[Congressional Record Volume 164, Number 85 (Wednesday, May 23, 2018)]
[Senate]
[Pages S2857-S2862]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                            VA MISSION BILL

  Mr. ISAKSON. Madam President, I am delighted to stand today, shoulder 
to shoulder with all my colleagues on the Veterans' Affairs Committees 
in the House and the Senate, to thank the Senate for a very strong vote 
on cloture yesterday to take us to a point today where we will pass the 
VA MISSION Act, which is this legislative body fulfilling a promise to 
those who fought and sacrificed for each of us to be here today--our 
families and loved ones as well.
  For years, there have been problems in the VA in terms of healthcare. 
You read the headlines. I read them, too, and our constituents read 
them. In Arizona, we had veterans who died waiting to get a routine 
appointment. We had scheduling errors. People were getting bonuses for 
scheduling things they had falsified. We had a lot of things that were 
disappointing to all of us. We worked hard in the Veterans Affairs 
Committee in the House and Senate to address these tough issues head-on 
and fix them so that the VA would be the best functioning health 
delivery system it could possibly be for the people who were willing to 
risk their lives for each of us when they joined the military.
  I think it is appropriate that we are doing this the week before 
Memorial Day. Next Monday, we will celebrate all of those who, in all 
the wars that preceded the fight we have today, represented our 
country, volunteered unselfishly, fought, and in some cases died for 
America's peace, freedom, liberty, and the perpetuation of our 
democracy.
  One promise we made to them was that they would have good quality 
healthcare, and it would be successful. Four years ago, with the 
leadership of John McCain, we started the movement toward Veterans 
Choice. We passed a good bill with a 40-mile rule and a 30-day rule. 
The 40-mile rule said that if you live within 40 miles of a VA clinic 
or service, you can go to a closer clinic in the private sector, as 
long as it is approved by the VA. The 30-day rule said that if you 
couldn't get an appointment for a routine medical service in 30 days, 
you could get an appointment in the private sector, and the VA would 
approve it. But the labyrinth of the approval process for that 30-day 
appointment or that 40-mile access made it almost impossible for the 
veteran, in many cases, to get access that is as timely as we would 
like it to be.
  It was a good start. It was an improvement in our process. It 
addressed the problem--but not well enough. We learned enough as a test 
bed to know that veterans liked Choice, as long as it was not so 
cumbersome that they couldn't use it. The VA liked Choice, as

[[Page S2858]]

long as they were a partner with a veteran who made the choices, so we 
lost no continuity in healthcare.
  With the passage of the MISSION Act, we are repealing both the 30-day 
rule and the 40-mile rule. Instead, we are saying the following: If you 
are an eligible veteran for VA healthcare services, you can choose a 
private sector doctor if you want to, as long as the conditions and 
circumstances, in concert with your VA primary care doctor, fit. In 
other words, the VA needs to know about it and work with you in making 
that decision and work with you in finding that private doctor. We are 
not going to have mountains of paperwork and third-party administrators 
breaking the rules and regulations and slowing things down. Instead, 
the VA will be motivated to see you, the veteran, get fast, timely 
service and quality healthcare, whether it is private or the VA.
  There have been some who have talked about this being privatization. 
It is not privatization; it is mobilization. We are mobilizing 
healthcare for the veterans to see to it that they have access in a 
timely fashion. The VA is an instrumental service for our veterans who 
come home. Many of them come home with injuries and sicknesses and 
illnesses and diseases that, quite frankly, nobody ever contemplated 
people surviving.
  Who heard of PTSD and TBI 20 years ago? Who saw veterans lose arms 
and legs--in some cases, all of their arms and legs--and survive a 
battlefield wound? How many of you have seen people wear an eye 
prosthesis, where they had an eye replaced? The VA has specialists who 
can do all of those things, the best in the world. They can deliver 
high-quality healthcare and high-quality rehabilitation to veterans 
with the most serious injuries in the history of warfare. We will 
always continue to do that, but we also have to understand that when 
healthcare in the private sector can be utilized for the convenience of 
the veteran--not as a competitor to the VA--we can use it as a force 
multiplier to lower the number of people we have to hire and, in 
addition, lower the number of hospitals we have to build and instead 
provide that money for services to our veterans. It is a win-win 
proposition for the VA and for all of us.
