, and I ask unanimous consent for 4
additional minutes for this side, following the Senator from Vermont.
The PRESIDING OFFICER. Is there objection?
Hearing none, it is so ordered.
The Senator from Alabama.
Mr. SESSIONS. Mr. President, I appreciate the work of my colleagues
on this legislation. They have accomplished some very good things. We
need legislation to pass to help our veterans. The needs are real, and
recent revelations of substantially substandard care--and too often no
care at all--at our VA medical centers are shocking. There is and has
been a long-term problem with the management of that agency. It is
heartbreaking. It is an embarrassment. We owe our veterans better care
than they have been given.
One of the keys to improve that care is improving accountability,
ensuring money is being properly spent, not simply wasted by government
bureaucrats. The money needs to get to our veterans.
Our national debt now is $17 trillion. It is growing rapidly. We
cannot be lighthearted or cavalier about our responsibility to follow
our agreement to honor the budget limitations we have. There are a lot
of budgetary freedoms we have and a lot of ability we have and duties
we have to set priorities in our spending. Veterans clearly are a
priority. I fought hard against the recent push to cut veterans
pensions and led an effort to restore those pensions payments.
In this case we are dealing with an issue of bureaucratic
accountability. What happens so often is that in the crush and press of
business, we are unable to reach agreements on finding money somewhere
else in this monstrous bureaucracy and government of ours, and we
simply break the budget and add to the debt. Our veterans deserve
better than that.
I am the ranking Republican on the Budget Committee. We wrestle with
these issues--the chairman of the committee, Senator Murray--and the
numbers from the Congressional Budget Office indicate that this
legislation, as drafted, violates the Budget Act.
Indeed, the entire bill, the way the language is written, has been
declared an ``emergency'' which allows its authors to avoid finding the
efficiencies and the accountabilities needed to stay within the Federal
budget limits both parties agreed to. There is plenty of wasteful
spending to be cut elsewhere in government, and much we can do to
increase accountability at the VA.
Even more concerning is the new open-ended entitlement legislation in
the bill. The bill would authorize emergency spending but sets no
limits on that spending. Section 801 says ``such sums as necessary.''
Well, how much is necessary? This is an important conversation to have,
to wrestle with, and to develop solutions. But by simply not developing
these solutions, we invite more of the same kind of accountability
problems we have seen that brought us here.
I feel strongly that we have to do the right thing for our veterans,
but history suggests a blank check for the bureaucracy, an unlimited
entitlement program, will not have the desired results--indeed, may
even yield the opposite results from what we hope to achieve.
We need to resist the temptation to create more entitlements and more
entitlements, which is one of the reasons we are heading recklessly
toward fiscal crisis, as our own Congressional Budget Office has
indicated, and instead focus on creating reforms and solutions that
improve that quality of service and the effectiveness that is
delivered. Isn't that our job? Isn't that what our veterans deserve
from us--the very best we can give them? As many hours as it takes for
us to get this right, instead of simply avoiding the difficult issues
we must tackle to solve this calamity long-term?
There are also 3 years of emergency spending under the legislation,
which I think is an unwise precedent for us to set. Again: it leads to
the kind of unaccountability, the lack of oversight that helped create
this crisis in the first place. We should designate--maybe if we have
to do this--2014 money this year where the crisis is. We have already
appropriated money. If we need some more, that could be perhaps
justified as emergency spending, but a 3-year bill goes beyond what I
think is proper. It fails to establish the oversight that Congress has
a solemn duty to deliver. We can't just write a blank check and think
it will solve these problems. We have to ask the tougher, deeper
questions about the changes needed in Washington to do right by our
veterans. Details matter. Every line of legislation matters. We need to
get this right.
The Appropriations Committee has already reported out the 2015 VA-HUD
bill. It is already on the floor and could be here as early as next
week. The Senate could easily attach a bipartisan amendment to that
that provides the spending called for in this bill with offsets, cuts,
efficiencies, and reductions in other spending to pay for it. There are
places we could do this.
So I have to tell you, there are some good things in the bill. I
think there are. It improves the situation. I like the idea of giving
veterans more choice to go to the doctor who is close to them. It is
something Senator McCain and Senator Sanders have agreed on. I think
that is progress, very much so, but I have to say I cannot suggest to
my colleagues that the budget violation now before us should be waived.
It should not. Ignoring this requirement will not help our veterans in
the long run, but will lead to the same kind of problems we are
confronting today. We should adhere to the agreement we reached on
spending by finding offsets. If we don't adhere to our spending limits,
other programs will crowd out the budget for veterans and mean we have
less money in the future not more, to fund these programs. If we ignore
our debt, we do a disservice to our veterans. Unfortunately, the bill
does not do what the law we agreed to requires. It is not paid for. We
all agree veterans are our priority. So then is it not our duty to them
to fulfill this priority by reducing wasteful spending elsewhere so
that money can be spent on veterans instead? Can we not deliver for
these veterans that most basic level of responsibility on our part as
lawmakers?
Finally, colleagues, a vote to sustain the budget point of order is a
vote that tells the committee to find appropriate money for the bill
and does not kill the bill. It does not knock down the bill. It allows
it to continue to be alive and a piece of legislation before us. It
would just require us to fix the funding. It would require us to fix
the bill. So that

