[Congressional Record (Bound Edition), Volume 151 (2005), Part 5]
[Senate]
[Pages 6050-6062]
[From the U.S. Government Publishing Office, www.gpo.gov]




            EMERGENCY SUPPLEMENTAL APPROPRIATIONS ACT, 2005

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of H.R. 1268, which the clerk will 
report.
  The assistant legislative clerk read as follows:

       A bill (H.R. 1268) making emergency supplemental 
     appropriations for the fiscal year ending September 30, 2005, 
     to establish and rapidly implement regulations for State 
     driver's license and identification document security 
     standards, to prevent terrorists from abusing the asylum laws 
     of the United States, to unify terrorism-related grounds for 
     inadmissibility and removal, to ensure expeditious 
     construction of the San Diego border fence, and for other 
     purposes.

  The PRESIDING OFFICER (Mr. Sununu). The Senator from Arizona.
  Mr. KYL. Mr. President, as was just indicated, we are now back on the 
supplemental appropriations bill, which is critical to the funding of 
our effort to continue our activities in Iraq and Afghanistan and 
elsewhere around the world.
  One of the reasons Senator Cornyn and I want to speak for a few 
minutes this morning is to make the point that we very much hope our 
colleagues will join with us in ensuring the quick passage of this bill 
so we can get on with that effort and then move to other business.
  There has been a suggestion that amendments might be offered to the 
bill that do not relate to the funding of the war effort. For example, 
some of our colleagues have talked about offering amendments that 
relate to the subject of immigration. Now, that subject is one we are 
going to have to debate this year, and we are going to have to consider 
legislation very seriously later on this year, but our view is that it 
would be inappropriate to consider that legislation in the context of 
this supplemental appropriations bill.
  We are aware of the fact there was a provision in the House bill that 
related to driver's license standards and asylum, but those are matters 
that relate more to terrorist activities than our immigration laws, as 
they pertain to illegal immigration. Therefore, our view is that we 
would refrain from offering amendments of that kind and would hope our 
colleagues would as well.
  We would hope, by indicating what we plan to do, that our colleagues 
would appreciate our commitment--that is to say, Senator Cornyn and 
myself--to seeing that the issue of illegal immigration generally and 
immigration reform specifically will, in fact, be considered by the 
Senate a little bit later on this year.
  It is our intention to introduce legislation and to work through the 
amendment process, perhaps before that, to ensure that we are doing 
everything we can in the Congress to ensure our borders are secure, 
that we have adequate law enforcement both at the borders and in the 
interior of the country, and that we, therefore, create the 
precondition for the consideration of immigration reform, which is that 
we do have a commitment to enforce the law and abide by the rule of law 
in this country.
  There is one thing I think almost everybody interested in the 
immigration debate will agree on, and that is that we have a broken 
legal system right now. Employers pretend they are not employing 
illegal immigrants, but they know they are, and they have documents the 
Government has called for. The Government pretends to enforce the law, 
but it knows the documents, in many cases, are counterfeit.
  The industry will very candidly tell you they do not know what they 
would do without the illegal employment they have today. So they are 
putting pressure on some of our Members to come forward with 
legislation to create a legal regime for these employees and, indeed, 
there should be.
  We should get to the point where nobody in this country hires illegal 
immigrants anymore. To do that, we are going to have to demonstrate a 
couple things. The first is that we are committed to enforcing such a 
law, because our constituents rightly tell us: Why should we consider 
immigration reform--temporary worker reform, for example--if we don't 
think it is going to be enforced? You are not enforcing the law today. 
What makes us think you are going to enforce the law in the future?
  It is a good question. We have to be able to answer that question in 
the affirmative and say we are committed to enforcing the law. It 
begins with enforcement at the border, and it goes right on through 
with the rest of the law that makes it illegal to hire illegal 
immigrants. Those laws do need to be adequately enforced.
  If we could commit ourselves to do that, then I believe we could lay 
the foundation for successfully getting legislation to provide some 
kind of guest worker or temporary worker program that will both 
liberalize the ability of employers to bring legal immigrants into this 
country to work for them on a temporary basis and also deal with the 10 
to 15 million--nobody knows exactly how many for sure--illegal 
immigrants who exist in the country today. Many of those people work 
hard. They come to work here. They intend only to send money back to 
their relatives in Central America or Mexico or wherever they came 
from. Many of them are, indeed, needed in our workforce. But we cannot 
condone a situation in which they are working illegally. So we have to 
come up with a structure that would permit us to take advantage of 
their desire to work here, but to do so in a legal construct and not to 
reward them with any kind of amnesty.
  The specifics of doing that have been discussed a little bit by the 
President of the United States, who laid out some principles for a 
guest worker program, as he calls it. What Senator Cornyn and I are 
here to talk about today is the fact that we are working on legislation 
to try to embody many of the principles the President has laid out to 
create a legal mechanism by which we can meet our workforce needs in 
this country but to do so all within the rule of law, where the law 
will be strictly enforced, there will be no more hiring of illegal 
immigrants, and therefore we remove the magnet which currently exists 
which draws illegal immigrants into our country because they can be 
employed easily.
  So we remove that magnet, but we do so in a way that does not reward 
the lawbreakers, the people who come here

