[Congressional Record Volume 160, Number 118 (Friday, July 25, 2014)]
[House]
[Pages H6847-H6851]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 MOTION TO INSTRUCT CONFEREES ON H.R. 3230, PAY OUR GUARD AND RESERVE 
                                  ACT

  Mr. RAHALL. Mr. Speaker, I have a motion at the desk.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:

       Mr. Rahall moves that the managers on the part of the House 
     at the conference on the disagreeing votes of the two Houses 
     on the House amendment to the Senate amendment to the bill 
     H.R. 3230 (an Act to improve the access of veterans to 
     medical services from the Department of Veterans Affairs, and 
     for other purposes) be instructed to--
       (1) recede from disagreement with section 203 of the Senate 
     amendment (relating to the use of unobligated amounts to hire 
     additional health care providers for the Veterans Health 
     Administration); and
       (2) recede from the House amendment and concur in the 
     Senate amendment in all other instances.

  The SPEAKER pro tempore. Pursuant to clause 7(b) of rule XXII, the 
gentleman from West Virginia (Mr. Rahall) and the gentleman from Texas 
(Mr. Flores) each will control 30 minutes.
  The Chair recognizes the gentleman from West Virginia.
  Mr. RAHALL. Mr. Speaker, I yield myself such time as I may consume.
  The House has just finished its rollcall votes for this week. With 
the conference committee at an impasse on H.R. 3230, the Veterans' 
Access to Care through Choice, Accountability, and Transparency Act, 
hope is fading that any legislation will be enacted this summer to 
address the urgent needs at the Department of Veterans Affairs.
  This is truly shameful, and as an American, I think this is shameful. 
It is beyond me to understand why our legislative branch of government 
cannot get this done.
  It is true that this body has taken some modest steps toward 
improvements, like allowing veterans to seek care at non-VA providers 
when they cannot get medical appointments. I

[[Page H6848]]

have supported that effort. That is fine where private sector health 
providers are available, but for elderly veterans in rural areas, where 
travel is difficult and costly, where physician shortages and medically 
underserved areas are abundant, like in southern West Virginia, that 
doesn't help much.
  My State's VA facilities need funding to hire doctors--lots of them. 
We need primary and specialty care providers and mental health 
specialists. We need the resources to train and recruit health 
professionals and to pay them competitive salaries.
  Our VA health providers, many of them veterans themselves, have a 
unique understanding of our veterans' needs. That expertise cannot be 
duplicated in the private sector.
  The VA health system is designed to take care of elderly veterans 
with special needs. It is designed to treat combat wounds, physical and 
psychological--something not commonly seen in the private sector.
  The VA health system is designed so that doctors can build long-term 
relationships with their patients and can build expertise in illnesses 
unique to veterans. Clearly, a Vietnam veteran who is suffering from 
exposure to a toxic substance like Agent Orange could expect to find a 
greater depth of knowledge and experience with the particular 
infirmities from the VA than from a private sector facility.

