[Congressional Record Volume 163, Number 124 (Monday, July 24, 2017)]
[House]
[Pages H6151-H6158]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
DEPARTMENT OF VETERANS AFFAIRS BONUS TRANSPARENCY ACT
Mr. ROE of Tennessee. Madam Speaker, I move to suspend the rules and
pass the bill (S. 114) to amend title 38, United States Code, to
require the Secretary of Veterans Affairs to submit an annual report
regarding performance awards and bonuses awarded to certain high-level
employees of the Department of Veterans Affairs, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
S. 114
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. APPROPRIATION OF AMOUNTS.
(a) Veterans Choice Program.--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, $2,000,000,000 to be deposited in the
Veterans Choice Fund under section 802 of the Veterans
Access, Choice, and Accountability Act of 2014 (Public Law
113-146; 38 U.S.C. 1701 note).
(b) Availability of Amounts.--The amounts appropriated
under subsection (a) shall be available for obligation or
expenditure without fiscal year limitation.
SEC. 2. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED
BY DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN
VETERANS COVERED BY MEDICAID PLANS FOR SERVICES
FURNISHED BY NURSING FACILITIES.
Section 5503(d)(7) of title 38, United States Code, is
amended by striking ``September 30, 2024'' and inserting
``December 31, 2027''.
SEC. 3. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR
HOUSING LOANS GUARANTEED BY SECRETARY OF
VETERANS AFFAIRS.
Section 3729(b)(2) of title 38, United States Code, is
amended--
(1) in subparagraph (A)--
(A) in clause (iii), by striking ``September 30, 2024'' and
inserting ``December 31, 2027''; and
(B) in clause (iv), by striking ``September 30, 2024'' and
inserting ``December 31, 2027'';
(2) in subparagraph (B)--
(A) in clause (i), by striking ``September 30, 2024'' and
inserting ``December 31, 2027''; and
(B) in clause (ii), by striking ``September 30, 2024'' and
inserting ``December 31, 2027'';
(3) in subparagraph (C)--
(A) in clause (i), by striking ``September 30, 2024'' and
inserting ``December 31, 2027''; and
(B) in clause (ii), by striking ``September 30, 2024'' and
inserting ``December 31, 2027''; and
(4) in subparagraph (D)--
(A) in clause (i), by striking ``September 30, 2024'' and
inserting ``December 31, 2027''; and
(B) in clause (ii), by striking ``September 30, 2024'' and
inserting ``December 31, 2027''.
SEC. 4. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION.
Section 5317(g) of title 38, United States Code, is amended
by striking ``September 30, 2024'' and inserting ``December
31, 2027''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Tennessee (Mr. Roe) and the gentleman from Minnesota (Mr. Walz) each
will control 20 minutes.
The Chair recognizes the gentleman from Tennessee.
General Leave
Mr. ROE of Tennessee. Madam Speaker, I ask unanimous consent that all
Members have 5 legislative days in which to revise and extend their
remarks and to include extraneous material.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Tennessee?
There was no objection.
Mr. ROE of Tennessee. Madam Speaker, I yield myself such time as I
may consume.
Madam Speaker, I rise today in support of S. 114, as amended, a bill
to authorize appropriations for the Veterans Choice Program. This bill
would authorize and appropriate $2 billion for the Department of
Veterans Affairs' Veterans Choice Fund.
Allowing the Veterans Choice Fund to run dry is not a viable option.
The Choice Program has provided critical care to millions of veteran
patients.
In March, Secretary Shulkin testified that the expiration of the
Choice Program would be a ``disaster'' for veterans. Just a few weeks
ago, the Acting Under Secretary for Health reiterated that sentiment
when she testified that veteran wait times would increase if the Choice
Program went away.
Congress created the Choice Program in response to a nationwide wait-
time scandal in 2014 to increase access to care through VA community
providers for veterans who either cannot access care at a VA medical
facility within a timely manner or who live far away from the nearest
VA medical facility. Since the Choice Program was signed into law
almost 3 years ago, it has gone through many growing pains and evolved
considerably.
We know from a Government Accountability Office report from earlier
this year that most of the veterans who use the Choice Program do so
because VA does not offer the service that veteran needs.
We also know that veteran demand for care through the Choice Program
has never been higher, and, consequently, the remaining money in the
Veterans Choice Program will run out in mid August, a few short weeks
from now.
We cannot allow that to happen, and with passage of S. 114, as
amended today, we won't.
There are allegations that providing more money for the Choice
Program is
[[Page H6152]]
inappropriate unless we also provide more money for the VA healthcare
system. I fail to understand the logic of that argument.
First, providing money for the Choice Program is providing money for
support to the VA healthcare system. Choice is a VA program. Through
it, VA patients and veteran patients are able to access care that would
have otherwise have required either a long, possibly debilitating wait
or an excessive travel time.
Second, the idea that Congress has been pouring money into VA
community care programs to the detriment of addressing VA's in-house
capacity is simply erroneous. VA's bottom line has increased
substantially since the turn of the century while most other government
agencies have seen theirs stagnate or reduced.
Madam Speaker, VA's budget has gone up four times since 2001. It has
quadrupled. Two weeks ago, former Secretary Principi testified that
since he left the Department in 2005 to the most current VA budget
submission released in May, VA's budget increased a stunning 268
percent. That growth will likely continue, which is appropriate, given
our Nation's commitment to serving her veterans.
Yet, especially considering that the Choice Program is just 3 years
old, the idea that Congress is focused only on growing VA's external
capacity is false.
That said, there are certainly priorities that remain unaddressed in
the bill before us, and I am committed to continuing to work on those
in the coming months.
However, providing $2 billion today will ensure that the Choice
Program remains funded for the next 6 months, solving our most pressing
issue and preventing yet another veteran access crisis like the one
that led to the creation of the Choice Program 3 short years ago while
we addressed other important issues.
An important point to note is that the bill's costs are paid for
using the same offsets that were used in the original act creating the
Choice Fund.
I look forward to working with the minority, our colleagues in the
Senate, and other stakeholders to charter a long-term path forward for
the Choice Program and to address other needs to ensure that the VA
healthcare system remains strong and stable for generations to come.