[[Page S3591]]

is what we should be doing. That is why I feel I must raise the budget
point of order.
In summary, the bill has mandatory spending that violates the limits
we have agreed to in the Budget Act, and the bill also abuses the
emergency designation to circumvent the requirement for offsets and the
need for accountability.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. SESSIONS. Mr. President, I raise a point of order against the
emergency designation provision contained in Section 802(b) of H.R.
3230, the vehicle for S. 2450, the Veterans' Access to Care Through
Choice Act, pursuant to section 403(E)(1) of the fiscal year 2010
budget resolution, S. Con. Res. 13.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. SANDERS. Mr. President, I am going to yield to Senator McCain in
a moment, but before I do that, pursuant to section 904 of the
Congressional Budget Act of 1974, the waiver provisions of applicable
budget resolutions and section 4(g)(3) of the Statutory Pay-As-You-Go
Act of 2010, I move to waive all applicable sections of those acts and
applicable budget resolutions for purposes of the pending bill, and I
ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
Mr. McCAIN. Mr. President, how much time remains on both sides?
The PRESIDING OFFICER. The Senator from Arizona has 4 minutes, the
Senator from Vermont has 10 minutes.
Mr. McCAIN. Does the Senator from Vermont want to go ahead?
Mr. SANDERS. I am happy, if the Senator from Arizona needs more time
at the end of his 4, for him go right ahead.
Mr. McCAIN. Mr. President, I wish to thank a lot of people, including
the staffs of the committees, Senator Sanders' staff, Dahlia Melendez
and Travis Murphy; Senator Burr's staff, Natasha Hickman, Maureen
O'Neill, Anna Abram, and Victoria Lee; Senator Coburn's staff, Jabari
White; my own staff, Elizabeth Lopez, Jeremy Hayes, and Joe Donoghue,
and all the hard work that has gone into this legislation.
I think it is well known to my colleagues that this is an
unprecedented piece of legislation in that for the first time it is
going to provide our veterans with a choice. There are many other
provisions I would like to discuss also but have been, and I am sure my
colleague from Vermont will be addressing those.
There are, according to a recent VA audit, over 57,000 veterans who
have been waiting for an appointment for over 3 months to see a
physician at the VA. Over 63,000 veterans over the past 10 years have
never been able to get an appointment at all. There are allegations in
the Phoenix VA hospital that 40 veterans have died.
Today, June 11, the Federal Bureau of Investigation has opened a
criminal investigation into allegedly misleading scheduling practices
at the Department of Veterans Affairs that may have concealed how long
veterans had to wait for appointments to see a doctor. ``Our Phoenix
office has opened a criminal investigation,'' FBI Director James Comey
said in response to a lawmaker's question at a hearing Wednesday.
If that is not an emergency, I do not know what is. If it is not an
emergency that the very lives of the men and women who have served our
country with honor and distinction are being either jeopardized or
allegations of absolutely being lost through malpractice and
malfeasance, if that is not an emergency, I have never seen one before
this body.
I urge my colleagues to vote this for what it is, this budget point
of order. This is an emergency. If it is not an emergency that we have
neglected the brave men and women who have served this country and keep
us free, than I do not know what an emergency is.
Hard work has been done on this legislation, hard work and a lot of
compromises. I am happy to see that the majority of the veterans
service organizations are now in support of it. Is it a perfect piece
of legislation? No. Is it exactly what I wanted? No. Is it exactly what
the Senator from Vermont wanted? Absolutely not. But this is an
emergency. I tell my colleagues, if it is not an emergency of how we
care for those who have served on the field of battle, then nothing
else is before this body.
It breaks our hearts. It breaks American's hearts when they hear and
see these stories of those brave men and women and the neglect they
have suffered, the lack of a fulfillment of an obligation we made to
them. I hope we will vote against this budget point of order. I hope we
will vote unanimously, 100 to 0, to pass this legislation, send it to
the House, go to conference, get it to the President's desk, and start
healing the wounds that have been inflicted on these men and women.
There is no way we can ever compensate for those who have gone
without the treatment they have earned, but at least we can
expeditiously fix this problem to the best of our ability. Is this the
ultimate and final solution to those problems that have been uncovered?
No, but it is a beginning. It is not the end of the beginning, it is a
beginning. There will be more proposals before us. There will be more
efforts to fix this gaping wound in America's conscience.
I urge my colleagues to vote to waive the budget point of order. This
is an emergency. I urge my colleagues to vote for the bill. Again, I
thank everyone for their involvement, especially Senator Burr and
Senator Coburn.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. SANDERS. Let me just thank Senator McCain for his very hard and
bold work on this issue. He stood and came forward when we needed
someone to do so. I think we have made real progress in a bipartisan
way.
As Senator McCain just said, and I agree with him, if this is not an
emergency, I am not quite clear what an emergency is.
During the last 4 years some 2 million new veterans have come into
the VA system. Many of them have come in with very difficult medical
problems, PTSD, TBI. We have an aging veteran population. Taking care
of older people is complex and expensive. The simple truth is that in
many parts of this country--not all parts I suspect, but in a number of
places in this country--we simply do not have the number of doctors,
nurses, and other medical staff to accommodate the needs of our
veterans. I have been told, unofficially at least, that at the very
minimum there is a need for 700 new physicians in the VA. I am told
that is the floor, that the reality may be higher than that.
I have been told that in Phoenix alone there is a need for hundreds
of new providers in order to address the problems in that one large
facility. Further, this legislation says to veterans that if there are
long wait times, if they cannot get into a facility in a reasonable
time, they can go outside of the VA. That is what this bill says.
You know what. That is going to cost money. That will cost money.
This legislation also says that if they live 40 miles or more from a VA
facility, they have the option of going to a private provider. That
benefit is going to cost money. The bottom line is that if we are going
to do what in my view we should do; that is, to make sure every
facility in the VA has adequate staffing--doctors, nurses, other
medical personnel--and to make sure there is available funding to pay
for those veterans who will now get care outside of the VA--right now
the VA is spending about $4.8 billion a year in contract fees. There is
no question in my mind that number is going to go up, but that is what
we are voting on now.
If you want to provide timely care to veterans, if you agree they
should go outside of the VA, it is going to cost money. If we are going
to do that and the other things in this bill, that legislation needs to
be passed as written, and we must waive the point of order brought up
by Senator Sessions.
Lastly, I remind my colleagues that when Congress voted to go to war
in Afghanistan and Iraq, it did so with emergency funding. Those wars
will, it is estimated, cost between $3 and $6 trillion by the time we
take care of the last veteran. If we can spend that kind of money to go
to war on an emergency basis, surely we can spend one-tenth of 1
percent of that amount to take care of the men and women who fought
those wars.
What we have done, as Senator McCain has indicated, is developed a
compromise. I am sure he is not happy