                              {time}  1345

  My State needs VA doctors. We need VA specialty care providers. We 
need VA facilities.
  The veterans bill in conference can provide relief to our veterans in 
need of care, but it remains stuck in conference, frustratingly hung up 
in partisan politics.
  When it comes to the shortage of health providers in general, that is 
not a local problem affecting only my State. The Association of 
American Medical Colleges estimates a nationwide doctor shortage of 
more than 91,500 physicians by the year 2020. The shortage will grow to 
more than 130,000 by 2025.
  The impact is most severe in rural States, so any notion of private 
sector medical care serving as a backstop to the VA is completely 
wrongheaded.
  This is not a new problem either. We all know it has been projected 
going back years, before this administration, before the Affordable 
Care Act, to the Bush administration and beyond.
  Baby boomers are getting older. Doctors are retiring. More patients 
require specialized and extended care.
  We, this Congress, must address this crisis, and it is a crisis. But 
the House stands immobilized, ``frozen in the ice of its own 
indifference,'' as a great American President, Franklin Roosevelt once 
said.
  So today, I am calling upon this House, I am imploring this House to 
put politics aside, advance the work of the ongoing conference, and get 
this bill done.
  This motion calls for the House to recede from disagreement with 
section 203 of the Senate amendment relating to the use of unobligated 
amounts to hire additional health care providers for the Veterans 
Health Administration; and recede from the House amendment and concur 
in the Senate amendment in all instances.
  I urge the House to support this motion to instruct conferees.
  Mr. Speaker, I reserve the balance of my time.
  Mr. FLORES. Mr. Speaker, I rise in opposition to the motion to 
instruct and yield myself such time as I may consume.
  Mr. Speaker, the motion to instruct would instruct the House 
conferees to recede from disagreement with the Senate with respect to 
section 203 of the Senate amendment to H.R. 3230, which would require 
the Department of Veterans Affairs to use unobligated balances to hire 
additional health providers.
  It would also instruct the House conferees to recede to the Senate 
position on all other matters.
  This is the fifth such motion that has been introduced in the last 10 
days. None of them have brought us any closer to reaching the 
compromise our veterans deserve in the fiscally responsible manner that 
respects the rights of our taxpayers.
  In addition, none of them have brought us any closer to correcting 
the systemic bureaucratic deficiencies that have led to thousands of 
veterans waiting for weeks, months, or even years to get the care that 
they need.
  Today, our attention is best spent devoted on working in tandem with 
our Senate counterparts to find a true compromise. Instead, here we 
are, yet again, debating an unnecessary, unhelpful, and unbinding 
motion to instruct.
  Mr. Speaker, just yesterday afternoon, Chairman Miller offered a 
formal proposal to the conference committee that would do the 
following:
  First, it would accept title I through title VII of the original 
Senate bill, along with additional amended language to include the 
Oklahoma lease authorization that was included in the House-passed 
bill, H.R. 3521, but that was left out of the Senate language.
  Second, it would provide the VA with $102 million for fiscal year 
2014 to address the Department's internal funding shortfalls.
  Third, it would provide $10 billion of no-year, mandatory emergency 
funding to cover the cost of the Senate's choice provision, with the 
remaining Senate provisions subject to appropriations on an annual 
basis.
  I am supportive of Chairman Miller's proposal, and I, like him, 
continue to remain optimistic that the House and Senate conferees will 
be able to successfully accomplish our mission and come to an agreement 
in advance of the August district work period which is scheduled to 
begin next week.
  There are many important aspects of the bill where the House and the 
Senate do agree. Recently, however, Senator Sanders, who is the 
chairman of the Senate Veterans' Affairs Committee and the cochair of 
the conference committee, has indicated his desire to expand the scope 
of the conference to include the VA's recent request for as much as an 
additional $17.6 billion.
  The VA health care system has not yet proven itself able to make 
effective use of the resources that it has been provided. Increasing 
those resources significantly at this time would be irresponsible, 
particularly in light of the insufficient details that the VA has 
provided about how it arrived at this request and how, specifically, 
this money would be used to increase access for our Nation's veterans 
and increase accountability for VA bureaucrats.
  This summer, the House Veterans' Affairs Committee has received hours 
of testimony from VA leaders and key, outside stakeholders in an effort 
to thoroughly understand and evaluate the access and accountability 
failures of the VA and, by extension, our Nation's veterans, the 
problems that they have been experiencing.
  Those hearings have confirmed that the problems the VA is facing 
today require long-term and large-scale reform that more money, more 
people, and more buildings will not bring, by themselves.
  Mr. Speaker, we are continually trying to work out a deal with the 
Senate, and I would argue that these motions to instruct have become 
not just tiresome but, in fact, they have become very 
counterproductive.
  I urge my colleagues to vote ``no'' on the motion to instruct, and to 
allow the conference committee the time and the latitude to work and 
reach the best possible compromise for the benefit of America's 
veterans. Our veterans deserve nothing less.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RAHALL. Mr. Speaker, I am honored to yield 2 minutes to the 
gentlewoman from Arizona (Mrs. Kirkpatrick), a true leader on veterans 
issues and a member of the VA conference committee.
  Mrs. KIRKPATRICK. Congressman Rahall, thank you for your strong 
support of one of the most important provisions in the Senate 
amendments to H.R. 3230.
  Mr. Speaker, I urge all my colleagues to support this motion to 
instruct the conferees. Both the Senate and the House amendments will 
expand access to non-VA care for veterans, but this program will only 
last for 2 years.
  It will only address the current emergency by ensuring those veterans 
who are waiting too long for appointments receive timely care. If we do 
not address the VA's doctor, nurse, and medical support staff shortage 
now, we will face the same crisis again in 2 years.
  Just yesterday, I learned that the one physician serving the 
community-

