[Congressional Record Volume 165, Number 103 (Wednesday, June 19, 2019)]
[Senate]
[Pages S3824-S3826]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                             VA MISSION Act

  Ms. ERNST. Mr. President, one of the most sacred promises our Nation 
makes is our pledge to care for our men and women in uniform when they 
return home.
  When it became clear that the VA was falling short of that standard, 
I am proud to say that we here in the Senate put politics aside, rolled 
up our sleeves, and actually got to work.
  The result was the VA MISSION Act, a bipartisan bill that aims to 
ensure our veterans are receiving the quality care they have earned and 
deserve. I was honored to have been on hand in the Rose Garden 
representing Iowa, its veterans, and its military families, as 
President Trump signed this bill into law.
  This month, the more than 200,000 veterans across Iowa will begin to 
see the benefits of those reforms as the VA begins to implement the VA 
MISSION Act. That is because one major focus of the bill was to make 
sure it would help the VA do a better job of taking care of our 
veterans in rural and underserved areas.
  Toward that end, one significant reform that is going into effect 
this month aims to allow rural or disabled veterans to receive care 
from the comfort of their own home by increasing telehealth and 
telemedicine services provided by the VA. This was a provision I pushed 
for, starting with my VETS Act, and I am so glad it made it into the 
final package.
  You see, we in Iowa know that rural and disabled vets face an even 
harder uphill battle when it comes to getting quality healthcare. This 
is because doctors aren't right down the street or a short drive away. 
These folks have to drive many miles just to see a caregiver and 
sometimes many more for followup treatments or procedures.
  The law includes a lot of other great reforms. It expands VA 
caregiver benefits to pre-9/11 veterans. It takes steps to modernize VA 
facilities, increases resources to hire more providers, and helps 
ensure prompt payment to community providers. It is just another 
example of how, despite what folks may see on television, the Senate is 
passing legislation that is making a positive impact on Americans' 
lives.
  Our veterans have selflessly sacrificed in defense of our freedom and 
our great way of life. They deserve nothing less than the benefits they 
were promised and better access to quality care.
  With the VA MISSION Act, the Senate has given the VA the tools it 
needs to work toward keeping that promise. I am so thankful for the 
other Members who will be joining me here today on the floor to talk 
through the successes of the implementation of the VA MISSION Act.
  Of course, a strong leader who brought this bill over the finish line 
is the chairman of the Veterans' Affairs Committee.
  I yield to the wonderful Senator from the great State of Georgia, 
Johnny Isakson.
  (Mr. PERDUE assumed the Chair.)
  Mr. ISAKSON. Mr. President, just for the record, a staff sergeant 
just addressed a lieutenant colonel. She is beautiful, and she is also 
very smart. I am glad to be in the military with her. I am glad to have 
served our country and proud of the service she has given our country 
and the service she gives to the U.S. Senate and the great State of 
Iowa.
  As chairman of the Veterans' Affairs Committee, I have had a great 
experience the last few years pretty much lined up with what Senator 
Ernst said.
  When we got here 4 years ago in the Senate and took this committee, 
the VA was a mess. Veterans services were not being met. There was 
story after story after story of veterans not getting appointments 
kept, the wrong tooth being pulled, the wrong leg being set, the wrong 
disease being treated. Lots of hospitals had sanitation problems. There 
were just a whole lot of things, and I said ``What have I gotten myself 
into?'' because I came here to go on the committee and try to help our 
veterans get better healthcare. Instead, I thought I was presiding over 
the end of healthcare.
  So we all set our minds--Senator Ernst and I, Senator Perdue in the 
Chair now, and Mr. Scott from the great State of Florida--all of us 
rallied and said: We are going to make this right. We are going to go 
on a mission. Our mission is to make the VA work and make it work for 
our veterans. We are not going to take no for an answer.
  On the 6th day of June, a week and a half ago, we all celebrated the 
75th anniversary of D-day. But it was the first anniversary of a 
renewed VA--a VA on a mission. I am proud to tell you now that on the 
first anniversary of the VA MISSION Act, which passed last year, we 
have fewer complaints, more compliments, better reserve, and better 
outcomes. We are working toward seeing to it that we have the best 
possible healthcare we can have for our veterans.
