[Congressional Record Volume 168, Number 98 (Wednesday, June 8, 2022)]
[Senate]
[Pages S2849-S2850]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                     Honoring Our PACT Act of 2021

  Mr. SANDERS. Mr. President, I rise today in strong support of the 
PACT legislation that we are now considering.
  As a former chair and longtime member of the Senate Veterans' 
Committee, one of my highest priorities is to make certain that every 
veteran in this country, people who have put their lives on the line to 
defend us, get the quality healthcare and benefits that they have 
deserved.
  This is an important piece of legislation, and I want to congratulate 
Senator Tester, chair of the committee, and Ranking Member Moran for 
their hard work on this. This legislation will improve healthcare, 
research, and resources for veterans who were exposed to deadly toxic 
substances and environmental hazards, including open-air burn pits, 
during their military service. This legislation will finally recognize 
and treat toxic exposure as a cost of war for the millions of veterans 
Congress has ignored for far too long. And we do that by adding 23 burn 
pit and toxic exposure-related conditions to the VA's list of service 
presumptions. This will mean that some 3.5 million veterans will now be 
eligible for VA healthcare, and that is very, very important.
  It goes without saying that in the wealthiest country on Earth, where 
we spend more on defense than the next 11 nations combined, no veteran 
should be without the healthcare that they are, in my view, entitled 
to. I understand there is not the political support for this in 
Congress right now, but I happen to believe that in a world in which 
nation after nation guarantees healthcare to all of their people as a 
right--in fact, we are the only major country on Earth not to do that--
that the very least we could do is to make certain that every man and 
woman who has put the uniform of the United States of America on, put 
their lives on the line, are, in fact, entitled to healthcare because 
they served our country. That is my view. This bill does not do that, 
but this bill does at least enroll 3.5 million more people for VA 
healthcare, and it is a step forward.

  In terms of this bill, clearly, it is unacceptable that we have 
exposed our military members to toxic burn pits and other dangerous 
substances on the battlefield. For decades, the Pentagon has utilized 
open-air burn pits to dispose of a wide variety of waste, including 
medical, human, and hazardous waste.
  Way back in 2009, when he led the U.S. Central Command, GEN David 
Petraeus sounded the alarm ``about the effects of burn pits and 
airborne toxins on our servicemembers and civilians.'' Despite those 
concerns, DOD continued to expose U.S. forces to burn pits, leaving the 
VA with the responsibility of dealing with the consequences of these 
dangerous and deadly actions.
  So the bottom line is, I am deeply supportive of this legislation. It 
is a step forward. But we can significantly improve this bill, and that 
is why I have introduced four amendments to this important bill that I 
hope will be supported by the Senate.
  First, this first amendment that I have offered will expand permanent 
access to VA healthcare to members of the National Guard and Reserve 
who are not otherwise eligible. Right now, National Guard men and women 
who are activated on Presidential orders are eligible for VA 
healthcare, and that is good, but that turns out to be only a very 
small percentage of people who are in the National Guard and Reserve. 
And I happen to believe that if you are in the National Guard or 
Reserve and you could be called up at any moment to put your life on 
the line, I think you should be entitled to VA healthcare. And that is 
what that amendment does.
  The second amendment deals with--what can I say--a pathetic and 
laughable bureaucratic nightmare that currently exists in the VA. And 
Rube Goldberg would have a hard time coming up with a system like this. 
This is really quite amazing. And that is, within the VA bureaucracy, 
which is itself difficult to overcome for many veterans, you have a 
system which now has over 3,000 income eligibility standards based on 
ZIP Codes.
  So a veteran out there watching this says: You know, I would like to 
apply for VA healthcare. I served my country honorably. How do I do it?
  Well, it turns out that, depending on your income and depending on 
the ZIP Code that you live in, you may or may not be eligible for VA 
healthcare. So, in other words, in Vermont you can have one veteran 
with an income of X living across the street from another veteran who 
has an income of Y, $3,000 more or less. One veteran will be eligible 
for VA healthcare; another will not. In a large State like California, 
you have literally hundreds of different income eligibility standards 
that veterans are going to have to overcome.
  So if people go to a service officer in the VFW or the American 
Legion and ask: Am I eligible, it takes a lot of research to determine 
whether you are eligible. Look at the eligibility standards for San 
Francisco versus Los Angeles, for example. There are many, many 
thousands of dollars in differential. So you could be eligible in San 
Francisco--rather, eligible in Los Angeles and not in San Francisco. It 
really makes no sense. It is a nightmare.
  This amendment simplifies it. It simply says that every State in the 
country takes the highest level of income eligibility and that is the 
standard. So you will have 50 standards rather than 3,000 standards, 
and I think that will make it a lot easier for veterans to access VA 
healthcare.
  My third amendment is a pretty simple one. It says that the VA should