[[Page S3592]]

with everything in the bill. I am not happy with everything in the bill
as well. I did want to also remind Senators about a few of the other
provisions that are in this bill that are important and I think do have
bipartisan support.
This bill allows for 26 major medical facility leases, which means
improved and expanded care for veterans in 27 States and Puerto Rico.
This bill provides for the expedited hiring of VA doctors and nurses
and $500 million targeted to hire those providers with unobligated
funds. As I mentioned earlier, this bill allows for veterans to go
outside of the VA when there are waiting lines and when they live 40
miles from a facility. This bill also deals with an issue where there
is widespread support both in the House and the Senate; that is, the
need to address instate tuition for all veterans at public colleges and
universities.
It also provides that surviving spouses of those who die in the line
of duty will be eligible for the post-9/11 GI bill. This bill also
importantly establishes commissions to provide help to the VA in terms
of improving scheduling capabilities--God knows they certainly need
that help--and also for capital planning.
Lastly--and we need to reiterate this point--this bill gives the
Secretary of the VA the authority to immediately fire incompetent
employees and those who have falsified or manipulated data in terms of
waiting periods.
Our legislation differs from the House in that in order to prevent,
in my view, the politicization of the VA or eliminate all due process,
it provides for a very expedited appeals process.
The House of Representatives passed legislation yesterday which
covers a lot of the same ground the Sanders-McCain bill covers, and I
am absolutely confident that working with Chairman Miller and Ranking
Member Michaud we can bridge the differences and send the President a
bill that he can sign in the very near future.
Finally and lastly, I want to say to the 300,000 employees who work
at the VA that the overwhelming majority of those people are hard-
working, honest, serious people. For many of them, taking care of
veterans is not a job; it is a mission. Many of them are, in fact,
veterans themselves. These people understand the sacrifices the
veterans have made to protect our country, and they are doing the best
that they can to support our veterans.
I hope we pass this bill. I hope we pass a waiver for the budget
point of order. I hope we get a conference committee moving
immediately, and I hope we get a bill to the President as soon as
possible.
Furthermore, as Senator McCain has just mentioned, I don't think this
is the end of the discussion regarding the needs of veterans. I hope
very much that in our committee and on the floor we can begin to
address some of the other very serious issues facing the veterans'
community.
With that, I yield the floor.
The PRESIDING OFFICER (Mr. Brown). The senior Senator from Arizona.
Mr. McCAIN. I ask unanimous consent for 5 minutes for Dr. Coburn.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The Senator from Oklahoma.
Mr. COBURN. I thank the chairman of the Veterans' Affairs Committee
for working with Senator McCain to get a bill.
I support Senator Sessions and the budget points of order on this
bill. I take exception to some of the statements by my colleague from
Vermont.
As reported yesterday, if you look at the patient list for many of
the primary care doctors in the VA, they are half of what the average
practicing physician outside the VA is. When you drill down on those,
many of them have patients that have been deceased for years. About 10
to 15 percent of their patient list has never been to the VA, or they
came once from a different State or were transferred from somewhere
else. What you actually see is the patient load in the private sector
is about 2\1/2\ times what the patient load is in the VA.
I have no doubt we need to increase the number of physicians in the
VA, but we also need to increase markedly the amount of output that
those physicians perform.
The other thing that is important in this bill is the transparency--
which I don't believe has been mentioned--that will actually allow
veterans to know the quality outcomes of where they are being treated
and the credentials of those who are treating them. Those are important
factors for care.
Our veterans deserve the best care. I agree with the chairman of the
Veterans' Affairs Committee that the vast majority of our VA employees
are hard-working employees, but there are some who aren't.
Our lack of oversight and the lack of management expertise at the VA
has now exploded into issues that are going to continue to be exploded.
We hear every day new whistleblowers coming forward on the problems in
the VA.
It is not only scheduling; it is a lack of truthfulness in a lot of
other areas. It is a lot of inaccuracy in terms of outcome.
I agree with the chairman. This is just the beginning. But if, in
fact, somebody puts their life on the line for us, we certainly, at a
minimum, ought to make sure that we don't just have words that say we
are going to give you the health care if you are an injured returning
war veteran, but that we actually give that care, and that it meets the
standard of care we want for anybody in our family. This is just the
start.
The other thing that I would say, in agreement with Senator Sessions,
there are ways to pay for this bill.
On the clinics, we drill down on one clinic--and I am going to go
spend just a minute talking about it. It is a clinic that will triple
in size, but with an average expected increase in veteran population of
5 percent and visits of less than 7 percent over the next 20 years. So
it is going to go from 50,000 to 190,000 square feet.
We are going to spend $188 million for that facility and pay $40 a
square foot per year for it on a rate of increase of 4 percent in part
of the lease. We can rent the same space in Tulsa at $15 a foot and
spend less money than we pay for the engineering cost for this to have
a clinic just as good or better.
So the planning and the management of the VA on these clinics is
suspect, and I plan on drilling down on every one of those before this
bill comes to conference and give our conferees the information based
on that. Because we are going to spend emergency money, as the chairman
would like to do on this, we ought to make sure there isn't a penny
that is wasted.
So we can do it. We can do it better, we can do it for less money,
and we can do it in the confines of what we are actually going to see.
The final thing is I would say again to my colleague from Vermont, I
appreciate his willingness to compromise on the issues. His heart is
dedicated to veterans, and I understand that. Our philosophies are
different on how we get there, but his commitment is nonetheless real
and felt, and I thank him.
I yield the floor.
Mr. SANDERS. I yield back the remainder of the time.
The PRESIDING OFFICER. Without objection, all time is yielded back.
Mr. SANDERS. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion to waive.
The yeas and nays have been ordered.
The clerk will call the roll.
The assistant bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from Missouri (Mrs.
McCaskill) and the Senator from Oregon (Mr. Merkley) are necessarily
absent.
Mr. CORNYN. The following Senators are necessarily absent: the
Senator from Mississippi (Mr. Cochran), the Senator from South Carolina
(Mr. Graham), the Senator from Kansas (Mr. Moran), and the Senator from
South Carolina (Mr. Scott).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 75, nays 19, as follows:

[Rollcall Vote No. 186 Leg.]

YEAS--75

Alexander
Ayotte
Baldwin
Begich
Bennet
Blumenthal
Booker
Boozman
Boxer
Brown
Burr
Cantwell
Cardin
Carper
Casey
Chambliss
Collins
Coons

[[Page S3593]]

Cornyn
Donnelly
Durbin
Feinstein
Fischer
Franken
Gillibrand
Grassley
Hagan
Harkin
Hatch
Heinrich
Heitkamp
Heller
Hirono
Hoeven
Inhofe
Isakson
Johanns
Johnson (SD)
Kaine
King
Kirk
Klobuchar
Landrieu
Leahy
Levin
Manchin
Markey
McCain
McConnell
Menendez
Mikulski
Murkowski
Murphy
Murray
Nelson
Pryor
Reed
Reid
Rockefeller
Rubio
Sanders
Schatz
Schumer
Shaheen
Stabenow
Tester
Toomey
Udall (CO)
Udall (NM)
Vitter
Walsh
Warner
Warren
Whitehouse
Wyden

NAYS--19

Barrasso
Blunt
Coats
Coburn
Corker
Crapo
Cruz
Enzi
Flake
Johnson (WI)
Lee
Paul
Portman
Risch
Roberts
Sessions
Shelby
Thune
Wicker

NOT VOTING--6

Cochran
Graham
McCaskill
Merkley
Moran
Scott
The PRESIDING OFFICER. On this vote the yeas are 75, the nays are 19.
Three-fifths of the Senators duly chosen and sworn having voted in
the affirmative, the motion is agreed to. The point of order falls.
The amendment was ordered to be engrossed and the bill to be read a
third time.
The bill was read the third time.
The PRESIDING OFFICER. Under the previous order, the bill having been
read the third time, the question is, Shall it pass?
Mr. PORTMAN. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from Missouri (Mrs.
McCaskill) and the Senator from Oregon (Mr. Merkley) are necessarily
absent.
Mr. CORNYN. The following Senators are necessarily absent: the
Senator from Mississippi (Mr. Cochran) and the Senator from Kansas (Mr.
Moran).
The PRESIDING OFFICER (Mr. Blumenthal). Are there any other Senators
in the Chamber desiring to vote?
The result was announced--yeas 93, nays 3, as follows:

[Rollcall Vote No. 187 Leg.]

