[Congressional Record Volume 161, Number 18 (Tuesday, February 3, 2015)]
[Senate]
[Pages S730-S732]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               CHOICE ACT

  Mr. MORAN. Mr. President, I am on the floor today to speak about an 
issue that I spoke about just a few days ago, the Choice Act.
  Let me take my colleagues back in history just a few months, just to 
last year. I don't imagine any of us don't remember the scandal the 
Department of Veterans Affairs was facing--the stories across the 
country of fake waiting lists, of services not provided, of the 
potential death of veterans while waiting for those services to occur. 
I also would think that at least many of my colleagues would agree that 
for much of the past few years the Senate hasn't done much of the 
business it was designed to do and that needed to be done in our 
country.
  But I remember a day in August of 2014 in which the Senate and the 
House of Representatives were successful in passing a bill. It is 
somewhat embarrassing to me to be on the floor praising the 
accomplishment of a bill passage. It is a significant part of what 
should be the normal course of business of the Senate.
  But those of us--and I would put all of my colleagues in this 
category who care about the service men and women who sacrificed for 
the benefit of their fellow countrymen and came home to a Department of 
Veterans Affairs that failed to meet their needs. I have indicated that 
since I came to Congress, both in the House and the Senate, I have 
served on the Veterans' Affairs Committee. This is an issue that we 
need to make certain we get right.
  Just this week, in fact this morning, we passed a piece of 
legislation, the Clay Hunt Suicide Prevention for American Veterans 
Act. That is an accomplishment. I remember the testimony of the two 
mothers in the Veterans' Affairs Committee who came to talk to us about 
the importance of this legislation, their experience as mothers, and 
the death of their sons by suicide.
  In the time that I have been in Congress, it is among the most 
compelling testimony I have ever heard. The part that sticks with me 
the most is the belief by these two mothers that had the Department of 
Veterans Affairs done their work, their sons would be alive. What that 
tells me is the decisions we make and those decisions as implemented by 
the Department of Veterans Affairs in some cases--in fact in many 
cases--are a matter of life and death.
  We saw the scandal that came about last year. We know the decisions 
we make have huge consequences on veterans and their families. We 
rejoiced--at least I did--in the passage of the Choice Act, which gave 
veterans the opportunity to choose VA services, to choose health care 
to be provided in their hometowns by their hometown physicians and 
doctors.
  The criteria that is set out in the Choice Act for that to occur is 
pretty straightforward. It says if you live more than 40 miles from a 
VA facility, you are entitled to have the VA provide the services at 
home, if that is what you want. It says that if those services can't be 
provided within 30 days of the time you need those services, then the 
VA shall provide those services at home if you choose. You can see the 
hospital, you can be admitted to the hospital of your choice, and you 
can be seen by the doctor of your choice.
  That was actually something to rejoice about, to be excited about--
that this Congress and this Senate came together and passed what I know 
to be a very significant and important piece of legislation. It is 
important for the reasons that common sense tells us it is important--
that a veteran who lives a long way from a VA hospital or a VA facility 
can now get services at home. A veteran who had to wait in line for too 
long could now get those services at home.
  The other aspect of that is that the Department of Veterans Affairs 
has told us time and again about the inability to attract and retain 
the necessary health care providers, the doctors and others who provide 
services to our veterans.
  So one way to improve that circumstance is to allow other health care 
providers, those in your hometown, to provide that service.
  The Choice Act was a good measure for the Department of Veterans 
Affairs to meet its mandate to care for our veterans, and the Choice 
Act was a good measure for veterans who live long distances from a VA 
facility, especially in States such as mine and the Presiding 
Officer's, where it is a long way to a VA facility.
  So I remember the moment in which that bill passed and was sent to 
the President. Finally something good has come. A bill has been passed. 
Something important to our veterans is occurring.
  But the reality is the implementation of the Choice Act has created 
many problems and, in my view, the Department of Veterans Affairs is 
finding ways to make that implementation not advantageous to the 
veteran but self-serving to the Department.
  This is what catches my attention today. We are reviewing the 
President's budget, and within that budget is this language:

       In the coming months, the Administration will submit 
     legislation to reallocate a portion of Veterans Choice 
     Program funding to support essential investments in VA system 
     priorities in a fiscally responsible, budget-neutral manner.

