[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
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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
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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.
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