  It is no secret why every former VA Secretary who has served this 
country has endorsed the VA MISSION bill. All of them have endorsed it, 
every one of them, whether a Republican appointment or appointment by a 
Democratic President. They all know this is something we needed to do 
for a long time. It is no secret why we got a vote of 91 to 4 yesterday 
on the floor of the U.S. Senate to invoke cloture and go to a vote 
today on the VA MISSION Act. It is past time we made sure our laws for 
healthcare available to our veterans are as high quality as our 
veterans are when they go to fight wars for us.
  Secondly, I want to focus on another feature which is very important 
to me because I was in the service. I was not in Vietnam. I am a 
Vietnam-era veteran. I was in the Georgia Air National Guard during the 
Vietnam War. I lost buddies in that war. I know a lot of our soldiers 
sacrificed in that war and made it home with terrible injuries, but 
because of our healthcare delivery system in the battlefield and at 
other hospitals around the world, we were able to save veterans and 
rehabilitate them, but the need for ongoing medical healthcare for the 
basic essentials of life is sometimes one of the byproducts for some of 
the injuries and for some of those who survived those wounds.
  There are veterans who have difficulty feeding themselves. There are 
veterans who can't dress themselves. There are veterans who need 
assistance in the five basic essentials of life, and then from time to 
time, they have to call in a caregiver. There are spouses, moms, in 
some cases, dads, brothers, and sisters who come and deliver those 
services to their brother or sister or son or daughter. If they are a 
veteran of almost any area except Vietnam, they get caregiver benefits 
from the VA or a stipend benefit provided to that volunteer to help 
that veteran. It helps the veteran pay for their service, and it helps 
the VA not have to go out to find someone to do it because there is 
someone offering to be their caregiver. We are expanding the caregiver 
services in the VA to all veterans, so finally the Vietnam-era veterans 
and their families will be as eligible as anybody else who is entitled 
to VA benefits.
  Patty Murray of Washington, Susan Collins of Maine, and a lot of 
Members of this Chamber today deserve credit for that. We fought for 
caregivers for a long time. It is a big step forward, and it is going 
to be a lifesaver and a life extender for many and remove just one of 
the major burdens that some have to care for a spouse or a loved one 
injured in battle or who has fought for us.
  I can go on and on and on about detail after detail after detail in 
this bill, but I don't want to bore everyone. I want everybody to 
realize, when they go home this weekend, how important it is to tell 
them what we have finally done. We have finally dealt with the 
accessibility of healthcare to our veterans. There will be no more 
headlines of veterans dying because they can't get an appointment 
because they are going to be able to get an appointment. They are going 
to be able to make the choice with the VA at that appointment. It is 
not the case anymore where a veteran is going to die because they can't 
get a basic service to stay alive at their home, that if they don't 
have the money to pay for a caregiver, they therefore languish, unable 
to feed themselves or clothe themselves or live in a sanitary 
condition. That is the very least we owe to our veterans. Today, when 
you cast your vote for the VA MISSION Act, you will do just that.
  I want to address some individuals, if I can, and thank them. One, I 
thank John McCain, whose idea this was originally. He is a great hero 
to all of us, a friend to all of us, one we love and pray for today as 
he recovers from cancer. John is the one who started the movement 
toward Choice, and he deserves the credit for it.
  I thank all of those Secretaries who have worked with us over the 
past 3 or 4 years to get to the point where we are able to pass the VA 
MISSION Act today.
  I will tell you whom I really want to thank. I want to thank all 
those veterans who sacrificed and died for us in the wars before now. 
The reason we enjoy our freedom and you, Madam President, can preside 
freely without fear of retribution, I can say what I think without fear 
of retribution, I can say to our constituents who gather in the Gallery 
and listen to what we have to say, and protest if they wish, is we have 
a Constitution and 10 basic amendments, the first 10 being our Bill of 
Rights. It gives us everything, but the ones who protected that gift 
are our veterans.
  It is not a stretch to remember that had it been a different outcome 
in World War II, I might be speaking Japanese or German today, not 
English, but because of our veterans and because of our soldiers who 
fought in the Battle of the Bulge, who fought in the Pacific--my 
father-in-law flew reconnaissance in the Pacific. My brother-in-law was 
in the Air Force in Vietnam. If those vets had not risked their lives 
and really offered their lives in exchange for our liberty and freedom, 
we wouldn't be enjoying this today. So we owe no less than the MISSION 
Act to our veterans. I am proud to be part of it, and I am proud of my 
committee and my committee members who are doing so much to help us.
  Let me just say thank you to my colleagues for your vote yesterday. I 
urge you to vote today for passage of the VA MISSION Act. It is an 
honor to serve our country as a Member of the U.S. Senate. It is an 
honor to be an American. May God bless our country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. HOEVEN. Madam President, I rise to speak in support of the VA 
MISSION Act. I want to begin by thanking the chairman of the Veterans' 
Affairs Committee who has shown incredible leadership on behalf of our 
veterans for many years, and this bill fits right in that mold.
  This is a very important bill for a number of reasons. Obviously, it 
is an important bill because it supports our veterans, but it really 
has important provisions in it that will make a difference for our 
veterans. I want to thank the chairman of the VA Committee. I want to 
thank him not only for the quality of the work in this bill but for 
building the bipartisan coalition necessary to pass it because it 
really does make a difference for our veterans, to whom we owe so much.

[[Page S2859]]

  I would like to go through not all but some of the provisions that I 
think are really important, some I worked on and some I think really do 
make a difference for our great veterans.
  As I said, I speak in support of the VA MISSION Act. It is bipartisan 
legislation that will help ensure veterans receive the care they so 
very much deserve.
  This piece of legislation not only strengthens the VA's ability to 
care for our veterans, but when the VA is unable to provide that care, 
it gives our veterans a choice to seek care in their home communities 
and to do it on a basis that is convenient, that works for them, and 
then to make sure those healthcare facilities will provide that service 
to our veterans because they know they will be compensated for it by 
the VA.
  That is a huge issue because it is not just about making sure there 
is care out there for our veterans but making sure it is quality care 
and that it is available to them.
  We owe our veterans more than we can ever repay for their incredibly 
dedicated service. Expanding veterans' access to healthcare options 
closer to home is just one of the ways we can show our deep 
appreciation for their service to our country.
  Providing this kind of care has proven to be particularly challenging 
for our veterans residing in rural areas. I live in a rural State, and 
to get that access to quality service in these rural areas is a 
challenge. It is a challenge we have to address and a challenge we 
address directly in this legislation, which is why I am so deeply 
appreciative that we are working to pass this legislation.
  In 2014, the Veterans Choice Program was enacted to alleviate 
unacceptable waiting times for care at the VA. However, the Veterans 
Choice Program has been in need of improvement.
  In 2016, I worked to secure and implement the Veterans Care 
Coordination Initiative at our Fargo VA health center. The Fargo VA 
health center serves all of North Dakota, and it serves half or more of 
Minnesota as well. The initiative we worked to put in place at the 
Fargo VA--and the Fargo VA does a tremendous job. We have some VA 
health centers around the country that obviously need improvement, but 
the Fargo VA health center does a top-quality job.
  This initiative is an initiative we put together as part of the 
Veterans Choice Program. It has allowed veterans seeking community care 
to coordinate all of their healthcare through the Fargo VA health 
center rather than the third-party contractors that were set up under 
Veterans Choice, and obviously we had some challenges with those 
contractors. So this allowed the VA health center to provide that 
service directly, both if the veteran came into VA for institutional 
care at the healthcare center or at one of its CBOCs or if they wanted 
to get Veterans Choice care from a private provider in their local 
community. The initiative has been very successful and has 
significantly reduced wait times for community care appointments.
  The VA MISSION Act builds on that very effort. It builds on that 
effort by requiring the VA to schedule medical appointments in a timely 
manner. When the veterans need healthcare, they have to be able to get 
in and get that care in a timely way.
  The MISSION Act improves community care initiatives at the VA, 
including the Veterans Choice Program, by streamlining it into a single 
veterans community care program that will be able to provide better 
care for our veterans. That is the bottom line--better care for our 
veterans.
  Today I want to highlight three priorities we worked to include in 
the MISSION Act to provide veterans in North Dakota and across the 
country with better care closer to home.
  First, the long-term care piece. When we are talking about care, it 
is not just medical care; it is long-term care. It is in-home care. It 
is nursing home care. It is that whole continuum of care that is so 
important. The VA MISSION Act includes key pieces of legislation I 
introduced as a stand-alone act. That bill was the Veterans Access to 
Long Term Care and Health Services Act, and it focused on that long-
term care piece, making sure veterans could get the VA to reimburse 
nursing homes and that nursing homes would take that VA reimbursement 
and take veterans.
  That is why I introduced the legislation, along with some of my other 
colleagues, to increase veterans' access to long-term care options in 
their communities.
  For example, currently, in our State, only about 20 percent of the 
nursing homes contract with the VA due to difficult regulations and 
reporting requirements. That is not dissimilar from across the country. 