  What the President's budget is telling us is that there is excess 
money within the Choice Act. We allocated money--emergency spending--to 
fund the Choice Act, and the President's budget is telling us: Well, we 
think there is too much money in there. We are going to submit 
legislation to reallocate that money to something we think is a higher 
priority.
  I don't expect many of my colleagues to remember, but I was on the 
Senate floor last week talking about a specific problem in the 
implementation of the Choice Act, and it was this: The Department of 
Veterans Affairs shall provide services at home to a veteran who lives 
more than 40 miles from a facility.
  Well, the problem I described last week is that the VA has determined 
that if there is an outpatient clinic within that 40 miles, even though 
it doesn't provide the services that the veteran needs, that veteran, 
he or she, must drive to the VA, wherever that is

[[Page S731]]

located, and does not qualify for the at-home services.
  Does this make any sense to any of us, that the VA says: Oh, there is 
an outpatient clinic within 40 miles of you, Mr. Veteran? Even though 
it doesn't provide the service that you need, we are still going to 
require you to drive to a VA hospital to receive those services and you 
don't qualify to go see your hometown doctor or be admitted to your 
hometown hospital.
  Who would think--in fact, I admired Secretary McDonald in his early 
days at the Department in which he talked about how the VA is going to 
serve the veteran: The decisions we make at the VA will be directed at 
how do we best care for our veterans.
  I respect Secretary McDonald for that attitude and approach, and I 
want the Department to follow his lead in accomplishing that mission.
  But clearly deciding that a facility, even though it can't provide 
the service you need, precludes you from getting services at home makes 
no sense, and it certainly doesn't put the veteran at the forefront of 
what is in the best interest of a veteran.
  So why would the Department of Veterans Affairs make that decision? 
We have a facility within 40 miles, but you don't qualify. So drive 3 
or 4 hours to the VA hospital.
  Well, one might think they have made the decision that we are going 
to enforce that aspect of the Choice Act. We are going to enforce the 
idea that you don't qualify because they don't have enough money to pay 
for those services. But, lo and behold, the President's budget says 
there is excess money that we now want to transfer to other priorities.
  So, clearly, it is not funding issues. The Department is making 
decisions for some reason that makes absolutely no sense, defies common 
sense, and certainly doesn't put the veteran ahead of the Department of 
Veterans Affairs.
  I don't know what the story is that these kinds of decisions would be 
made, but it certainly is worthy of the Senate to make certain the 
Department implements its moment of triumph, the Choice Act, in a way 
that benefits those we intended for the legislation to serve.
  I will ask some questions of the Department, and I wonder about the 
attitude. I have been on task trying to get services provided closer to 
home for veterans for as long as I have been in Congress.
  One of the other programs, aside from the Choice Act, is a program 
called ARCH for accessing services closer to home. There are pilot 
programs across the country to do that. One of them is in Kansas.
  In an internal memo from Washington, DC, to a VA hospital in Kansas, 
the Department of Veterans Affairs indicated to the VA hospital in 
Kansas they could not promote, encourage or market the idea of a 
veteran seeking services at home.
  So already I bring skepticism about the attitude at the Department of 
Veterans Affairs. For a long time they have been told not to encourage 
veterans to find health care outside the VA hospital, outside the VA 
outpatient clinic.
  Here are a few questions. How do you reach the conclusion that there 
is excess money when the program is just now being implemented and, in 
fact, there has been a significant delay in getting the choice cards 
out to veterans so they could determine whether they were interested 
and qualified?
  I also have learned that the Department of Veterans Affairs has 
intentionally narrowed the veteran population that is eligible for the 
choice program by rule, narrowing the number of medical procedures for 
which they will consider whether it can be performed outside the VA on 
the 30-day rule.
  I didn't say that quite right. I didn't say it quite as well as I 
would like. But the VA already narrowed, by regulation, the services 
that might qualify for hometown services if it takes longer than 30 
days to get those services.
  The VA added an unnecessary reimbursement requirement. I am told now 
that if there is a third-party provider and you have some insurance, 
the VA is going to require that the veteran pay the copayment up front 
and then seek reimbursement from the Department of Veterans Affairs.
  Of course, the fourth one is how can you reach the conclusion that a 
veteran, who needs colonoscopy--in my hometown, as I talked about last 
week, one must drive 3 or 4 hours to Wichita to the VA to get the 
colonoscopy because there is an outpatient clinic within 40 miles of my 
hometown, but the outpatient clinic doesn't provide colonoscopies.
  Now we learn that it is not a matter of money. It has to be a matter 
of attitude, approach, and culture.
  Just today, a few minutes before I came to the Senate floor to talk 
about this issue, I received an inquiry from a constituent who is a 
health care provider. What they indicated to me is their interest in 
providing services under the Choice Act. They have contacted the VA, 
pursued the opportunity to be a provider for that veteran population in 
rural Kansas, and they were told the rate of reimbursement would be 
something significantly less than Medicare.