YEAS--93

Alexander
Ayotte
Baldwin
Barrasso
Begich
Bennet
Blumenthal
Blunt
Booker
Boozman
Boxer
Brown
Burr
Cantwell
Cardin
Carper
Casey
Chambliss
Coats
Coburn
Collins
Coons
Cornyn
Crapo
Cruz
Donnelly
Durbin
Enzi
Feinstein
Fischer
Flake
Franken
Gillibrand
Graham
Grassley
Hagan
Harkin
Hatch
Heinrich
Heitkamp
Heller
Hirono
Hoeven
Inhofe
Isakson
Johanns
Johnson (SD)
Kaine
King
Kirk
Klobuchar
Landrieu
Leahy
Lee
Levin
Manchin
Markey
McCain
McConnell
Menendez
Mikulski
Murkowski
Murphy
Murray
Nelson
Paul
Portman
Pryor
Reed
Reid
Risch
Roberts
Rockefeller
Rubio
Sanders
Schatz
Schumer
Scott
Shaheen
Shelby
Stabenow
Tester
Thune
Toomey
Udall (CO)
Udall (NM)
Vitter
Walsh
Warner
Warren
Whitehouse
Wicker
Wyden

NAYS--3

Corker
Johnson (WI)
Sessions

NOT VOTING--4

Cochran
McCaskill
Merkley
Moran
The bill (H.R. 3230), as amended, was passed.
The PRESIDING OFFICER. The Senator from Montana.
Mr. TESTER. I ask unanimous consent that the title amendment to H.R.
3230, which is at the desk, be agreed to.
The PRESIDING OFFICER. Is there objection?
Mr. INHOFE. Reserving the right to object, let me inquire of the
Senator if it is his intent to speak on that tonight.
Mr. TESTER. In a moment I am going to ask unanimous consent to go
into morning business, and I am going to speak on the veterans bill.
The PRESIDING OFFICER. The Senator from Michigan.
Mr. LEVIN. If the Senator from Montana would yield for a question, is
there any kind of order established regarding whom would be recognized
at this point?
The PRESIDING OFFICER. There is not.
Mr. LEVIN. The Senator from Oklahoma and I thought we would be
recognized 1 hour ago. We understood the exigency that there would be
some delay.
If we could establish an order--apparently Senator Grassley is
waiting to be recognized as well.
May I ask the Senator from Montana how long he would be speaking?
Would it be in order?
The PRESIDING OFFICER. The Senator from Montana.
Mr. TESTER. How long am I speaking?
Mr. LEVIN. Yes.
Mr. TESTER. About 7 minutes.
Through the Chair to the Senator from Michigan, it was my
understanding that I was going to speak, the Senator would have his
colloquy with Senator Inhofe, and then Senator Grassley would speak.
Mr. LEVIN. I thank the Senator.
Mr. GRASSLEY. May I ask the Senator a question.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. GRASSLEY. How much time is the colloquy going to take?
Mr. LEVIN. I would say about 7 or 8 minutes.
Mr. INHOFE. I think I had the floor, and I was objecting to the UC.
Let me just share that we would--we could--do ours probably in about
12 minutes, and then we could have more time tomorrow, if that would
work out.
I withdraw my objection.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment (No. 3237) was agreed to, as follows:

Amend the title so as to read:
``To improve the access of veterans to medical services
from the Department of Veterans Affairs, and for other
purposes.''

The PRESIDING OFFICER. The Senator from Montana.

____________________