[[Page S2850]]

maintain a dental clinic in every State in the country to provide 
necessary dental services for veterans. Right now, there are very few 
States that do not have at least one dental clinic. My own State of 
Vermont is one of those States, and I think every State should have 
that.
  My fourth amendment again deals with the issue of dental care. One of 
the many, many crises facing the American dysfunctional healthcare 
system is that, by and large, we do not recognize dental care as being 
healthcare, and the result of that in the general public is there are 
many, many, many millions of people who cannot afford the outrageously 
high cost of dental care. These are people, including many seniors, who 
literally lose all of the teeth in their mouth; they can't chew their 
food properly. For younger people, they can't go out and get a job 
successfully because if you open your mouth and you don't have any 
teeth in it, it is kind of hard to get hired under those conditions.
  Currently, out of the 8.9 million veterans enrolled in VA healthcare, 
only 16 percent--or 1.4 million veterans--are eligible for dental care, 
and that is because, within the VA, almost the only people eligible for 
dental care are those with service-connected problems. In other words, 
if you have a service-connected issue with your mouth, with your teeth, 
you are eligible for VA healthcare, but if you don't, if you are simply 
a veteran whose teeth are rotting in his or her mouth, sorry, you are 
not eligible.
  And the limitations of that approach are not only that dental care 
should be considered as healthcare in general; if somebody is suffering 
with poor dental care, we should take care of that person because it is 
healthcare. But there is no question that dental problems, oral 
problems--infections, et cetera--have an impact on our overall health.

  According to the VA, there are roughly 3.9 million veterans who have 
chronic diabetes and heart disease who are enrolled in the VA--3.9 
million. Most of the veterans diagnosed with diabetes were exposed to 
Agent Orange during their service in the Vietnam war. Furthermore, the 
overwhelming healthcare consensus is that poor oral health worsens the 
symptoms of diabetes and heart disease. So what that means in English 
is that you have veterans out there who are struggling with diabetes, 
struggling with heart disease, and their problem is exacerbated by poor 
dental health, poor oral health; and yet they can't get the dental care 
they need, which not only should be an end in itself, but it also 
impacts their overall health.
  So, without going into great detail, I would say that providing 
dental care to veterans not only eases pain, not only addresses overall 
healthcare concerns, but it ends up being a very cost effective 
approach. In a 2019 report to Congress on the cost of expanding dental 
care--something that I asked for--the VA stated--and I quote:

       . . . the provision of dental services could result in some 
     reduction in total health care costs.
       Neglecting oral health can contribute to health problems 
     including bacterial pneumonia, cardiovascular disease, and 
     oral cancer.

  In other words, when you treat oral problems, you are treating 
overall health issues; and you can keep people healthier and not have 
to expend a whole lot of money dealing with the health problems of 
those veterans.
  During a VA briefing earlier this month, the VA's office of dentistry 
stated unequivocally that ``dental care is essential to overall health 
care'' while simultaneously advocating to maintain VA's dental 
eligibility status quo.
  The bottom line is that it is not complicated; dental care is 
healthcare. By ignoring dental care, we cause other healthcare problems 
and we increase expenses to the VA.
  So those are the four amendments, and I hope the Senate will give 
them serious consideration.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas.