[Congressional Record Volume 161, Number 143 (Thursday, October 1, 2015)]
[Senate]
[Pages S7062-S7065]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MILITARY CONSTRUCTION, THE DEPARTMENT OF VETERANS AFFAIRS, AND RELATED
AGENCIES APPROPRIATIONS ACT, 2016--MOTION TO PROCEED
The PRESIDING OFFICER. Under the previous order, the Senate will
resume consideration of the motion to proceed to H.R. 2029, which the
clerk will report.
The legislative clerk read as follows:
Motion to proceed to Calendar No. 98, H.R. 2029, a bill
making appropriations for military construction, the
Department of Veterans Affairs, and related agencies for the
fiscal year ending September 30, 2016, and for other
purposes.
The PRESIDING OFFICER. The Senator from Alaska.
Ms. MURKOWSKI. Madam President, I am here this morning to speak about
the issue that is before this body, the motion to proceed to H.R. 2029,
or what we refer to as the MILCON-VA appropriations bill.
I certainly intend to support closing off debate on this and moving
to take up this important appropriations measure. This is important for
a host of different reasons, not the least of which is that we need to
get to the substance of this issue. We need to get back to a regular
order process in order to advance the appropriations bills that we on
the Appropriations Committee have spent a considerable amount of time
and effort drafting.
[[Page S7063]]
Over these past many months, we have worked to make sure that the
bills were ready for floor consideration. We didn't want to find
ourselves in a situation where, at the end of this year, we scramble to
piece together an omnibus measure that has not had the considered
debate and opportunity for amendment that I believe we all seek as
lawmakers. It is important that we consider the Military Construction-
VA bill in regular order and do it now--not stick it on the back end of
another measure, not incorporate it into an omnibus bill or into some
fashion of a CR omnibus right before Christmas.
I serve on the Appropriations Committee. I had input into this bill
at the subcommittee level and again at the full committee markup, which
is a lot more than can be said of many of my colleagues in this body
who don't have that opportunity since they are not on the
Appropriations Committee. But even after having the input that I have
had, it is extraordinarily important that I have another opportunity to
influence the bill, and I will illustrate why.
I am going to speak about one very specific issue today that has
garnered the attention, concern, and passion of Alaskans and veterans
around the State, and that is the issue surrounding the Veterans Choice
Card.
In the view of many Alaskans, the Veterans Choice Card is an
unmitigated disaster in our State, and there are many reasons that is
the case. We don't host a stand-alone VA hospital in Alaska. So the VA
has issued a Choice Card to every veteran in the State who is enrolled
for health care. In order to use the Choice Card, you have to identify
a provider that is willing to accept the card, qualifies under the very
onerous Choice Card standards, and is also willing to put up with the
bureaucratic strings that are attached to determining which care is
approved by the VA over what period of time and for what price.
In Alaska, we have a demand for health care providers that far
outstrips the supply, and I have been on the floor many times speaking
on that subject. We have many Alaskans that have private health
insurance which pays the providers better, and it is certainly more
efficient than the government-sponsored programs.
Structurally, the way the Veterans Choice Card Program is currently
designed, it does not provide Alaska's veterans with the choices that
it promises. It is just as simple as that, and those are just the
structural problems we are talking about. Many of our colleagues know
that TriWest has encountered difficulties with implementing the
program, and the VA has had trouble coordinating TriWest's work with
the work of the local VA facilities. Unfortunately, these problems have
led to some dangerous near-misses.
We had one situation with a veteran who was scheduled for a fee-basis
neurosurgery. He was going to receive this care from a community
provider in the State. Then he was told by the VA that the VA had
changed its mind. They were not going to sign off on paying for the
care. The vet was told to call TriWest. The TriWest call center
operator gave the veteran a list of behavioral health providers who had
signed up to accept the Choice Card. The call center operator didn't
know that neurosurgery is not the same as behavioral health. By the
time the VA had reversed itself, the neurosurgery that the veteran had
initially scheduled was no longer available. The vet had to wait for
one to become available.
What happened in the interim? They gave the veteran pain medicine.
In another case, we had a veteran sent to Seattle for a course of
radiation therapy, and in the middle of this course of radiation
therapy the vet was told to return home because his authorization had
expired. He was told: The authorization has expired. Go home.
It is not as if he could just get in a car and drive 20 minutes back
to his house. He had been sent to Seattle from a rural community in
Southeast Alaska for the care--for the radiation therapy. They said: Go
home. Your authorization has expired.
So there was a whole series of exchanges with TriWest and then with
the VA itself. The vet began, basically, calling family members to tell
them he was coming home to die and to start making funeral
preparations. This is not how we treat our veterans.
Now the Veterans Choice legislation provided that the Choice Card
program does not displace any of the existing VA purchased care
programs. It explicitly supplemented those programs, which for us in
Alaska would be a good thing. In Alaska, the VA--and this was under
Secretary Shinseki's leadership--established two purchased care
programs to address gaps in VA capacity in Alaska. One of the programs
provided for partnerships with our tribal health system to care for our
vets in more remote areas of the State where the VA simply doesn't have
a presence. It was innovative. It was innovative at the time, and these
partnerships worked. They really did help to facilitate the care. The
other program called ``Care Closer to Home'' enabled the VA to purchase
care from community providers in the State who performed medical
services that the VA didn't offer--services such as neurosurgery and
specialized forms of radiation therapy.
Before this program was implemented, the VA forced veterans to fly to
Seattle or other parts of the country for services that we would
consider pretty routine. You have a 1,000-mile-plus flight to Seattle
for an orthopedic appointment or for a neurosurgery appointment. This
is what we are putting our veterans through. Imagine you are 70 years
old, 80 years old, and you are told to go take a flight for 3\1/2\
hours to Seattle--get yourself to the hospital just for an orthopedic
appointment. By the time the veteran is at this place and needs that
appointment, you are not feeling well in the first place.
I have talked and written before about a veteran on the Kenai
Peninsula who died while fighting with the VA over urology care. He
couldn't travel to Anchorage, which is about a 3-hour drive, much less
to Seattle where the VA wanted to send him because he was in very frail
condition, but the VA refused to purchase his care on the Kenai
Peninsula where there are facilities that could have helped him. I
think we would all agree that when our elderly veterans are in perhaps
their final months of life, they have got a lot better things to do
than fight with the VA and the bureaucracy.
When the VA came to the hearings before the appropriations
subcommittee, I asked them pointblank whether the implementation of the
Veterans Choice Card would adversely affect the existing purchased care
programs in Alaska, whether it is through IHS or further specialized
care, and the answer was clear. There was no nuance; there was no
doubt. The answer was no, it is not going to impact negatively the
purchased care program. When the Senate Appropriations Committee marked
up the MILCON-VA bill on May 21, the VA hadn't changed its answer. It
is not going to negatively impact, they said.
Then a week later, on May 28, I happened to be visiting the VA
facility in Anchorage, and I learned there that the VA had spent all of
its fiscal year 2015 purchased care money and was planning to suspend
its relationships with community providers and the Alaska tribal health
system.
I had gone to the VA center to get an update, to check in with the
new docs who were there and to see how things were going. It was
basically a checkup with the folks at VA, and they laid this bombshell.
They weren't trying to be coy with me or hide the ball. They had just
learned themselves. I don't know who was in greater shock, me or the
folks there at the VA and their military partners.
We were also in a situation where there were a lot of rumors that the
VA was going to pull out of the Joint Venture Hospital that it shares
with the Air Force on the Joint Base Elmendorf-Richardson. Again, this
was a bombshell of news. Now we know that the VA was not just out of
purchased care money, it was out of money to operate its health care
system, and without the emergency infusion of money we provided from
the Choice Act fund before August recess, the VA would have run out of
money before we had come back from the August recess.
It was a situation that was a mess. We fixed the mess for 2015 but
did nothing for 2016.