[[Page H6849]]

based outpatient clinic in Flagstaff, Arizona, where I live, is 
leaving, and there is no physician identified as his replacement.
  In another VA clinic in my district, the one doctor there is planning 
to retire, without a replacement doctor identified.
  Our rural veterans struggle to access care, and VA hospitals and 
clinics must be able to recruit and retain doctors and nurses to serve 
veterans in rural and underserved communities.
  Currently, 10 percent of all health care provider positions in the VA 
remain unfilled. By ensuring that the VA has the ability to quickly 
hire doctors and nurses and fill these positions, we help the VA ensure 
it has the capacity to provide timely, world-class care to our veterans 
before this 2-year program ends.
  As a member of the conference committee, I strongly believe that the 
negotiations between the House and the Senate must continue. We need to 
put political differences aside and maintain our focus on the veterans 
we are here to serve.
  Mr. FLORES. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. RAHALL. Mr. Speaker, I yield 3 minutes to the gentleman from 
Texas (Mr. Gallego).
  Mr. GALLEGO. Mr. Speaker, I appreciate the opportunity.
  I am constantly frustrated in this Chamber by our inability to come 
to an agreement. And today, we stand here arguing about whether a 
Senate position is better or whether a House position is better.
  The truth is that the American people want action. One of the basic 
things that we can all agree on is that we do not have enough medical 
providers in our system. We see a lot of veterans, and we try to force 
a lot of veterans through a very small funnel with very few providers.
  In fact, if you look at the data recently, as men and women come back 
from different places across the world, like Iraq and Afghanistan, we 
have a much higher pronounced need than ever before for physicians to 
treat PTSD. And yet, we have fewer physicians able to do that because, 
in that area of specialization, we do not have enough medical care 
providers in the VA.
  It seems pretty basic that one of the things that we ought to be able 
to agree on is the fact that we need more health care providers in our 
system. You can leave aside the issue of construction or leave aside 
the issue of technology or any of those kinds of things.
  The fact is that when a person, a patient, comes into the VA system, 
he needs a health care provider to be able to see him or her, and we do 
not have enough health care providers. That fact is inescapable.
  Today's motion, essentially, seeks to take care of that one issue, 
and that one issue is that we need more health care providers.
  It makes no difference to me, to the American people, to anyone that 
I know, whether we adopt the Senate position or the House position. The 
idea that we are arguing about that, about whether the Senate does this 
or the House does that is, frankly, ludicrous.
  We should all come together on that one point. We should all 
understand that we need more health care providers. Our veterans 
deserve it. Our veterans need it. They are asking for that. The 
American people are demanding it. And Congress needs to be able to 
respond.
  How should they respond?
  They should respond through this motion to instruct the conferees so 
that we can agree on a very limited provision of the bill, a limited 
provision that says, regardless of all of the disagreements, regardless 
of all these side fights, we will agree on this one area, and that one 
area would be, we need more health care providers.
  PTSD isn't the only thing where we are short of physicians. We are 
short of cardiologists, we are short of a lot of things. And if the VA 
has the opportunity and the permission to go forward and look for 
additional health care providers now, then we will be up and running 
much earlier than if we wait and wait and wait.
  The challenge with Congress: manana seems to be the busiest day of 
the week here. We wait until tomorrow and tomorrow, and maybe next week 
there will be an agreement or maybe the week after that there will be 
an agreement. We need an agreement today, and this is our opportunity 
to do that.
  Mr. FLORES. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I think it is important to know that politics have not 
been part of this discussion in the conference committee, and any 
assertions to that standpoint are not true.
  In terms of the manana comment, I will say this. We have worked 
diligently on the conference committee, on both sides of the aisle, to 
try to get to a solution with the Senate. We will continue to do that.
  Mr. Speaker, with that, I reserve the balance of my time.
  Mr. RAHALL. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Bera), a doctor.
  Mr. BERA of California. Mr. Speaker, I would like to thank 
Congressman Rahall for yielding, and for your leadership on this issue 
to make sure our veterans get the health care that they deserve.

  Mr. Speaker, I rise today to speak in support of the Rahall motion to 
instruct our conferees. I look at this issue, not as a Member of 
Congress, but as a doctor who has worked in the VA system.
  Now, these are men and women who stepped up to answer the call to 
duty, to protect our freedoms, American freedoms, and we need to give 
them that same duty when they return. That is why we need to have 
enough doctors, nurses, and health care professionals in the VA system.
  It has been reported, many of these men and women, needing necessary 
care, often have to wait 30 days, 60 days. That is unconscionable.
  This isn't a Democratic or Republican issue. This is an issue of 
getting our men and women, our veterans, the necessary health care that 
they need.
  And as a doctor, you have to have a work force. You have to have 
necessary health care professionals that can address these needs in a 
timely manner.
  This is a very simple section of the Senate bill that Congressman 
Rahall is suggesting we move forward, section 203. It would directly 
address the workforce shortage and the doctor shortage in the VA by 
targeting funding to hire additional health care providers and 
prioritizing these additional providers for the facilities that need 
them most.
  It is common sense. It is the right thing to do to serve our men and 
women, to serve our veterans. Accepting these provisions is just one of 
many steps that we must do to ensure that they get the care that is 
necessary.
  There are other things that we can do, but this is something we can 
do immediately, and we shouldn't delay it another week, another year. 
Let's take care of our veterans.

                              {time}  1400

  There is other legislation out there. We have a bipartisan bill, the 
Doctors Helping Heroes Act. It is Democrat and Republican. It is common 
sense.
  Once we get section 203 passed, let's do more to train those 
necessary doctors. We can do it, and we have got the will, and I really 
commend my colleague from West Virginia, Congressman Rahall, for taking 
the lead here. Let's do what is necessary to serve our men and women, 
our veterans, and let's move section 203 forward.
  Mr. FLORES. I continue to reserve the balance of my time.
  Mr. RAHALL. Mr. Speaker, at this time, I am honored to yield 3 
minutes to the gentleman from North Carolina (Mr. Price), a 
distinguished member of the Military Construction-VA Appropriations 
Committee.
  Mr. PRICE of North Carolina. I thank my colleague for yielding and 
for his leadership in offering this motion to instruct conferees.
  Mr. Speaker, our Nation has a sacred obligation to provide for those 
who served and sacrificed for this country. Just as the military leaves 
no soldier behind on the battlefield, we must leave no veteran behind 
when they return home, and yet, Mr. Speaker, as too many veterans and 
their families can attest, our collective efforts often fall short.
  The recent revelations of deceptive and dishonest scheduling 
practices at the Phoenix VA and elsewhere throughout the country have 
underscored a much more ominous reality:

[[Page H6850]]

serious structural systemic problems at the VA that must be addressed 
immediately. We clearly have work to do.
  As a member of the Appropriations Subcommittee responsible for 
funding military construction projects and the Department of Veterans 
Affairs, my colleagues and I have fought for years to ensure that the 
Department has the resources it needs to provide for our Nation's 
veterans.
  While money alone is not a guarantor of timely access to quality 
care, a Department tasked with as monumental an undertaking as 
providing for millions of veterans, generations of veterans--from World 
War II to the current conflict in Afghanistan--must be ably prepared 
and equipped from the inside out, from top to bottom, with the 
resources it needs to get the job done.
  Financial resources must translate into human resources. As the head 
of any large organization can tell you, it is the people who comprise 
the organization that ultimately make the difference.
  That is why I rise in strong support of this motion to instruct, Mr. 
Speaker. My district in North Carolina is home to tens of thousands of 
veterans who rely on the VA medical centers in Durham and Fayetteville 
or one of the many smaller facilities throughout the region for care.
  I know firsthand the importance of an organization like the 
Department of Veterans Affairs, tasked with providing comprehensive 
medical care for so many veterans and for having sufficient staff on 
hand to do that, and too many VA facilities around the country don't 
have sufficient staff. They face glaring shortfalls of key medical 
personnel, particularly primary care and mental health professionals.
  Now, Mr. Speaker, what about the bad actors within VA management? 
They have received much attention since the current scandal broke. For 
certain, there is no question that bad actors within the Department 
must face the consequences of their actions. Those who bent or broke 
the rules have to be reprimanded or, in egregious cases, terminated.
  This body has passed a bill that would provide the Secretary more 
authority to do just that, but too often overlooked are the tens of 
thousands of men and women--many, themselves, veterans--at the 
Department of Veterans Affairs who work tirelessly every day, often 
long hours, to ensure that our veterans receive the care they have 
earned and that they deserve.
  I urge my colleagues in both Chambers and on both sides of the aisle: 
lay off the shots at ``VA bureaucrats,'' set aside partisan 
differences, work together to solve this crisis. We must address these 
shortcomings by enacting comprehensive VA reform legislation that is 
worthy of the men and women who have sacrificed so much.
  That is why it is critically important, Mr. Speaker, to ensure that 
the Secretary of Veterans Affairs has the authority and the resources 
required to hire and employ sufficient numbers of medical 
professionals. This motion would do just that, and I urge my colleagues 
to support it.
  Mr. FLORES. Mr. Speaker, the gentleman made a profound comment, and 
that is that money alone is not a guarantee of quality care for 
veterans, and that is one of the issues at stake here in the 
negotiations.
  The Senate has decided to use this crisis to grab more money for the 
VA, when we are not sure the VA can handle the money it has 
appropriated today, which is substantial.
  We want to make sure that we fix the VA right and do it right the 
first time. That is the crux of the issue. That is the objective that 
really gives our veterans the quality care that they deserve, and that 
is what the conference committee is committed to do.
  I reserve the balance of my time.
  Mr. RAHALL. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California, Mrs. Lois Capps, and commend her for her leadership on this 
issue as well.
  Mrs. CAPPS. Mr. Speaker, I thank my colleague from West Virginia for 
yielding me the time and for offering this motion to encourage 
conferees to swiftly settle their differences on this bill.
  Mr. Speaker, I rise today in support of Congressman Rahall's motion 
to instruct conferees, so that our veterans are assured the care that 
they have earned.
  For far too long, we have heard stories of men and women facing 
unacceptable wait times at the VA, and we have heard even more 
disturbing accounts of misconduct in the very organization our veterans 
should be most able to trust. In response to this scandal, both 
Chambers of Congress have passed bipartisan bills to hold the VA and 
its leadership accountable.
  I was encouraged to see this body act quickly to address a very real 
problem and was pleased to support bipartisan legislation to help solve 
this crisis, but we cannot allow this momentum to fade or allow 
disagreement to stand in the way of our veterans getting the care they 
have earned and so clearly deserve.
  This motion to instruct simply urges the conferees to move past 
disagreements that are stalling this critical bill. It would ensure 
that the VA can use resources it already has to hire additional health 
professionals to meet the needs of our veterans. Doing this will enable 
the VA to cut down on excessive and unacceptable wait times.
  As a nurse, I know the importance of having adequate staffing levels 
filled with our Nation's best health care providers. We need to 
encourage the VA to bring these experts into the VA to treat our vets 
in need, and most importantly, the motion supports actions to give VA 
the resources it needs to improve care and responsiveness at every 
level while finding appropriate areas to cut back.
  We owe it to our veterans to work tirelessly to finish this bill 
before we leave Washington. Veterans have already waited long enough. 
Let's not allow this critical bill to stall any longer. It is time to 
finish the job.
  Mr. FLORES. I reserve the balance of my time.
  Mr. RAHALL. May I have a time check, please, Mr. Speaker?
  The SPEAKER pro tempore. The gentleman from West Virginia has 13\1/2\ 
minutes remaining. The gentleman from Texas has 25 minutes remaining.
  Mr. RAHALL. Reserving my right to close, I will reserve the balance 
of my time.
  Mr. FLORES. Mr. Speaker, once again, I urge all Members to oppose the 
motion to instruct. The conference committee is working diligently on 
both sides of the aisle to try to reach agreement with the Senate, and 
we want to do it in a responsible manner that puts the interests of our 
Nation's veterans at the forefront of the negotiations, but also is 
respectful of the resources required from our taxpayers to meet that 
objective.
  So, again, I urge Members to oppose the motion to instruct. I yield 
back the balance of my time.
  Mr. RAHALL. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, America's veterans deserve the very best care our Nation 
can muster. The gentleman from North Carolina said it well. Many 
Americans have said it well. Every one of our soldiers knows it is 
their motto to leave no soldier behind. Therefore, we, as Americans, 
should have as our creed and our basic principle guiding us that we 
leave no veteran behind.
  That prescription begins with the very best corps of physicians that 
we can assemble. Time alone will not heal the wounds of war that our 
veterans have suffered. They are our true American heroes.
  We have, time and time again, mustered the budgetary resources to 
deploy and support our troops in Iraq and Afghanistan and lands beyond, 
and we salute those of our Armed Forces serving as we speak for 
defending this great Nation of ours.
  America's sons and daughters, those who have volunteered to defend 
our national causes, did not hesitate for an instant to go. They went. 
They served. They suffered. They sacrificed their good health. They 
gave their all.
  We are proud in West Virginia, as a strong, patriotic State, to serve 
up there at the top of the 50 States, on a per capita basis, of our 
number of young men and women that answer the call of duty for all 
wars.
  Now, the bill for war has come due; but, alas, where has all of this 
body's patriotic fervor gone? It appears to be buried beneath a mound 
of budgetary spreadsheets and handwringing about deficits, about the 
need to trim back, about the need to cut back on deficits.

[[Page H6851]]

  I say this House ought to take a different course, one in which we 
can stand united with those who fought with meritorious service on 
behalf of a grateful Nation. Let us pay the medical bills of America's 
sons and daughters. Let us do so with dispatch. Let us hire the doctors 
that America's sons and daughters deserve.
  Mr. Speaker, we have heard a great deal about this issue over the 
last several months. We know it is not a new issue. We have heard that 
it has been going on through several different administrations, but 
that should not hinder us from stepping up to the plate and doing what 
is necessary today, not after we come back from our so-called vacation 
in August, but we should address it today before we go home.
  So I urge that this motion to instruct conferees be accepted by this 
body, and I yield back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to instruct.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to instruct.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. RAHALL. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

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