[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.