  I am glad to join Senator Ernst and the other Senators who will speak 
about the promises of the VA system now being met for those who have 
sacrificed and risked their lives for us, being sure they are given the 
healthcare they want. We are doing it by applying the right types of 
principles and the right type of can-do attitude.
  Care in the community, which is a major portion of the MISSION Act, 
was the most important part. Care in the community is basically all of 
the services we put together to make healthcare accessible to our 
veterans. We were having a problem with veterans getting appointments 
within 30 days of making the appointment. We were having trouble with 
veterans who live more than 40 miles from a VA hospital or VA CBOC to 
get appointments in time in the system. We have had problems with 
certain rare diseases and difficult problems only from the types of 
warfare we are in today with IEDs and things like that to get the right 
doctors with the right veterans at the right time.
  Then, we had the problem of America being a country spread out all 
over the place, 48 contiguous States from Montana to Florida. A lot of 
doctors have to be utilized to get care to the veteran. It is the same 
thing with Hawaii, the same thing with Alaska.
  But we put the whole thing together in a care in the community 
package, which started during last year and now is in full swing, and I 
am proud to tell you--and I am sure I am going to regret saying this--
but we didn't have a complaint in the first week after the inception 
last year about the system failing to work.
  The access standards have been looked at and improved. We took the 
mistakes we made a year ago and put the answers in place, solutions in 
place. We did everything we could to make our mission a winner for the 
veterans, and we did. I am here today to join my other colleagues who 
are going to speak about the MISSION Act and about our veterans. We are 
very proud that we took the challenge to see to it that something we 
had promised them years ago--our vets--works and worked better for 
them, and we will continue to keep that pledge in the years to come.
  We owe no greater obligation than we do to those who served our 
country in the military. Our obligation is to see to it that what we 
promised them when they joined is what they get when they are in the 
veteran status. As long as I have the ability to serve in the U.S. 
Senate and as chairman of that committee, I will remain committed and 
remain on a mission to see to it that we make that a reality for all of 
our veterans.
  With that said, I suggest the absence of a quorum.

[[Page S3825]]

  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. HOEVEN. Mr. President, I ask unanimous consent that the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HOEVEN. Mr. President, I am pleased to come today and join my 
colleagues to highlight the VA MISSION Act--legislation we passed to 
provide our veterans with access to health and long-term care closer to 
home. This month, I had the opportunity to join a Senate delegation in 
Normandy for the 75th Anniversary of D-day. We had the honor of meeting 
with some of our veterans who landed on the beaches of Normandy, and we 
were reminded, once again, of the tremendous sacrifices our Nation's 
veterans have made to preserve our way of life and keep our Nation 
free.
  Given their service and sacrifice, the least that our Nation can do 
is uphold its commitment to provide our veterans with the healthcare 
they have truly earned. Over the last year, we have been working with 
the VA to ensure that the MISSION Act is properly implemented so it 
truly benefits our veterans. This bipartisan legislation not only 
strengthens the VA's ability to provide care for our veterans, but when 
the VA is unable to do so, it gives our veterans more options to seek 
care in their home communities. This has been a top priority for 
veterans in my home State of North Dakota and across the country.
  The VA MISSION Act removed the arbitrary 30-day, 40-mile eligibility 
requirement that prevented veterans living within 40 miles of a VA 
facility from being eligible for care in their home community. Now, 
when a VA Medical Center or community-based outpatient clinic isn't 
able to provide the services a veteran needs, our veterans are able to 
access healthcare services in their local community.
  Additionally, the VA MISSION Act contains provisions from the 
veterans access to long-term care and health services legislation I had 
introduced, which allows non-VA, long-term care providers--so now long-
term care providers, nursing homes and others--to enter into veterans 
care agreements with the VA. These agreements will help cut through the 
bureaucratic redtape at the VA and help veterans access nursing home 
and other long-term care in their communities, including home-based 
care services--again, providing not only healthcare but long-term care 
to our veterans closer to home, in their home communities and closer to 
their loved ones.
  We are continuing to work with the VA and long-term care providers to 
ensure that providers that want to treat veterans are able to do so 
without unnecessary burdens, meaning without additional inspections, 
without additional redtape that in some cases, causes our long-term 
care providers--whether it is nursing homes or in-care providers--to 
not accept VA reimbursement. This makes sure that they can take VA 
reimbursement and that the rules and requirements are the same as if 
they are taking Medicaid or Medicare reimbursement. This is very 
important for our veterans, but it makes sure that we streamline the 
process so those nursing homes or those home-based and community-based 
services in a community provide those services to our veterans and take 
VA reimbursement to do it.