What does the VA's failure to properly project the cost of purchased
care in 2015 mean for its fiscal year 2016 appropriations? After asking
the VA on several occasions, I am left with the impression that the VA
once again will
[[Page S7064]]
run out of money for purchased care and then will remedy this situation
by shoving veterans who are seeking care under the Choice Card whether
the care is meaningfully available or not. So we have been pushing the
VA on this, and to Secretary McDonald's credit, he came to Alaska this
summer. The Undersecretary for Health, Dr. Shulkin, visited Alaska.
They weren't sheltered from the anger that our vets were feeling.
My colleague Senator Sullivan conducted an incredible field hearing
to create a record of how the VA, TriWest, and the Choice Card Program
were individually and collectively failing Alaska's veterans. But
here's the problem. We don't have a fiscal year 2016 solution locked
down, and we may not have an acceptable solution locked down by
Veterans Day, either.
Without an opportunity to debate the fiscal year 2016 appropriations
bill on the floor, I have limited opportunity to press this point, to
demand that the GAO investigate what actually is going on and try to
amend the bill to ensure that the VA has adequate purchased care money
available so that it doesn't drop these veterans through the cracks
when it can't serve their critical care issues, and neither can the
Choice Card program. Without the opportunity to debate in regular
order, I can't do what the people of Alaska have asked me to do in
representing them the way I know that we need to in order to deal with
this.
I hear what the Democratic leader is saying, that the Budget Control
Act needs to be addressed, but I don't agree with the tradeoff that we
cannot consider appropriations bills in regular order while
conversations are ongoing to address the bigger, broader question.
Failing to consider these bills in regular order corrodes the influence
of this body; it corrodes the ability of Members to fulfill the
responsibilities that we have to the people that we work for. These are
issues.
Again, I chose to focus my comments this morning on one area within
the MILCON-VA, on that implementation of the Choice Card in Alaska, and
how it has so basically failed our veterans. But there is so much more.
Again, if we don't have that opportunity to bring it up, to offer our
amendments, to do our best to serve the needs of our veterans, we fail
them. We fail the system.
I do hope we will have the opportunity this afternoon to advance to
these important measures. Remember, this is just the first of 12. It is
very important work that we have in front of us.
Madam President, I know my colleague from Connecticut has arrived on
the floor, but before I yield the floor to him, I want to briefly
mention a meeting that I had this morning in my office.
Welcoming Members of The Anchorage Fire Department Honor Guard
Madam President, I was able to welcome members of the Anchorage Fire
Department Honor Guard to my office. They are making their way to
Emmitsburg, MD, to be part of a ceremony at the National Fallen
Firefighters Memorial, where they will pay tribute to and honor the
firefighters who have given their lives in the line of duty during the
year 2014.
Remembering Jeff Bayless
The firefighter whom Alaska is recognizing and honoring is a
gentleman by the name of Jeff Bayless. He died at the age of 51 on
March 7, 2014, during a strenuous training exercise in Anchorage.
How Jeff Bayless lived his life as a fourth-generation Alaskan, and
as one who had not only a love for the outdoors but a love and care for
people, is something that we want to pay tribute to, and we want to
honor and recognize him.
This weekend, on the campus of the National Fire Academy in
Emmitsburg, MD, the name of fallen Anchorage firefighter Jeffery Edward
Bayless will be inscribed on the National Fallen Firefighters Memorial.
A total of 87 firefighters will be honored, and 84 of those
firefighters, including Jeff, gave their lives in the line of duty
during 2014. Three died in previous years. This week, I welcome members
of the Anchorage Fire Department Honor Guard to my office, as they make
their way to Emmitsburg to celebrate Jeff's life and his contributions
to the fire service.
I wanted to reflect for a moment on the life of fire hero Jeff
Bayless. Jeff died at age 51 on March 7, 2014, during a strenuous
training exercise in Anchorage. Heroes are remembered for the way they
lived their lives and this is how we should remember Jeff Bayless.
Jeff was a fourth generation Alaskan. He grew up in Copper Center,
attended Alaska Bible College in Glennallen, and then became a
paramedic through the Oregon Health Sciences University training
program. Jeff was also trained as a Registered Nurse. After serving as
a paramedic in Oregon, he returned to Alaska to work as a first
responder in Matanuska-Susitna Borough. Ultimately he found his home at
the Anchorage Fire Department, first as a paramedic and then as a
firefighter. He excelled in both roles. Working his way up the ranks,
Jeff was a Senior Captain at the time of his passing.
As would be expected of a fourth generation Alaskan, Jeff had a love
for the out of doors. From an early age, Jeff put his mastery of the
outdoors to work in the service of lifesaving. As an older teenager,
Jeff and his buddy happened upon a flash flood in the Yukon that swept
vehicles off the road. Using their wilderness savvy, they roped up and
rescued every person.
Later in life, as a member of the Anchorage Fire Department's
whitewater rescue team, he plucked several victims from dangerous
waters. One of these rescues was particularly memorable. On September
16, 2012, Jeff's Station 11 was called out to rescue a kayaker on the
Eagle River who was lodged against a tree after his kayak overturned.
The kayaker was in the water for about 90 minutes when a bystander
called for emergency assistance. First the tree had to be cut, then the
kayaker plucked from the water by his lifejacket. The kayaker was
hypothermic by this point. While a number of units from the Anchorage
Fire Department responded, Jeff was senior on the three-man jet boat
team that plucked the victim out of the water. Jeff's team won the
American Red Cross of Alaska Wilderness Rescue Heroes award. Jeff
characterized the rescue as one of the most challenging successful
rescues his team had ever been involved with. The team was well trained
to perform the rescue and in spite of the dangers ``everyone went
home,'' including the victim.
I cannot characterize Jeff's life in words more touching than on his
National Fallen Firefighters Foundation official biography. He spent
his life simply doing what he loved, completely engaged, lost in the
moment. Without any consciousness of the impact his own life was
having, he left behind a great legacy of life, encouragement,
accomplishments, and friendship.
That, my colleagues, is the definition of a fire hero.
He would say he was one of the guys who was just doing his job, but
as one of those men who was just doing his job, he needs to know that
we view him as one of our heroes.
Our thoughts and our prayers are with his family and all of his
brother and sister firefighters as they gather this weekend in
Emmitsburg.
Madam President, I yield the floor.
The PRESIDING OFFICER. The Senator from Connecticut.
Zadroga 9/11 Bill
Mr. BLUMENTHAL. Madam President, I thank my colleague from Alaska for
yielding and giving me this opportunity to discuss two measures that
ought to be beyond debate or discussion on this floor as well as in
America--two issues where Americans ought to unite and be together
without controversy or contention.
The first relates to the emergency responders who rushed to the
rubble of the World Trade Center in New York in the wake of that
horrific attack on America on September 11. I want to join and thank my
colleague from New York, Senator Schumer, who just spoke on the floor,
and associate myself completely with his very eloquent and powerful
explanation for why this Nation must meet its obligation to provide
critical health care for those emergency responders, firemen, police,
and medical personnel who went to that site, even as it continued to
smolder with poisonous chemicals and fumes, risking their lives in the
face of peril that they little understood and could not know. They
never asked whether that place was dangerous, but, in fact, as we now
know, it has caused
[[Page S7065]]
countless cancers, blood diseases, and lung problems, which have
manifested themselves in the years after.
Yet at midnight last night, the beginning of this day, the programs
designed to provide critical medical care and compensation to the
victims were permitted to expire. That is unconscionable and
unacceptable.
I join my colleagues from New York and New Jersey as a leading
cosponsor in urging this Congress to act--and to act immediately and
urgently--to make sure that we do what is right for those emergency
responders who served and sacrificed in the wake of 9/11. Failure to do
so is absolutely outrageous. The fund still has some money, and it will
continue to function. But this Congress should act to pass the Zadroga
9/11 bill immediately.
Madam President, the second area where I think we ought to be all
agreeing relates to doing what is right for our veterans, and that
means restoring the $857 million that has been deleted from the
President's request for veterans in the Military Construction, the
Department of Veterans Affairs, and Related Agencies Appropriations
Act, 2016. This bill essentially shortchanges our veterans and
straitjackets the Veterans' Administration.
Madam President, I ask unanimous consent to have printed in the
Record a letter from the American Legion.
There being no objection, the material was ordered to be printed in
the Record, as follows:
The American Legion,
Office of the National Commander,
Washington, DC, September 30, 2015.
Hon. Mitch McConnell,
Majority Leader, U.S. Senate,
The Capitol, Washington, DC.
Dear Majority Leader McConnell: Last May then-National
Commander Michael D. Helm called on Congress to pass a budget
for the Military Construction-Veterans Affairs Appropriations
bill that won't shortchange the Department of Veterans
Affairs (VA). On April 30 the House of Representatives had
passed a funding bill which unfortunately underfunds VA's
medical care, major construction and Information Technology
accounts by more than $1.5 billion below the Administration's
request.
We were pleased when the Senate Appropriations Committee
remedied that shortfall somewhat, but because they were
tasked with making an unworkable allocation workable, the
Senate version of the bill still underfunds veterans by
approximately $857 million. This comes at a time when the VA
is faced with an unprecedented demand for services, in terms
of both numbers and complexity.
We need your help to ensure that VA is fully funded so it
can provide the care and services veterans have earned and
need. An inadequate VA budget will have a negative effect on
the timeliness and quality of care that veterans will
receive. Fully funding VA must be a very high priority for
Congress.
The American Legion is the largest veteran service
organization in the nation and we take our responsibility to
analyze and evaluate veterans' healthcare options very
seriously. As VA, Congress and The American Legion move
forward together we must ensure that America's veterans are
provided with the healthcare and services they have earned
and were guaranteed.
Respectfully,
Dale Barnett,
National Commander.
Mr. BLUMENTHAL. This letter emphasizes the challenges that the VA
faces in meeting the unprecedented and increasing demand for services
that our veterans need and deserve. This obligation for our country is
not a matter of discretion or convenience, it is a promise that we have
made and we must fulfill to provide medical care, skills training, job
opportunity, and, most especially, the mental health care that our
veterans need so that we can stop the 22 suicides every day in this
country--the greatest, strongest, country in history of our world,
where 22 of our Nation's heroes commit suicide every day.
They suffer from the invisible wounds of war, post-traumatic stress
and traumatic brain injury. Many of our veterans suffer the more
visible wounds, and they need care as well. Many of our veterans in
increasing numbers will be coming out of the service needing jobs and
skills training, not only through the VA but the Department of Labor.
Just yesterday, the nominee for the Veterans Employment and Training
Services position in the Department of Labor testified before the
Veterans' Affairs Committee as to the importance of services provided
by the Department of Labor, and yet they too will be shortchanged by
this budget.
So I urge my colleagues to provide sufficient funding to restore that
$857 million and to make sure that we meet those needs of our veterans.
Failing to do so is as unacceptable as failing to meet the needs of the
emergency responders who went to the 9/11 site. This bill underfunds
the VA's medical facilities by $100 million, reducing the VA's ability
to keep pace with the need for critical facility maintenance. This is
upkeep that is vital for basic repair and maintenance. Facilities will
decay and downgrade without that funding. It is an investment in basic
infrastructure.
We ought to be investing in the personnel of the VA--the doctors and
nurses and other professionals--so that we recruit and retain the men
and women who will really do the work on the ground in the trenches to
make sure that the VA provides the best care possible--world-class care
to our veterans. They deserve no less. Fully funding the VA honors the
service and sacrifice of men and women who have risked their lives to
keep our great Nation free. Freedom is never free, and this Nation
ought to be keeping its promise to those veterans, which,
unfortunately, sadly, reprehensibly, this measure fails to do.
I yield the floor.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. FLAKE. Madam President, I ask unanimous consent to enter into a
colloquy with the Senator from Wisconsin.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________