[[Page 6051]]

illegally and use illegal documentation to obtain employment and, in 
many cases, are creating a drain on society, and ensure they are not 
rewarded for their illegal behavior by amnesty, which I think most 
people would agree, at a minimum, means they would not be granted a 
path to citizenship or be able to chain migrate their family into the 
country ahead of those who want to do so legally; meaning, 
specifically, that, of course, anyone who wanted to do that could get 
in line in their country of origin with a worker sponsor for legal, 
permanent residency or green card status. If they acquired that status, 
then there are other things that flow from that, such as the ability to 
apply for citizenship. But that should only come as a result of going 
home, being there, and getting in line with everybody else. It 
certainly should not be granted to people who came here illegally and 
would be permitted to stay here while that status was pending. That is 
the kind of thing we mean by saying no amnesty.
  But at the end of the day, I think President Bush is right, that we 
have to come to grips with this problem. We have to find a way, as he 
said, to match willing workers with willing employers but to do so 
strictly in the confines of a legal regime. What Senator Cornyn and I 
have been working on for several weeks now is a bill we hope would 
embody many of those principles. It is not going to track exactly what 
the President has proposed. I would also say the President has not 
gotten real specific about several areas, and we are going to have to 
fill in a lot of those blanks.
  We will talk to our colleagues, and we will talk to the various 
groups that are involved in this issue to see what their ideas are 
about how best to make this work. But the bottom line so far as we are 
concerned is, if we do this, we have to be able to commit to the 
American people that since we now have a legal and relatively easy 
mechanism for filling the workforce needs here in our country, we are 
not going to condone any illegal employment in this country. If we 
establish that principle, we then help to remove that magnet which is 
drawing so many illegal immigrants to the United States.
  Just to conclude with this point. I mentioned the fact we would be 
introducing legislation, which we intend to do. But there are also 
opportunities for us to demonstrate this commitment to enforcing the 
law. Let me mention a few of those. In whatever way we can accomplish 
this, whether it be before the introduction of such legislation or in 
conjunction therewith, we intend to move forward.
  The intelligence reform bill of last year authorized 2,000 new Border 
Patrol agents each year for 5 years, but we do not have enough money in 
the budget for any more than about a tenth of that number.
  Currently, there are about 11,000 Border Patrol agents. A pre-9/11 
study conducted by the University of Texas said we needed at least 
16,000 Border Patrol agents on our southern border alone in order to 
secure the border. So we clearly have to fund the addition of more 
Border Patrol agents. Authorized in the intelligence bill as well were 
800 additional Immigration and Customs Enforcement investigators, again 
for a 5-year period, an additional 800 Customs/Border Protection 
inspectors at our Nation's ports, 8,000 new detention bed spaces, and 
some other requirements that all follow if we are going to enforce the 
law.
  We need to fund these programs to demonstrate our commitment to the 
law. We also need to reimburse the States for their incarceration of 
illegal immigrants in prisons. The so-called SCAAP funding accomplishes 
that. It is the State Criminal Alien Assistance Program. But there was 
not any money in the budget this year, and it needs to be at least $750 
million. We need to do some other work to ensure that States do not 
bear the costs of the Federal Government's failure to enforce the 
Federal law.
  There are a lot of things that have to be done. The point we are 
making is, one, this is complicated. It is big. It has to be done. It 
should not be attempted on a bill which we have to get passed quickly 
to ensure funding for our troops in Iraq and Afghanistan and elsewhere. 
This is a debate we can have in the future, and I am assuring our 
colleagues we are moving the process forward. I chair the Terrorism and 
Homeland Security Subcommittee of the Judiciary Committee. My 
colleague, John Cornyn, chairs the Immigration Subcommittee. We intend 
to try to move this legislation through the Judiciary Committee as a 
matter of regular order as soon as we can get our legislation complete.
  My colleague from Texas wants to make a presentation regarding this 
same subject.
  The PRESIDING OFFICER. Who seeks time?
  The Senator from Texas.
  Mr. CORNYN. Mr. President, I want to follow on the comments of 
Senator Kyl because we are working together on this important 
legislation, what we hope and expect will be comprehensive immigration 
reform. The message both of us would like to convey is that this is a 
complex topic. It can't be accomplished this week, especially not on 
supplemental appropriations designed to make sure our troops have the 
equipment and resources they need to fight the global war on terrorism.
  Let me give a little background to explain my perspective. It tracks 
closely with what Senator Kyl has already said.
  Our Nation's immigration system is badly broken. It leaves our 
borders unprotected, threatens our national security, and makes a 
mockery of the rule of law. We have failed to enforce our laws and to 
protect our borders for far too long through years of neglect. In a 
post-9/11 world, we simply cannot tolerate this situation any longer. 
National security demands a comprehensive solution to our immigration 
problem.
  Senator Kyl and I have determined that we would work together. We 
have a particular interest, being Senators from two border States along 
the southern border where the illegal immigration is perhaps the most 
rampant. We also want to come up with a plan that addresses not only 
our national security but deals with the economic issues that are 
integrally intertwined with this complex issue in a way that is 
compassionate and deals with the very real human consequences and 
causes for illegal immigration.
  We are undertaking a thorough review of our immigration laws as we 
speak. At the conclusion of our discussions, Senator Kyl and I plan to 
introduce a comprehensive immigration reform bill that will 
dramatically strengthen enforcement, bolster border security, and 
comprehensively reform our laws. I particularly am glad to be working 
with Senator Kyl. He chairs the Subcommittee on Terrorism, Technology, 
and Homeland Security, and I chair the Judiciary Subcommittee on 
Immigration, Border Security, and Citizenship. We have already had our 
first hearing, a joint hearing, on border security. The second one, 
this Thursday, will focus on interior enforcement, or maybe I should 
say interior nonenforcement, when it comes to our immigration laws.
  In the past, we have simply not devoted the funds, the resources, or 
the manpower to properly enforce our immigration laws and protect our 
borders. That must change. If we have anything to do with it, it will 
change.
  Let me put the matter as clearly and explicitly as I possibly can. No 
discussion of comprehensive immigration reform is possible without a 
clear commitment to, and a dramatic elevation in, our efforts to 
enforce the law. That includes enforcement both at the border and 
within the interior. We must have strong border protection between 
ports of entry and a strong employee verification system to put an end 
to the jobs magnet for illegal entry.
  Our immigration laws also present substantial difficulties to our 
already overburdened law enforcement and border security officials, 
separate and apart from inadequate funding and resources. It is my 
belief these difficulties simply cannot be solved by additional funding 
and additional resources alone, as important as they are. After all, 
under our current immigration laws, literally millions of people enter 
this country outside of legal channels