  Our veterans have sacrificed so much for our Nation, which is why we 
continue working to implement the VA MISSION Act properly and ensure it 
meets our goal--meets our goal of providing veterans access to 
healthcare and long-term care closer to home.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Indiana.
  Mr. YOUNG. Mr. President, having served in the Navy and as a Marine 
Corps officer, I am sensitive to the many challenges facing our 
veterans. The VA was established almost 90 years ago, so when the VA 
MISSION Act was passed, it was time for a wide-scale reform to 
modernize and improve the system.
  I was proud to support and vote for the VA MISSION Act, which was 
signed into law 1 year ago this month. This new program could 
dramatically change the way our veterans receive care. For the first 
time, veterans can walk into a local urgent care clinic, like most 
Americans can--as long as it is in network--and receive care that day, 
at no cost to them, up to three visits per year. They can even get a 
flu shot now at urgent care rather than having to visit the VA for such 
a simple procedure.
  The VA MISSION Act is already at work back home in Indiana. In fact, 
a Hoosier veteran recently approached me while I was traveling 
throughout the State, and he said there was an appointment he could not 
get scheduled with the VA until August or September. Now, we had this 
conversation some weeks ago, but when the VA MISSION Act went into 
effect at the beginning of this month, he tried again, and he was able 
to get an appointment right away. So I am sure this is just the first 
of many positive stories I am going to be hearing as I travel around 
the State in coming days and even years to come.
  It is also important that we in Congress listen to those whose 
experience with the VA has not improved. If there is a part of this act 
that isn't working or isn't being implemented as intended, then we have 
to revisit it. We have to work with the VA to get it right--removing 
barriers within the system and streamlining access to care. This is 
going to help veterans of all eras live happy and healthier lives. So 
that is what matters the most.
  I will continue to fight for the proper care and treatment of our 
veterans because they deserve nothing less.
  I yield back.
  The PRESIDING OFFICER. The Senator from Arkansas.
  Mr. BOOZMAN. Mr. President, I am pleased to join my colleagues today 
to show our continued support for improvements to the VA Community Care 
Programs. Last year, under the leadership of Senate VA Committee 
Chairman Isakson and Ranking Member Tester, we passed the VA MISSION 
Act so veterans would have access to healthcare and services in their 
own communities.
  I was proud to support this landmark legislation that improves how VA 
delivers healthcare. Earlier this month, the VA rolled out the Veterans 
Community Care Program. The VA MISSION Act offers veterans more options 
to better support their needs no matter where they live. This allows a 
veteran and his or her doctor to decide where it is best for the 
veteran patient to receive care, taking into consideration the 
veteran's healthcare needs and the availability and location of both VA 
and community care.
  For veterans who live in a rural State like Arkansas, this is 
especially good news. Arkansas veterans can be proud of the VA 
facilities in our State. The VA hospitals in Little Rock and 
Fayetteville and those in neighboring States provide quality care and 
service for our veteran population. The challenge is, these are located 
in more urban areas.
  The community-based outpatient clinics, known as CBOCs, make 
healthcare more accessible to veterans in rural areas, but if a veteran 
needs more advanced care than a CBOC can provide, it can mean a full-
day trip to the nearest VA Hospital. The reforms to community care will 
allow more veterans to avoid that extended travel time and enable them 
to receive quality care within their own community.
  This program expands access to more local doctors and urgent care 
within the VA's contracted network. Our Nation's veterans were promised 
access to healthcare for their service and sacrifice. The program 
continues our work to uphold that pledge.
  The VA MISSION Act improves the VA's ability to hire high-quality 
healthcare professionals, expands VA caregiver benefits to veterans of 
all generations, and creates a process to evaluate and reform VA 
facilities so they can best serve veterans.
  It is evident that under Secretary Wilkie's leadership, his team has 
been focused on executing a complete plan to implement this program and 
minimize any negative consequences our veterans might face as we 
transition to the new and updated Community Care Program.
  The VA has been proactive in educating veterans about the reforms and 
eligibility requirements with a variety of sources of information about 
criteria for the new community care.

[[Page S3826]]

  The Department has provided training to VA employees across the 
country on the updated criteria. Its initial outreach included talking 
to healthcare providers also about the changes.
  There are still parts of the VA MISSION Act that have not yet been 
enacted, but so far, I am pleased with the rollout. My colleagues and I 
on the Senate VA Committee take our oversight responsibility very 
seriously. We will continue to closely follow the implementation and be 
ready to fix issues that may arise along the way so we can be sure that 
benefits are delivered as they were promised. The responsibility to 
ensure funding for community care programs falls to the Appropriations 
Subcommittee on Military Construction and Veterans Affairs.
  As the chairman, I will continue working to fully fund the expansion 
of community care, and I look forward to support from my colleagues to 
provide the necessary resources to ensure this program's success.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Indiana.
  Mr. BRAUN. Mr. President, my hometown of Jasper, IN, sits in the 
county with the most veterans per capita in the State. My father was a 
tail gunner on a B-17 himself, and I will never forget the lesson he 
and my community impressed upon me of honoring those who have served so 
effortlessly and selflessly.
  Providing for the health and well-being of the men and women who have 
sacrificed so much for our country is the least we can do, and it ought 
to be one of the things we can all agree on in this Chamber.
  When the Trump administration took over, the VA had been in dire 
straits for many years. The passage of the MISSION Act represented a 
great stride toward improving access to quality healthcare services for 
our vets and, especially, a great step for Hoosier veterans.
  A few of the valuable provisions for Hoosier veterans in the MISSION 
Act include these: replacing the mileage requirement with a drive time 
requirement; greatly expanding access to care for Hoosier veterans who 
report to VA hospitals in bigger cities like Chicago, Indianapolis, 
Louisville, and Cincinnati; reducing the maximum wait times and 
reducing the strain on smaller VA facilities that may not have the 
resources or specialties available to serve patients in a timely 
manner; implementing a new urgent care benefit so veterans can now 
utilize urgent care and walk-in facilities from providers in the VA 
network without prior authorization; and a big win for access to care 
for Hoosier vets, allowing veterans to seek out community care if the 
VA medical service line is unable to meet quality standards.
  Before this legislation, Hoosier veterans not receiving proper care 
would have nowhere else to turn. The MISSION Act offers Hoosier 
veterans better choices, better access, and better care.
  As we reflect on the sacrifice of our servicemen and servicewomen 
this upcoming Fourth of July season, we must also remember our 
commitment to them once they return from the field of battle. We have 
made great strides in improving access and quality for veteran care in 
the last 2 years, and the MISSION Act is a big win for Hoosiers and all 
American veterans.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. DAINES. Mr. President, 1 year ago, we came together not as 
Republicans or Democrats but as Americans. We passed a major milestone 
for our veterans. The bipartisan VA MISSION Act brought us a step 
closer to fulfilling our obligation to care for our men and women who 
serve in uniform.
  In Montana we have one of the highest veteran per capita populations 
in the United States, and the issue of access to veteran healthcare is 
one that I hear across every corner of our State.
  My dad is a U.S. marine. I am proud we were able to get this 
important bill signed into law. The VA MISSION Act will help fix many 
of the problems plaguing the VA Choice Program. The veterans across our 
rural communities in Montana will have greater and more convenient 
access to care. Telemedicine services will be strengthened to 
accommodate those who live a long ways away from traditional hospitals 
or health clinics. Oversight of opioid prescriptions will be 
strengthened. There will be greater accountability in how companies 
manage this new program.
  It will help fill the VA's medical professional shortage through 
scholarship and loan repayment programs for medical and dental students 
who commit to serving in the VA. The MISSION Act was an important step 
forward, and I am proud to have helped get this bill across the finish 
line and onto President Trump's desk.
  Now we must hold the VA and the program administrators accountable 
for ensuring the MISSION Act works for our veterans. I will be in 
constant contact with local VA leaders and veterans themselves to get 
firsthand feedback as this is implemented.

  As we celebrate this important milestone, we must not slow down our 
efforts to continue to improve our veterans' healthcare. I look forward 
to continuing to work on behalf of our veterans and build off the good 
work that was accomplished here last year. We must ensure that veterans 
in Montana and across our Nation receive the care they have earned. I 
am honored to fight this fight for the brave men and the brave women 
who served in uniform.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma.