[Congressional Record Volume 163, Number 200 (Thursday, December 7, 2017)]
[Senate]
[Pages S7920-S7922]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 VETERANS COMMUNITY CARE AND ACCESS ACT

  Mr. MORAN. Mr. President, I am glad to see the Presiding Officer in 
the Chair because I came to talk about a topic that he and I share a 
great concern and compassion about--the veterans of our States and our 
Nation.
  I first want to thank Senator John McCain, of Arizona. Many of my 
colleagues have spent a much longer time in the Senate than I have, and 
they have had the opportunity to work side by side with Senator McCain 
more often than I have, but I am honored today to join him in 
legislation that we introduced earlier this week. It is S. 2184, the 
Veterans Community Care and Access Act of 2017.
  I am honored to have the opportunity to work side by side with 
Senator McCain and other colleagues as we try to determine how best we 
can care for those who served our Nation. I wish to use this 
opportunity to pay tribute to the Senator from Arizona for his service 
to our Nation and what I know of his experience in Vietnam and his 
service to the Nation but what I also know

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of him in difficult circumstances in which he continues to work for the 
benefit and well-being of the people of our country. We both share--he 
is a veteran, not I--the ideals and beliefs that those who served our 
country deserve only the best from a grateful nation.
  I have been a member of the Veterans' Affairs Committee since I came 
to Congress with that goal in mind, and I continue to serve in the 
Senate as a member of the Veterans' Affairs Committee. I serve now as 
the chairman of the appropriations subcommittee that funds the 
Department of Veterans Affairs. We have introduced the Veterans 
Community Care and Access Act because we want to call on the VA to do 
what it is they say they want to do. This bill fulfills priorities.
  The reason this bill comes to the Senate floor at this point in time 
is that the Veterans Choice Program was created at a time of crisis at 
the VA in which veterans were not being served and not being well 
served, and Congress responded with a program to allow veterans to 
access care in their communities. It is before us again because that 
program expires presumably this month, perhaps early in January. The 
bill expires when the funding for the Veterans Choice Program is used 
up, and that is a matter of days or weeks away. The effort, in part, is 
to reauthorize the Veterans Choice Program but, more importantly, to 
make certain that we revitalize, update, improve, alter, and transform 
the Department of Veterans Affairs.
  In my view, it would be a sad circumstance in which we reach the 
conclusion that we must simply reauthorize the Choice Program without 
using this opportunity to transform the VA into something better that 
can serve the needs of more veterans in a better way to fulfill the 
needs of those veterans.
  The legislation that Senator McCain and I have introduced does 
several things with regard to transforming the VA. It merges and 
modernizes the community care programs into one program. It provides 
greater access to care for veterans within the VA and within the 
community. In my view, this is not just about improving access or the 
quality of care in the community. It is about improving the opportunity 
of the VA to care for veterans within the VA. It establishes a 
framework for the VA to build a high-performing healthcare network. 
That network is designed to care for veterans where they can best 
receive the care, where they can receive the best quality care, and 
where they can geographically attain the care they need.
  In addition to that, it requires the VA to coordinate that care 
within that network across the system so that once a veteran is a 
patient of the VA, they are not forgotten, they are followed, and they, 
as an individual veteran, have a care coordinator within the Department 
of Veterans Affairs.
  Regarding reform legislation on this VA community care, Secretary 
Shulkin, the Secretary of the Department of Veterans Affairs, told me: 
``We need more specificity.'' So we developed legislation that balances 
instruction and guidance from Congress with the VA's own proposal. 
Secretary Shulkin also told me that if too much is left to the 
regulation process, ``the VA will keep things the way they are now''--
that things will not change. This is a recognition of the bureaucracy 
that he manages, and it is a recognition of that bureaucracy's refusal 
to change.
  Refusal to change, unfortunately, is what got us to the 2014 
scandal--exhibited, particularly, in Phoenix--which revealed nationwide 
system failures and resulted in the deaths of veterans. It is also 
evidenced by refusal to change, which is shown the number of times we 
have had a crisis in which the VA has run out of money to pay for the 
Choice Program and again comes to us at the 11th hour telling us they 
need help financially to keep the Choice Program going. It is a reason 
why today we can't tell you how much money is needed or when the 
current resources will expire.
  I don't want us to miss the opportunity to do something more than 
simply reauthorize the Choice Program. I want to use this opportunity 
to create a system that not only works for veterans but modernizes and 
transforms the VA into a 21st century healthcare system that will serve 
our veterans today and veterans for generations to come.
  This legislation reforms the VA healthcare system by connecting 
independent demand and capacity assessments to objective access and 
quality standards, which are used, then, to provide the veterans access 
to care in their community. The point here is that the VA remains the 
gatekeeper. The point, also, is that the criteria--the broad outline by 
which community care should be and must be provided--is determined by 
Congress, not by rules and regulations from within the bureaucracy of 
the Department. This legislation creates the tools the VA must use to 
reform healthcare, safeguards our veterans from inconsistent 
experiences, and leads to poor health outcomes.