I am grateful to Ranking Member Walz for his leadership and
commitment in working very closely with me to come to a mutually
agreeable solution today and to committing to continue to stand
shoulder to shoulder in finding solutions in the months ahead. He has
been a great partner.
Madam Speaker, I urge all of my colleagues to join me in supporting
S. 114, as amended, and I reserve the balance of my time.
{time} 1415
Mr. WALZ. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, you are going to hear today and we have a series of
bills, many of them historic in nature, many of them--all of them--
worked in a bipartisan manner.
There has been a lot of talk lately of the one place in Congress that
is really functioning well, and that is in the Veterans' Affairs
Committee, and I would echo that. It is because of the commitment, the
dedication, and the end state that all of us agree on is the best
possible care for those warriors willing to put their lives in harm's
way, their families, and the care that was pledged to them.
Also, with that being said, democracy is hard. It requires us to do
the work here, with the stakeholders, and there is no issue that has a
more committed group of stakeholders than the veterans' community. Some
of the names you are going to hear of veterans service organizations
are a hallmark and a bedrock of not just veterans' issues, but of our
communities. We work with them hand in hand to make sure that this
Congress understands exactly what they need.
And democracy is hard. It is that old sausage-making adage sometimes.
It is a disappointment to me that we are on the floor because I think
we are just a little bit early; I think we are about a day. Like we
have before, we stood on this floor when we had a very important
accountability bill forward, and I said at that time we were going to
have to work with the Senate to make sure we got something passed. We
did that, it passed, and I am proud that we were able to do that.
It happened with the GI Bill that is coming up. The first run we went
at it did not work because we had not built that collaboration, and I
am disappointed today that I believe S. 114 has fallen into that.
This is a very fast-moving problem, because I want to be clear. What
this does is it extends veterans' access to care in the community
through the Veterans Choice Program without providing additional
resources for the Department of Veterans Affairs to enhance its
internal capacity.
I agree with my colleague who was very clear about the capacity of
the VA, what Choice does, and I would absolutely echo not funding this
program before we leave for the August recess is unacceptable. But not
getting a bill that the Senate can agree on, not getting a bill that
the President can sign, and not getting a bill that actually does what
we are supposed to do is also not acceptable.
The gentleman is also right: we have quadrupled the VA budget, and I
am proud of that. I also think it is probably not lost on anyone that
that started in 2001 at the same time that we fought America's longest
war and are still engaged around the world, with an aging population of
Vietnam, Korean, and World War II veterans.
As it became apparent that the Veterans Choice Program was facing a
funding shortfall earlier this summer, nine veterans service
organizations--Disabled American Veterans, the American Legion,
Veterans of Foreign Wars, Paralyzed Veterans of America, AMVETS, Iraq
and Afghanistan Veterans of America, Military Officers Association of
America, Military Order of the Purple Heart, and Vietnam Veterans of
America--issued a letter which provided very clear guidance to House
and Senate leadership and House and Senate Veterans' Affairs Committees
in terms of a solution, and I include in the Record the letter from
these organizations.
June 28, 2017.
Hon. Johnny Isakson,
Chairman, Senate Veterans' Affairs Committee, Washington, DC.
Hon. Jon Tester,
Ranking Member, Senate Veterans' Affairs Committee,
Washington, DC.
Hon. Phil Roe, M.D.,
Chairman, House Veterans' Affairs Committee,
Washington, DC.
Hon. Tim Walz,
Ranking Member, House Veterans' Affairs Committee,
Washington, DC.
Dear Chairmen Isakson and Roe, Ranking Members Tester and
Walz: As leaders of the nation's largest veterans service
organizations, and on behalf of our combined five million
members and auxiliaries, we write to urge you to
expeditiously reach agreement on and advance legislation to
ensure continuous access to health care for millions veterans
enrolled in the Department of Veterans Affairs (VA) health
care system, including care provided through the Choice
program. Specifically, we call on you to reach agreement on
an emergency appropriation and authorization bill that would
address urgent resource shortfalls endangering VA's medical
care programs--including Choice, community care and medical
services. Further, in order to prevent these problems from
recurring in the future, we call on you to equally invest in
modernizing and expanding VA's capacity to meet rising demand
for care, as well as finally address the glaring inequity in
law that prevents thousands of family caregivers from getting
the support they need to care for their veterans severely
disabled before September 11, 2001.
In recent weeks, VA Secretary David Shulkin has repeatedly
made clear in his public statements and congressional
testimony that current funding is no longer projected to be
adequate to meet the needs of an increasing number of
veterans seeking medical treatment directly through the VA
system as well as through community care programs,
particularly the Choice program. Secretary Shulkin has made
clear that rising demand for care by veterans has consumed
more VA resources than previously anticipated, threatening
the ability of VA to meet all of its obligations to ill and
injured veterans both this year and next. Although Public Law
115-26 extended the Choice program beyond its prior sunset
date of August 7, 2017, VA now projects it will likely run
out of funding prior to the end of fiscal year (FY) 2017
unless additional funding is made available. Further, based
on recent utilization trends, VA projects a higher demand for
both community care and Choice next year (FY 2018), and
anticipates additional funding requirements above the budget
request made just weeks earlier. In order to ensure
continuation of the Choice program--and absent an infusion of
new funding--VA has stated its intention to take
extraordinary budget
[[Page H6153]]
actions, including pulling back unobligated funding from VA
medical facilities and utilizing funding in FY 2017 that had
been designated as carryover funding for its FY 2018 budget
request, thereby further reducing available medical care
resources for next year.
Messrs. Chairmen and Ranking Members, our nation has a
sacred obligation to ensure the men and women who served and
sacrificed to defend our way of life receive timely, high-
quality health care through a fully-funded VA health care
system, which includes community care or Choice options
whenever and wherever necessary. With the Choice program
rapidly running out of funds and its successor community care
program still many months away, it is imperative that
Congress not allow veterans to go without needed care before
this transition is completed.
We note that VA's FY 2018 budget submission included a
request for $3.5 billion in mandatory funds to continue the
Choice program. In order to meet Congressional PAYGO
requirements, VA also included two legislative proposals we
vehemently oppose which would cut billions of dollars from
veterans disability compensation through changes to
Individual Unemployabilty eligibility and rounding down cost-
of-living adjustment (COLA) increases to ``pay'' for the new
Choice funding. We find it absolutely unconscionable to cut
benefits for disabled veterans to ``pay'' for their medical
care. Congress imposed these PAYGO rules on itself and
Congress has the authority to waive them by designating new
funding for the existing Choice program as emergency
spending, just as it did when the Choice program was created
in 2014 through Public Law 113-146, the Veterans Access,
Choice and Accountability Act (VACAA). It is our
understanding that the actual need to continue the Choice
program for the balance of this year and through the end of
FY 2018 is approximately $4.3 billion.
We remind you that the primary reason the Choice program
was created was to address gaps in access due to the lack of
clinicians and clinical space necessary to provide timely
access to health care for all enrolled veterans. As such,
VACAA not only included emergency funding to allow additional
access to community care outside VA, it also contained
funding to rebuild and expand capacity inside VA. Therefore,
we call on you to continue this commitment to strengthen and
modernize the VA by providing equal emergency funding to
address VA's infrastructure and personnel gaps. There are at
least 27 VA health care facility leases awaiting funding in
order to be activated. In addition, there are dozens of minor
and major construction projects that require billions of
dollars in funding to sustain and expand VA's capacity to
provide timely care to enrolled veterans. Furthermore, VA has
tens of thousands of vacant positions which will require not
just funding, but innovative new programs to recruit and
retain hard-to-fill clinical positions in many areas of the
country. Therefore, we call on you to include an equivalent
level of funding--$4.3 billion--to support VA's internal
capacity to deliver care.
Finally, since enactment of the Public Law 111-163 in 2010,
which created the Program of Comprehensive Assistance for
Family Caregivers (PCAFC), eligibility has been restricted to
caregivers of severely disabled veterans injured or made ill
on or after September 11, 2001. The clear intention of the
law was to initiate this program rapidly for post-9/11
veterans to address their urgent needs, thereafter working to
expand the program to meet the critical needs of family
caregivers of seriously disabled veterans of all generations
as soon as feasible. However seven years later, Congress has
yet to begin addressing the blatant unfairness facing
caregivers of severely disabled veterans injured prior to
September 11, 2001. As Secretary Shulkin and other experts
agree, supporting caregivers who allow veterans to remain in
their homes will save VA money that would otherwise need to
be spent for long term institutional care. Therefore, we call
on you to include both authorization and funding to eliminate
this indefensible inequity based on existing bipartisan
legislation in the Senate (S. 591) and the House (H.R. 1472,
H.R. 1802).
While the current funding crisis must be addressed in the
short term through emergency funding and authorization, we
remain focused on moving beyond the flawed Choice program as
soon as practicable. We continue to urge you to work with us,
Secretary Shulkin and other critical stakeholders to design
and implement a new paradigm for veterans health care built
around an integrated network, with a modernized VA serving as
the coordinator and primary provider of care, and community
providers addressing remaining gaps in access and services.
We further urge you to consolidate all community care
programs through a single unified discretionary funding
source that includes the necessary flexibility and
accountability to ensure that VA can deliver the highest
quality of care in the most appropriate clinical settings
within the network.
Messrs. Chairmen and Ranking Members, we recognize the
continuing attention and commitment you have all shown to
providing timely and accessible care to our nation's injured
and ill veterans, and we hope you will work with us and
Secretary Shulkin to address this urgent funding shortfall.
America's veterans have earned the right to high-quality,
timely and accessible health care. We believe that the
comprehensive plan outlined above will ensure our nation
continues to meet that sacred obligation and call on you to
support it.
Respectfully,
Garry J. Augustine, Executive Director, Washington
Headquarters, DAV (Disabled American Veterans); Robert
E. Wallace, Adjutant General, Veterans of Foreign Wars
of the United States; Joseph Chenelly, National
Executive Director, AMVETS; Dana T. Atkins, Lieutenant
General, U.S. Air Force (Ret.), President, Military
Officers Association of America; Rick Weidman,
Executive Director for Policy and Government Affairs,
Vietnam Veterans of America; Verna L. Jones, Executive
Director, The American Legion; Sherman Gillums, Jr.,
Executive Director, Paralyzed Veterans of America; Paul
Rieckhoff, Founder and CEO, Iraq and Afghanistan
Veterans of America (IAVA); Hershel Gober, National
Commander, Military Order of the Purple Heart.
Mr. WALZ. In their letter from June 28, they wrote: ``Specifically,
we call on you to reach an agreement on an emergency appropriation and
authorization bill that would address urgent resource shortfalls
endangering VA's medical care programs--including Choice, community
care and medical services. Further, in order to prevent these problems
from recurring in the future, we call on you to equally invest in
modernizing and expanding VA's capacity to meet rising demand for care.
. . .''
Choice means choosing to go to the VA hospital and choice means
choosing to use community care. Both are equal opportunities for our
veterans to get the care they need.
The current bill before us does not meet the requirements asked for
by our veterans service organizations. In fact, in order to keep the
Veterans Choice Program going, House leadership and the Budget
Committee have refused to see this as an emergency and are requiring $2
billion in offsets to pay for the bill.
While the actual offsets being offered are noncontroversial and are
the ones the committee has used in the past, the fact that the
leadership is requiring offsets from VA programs to pay for private
care is wrong--all of this to appease a small vocal minority who simply
sees any spending as unnecessary.
On Friday, a number of the same VSOs listed above issued a joint
statement, which noted:
``Veterans healthcare benefits have already been `paid for' through
the service and sacrifice of the men and women who wore our Nation's
uniform, millions whom suffered injuries, illnesses and lifelong
disabilities.''
I agree with them. Without emergency funding, robbing Peter to pay
Paul, an analogy used by the Paralyzed Veterans of America, is not a
viable path. It is actually robbing future Peter to pay current Paul.
Had it been apparent VA would be facing this shortfall, Congress
maybe would have never extended the Veterans Choice Program beyond its
sunset of August 7 and would have, instead, begun working on
legislation that would have consolidated VA's multiple community care
programs into one easy-to-understand and -use program.
I reiterate: Choice is not a permanent VA program. Now, it may end up
being that. It may be someone's wish, but it is not. It was a short-
term fix that was testified we need to extend the program. Several
weeks later, leadership of the VA came back and told us they are 4-
point-whatever billion dollars short and asked us to fix it. That is
not the chairman's fault; that is not the Members of this House's
fault; but it is our responsibility.
Now, the question is: How do we ensure that the care is continuous?
How do we make sure care is not interrupted? How do we make sure a
veteran who is getting chemotherapy in the private setting right now is
not told to not come back because we are not going to pay it?
The sense of urgency is with all of us. What I ask is that we try and
come back, take a look at what we can do. And I will say this: the
chairman of the Veterans' Affairs Committee in the House has made as
good faith an effort to do this as anyone could possibly ask. I
understand the challenges coming from a broader caucus and asking for
this. This, where we are at today, is significantly changed from where
we started, but it is apparent, in the Senate, that it will not pass.
We will not have money for the Veterans Choice Program, so we need to
[[Page H6154]]
decide: Do we stand and make a statement of ideological, fiscal,
whatever they want to call it, or do we come together, unanimously
agree on something we can move forward, build capacity into the VA to
assure that Choice is there, everything from the research into the VA
to the care in the communities, and come together to find that?
Moreover, these shortages are further reinforced in Choice when you
take into account veterans' reliance on VA's system for care has
steadily increased. While enrollment has been flat in fiscal years 2014
through 2016, the total number of veterans utilizing VA healthcare has
grown by 3 percent. The total appointments in VA increased by more than
5 percent during this period.
In order to address that need, since the Veterans Choice Program was
implemented, the total number of community care appointments has
increased by 61 percent, and more than 25 million appointments were
completed in fiscal year 2016. Over one-fifth of this care was
completed in the Veterans Choice Program. No disagreement. Community
care has always been there, and community care is an absolute staple of
the VA.
What is also not debatable is capacity inside the VA must remain
there. Any shortfall in capacity is going to distort where people are
getting their care.
While we are not here to oppose the premise of veterans having access
to care, members of my Caucus, as this stands right now, cannot go
forward until we figure out how we are going to come to a compromise
that gets the capacity as it should be in the VA and also allows us and
everyone--we should never have this discussion in this House. If we
can't find compromise that gets something across the finish line that
actually does something for veterans, everything else is just messaging
for politics.
Madam Speaker, I look forward to the chairman's words, and I reserve
the balance of my time.
Mr. ROE of Tennessee. Madam Speaker, I yield myself such time as I
may consume.
Madam Speaker, I think the one way that we don't have the Veterans
Choice Program work for veterans is not vote for S. 114. Just to
clarify a couple of things, this $2 billion is emergency spending that
our Budget Committee agreed to.
I want to just for a minute kind of go over how we got to this
position where we are right now.
The Veterans Choice Program, in April, we were told, would last until
next January or February. So we passed the CHOICE Act, and the
President signed it into law. We found out a short 60 days later that
the funds would run out in mid August--the 7th to the 15th of August is
when the Secretary told us--so that kind of caught us off guard, and we
had to get moving rather quickly.
The June 28 letter that my good friend, Mr. Walz, referred to sort of
got us started with this process. I want to go through it because the
process is important about how we are here today.
The Members need to understand that my efforts to work with the
committee's ranking member and, indeed, all members of the committee on
a path forward which addresses the concerns of all of the
organizations, I have done that.
Let me begin by saying I fundamentally disagree that we have
neglected the needs of our internal VA healthcare system. We just
passed a MILCON-VA bill last week. I stated the reasons for that in my
earlier remarks. I think the Secretary's op-ed this morning in USA
Today clearly makes the point.
Madam Speaker, I include in the Record that article.
[From USA Today, July 24, 2017]
Veterans Affairs Secretary: VA Health Care Will Not Be Privatized on
Our Watch
(By David Shulkin)
As a physician, my professional assessment is that the
Department of Veterans Affairs has made significant progress
over the past six months--but it still requires intensive
care. In order to restore the VA's health, we must strengthen
its ability to provide timely and high quality medical care
while improving experiences and outcomes for veterans.
I believe the best way to achieve this goal is to build an
integrated system that allows veterans to get the best health
care possible, whether it comes from the VA or the private
sector.
This is not a novel idea. No health care provider delivers
every treatment under the sun. Referral programs for patients
to get care through outside providers (known as Choice or
Community Care at the VA) are as essential to the medical
profession as stethoscopes and tongue depressors. But VA
attempts to offer veterans these options have frequently
stirred controversy.
Some critics complain that letting veterans choose where
they get certain health care services will lead to the
privatization of VA. Nothing could be further from the truth.
VA has had a community care program for years. Congress
significantly expanded these efforts in 2014 in response to
the wait time crisis. As a result, since the beginning of
this year, VA has authorized over 18 million community care
appointments--3.8 million more than last year, or a 26%
increase, according to the VA claims system.
But as VA's community care efforts have grown, so has our
capacity to deliver care in-house. The VA budget is nearly
four times what it was in 2001. Since then, the department's
workforce has grown from some 224,000 employees in 2001 to
more than 370,000 today, according to the Office of Personnel
Management. And we're delivering 3 million more appointments
at VA facilities per year than we were in 2014.
In other words, community care or private capacity and VA's
internal capacity are not mutually exclusive. We are ramping
up both simultaneously in order to meet the health care needs
of the veterans we are charged with serving. Our fiscal 2018
budget continues this trend. It will spend $2.7 billion more
for in-house VA care, compared to a $965 million increase for
community care. This means that the total dollar increase for
medical care within VA is three times that of the increase
for community care. Overall, when all funding sources are
taken into account, we expect to spend $50 billion on health
care services within VA and $12.6 billion on VA community
care in fiscal 2018.