That is what we are seeing across the country, only a percentage--
ultimately, a small percentage--of nursing homes that will take that VA 
reimbursement because of the redtape and difficulty contracting with 
the VA in order to get that reimbursement. A veteran should not have to 
relocate across the State because they can't go into a nursing home in 
their community because of that reimbursement issue. That is what this 
legislation addresses.
  Think how important that is. You want your veteran to be able to go 
in and get long-term care in their community, close to their home, 
close to their family, right? That is what this is all about. Our 
legislation will allow non-VA long-term care providers, including 
nursing homes, to enter into provider agreements with the VA. These 
agreements will cut through the bureaucratic redtape at the VA that has 
prevented our veterans from receiving long-term care services closer to 
home. This means veterans can access nursing homes and other long-term 
care in their communities closer to home and closer to their loved 
ones.
  The MISSION Act also expands caregiver benefits to veteran caregivers 
of all eras. Again, this is a very important provision. The VA's 
program of comprehensive assistance for family caregivers includes a 
monthly tax-free stipend, healthcare coverage under the VA Civilian 
Health and Medical Program--if the caregiver is not eligible for 
coverage under another health plan--counseling and mental health 
services, up to 30 days of respite care services, reimbursement for 
travel-related expenses required for an eligible veteran's examination, 
treatment, or episode of care, and travel for caregiver training is 
also reimbursed.
  Currently, these benefits are only available to caregivers of post-9/
11 veterans. The inclusion of this provision will help support pre-9/11 
veterans and the family and the friends who take care of them.
  The other provision I want to mention again is really important for 
our rural areas and for our veterans in the rural areas. This is a very 
important provision. This priority, this provision, removes the 
Veterans Choice Program's 30-day, 40-mile eligibility requirement. So 
it removes that 30-day wait, that 40-mile eligibility requirement. 
Instead, the bill allows veterans to receive care in their local 
community when services are not available through the VA or if the 
veteran and his VA medical team determine that receiving community care 
would be in the best interest of the veteran--again, what is best for 
our veterans.
  This is a priority we have been working on for veterans in my home 
State and really States across the country, particularly our rural 
States.
  As I mentioned, for example, North Dakota's only health center is in 
Fargo. We have CBOCs around the State, but the only health center, the 
full-scope health center, is in Fargo. As I said, it covers all of 
North Dakota and, frankly, most of Minnesota. We have these community-
based clinics out there. While they provide some services, they aren't 
always equipped to provide the care necessary for our veterans. So what 
does that mean? That means the veteran has to travel in some cases a 
long distance.

  Under the Veterans Choice Program's 30-day, 40-mile eligibility 
requirement, a veteran living within 40 miles of a CBOC meant they 
either had to go to that CBOC or travel a long distance to a VA health 
center. So they weren't eligible for that community care, as I say, 
forcing many veterans to travel long distances, often in inclement 
weather, in order to receive VA reimbursed care. This legislation, the 
MISSION Act, removes that requirement. So now, when a VA medical center 
or CBOC can't provide the service a veteran needs, then those veterans 
will be able to access healthcare services in their local community.

[[Page S2860]]

  So we have veterans traveling hundreds of miles now, round trip, 
inconvenienced, making it very difficult for them and their families. 
No more. Under this legislation, that 40-mile requirement and the 30-
day limit is taken away. If it is most convenient for a veteran to 
access care from a private provider in their community, they can do it. 
That is a huge step in making the Choice Program work for our veterans.
  Just a few days from now, our Nation will set aside a day to honor 
those who made the ultimate sacrifice. It is because of their sacrifice 
that we can experience the freedoms we enjoy as Americans. Sending this 
legislation to the President's desk is one way we can show our 
gratitude for their actions.
  I wish to congratulate again the great Senator from the State of 
Georgia and thank the Senate VA Committee staff for their leadership, 
perseverance, and hard work to get to this point. I am pleased that 
both sides of the aisle have come together to support this legislation 
and to support our veterans. I am proud to support the VA MISSION Act. 
Again, I urge my colleagues to support its passage.
  With that, I yield the floor for the Senator from the State of 
Missouri.
  The PRESIDING OFFICER (Mr. Cotton). The Senator from Missouri.
  Mr. BLUNT. Mr. President, I join my colleague from Georgia. I also 
join Senator Hoeven in mentioning the incredible leadership that 
Senator Isakson has shown for veterans and the way we deal with 
veterans' concerns. We honor their service.
  The Senator from North Dakota just mentioned that Monday, of course, 
is Memorial Day. On Memorial Day in 1983, President Reagan said:

       I don't have to tell you how fragile this precious gift of 
     freedom is. Every time we hear, watch, or read the news, we 
     are reminded that liberty is a rare commodity in this world.

  President Reagan's words from 35 years ago are every bit as 
significant today as they were then. The willingness to pay the price 
for freedom has been paid by every soldier, sailor, airman, and marine, 
and every person in the Coast Guard, the National Guard, and the 
Reserves. So on Memorial Day, we honor their willingness to do that.
  This is a good time also for us to discuss the things Congress has 
been doing to try to honor that service as we continue to look at the 
challenges that veterans face. I have spoken before about the HIRE Vets 
Act, which was signed into law last year. The bill established the HIRE 
Vets Program within the Department of Labor to provide tiered 
recognition of what employers do based on their contributions for 
veteran employment. Some of the criteria were things like these: What 
percentage of the new hires are veterans or what percentage of the 
overall workforce is veterans? What types of training and leadership 
development opportunities are made available that veterans have unique 
opportunities to take advantage of? What recognition is given to skills 
that veterans learn while serving? What other benefits and resources 
are offered to veterans--things like tuition assistance?
  Creating a national standard will help vets narrow down their 
employment options and focus on their job search efforts.
  The HIRE Vets Program is up and running. This year, over 300 
employers have signed up to participate in the pilot program, and we 
will see how that pilot works. I hope it works as well as those of us 
who sponsored and voted for the legislation thought it would--as a way 
to begin to give the recognition to employers that they deserve when 
they go beyond saying: Of course, we like to hire vets. HIRE Vets shows 
just exactly how much you like to hire vets and what difference it 
makes when you hire those vets.
  The second program that is getting started this year is the Military 
Family Stability Act. It was signed into law last November. We have the 
most powerful military in the world, the most well-trained military in 
the world, and a military that we have invested money, training, and 
energy in like none other. But the real strength of the military, 
according to military leader after military leader, is military 
families.
  In the Military Family Stability Act, we have created a new 
opportunity for families, because of education reasons or work reasons, 
to leave earlier than the spouse who is serving has been assigned for 
or to stay a little later if school is going to start before you 
otherwise were going to get there or school is going to be out a couple 
of weeks or a couple of months after the serving spouse had to leave. 
We have given families that option for the first time, where the family 
residential support money stays, and I think lots of families are going 
to take advantage of that. Families in the past could do that if 
everybody up and down the chain of command agreed. Now families get to 
do that because they think it works for their families.
  Secretary Mattis and Chairman McCain are very supportive of this 
program, as was the Chairman of the Joint Chiefs of Staff, General 
Dunford, and we are looking forward to seeing how families are able 
this year, for the first time, to look at that next assignment and 
decide when it is the right time for the family to move to that 
assignment.
  I have talked to lots of families, many of whom saw that moment as 
the moment they decided to leave the military or the moment they looked 
back and saw it as their most challenging time, when a spouse's job had 
to needlessly suffer or that last month of school couldn't be completed 
just because they didn't have that flexibility.
  Now, President Trump has just nominated Acting Secretary Robert 
Wilkie to head the VA. We look forward to his leadership there. The 
President and the acting head of the VA just signed a contract with 
Cerner, a Kansas City company that will modernize the VA's healthcare 
IT records, the records that healthcare providers in the whole system 
can access. Cerner was already in the process of coming up with a 
system that worked for the active Defense Department. So it only made 
sense for them to be the company that also makes that transition into 
the even bigger VA health system--a system that works.
  Almost 2 million veterans have used the Veterans Choice Program. 
Senator Isakson has talked about how the bill we will be voting on 
improves that program. The Senator from North Dakota just spoke about 
some of the obstacles that, frankly, the VA system had put in the way 
of veterans who wanted to take advantage of the program.
  I have had people from Missouri in our office lately who are looking 
at VA health. We had a great discussion with the hospital 
administrators in our State about how it not only helps them but 
particularly helps small community hospitals, if they can identify 
something that a community hospital does better than they do and they 
are able to assign that work to be done there.
  The bill expands, as Senator Hoeven just mentioned, the caregivers 
program and makes the eligibility for caregivers greater than it has 
been before.
  Senator Blumenthal and I had a bill that was incorporated into the 
program, the Veteran PEER Act, which just simply turns to peer group 
veterans and lets them become part of the emotional and mental support 
team for veterans who are being challenged. I am glad to see that 
legislation in the MISSION act that has gone through the process. 
Certainly, Senator Isakson and Senator Boozman and others on the 
Veterans Committee--the people who have served on that committee in 
many cases in the House and Senate--realize what needs to be done here. 
Nearly 40 veterans service organizations, like the VFW and the American 
Legion, support this legislation.
  Together with the VA MISSION Act, the electronic health records 
system contract that is now being performed by Cerner, the HIRE Vets 
Act, and the Military Family Stability Act, I think what we see here is 
that when we think we have done everything we need to do to honor our 
veterans and, then, we look more closely, we find that there are still 
things that we can do, that we will do, that we clearly are willing to 
do. We owe veterans that.
  We recognize veterans in many ways over the next few days, but the 
Veterans' Administration has a job to recognize veterans every day and 
fulfill our obligation to veterans every day. I look forward to seeing 
the implementation of this well-thought-out addition to the veterans 
health system.
  I see my friend from Arkansas, Senator Boozman, is here, and he is 
next on our list.

[[Page S2861]]

  The PRESIDING OFFICER. The Senator from Arkansas.
  Mr. BOOZMAN. Mr. President, I thank the Senator from Missouri very 
much.
  Our Nation's veterans were promised access to healthcare for their 
service and their sacrifice. This week we continue our work to uphold 
that pledge.
  The bill before us, the VA MISSION Act, aims to transform the 
Department of Veterans Affairs delivery of community healthcare. That 
is a welcome job.
  Specifically, the VA MISSION Act consolidates and improves VA 
community care programs so veterans have access to healthcare and 
services in their own communities. This is important because veterans 
should have access to the best healthcare and services in a timely 
manner, regardless of where they live.
  Under this legislation, a veteran and his or her doctor will decide 
where that veteran will receive care, taking into consideration the 
veteran's healthcare needs and the availability and the quality of both 
VA and community care.
  For largely rural States, like Arkansas, this makes all the sense in 
the world. We have two VA medical centers in the Natural State, in 
Little Rock and in Fayetteville, as well as facilities in neighboring 
States that often serve Arkansas veterans. The healthcare providers and 
staff at those facilities that are community-based outpatient clinics 
in Arkansas truly do an excellent job in caring for our veterans.
  But the VA medical centers are in populated areas, which, in cases 
where veterans need more advanced care than the CBOC can provide, it 
means a full-day trip for many veterans. It is unnecessary when a 
veteran could receive similar quality care outside the VA system in 
their communities. The service options provided in this bill will give 
veterans who live far from the VA facility and need frequent followup 
care easier access to local providers and walk-in clinics.
  As noted in a letter signed by over 30 VSOs supporting the VA MISSION 
Act, the legislation is an effort to ``supplement, not supplant, VA 
healthcare.'' That is very important to note. Much like the Choice 
Program that preceded it, the new system that will be established by 
the VA MISSION Act is not meant to replace VA healthcare. Rather, it 
builds on the foundation laid out by the Choice Program, which 
addressed many shortcomings within the VA system that led to the wait-
time process.
  Last year, I launched a listening tour to hear from Arkansas veterans 
about their experiences within the Choice Program, so we can better 
meet their needs. I heard from Arkansas veterans who have been able to 
get quality care from private providers in their own community when the 
VA system could not meet their needs. That is a good thing, but as the 
veterans with whom I met noted, the Choice Program had its share of 
problems, its share of troubles. I heard repeated stories of 
difficulties navigating the complex and confusing bureaucratic process. 
This legislation aims to alleviate those problems. While VA implements 
the new system, we cannot afford to let care slip for our veterans. 
That is why we made sure the VA MISSION Act authorizes funding to 
continue the current Choice Program for more than a year.

  In addition to the improvements to healthcare delivery, the bill will 
enable us to conduct better and more consistent oversight into how the 
VA spends money on veterans' healthcare. This is a priority for me as 
the chairman of the Appropriations Subcommittee on Military 
Construction and Veterans Affairs. We must ensure that the VA is 
efficiently and effectively providing veterans with quality healthcare, 
whether at a VA facility or a private facility in the community. The VA 
MISSION Act will also improve the VA's ability to hire quality 
healthcare professionals, strengthen opioid prescription guidelines for 
non-VA providers, and create a process to evaluate and reform VA 
facilities so they can best serve veterans.
  I wish to quickly highlight two other important provisions of the 
bill. One is the expansion of the VA caregiver benefits to veterans of 
all generations. This is a long-overdue reform that will correct an 
injustice that left family caregivers and veterans injured before 
September 11, 2001, without critical care. Caregivers and veterans of 
World War II, the Korean war, the Vietnam war, and the Gulf war will 
now have access to the same benefits as the post-9/11 veterans.
  The second revision is based off a bill I cosponsored that would 
authorize VA healthcare professionals to provide treatment to patients 
via telemedicine regardless of where the covered healthcare 
professional or patient is located. The Arkansas VA medical centers are 
leaders in telehealth, which holds great promise, especially for 
largely rural States like Arkansas. It is important that the VA 
continue to encourage its growth without unnecessary bureaucratic 
redtape.
  This bill is a great example of what we can accomplish through 
bipartisan, bicameral compromise, working together for our veterans.
  I thank the majority leader for swiftly bringing up this bill for 
consideration after the House overwhelmingly passed it. I commend 
Chairman Isakson's hard work and leadership. I appreciate the great job 
he has done and also Ranking Member Tester, who took the advice of all 
VA Committee members into consideration while working on this major 
piece of legislation.
  I look forward to supporting the VA MISSION Act on the Senate floor 
so our veterans have access to the quality care they deserve.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. LANKFORD. Mr. President, I ask unanimous consent to enter into a 
colloquy with Senator Isakson.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LANKFORD. Mr. President, I thank Chairman Isakson for the work he 
has done on this important issue. It has been a long road to work 
through reforming the VA. The VA is exceptionally complicated. There 
are a lot of interests engaged with this. He has heard a lot of voices 
from all over the country and all over this town in order to help 
resolve some of the issues and bring them together.
  This is exceptionally important, though, for our veterans--especially 
for our veterans who live in rural areas that are very far from 
healthcare.
  Section 101 of this bill requires the VA to give access to community 
care when a veteran's referring clinician agrees that furnishing care 
or services in the community would be in the best interest of the 
veteran after considering certain criteria--and this is very 
important--things such as the distance they have to travel; the nature 
of the care that is required; the frequency of the care, so they don't 
have to travel back and forth, often for long distances; the timeliness 
of available appointments; whether the covered veteran faces an unusual 
or excessive burden. It includes the family and the veteran. So in the 
conversation that is happening, it is not just a clinician making a 
decision; the veterans are at the table, and their family is brought 
into consideration.
  This is important not just for so many veterans who have to travel 
long distances; it is important for veterans who live close. The 
chairman and I have spoken on this briefly before.
  I have a veteran in my State who was at the Muskogee facility and who 
was getting great care. I stopped by to visit veterans in the Muskogee 
facility and went room to room visiting with people, checking on them 
and their care. I asked how he was doing, and he said he had great 
nurses and great doctors and has really done well.
  My next question: Is this the first time you have been in this 
facility?
  He said: Well, no--kind of. I had cancer treatment a couple of years 
ago. But they couldn't do it here in my town; they sent me to Seattle 
to get my cancer treatments.
  I said: Did your family get to go?
  He said: No, sir. They couldn't go.
  So that was the best facility.
  He said: I got good care there, but I went a long way and spent 
months and months away from my family getting chemo, radiation, 
surgery, and then followup.
  He would have loved to have done that at any number of cancer 
facilities in Oklahoma. In fact, in Oklahoma City, there is a National 
Cancer Institute--one of top 2 percent of all the cancer hospitals in 
the country is right down the road.
  The question is, Once this bill passes, in future situations where 
veterans are

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facing great need for specialties--like cancer and other issues--will 
this be a situation where veterans will continue to be sent across the 
country, away from their families, for care because that is easiest on 
the VA, or will their family members and the frequency of visits be 
brought to bear in that so they will be able to make the decision that 
maybe they can get that great care locally?
  Mr. ISAKSON. I thank the distinguished Senator from Oklahoma. I will 
tell him that the story of his veteran from Muskogee led us to the way 
we wrote a lot of the provisions in section 101. Comfort, ease, and 
accessibility for the veteran are equally important to every other 
consideration that will go in.
  The veteran who was sent to Seattle before would now be able to get 
treatment in Oklahoma City or in Muskogee or wherever else closer to 
home that is more convenient as long as it is in the best interest of 
that patient. Specifically, it says that a veteran and the veteran's 
referring clinician agree that the care or services in the community 
would be in the best medical interest of the veteran after considering 
criteria, including--and then all those criteria. So every personal 
criterion, as well as medical criterion, is considered. So that should 
never happen again because of the VA MISSION Act. I appreciate the 
Senator bringing it to our attention, and I hope it never happens again 
in Oklahoma or anywhere in the United States.
  Mr. LANKFORD. Anywhere else. I thank the chairman for that 
clarification. We look forward to doing what is in the best interest of 
the veteran and the veteran's care--not necessarily what is the 
simplest thing for the VA but what is in the best interest of that 
veteran and their family.
  I appreciate all the great folks at the VA who serve our veterans so 
faithfully every day and will continue to be able to give them what 
they need to do that but also help our veterans know that they are 
going to be taken care of in the best possible way.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, as we approach Memorial Day weekend, we will 
soon pause to honor and remember the members of our Armed Forces who 
have paid the ultimate price in service to our country.
  As Americans, we honor all our veterans who have sacrificially fought 
for our freedoms--certainly those who have paid with their lives but 
also those who have returned home, determined that we not forget their 
fallen brothers- and sisters-in-arms.
  Among the most meaningful ways Congress can honor our veterans is to 
uphold the promises that have been made to them. One such promise and 
responsibility is to ensure that America's veterans have access to the 
quality medical care they earned through their service.
  I thank Chairman Isakson and his staff for all the effort they have 
put into the bill before us. His tireless work on behalf of America's 
veterans has produced the compromise legislation now pending that aims 
to reform the VA's broken community care programs.
  I particularly appreciate Chairman Isakson for sending his staff to 
Wyoming to understand the problems our veterans and providers have had 
with VA Choice.
  Since the VA Choice Program was enacted in 2014, I have received 
hundreds of letters and calls from people across Wyoming who were so 
frustrated with the program that they felt they had no other choice but 
to call their Senator. I have been contacted by veterans who could not 
access timely followup care or critical screenings because of unpaid 
claims, leading to providers dropping patients. Some veterans are even 
facing collections from the Choice Program's failure to pay the 
providers' claims.
  Similarly, many providers have not been paid for medical services 
they have provided. That has led some of Wyoming's physicians to stop 
participating in VA Choice. We are the least populated State in the 
Nation, but earlier this month, we had 3,130 pending claims in Wyoming, 
with 1,025 of them being over 30 days old. To get those numbers to even 
that level has required multiple meetings with the Department of 
Veterans Affairs and the administrator of the VA Choice Program for 
Wyoming. At the end of March, there were 5,319 pending claims and 3,214 
more that were more than 30 days old. A number of my colleagues have 
participated in those meetings, and I appreciate their shared interest 
in improving care for our veterans in rural States.
  Despite those meetings, I still hear reports about how difficult it 
is to get simple questions answered. Whether dealing with the VA 
directly or with contractors who are supposed to administer the 
program, the process of receiving and paying for healthcare services is 
broken.
  I believe the problems faced by Wyoming's veterans and doctors will 
be improved by this bill. I thank the Senator from Georgia for 
including provisions related to healthcare providers, veteran 
education, prompt payment to providers, tools for the VA to resolve 
payment issues, and VA flexibility to enter into agreements between VA 
facilities and healthcare providers. However, I do have one 
disappointment. I do have one concern with the bill. It is not paid 
for. I believe we must acknowledge that borrowing more money to pay for 
this program isn't an ideal way to honor our veterans. CBO estimates 
that Federal outlays will total more than $56.6 trillion over the next 
10 years--that is $56,600 billion--and yet nowhere in that budget can 
we find $4.5 billion to offset the cost of this program?
  I believe we should care for our veterans in a fiscally responsible 
manner. In fact, I believe this is the best way to ensure their care 
long term, as well as the care for veterans of the next generation.
  I ask for support of the bill.
  I thank the Presiding Officer.
  I yield the floor.
  Ms. MURKOWSKI. Mr. President, I ask unanimous consent to engage in a 
colloquy with my friend and colleague, the distinguished chairman of 
the Senate Veterans' Affairs Committee, Senator Isakson.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. MURKOWSKI. Mr. President, I would like to confirm my 
understanding that the term Indian Health Service as it appears in 
section 101 of the MISSION Act of 2018 includes Tribal health providers 
that are funded by the Indian Health Service and step into the shoes of 
the Indian Health Service pursuant to the Indian Self-Determination and 
Education Assistance Act to provide healthcare.
  Mr. ISAKSON. Mr. President, the Senator is correct. The term Indian 
Health Service includes Indian Tribes and Tribal organizations that 
operate healthcare facilities in lieu of the Indian Health Service 
pursuant to a contract or self-governance compact with the Federal 
Government.
  Mr. ENZI. 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. BARRASSO. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.