  This effort was a collaboration, including a strong collaboration 
with the Department of Veterans Affairs, but also with the General 
Accounting Office, the Congressional Research Service, the Department 
of Defense, RAND, various healthcare industry experts across the 
country, as well as veterans services organizations.
  We worked closely with the entities that have investigated the VA. In 
the Appropriations subcommittee that I chair, we often have the IG or 
the GAO in front of us explaining one more time a flaw that occurred at 
the VA and what needs to be done to correct that flaw. We sought their 
input into how not to fix the consequences of a flaw but how to avoid a 
flaw. We want to fill in the gaps and develop solutions in advance of 
problems, and that requires real transformation within the VA.
  We need to get the VA's house in order so they can do what they want 
to do, what they are required to do, and what the Americans demand of 
them--care for our veterans. There is too much dysfunction still 
happening at the VA for Congress not to take a stronger and more 
measured approach to reforming the VA healthcare system. It is 
unacceptable, in my view, for us to rely on ``criteria the Secretary 
will develop'' because that translates into a VA bureaucracy 
determining veteran eligibility in that regulatory process.
  In large part, this legislation is derived, in my view from my 
experience as a Member of the Senate, in which not a day goes by that 
our office doesn't hear from veterans across Kansas and across the 
country. They bring to us the problems they have experienced, what all 
of us in the Senate would call casework. Somebody brings us a problem, 
and we work to solve it. The goal and my belief is that the outcome of 
this legislation reduces the amount of casework, which isn't about 
reducing our workload. It is about making certain that veterans don't 
have to come to their Congressman or Congresswoman and don't have to 
come to their U.S. Senator to get the services they are entitled to by 
law and by moral obligation. We don't learn from history. We need 
transformation. We need something more than just saying: Let's keep the 
current process in place for a while longer.
  Following World War II, GEN Omar Bradley was assigned the task of 
overhauling the VA for the millions of Americans who were returning 
home from World War II. He said some important things at that point in 
time. Bradley rightfully kept the needs of veterans at the forefront. 
He said: ``We are dealing with veterans, not procedures; with their 
problems, not ours.''
  The goal and the outcome of good legislation will be to reduce and, 
hopefully, over time, to eliminate most of the problems our veterans 
experience in dealing with the VA and in accessing the healthcare they 
have been promised.
  The VA has done an admirable job in many, many instances, but way too 
many veterans fall through the cracks. I would estimate that our office 
receives 30 new cases every week, and most of them deal with the issue 
of healthcare, and many of those deal with the issue of community care.
  We can reform this system. We can make it better for the veteran. We 
can make it better for the provider and for those hospitals and clinics 
across Kansas and around the country that are willing to serve the VA 
if there is a process in place by which they get paid and they get paid 
at a rate with which they can afford to care for those veterans. What I 
would say is that, in

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most instances, it is so they don't lose more money in caring for those 
veterans.
  Just like at the conclusion of World War II, when General Bradley 
overhauled the VA, today's VA is in need of another major reform. Just 
as General Bradley did, we must keep the veterans' unique wants and 
needs in mind as we reshape and reform the delivery of healthcare. 
Veterans require and deserve the best our Nation has to offer. If the 
VA is serious about restoring the trust with veterans, then, the VA 
needs to be committed to creating a modern, functional healthcare 
system that increases access--both within the VA and within the 
community--for timely and quality care. We ought not miss this 
opportunity. We ought not shy away from legislation that helps to 
achieve that outcome.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. CASEY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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