  The Choice Act says the Department of Veterans Affairs shall provide 
these services up to paying Medicare rates. The VA says if you are 
going to provide services to our veterans, we are only going to 
reimburse you at something significantly less. That is something this 
health care provider didn't believe they could make any money doing, 
but ultimately they concluded it was their responsibility to try to 
help veterans who lived in rural Kansas, and so they went back to the 
VA and said we are willing to take less rates. Certainly let's 
negotiate and see if we can find something mutually agreeable between 
the VA and us to provide those services. They have yet to receive a 
return to their inquiry to the VA--again, trying to preclude a willing 
provider who is willing to provide services at less than cost. How can 
that be common sense? How can that be putting veterans ahead of the VA?
  I look forward to working with my colleagues. I look forward to our 
Committee on Veterans' Affairs--a committee the Presiding Officer 
serves on--trying to make sure we get this right. I want to return to 
the day in August when the Senate passed the Choice Act and there was 
this feeling of accomplishment of something beneficial and useful.
  If the VA continues to implement this bill--if it doesn't reverse 
course, if it doesn't put the veteran first, we will have missed 
another opportunity to care for the needs of those who served our 
country. What American would we expect to receive the best health care 
possible in this country? Well, of course, I want all Americans to 
receive quality health care at an affordable cost. But I would say 
there is no group of people for whom it is more important that they 
receive what is their due, what was committed to them, than those who 
served in our military and are now our Nation's veterans.
  I represent a very rural State. The congressional district that I 
represented as a House Member is larger than the size of the State of 
Illinois. It has no VA hospital. How do you get to a VA hospital when 
you are a 92-year-old World War II veteran and the hospital is 4, 5, 6 
hours away?
  I thought we had finally come to a solution. I thought that earlier 
with the passage of legislation I introduced in the House that 
ultimately became the ARCH pilot program. While it gets rave reviews 
from veterans who are in those pilot program areas, it has not been 
expanded. It doesn't solve the country's rural needs.
  Then I thought, well, a great day has occurred; we passed the Choice 
Act. But as I look at the implementation, as I look at the decisions 
being made today at the Department of Veterans Affairs, I have to 
wonder if one more time we are providing false hope, false promises to 
those who served our country. We owe them something different than what 
is occurring today.
  I reaffirm my commitment to my colleagues, but also to the leadership 
of the Department of Veterans Affairs, to work closely, side-by-side, 
to make sure the choices made fit the reality of those who served our 
country in the circumstances they find themselves in today. Help those 
veterans who can't get the service because they can't get there. Help 
those veterans who need the services more quickly than the Department 
of Veterans Affairs can provide them.
  This seems straightforward to me, but I raise this concern today to 
make

[[Page S732]]

sure my colleagues and I are united in the effort to see that good 
things happen as a result of the passage of the Choice Act in 2014.
  Mr. President, I yield the floor.
  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.
  Ms. BALDWIN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Wisconsin.

                          ____________________