Even though these numbers make it abundantly clear VA is
not at all headed toward privatization, I understand the
underlying concerns of some critics. They don't want to lose
all that VA has to offer. I don't either--and we won't.
Many of VA's services cannot be replicated in the private
sector. In addition to providing some of the best quality
overall health care in the country, VA delivers world class
services in polytrauma, spinal cord injury and
rehabilitation, prosthetics and orthotics, traumatic brain
injury, post-traumatic stress treatments and other behavioral
health programs. The department plays a critical role in
preparing our nation's doctors and nurses--70% of whom train
at VA facilities. And we lead the nation in innovation, with
VA research having contributed to the first liver transplant,
development of the cardiac pacemaker, advancements in
treatments for PTSD, cutting-edge prosthetics, and many other
medical breakthroughs.
All of these factors underscore that fears of privatization
are simply unfounded. President Trump is dedicated to
maintaining a strong VA, and we will not allow VA to be
privatized on our watch. What we do want is a VA system that
is even stronger and better than it is today. To achieve that
goal, VA needs a strong and robust community care program.
Veterans deserve the best. If a VA facility isn't meeting
the community standard for care, doesn't offer a specific
service, or doesn't have an appointment available when it's
needed, veterans should have access to care in their
community.
This is precisely what they have earned and deserve. It's
what the VA is working with Congress and Veterans Service
Organizations to deliver. And it's what the system needs to
remain a valuable resource for our country's great veterans,
now and in the future.
Mr. ROE of Tennessee. Madam Speaker, I respect the veterans service
organizations and their point of view, and I am a member of most of
them. I, therefore, reached an agreement with the ranking member on a
plan to fund the Veterans Choice Program for 1 year, fund the life
safety maintenance issues at VA facilities, approve 28 VA clinic
leases, provide the Secretary with the tools to be more competitive in
attracting and retaining VA physicians, and conduct a long-overdue
asset review of VA's aging facilities.
When the ranking member and I briefed the VSOs on this plan and then
committee members--two separate meetings--it was clear that we needed
to take some time to work out the differences. There was some concern
there. And I have said that is fine. I think we can take a two-phased
approach.
Phase one was the one we are talking about today, and we agreed on
that. It is necessary to fund the Veterans Choice Program for 6 months
to ensure that the veterans get needed healthcare without long drives
and waits. That is exactly what we were dealing with 3 years ago.
The second phase, which we would consider 6 months from now, would
[[Page H6155]]
consider the remaining items I have talked about between the ranking
member and me. During the interim, the committee would conduct open,
transparent hearings on asset review and anything else--the leases or
anything else--that was in that agreement. There was full transparency
about this plan among committee members, which is why I found it a
little disheartening now what I am hearing.
The reality is, right now, we don't have an agreement from the Senate
or a bill to act on, so it is time for us to act because time is
growing short.
There are veterans out there, Madam Speaker, that are getting
chemotherapy as we speak. There are pregnant veterans who need to know
if they can have their baby and have it paid for by the VA. I could go
on and on. That is why we need to remove this right now. Then we would
have time to work these other issues out.
And just a couple of VA staffing issues. You hear the concern that VA
is going to be privatized and so forth. I hear that all of the time.
Well, this is what the VA has done, as far as their facilities are
concerned, since 2010. I arrived here in 2009.
Since then, the VA has added 3,600 physicians, almost 13,000 nurses--
and they are one of the largest employers of nurses in the country--
almost 4,000 LPNs, and over 3,200 nonphysician healthcare providers. I
could go on and on. The increase in medical services has been over $10
billion since then. So there have been huge increases.
And just a couple of things from the VA Secretary's editorial in USA
Today: ``But as VA's community care efforts have grown, so has our
capacity to deliver care in-house. The VA budget is nearly four times
what it was in 2001. Since then, the Department's workforce has grown
from some 224,000 employees in 2001 to more than 370,000 today,
according to the Office of Personnel Management.''
That doesn't sound like an organization that is being privatized. It
has grown in that capacity.
``And we're''--the VA--``delivering 3 million more appointments at VA
facilities per year than we were in 2014.''
They have grown that capacity internally.
In our fiscal 2018 budget, the trend continues. We are going to spend
$2.7 billion more on in-house VA care compared to a $965 million
increase in community care. So there is a $3 billion increase in in-
house VA care versus out-of-VA care, or outside care.
I think these are all good things. I think the fact that more
veterans are getting care, more appointments are being made, whether
they are in or out of the VA, is a good thing. But to make the argument
that this is privatization is clearly not there.
I would like to say that we can work these out. We need to make sure
we take that anxiety away. The Secretary has clearly stated that he has
to have this passed. I would simply pass it. It gives us 6 months,
Madam Speaker, to work on these issues, and I am more than happy to do
it. I have stated so to every organization out there.
Madam Speaker, I reserve the balance of my time.
Mr. WALZ. Madam Speaker, I yield myself such time as I may consume.
I would just like to respond to the chairman.
I, too, have not made the argument on privatization. I do not believe
that is the goal here. I do not believe that is what we talked about.
If there are those that have that, that is not the intention of this
committee, the chairman, his staff, or anyone involved with this.
And when we did talk--and I think this could be an interesting way
for this House to listen to how we do this. There was transparency in
these negotiations, and we sat in front of people and did them. And one
of the issues in there was we had to build the capacity amongst the
VSOs.
We need to stop for a minute. There may be times we need to take
those hard votes against it, but I ask all of the Members to think
about this, Madam Speaker. All of the veterans service organizations
have lined up in opposition to this.
{time} 1430
Now, that doesn't mean that they are totally right, and it doesn't
mean that there isn't something here we can talk and debate about. The
question is trying to get their goodwill.
I think when we talked the last time, we had some leases, and I am
not calling them token, but in the budget of the big VA, which I do
think in many cases is adequately funded, trying to get some of that to
show the sense of goodwill.
If I were counting on the decision being made strictly by the VA
Committee, I would encourage people to know this would get done, but I
am deeply concerned we are going to see a Frankenstein monster of
appropriation process this week that in no way resembles regular order.
That has nothing to do with this committee.
Again I would say, if it were left to us, bifurcating this issue and
coming back and fixing it, I have faith in that. In this House of
Representatives and the leadership now, I do not have that, nor do the
veterans service organizations.
So the question here is not questioning the motive, the question here
is not a false canard of privatization versus inside-the-VA care, it is
not even the discussion we are having right now of the adequacy overall
of the whole budget; it is a case of the VA leadership running a
program, running out of money way before they had, and coming to the
House and telling us that. And this is not and cannot be made that the
idea is you are going to go home without funding the VA. No one will
say that about you, and no one should say that about us. Everybody in
this House will get this thing done and get it funded. So it is not the
case.
I do understand this: we are against the wall, we are under the gun,
because they just handed us this. So it is our job to figure out how to
build everybody into this.
So the things that are being asked to do with the Choice Program, I
support that. The offsets and pay-for, I disagree with. To make that
work, our side was willing to say: Can we show some good faith and fund
some of these leases and get some payments for these folks in terms of
an emergency spending? But I understand the difficulty is if a spending
bill comes, there is going to be a vocal group of folks who are going
to make the case, as we have seen, that makes it very difficult to move
legislation.
Madam Speaker, you have witnessed it with healthcare, you have
witnessed it with other things, that we are going to have to
compromise. If we get into our corners, it is not going to work.
So I want to be very clear. The motives of the chairman to care for
our veterans is unquestioned, Choice being funded is unquestioned.
Making sure there is capacity and goodwill and the funding needs in
these leases and some of the things we are asking for is a necessity to
make sure the Senate can pass this, and that it shows them that we are
moving in the right direction.
So I would ask, give us a day, have us come back at this. Don't put
this thing on the board to fail and then let everyone else take the
message. Everyone here knows we are going to end up here and pass
something that can be signed into law, and that will happen. The
questions are: Do we do damage amongst ourselves; do we keep the
goodwill and the collaboration; or do we decide we need to make a
message first, then come back and then blame someone because they are
not funding the veterans? No one in here wants that to happen.
Madam Speaker, I reserve the balance of my time.
Mr. ROE of Tennessee. Madam Speaker, I yield myself such time as I
may consume.
Madam Speaker, I do agree with my good friend, the gentleman from
Minnesota, Tim Walz. We are not going to leave here until we pass this,
because there are veterans out there who are ill, who have served this
country honorably, who need care.
I am a physician. I have worked in a VA hospital, I have worked in a
medical unit in Southeast Asia many years ago, I have seen the results
and injuries of war, and I have seen the results and injuries of
current wars. And we are going to do this.
I know when I sat down and we put this compromise package together,
and as openly as I could, I brought in the VSOs, I brought in both the
Republican and Democrat sides, which we typically just check all that
at the door in this committee, which I am thankful for,
[[Page H6156]]
and work just for veterans, and there were some issues that were
brought up. And I recognized that, and I said: Well, the smart thing to
do is we know that Choice runs out of money in 2 to 3 weeks. We have to
fund the veterans' healthcare now, and we will take these other issues
up as a package and have time to debate them and discuss them. That is
all this is about. It is about emergency spending. We recognize that,
and that is okay with our side.
I say the easiest way to do this is put this $2 billion bill on
President Trump's desk, he will sign it, and veterans will have access
to this Choice Program for the next 6 months. That is what the
Secretary wants. He wrote a very eloquent editorial in USA Today about
this entire issue.
Madam Speaker, I reserve the balance of my time.
Mr. WALZ. Madam Speaker, may I inquire how much time I have left.
The SPEAKER pro tempore. The gentleman from Minnesota has 8 minutes
remaining.
Mr. WALZ. Madam Speaker, I yield 5 minutes to the gentleman from
California (Mr. Takano), the vice ranking member of the full Committee
on Veterans' Affairs.
Mr. TAKANO. Madam Speaker, I rise today to oppose S. 114.
A strong and sustainable Veterans Health Administration is critical
to providing America's veterans with the care they deserve. By funding
the Choice exception without investing in the VA itself, this
legislation explicitly prioritizes the private sector at the VA's
expense. This is not an acceptable way forward.
Care in the community has always been and will always be important in
ensuring veterans have access to care, the care that they have earned,
but it would be a profound mistake to funnel billions of dollars into
private care while neglecting the VA and the millions of veterans it
serves every year, and that is exactly what this bill does.
Veterans service organizations are speaking out, because they know
what is at stake. They understand the bigger policy implications of
today's vote.
This legislation is a referendum on the mistaken belief that the
private sector is better equipped to care for our Nation's veterans
than specialized VA doctors.
I have a statement from eight VSOs that echo these concerns, and I
include it in the Record.
Leading Veterans Organizations Call on Members of Congress To Defeat
Unacceptable Choice Funding Legislation
Urge House to Work with Senate to Reach a Bipartisan, Bicameral
Agreement
(Joint Statement from AMVETS, DAV (Disabled American Veterans), Iraq
and Afghanistan Veterans Association (IAVA), Military Officers
Association of America (MOAA), Military Order of the Purple Heart
(MOPH), Veterans of Foreign Wars (VFW), Vietnam Veterans of America
(VVA), and Wounded Warrior Project (WWP))
As organizations who represent and support the interests of
America's 21 million veterans, and in fulfillment of our
mandate to ensure that the men and women who served are able
to receive the health care and benefits they need and
deserve, we are calling on Members of Congress to defeat the
House vote on unacceptable choice funding legislation (S.
114, with amendments) scheduled for Monday, July 24, and
instead work with the Senate to reach a bipartisan, bicameral
agreement.
As we have repeatedly told House leaders in person this
week, and in a jointly-signed letter on June 28, we oppose
legislation that includes funding only for the ``choice''
program which provides additional community care options, but
makes no investment in VA and uses ``savings'' from other
veterans benefits or services to ``pay'' for the ``choice''
program.
Veterans health care benefits have already been ``paid
for'' through the service and sacrifice of the men and women
who wore our nation's uniform, millions of whom suffered
injuries, illnesses and lifelong disabilities.
In order to ensure that veterans can receive necessary care
without interruption, we call on House leaders to take the
time necessary to work together with Senate leaders to
develop acceptable ``choice'' funding legislation that not
only fills the current funding gap, but also addresses urgent
VA infrastructure and resource needs that led to creation of
the ``choice'' program in the first place.
All of our organizations are committed to building a future
veterans health care system that modernizes VA and integrates
community care whenever needed so that enrolled veterans have
seamless access to timely, quality care. However, if new
funding is directed only or primarily to private sector
``choice'' care without any adequate investment to modernize
VA, the viability of the entire system will soon be in
danger.
We call on leaders in both the House and Senate to work
together in good faith, and we remain committed to supporting
such efforts, in order to quickly reach an agreement that
ensures veterans health care is not interrupted in the short
term, nor threatened in the long term.
Mr. TAKANO. The organizations signing the statement are AMVETS; the
Disabled American Veterans; Iraq and Afghanistan Veterans Association,
IAVA; Military Officers Association of America, MOAA; Military Order of
the Purple Heart; Veterans of Foreign Wars; Vietnam Veterans of
America; and Wounded Warrior Project.
I would like to quote from a few of the paragraphs:
``In order to ensure that veterans can receive necessary care without
interruption, we call on House leaders to take the time necessary to
work together with Senate leaders to develop acceptable Choice funding
legislation that not only fills the current funding gap, but also
addresses urgent VA infrastructure and resource needs that led to
creation of the Choice Program in the first place.
``All of our organizations are committed to building a future
veterans healthcare system that modernizes VA and integrates community
care whenever needed so that enrolled veterans have seamless access to
timely, quality care. However, if new funding is directed only or
primarily to private sector Choice care without any adequate investment
to modernize VA, the viability of the entire system will soon be in
danger.''
I also have letters opposing S. 114 from the Paralyzed Veterans of
America and the VFW. I include these letters in opposition in the
Record.
Washington, July 22, 2017.--Paralyzed Veterans of America
(Paralyzed Veterans) today weighed in on options being
considered to fund the veteran ``choice'' program, as the
House of Representatives considers a vote on a draft bill, S.
114 as amended, on Monday, July 24. Priorities for the
organization include open discussion on the best way to build
up specialized veteran-centric services offered by the
Department of Veterans Affairs (VA), while expanding access
to non-specialized healthcare for veterans without cutting
critical non-healthcare VA benefits.
``The notion of streamlining VA is a necessary discussion
that must continue. The devil is in the details, though,''
said Sherman Gillums Jr., executive director of Paralyzed
Veterans of America. ``We do support the responsible `right
sizing' of VA, starting with the elimination of redundancies
and ultimately using cost savings to increase reinvestment in
VA's foundational services, such as spinal cord injury care.
Offsets, at least in part, may be necessary in order to
achieve that.''
Offsets, or program and benefit trade-offs used for
budgeting purposes, are not new to VA. Past offsets include
fees and collections related to housing loans and extensions
in the reduction of certain pensions used to pay for other
benefits. However, this is the first time Congress is
requiring VA to include deficit reduction as a component of
the agency's plan to maintain and expand the VA Choice
Program. Moreover, some veteran advocates have expressed
staunch opposition to offsets because they require VA to
employ a ``rob Peter to pay Paul'' approach to funding
programs.
``Paralyzed Veterans' main concern is that using these
offsets to pay for VA healthcare comes at the expense of
expanding non-healthcare benefits, such as disability
compensation,'' explained Gillums. ``However, we are not
prepared to simply oppose offsets because we believe VA is
open to strengthening healthcare for our most
catastrophically disabled veterans, which matters above all
else. Paralyzed Veterans leads as an expert voice on the most
complex healthcare challenges these veterans face, and we
intend to use that voice to promote new ideas and progress.''
``The bottom line is the discussion must continue with open
minds on all sides,'' concluded Gillums.
About Paralyzed Veterans
Paralyzed Veterans of America is the only congressionally
chartered veterans service organization dedicated solely for
the benefit and representation of veterans with spinal cord
injury or disease. For 70 years, we have ensured that
veterans have received the benefits earned through their
service to our nation; monitored their care in VA spinal cord
injury units; and funded research and education in the search
for a cure and improved care for individuals with paralysis.
As a partner for life, Paralyzed Veterans also develops
training and career services, works to ensure accessibility
in public buildings and spaces, provides health and
rehabilitation opportunities through sports and recreation
and advocates for veterans and all people with disabilities.
With more than 70 offices and 33 chapters, Paralyzed Veterans
serves veterans, their families and their caregivers in all
50 states, the District of Columbia and Puerto Rico
(pva.org).
Source: Paralyzed Veterans of America.
[[Page H6157]]
____
VFW Urges Opposition to S. 114
From: Carlos Fuentes, VFW Legislative Director.
Sent: Monday, July 24, 2017.
Subject: VFW Urges Opposition to S. 114.
On behalf of the nearly 1.7 million members of the Veterans
of Foreign Wars of the United States and its Auxiliary, we
urge all members of Congress to vote NO on S. 114, which
would gradually privatize the VA health care system.
At the VFW's 118th National Convention, VFW National
Commander Brian Duffy asked our members what they thought of
this bill.
Respectfully,
Carlos Fuentes,
Director, National Legislative Service,
The Veterans of Foreign Wars of the U.S.
Mr. TAKANO. Madam Speaker, after more than 2 years and more than $10
billion, the VA Choice Program has failed to deliver on its promise of
shorter wait times for veterans.
It is time for us to recognize that private care is not the panacea
for the complex challenge of caring for our Nation's veterans and that
the VA's role must remain foundational to veterans' care. This bill
does not reflect that reality.
I urge my colleagues to reject this legislation while we continue to
work toward a bipartisan, bicameral solution.
Mr. ROE of Tennessee. Madam Speaker, may I inquire as to the time
left on our side.
The SPEAKER pro tempore. The gentleman has 9 minutes remaining.
Mr. ROE of Tennessee. Madam Speaker, I yield myself such time as I
may consume. I want to clarify a couple of things that have been said
here today.
Madam Speaker, we did work out an agreement. When I met with all of
the interested parties, which I thought was our job, both the ranking
member and myself did this, as we always do, we found out some issues
that were there.
The primary thing we have to do right now is to provide healthcare,
or we will be right back to where we were in 2014, when there were
waiting lists around the country and veterans dying waiting on care.
Maybe not in urban America, but in rural America where I live, many
of these hospitals and veterans absolutely rely on this for their
health and welfare. The further they live away from a VA facility, the
more they rely on Choice.
Let me go over this again so that it is clear. I got into Congress in
2009. I was elected then and sworn in then. The VA was spending $93.7
billion on all VA care; that is the disability claims, healthcare, and
cemeteries. In this fiscal year, that budget is going to be $186
billion, where basically the discretionary budget in this Congress has
been flat, so that money has come from other places, education,
environment, other places that we have invested in our veterans, which
is, and I believe to this day, a good thing to be doing.
We have gone, in 2001, from 224,000 people, that is not a small
organization, to 370,000 people who work for the VA today. They are
providing that money.
I guess what I was hearing from the other side of the aisle was if we
didn't have the Choice Program, the wait times would have gotten
shorter. I mean, that is the reason we have the Choice Program, was the
VA wasn't doing it.
The fact is, they have hired people. I mentioned here just a moment
ago, since 2010, when I first got here, they have hired 13,000 more
nurses, 3,600 more doctors, 3,200 more physician extenders, nurse
practitioners and PAs. So the VA has increased its capacity, and they
have seen millions of more visits.
This week, we are going to take up the VA appropriations bill. I
misspoke a minute ago; I said last week. This week, we are taking up
the MILCON-VA appropriations bill where we talk about those things,
about the money that we are going to spend in the VA. That is going to
be debated this week.
This is a separate issue. This is about providing healthcare for
veterans after August 15, that is 2 to 3 weeks from now, when that
program will be shut off and veterans in the middle of care will not be
able to get care.
It is a simple vote. We can work these other things out in the next
few months after this very easily.
Madam Speaker, I reserve the balance of my time.
Mr. WALZ. Madam Speaker, I have no further speakers. I am prepared to
close, and I yield myself the balance of my time.
Madam Speaker, to be clear, we are very aligned on the goals here. I
am not implying that wait times went down if we didn't have Choice. I
was on the conference committee that created Choice as part of it.
There is community care that has been there. There is also a $12
billion shortfall in facilities rated D and F. We had sewer lines
breaking and running feces back into hospitals, those types of things.
I am not saying that maybe the money is not already there or they are
not using it correctly. The fact of the matter is this was a program
that was created out of the crisis of Phoenix. It did not stand up as
quickly as it could have; it was plagued with tons of problems that
many of us heard about. We kept committed to it. I would argue that
they are getting their legs under them and providing care in a timely
manner.
It grossly overspent where it was at. We have had no audit. And I
think we need to keep this in mind, that on this side of the aisle, I
will be the first to talk to anyone who grandstands this and makes this
as a case that this is a failure at the VA or the administration. I
don't know that yet.
What I would say is we are all in this together, so we want to get it
done. I am simply making the case today that in light of opposition
that is rarely seen from the VSOs in such opposition to this, that even
though the outcome is there, and nothing the chairman said was
incorrect, it is the spirit of what it takes to legislate that is
missing around here. You can go to the White House after passing a bill
in the House, and if the Senate doesn't do anything, it is not a law.
So we have other people to deal with: constituents, veterans,
veterans service organizations, Democrats in the Senate, Republicans in
the Senate, Democrats on this side.
So what I am asking is, just give a little on the side of what it
takes to build the coalition, get the thing passed, and then let's go
back and fund VA care and end this ridiculous argument of privatization
versus nonprivatization. Wherever a veteran can get the care and access
it as quickly, timely, and quality as possible is what we are trying to
shoot for. In many cases, that is in the VA; in other cases, it is in
the community. So this is not a drop-dead.
My hope on this is, is that a debate, when it comes to emergency
spending of money and depending on the Senate, is not going to split
the goodwill, the good work, and, I would argue, the fair democracy and
execution of how the House of Representatives is supposed to work.
So my final statements on this would be, I am in virtual total
agreement with the chairman on what needs to be done here. Our
differences lie in, he is right, when I went back and talked to people,
I could not sell to the VSOs the plan as it is, and they have every
right to speak out on that. And we could not sell the Senate at this
point.
So what I would ask the gentleman again is, don't make us oppose this
piece of legislation simply to make a statement for a few members.
Bring it back when we can have the Senate, the VSOs, and everyone in
and accomplish our goal.
Madam Speaker, I yield back the balance of my time.
{time} 1445
Mr. ROE of Tennessee. Madam Speaker, I yield myself such time as I
may consume.
Obviously, this has been a robust debate about a very important
issue, which is providing timely healthcare for veterans who have been
waiting. The ranking member and I negotiated in good faith and put an
agreement together, which fell apart this weekend.
We had met basically with both the VSOs and the committee members and
had an agreement to go forward. I then backed up on that agreement
because I realized it wasn't a consensus, and just divided it into two.
The most pressing need, Madam Speaker, is to provide healthcare,
whether it is chemotherapy or obstetrical care, surgery that a veteran
may need, timely visits to the doctor. In 2 to 3 weeks we are up that
close, and one of the reasons is, as has been stated multiple times,
the VA gave us some
[[Page H6158]]
really bad information 2 months ago. We thought this was going to last
for 6 more--8 more months before we ran out of money in this vital
program for veterans.
This is going to get passed. For all veterans or people out there,
citizens of this country watching this, we are going to provide this
for our veterans.
And I might add that not all VSOs do oppose this. Many were
mentioned, but many others do not oppose this legislation.
I think it is critical that we get this done, Madam Speaker, get this
off the table this week, signed into law, work the other part of the
agreement that we had agreed to out in the next coming weeks. I will be
willing to work as expeditiously as possible to get this done.
Once again, I encourage all Members to support this legislation, and
I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Tennessee (Mr. Roe) that the House suspend the rules and
pass the bill, S. 114, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. WALZ. Madam 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 motion will be postponed.
____________________