[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.--

[[Page S3567]]

       (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.

                          ____________________