[[Page 6052]]

to hold jobs that are offered by American businesses and are needed to 
ensure American economic growth. There is a serious concern that some 
fraction of this population may harbor evil impulses toward our 
country. Yet it is a practical impossibility to separate the well 
meaning from the ill-intentioned.
  Put simply, we must focus our scarce resources on the highest risks 
to our country and our national security. We need our law enforcement 
and border security officials to spend their highest energies on people 
who wish to do us harm rather than those who wish only to help 
themselves and their families through work. Our comprehensive 
immigration proposal will strengthen enforcement of the law, but it 
will also provide laws that are capable of strong enforcement.
  We agree with the President's stated principles. They are, however, 
just principles, and certainly he understands and looks to the Congress 
to come up with the specifics in the form of legislation. Such laws can 
be designed in a way to be compassionate and humane. Above all, they 
must be designed to protect U.S. sovereignty and to further U.S. 
interests. They must be reformed to better serve our national security 
and our national economy. They must ensure respect for the rule of law 
and not permit undocumented workers to gain an advantage over those who 
have followed the rules.
  In the coming months we will craft a proposal that implements all 
those objectives, and we welcome the coming debate as well as the input 
and the opportunity to work with our colleagues in the Senate.
  Finally, we speak today as the Senate is about to begin debate on a 
supplemental appropriations bill. Congress should not delay enactment 
of critical appropriations necessary to ensure the well-being of our 
men and women in uniform fighting in Iraq and elsewhere around the 
world. Attempting to conduct a debate about immigration reform while 
the supplemental appropriations bill is pending in the Senate would do 
just that--it would unnecessarily and inappropriately delay getting 
those funds to our troops who need them. Our immigration system is 
badly broken and fails to serve the interests of our national security 
and our national economy and undermines respect for the rule of law.
  To solve that problem, Congress must engage in a careful and 
deliberate discussion about the need to bolster enforcement of and to 
comprehensively reform our immigration laws. We should not short-
circuit that discussion by enacting legislation outside of the regular 
order of business in the House and the Senate. I hope we will enact 
this supplemental appropriations bill soon. Once that process is 
completed, I will continue to work closely with Senator Kyl and any 
other Member of this body who has a good idea to contribute to enact 
comprehensive immigration reform that is in the best interests of our 
Nation.
  I yield the floor.


                           Amendment No. 344

  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, I send an amendment to the desk and ask 
for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Washington [Mrs. Murray], for herself, Mr. 
     Akaka, Mr. Byrd, Mrs. Boxer, Mr. Bingaman, Mr. Rockefeller, 
     Ms. Mikulski, Mr. Jeffords, Mr. Salazar, and Mr. Dayton, 
     proposes an amendment numbered 344.

  Mrs. MURRAY. Mr. President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

   (Purpose: To provide $1,975,183,000 for medical care for veterans)

       On page 188, after line 20, add the following:

                               CHAPTER 5

                     DEPARTMENT OF VETERANS AFFAIRS

                     Veterans Health Administration

                            Medical Services

       For necessary expenses for furnishing, as authorized by 
     law, outpatient and inpatient care and treatment to 
     beneficiaries of the Department of Veterans Affairs and 
     veterans as described in paragraphs (1) through (8) of 
     section 1705(a) of title 38, United States Code, including 
     care and treatment in facilities not under the jurisdiction 
     of the department and including medical supplies and 
     equipment and salaries and expenses of health-care employees 
     hired under title 38, United States Code, and to aid State 
     homes as authorized under section 1741 of title 38, United 
     States Code; $1,975,183,000 plus reimbursements: Provided, 
     That of the amount under this heading, $610,183,000 shall be 
     available to address the needs of servicemembers deployed for 
     Operation Iraqi Freedom and Operation Enduring Freedom; 
     Provided further, That of the amount under this heading, 
     $840,000,000 shall be available, in equal amounts of 
     $40,000,000, for each Veterans Integrated Service Network 
     (VISN) to meet current and pending care and treatment 
     requirements: Provided further, That of the amount under this 
     heading, $525,000,000 shall be available for mental health 
     care and treatment, including increased funding for centers 
     for the provision of readjustment counseling and related 
     mental health services under section 1712A of title 38, 
     United States Code (commonly referred to as ``Vet Centers''), 
     increased funding for post traumatic stress disorder (PTSD) 
     programs, funding for the provision of primary care 
     consultations for mental health, funding for the provision of 
     mental health counseling in Community Based Outreach Centers 
     (CBOCs), and funding to facilitate the provision of mental 
     health services by Department of Veterans Affairs facilities 
     that do not currently provide such services: Provided 
     further, That the amount under this heading shall remain 
     available until expended.

  Mrs. MURRAY. Mr. President, I ask unanimous consent to add as 
cosponsors Senators Akaka, Byrd, Boxer, Bingaman, Rockefeller, 
Mikulski, Jeffords, Salazar, and Dayton.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. MURRAY. Mr. President, today in Iraq and in Afghanistan, our men 
and women in uniform are making great sacrifices to serve our country. 
Last month I had the opportunity to meet with some of them in Baghdad 
and in Kuwait and all of us can be very proud of their service. Every 
person I met with was a dedicated professional who was putting their 
duty above their personal well-being.
  Today, I am very concerned that when all of these new veterans come 
home and need medical care, they are going to be pushed into a veterans 
health care system that does not have the medical staff, the 
facilities, or the funding to take care of them.
  There is a train wreck coming in veterans health care. I am offering 
an amendment to deal with this emergency now before it turns into a 
crisis. The VA health care system is overcrowded. It is underfunded. It 
is understaffed. It is struggling to deal with existing veterans. I 
fear what will happen when tens of thousands of our new veterans are 
added to this already strained system.
  As Americans, we make a promise to those who join our military that 
we will take care of them when they come home. It is a promise all of 
us have to work together to keep, and that is why I am on the Senate 
floor today. This is not a Democratic issue. It is not a Republican 
issue. This is an American issue. I am willing to work with anyone to 
make sure all of our veterans get the health care they are promised.
  I appreciate the leadership of many Senators, especially Senator 
Craig who chairs the Senate Veterans' Affairs Committee on which I 
serve. I thank Senator Hutchison of Texas who chairs the committee that 
funds veterans health care. I truly appreciate their commitment to our 
veterans. I look forward to working with them, and I will work with 
many others to make sure we are doing everything we need to do to 
prepare for the influx of many new veterans.
  With Senator Akaka and others, I am offering a veterans health care 
amendment to this emergency supplemental. Our amendment recognizes that 
caring for our veterans is part of the cost of war. This is being 
offered on the emergency supplemental because our amendment recognizes 
that caring for our veterans is a part of the cost of war.
  Our amendment does three things: First, it makes sure all soldiers 
who need health care when they return home from Operation Enduring 
Freedom and Operation Iraqi Freedom can get that health care. To do 
that, this amendment provides $610 million. Second, it provides funding 
for mental

[[Page 6053]]

health care for our newest veterans. Specifically, it provides $525 
million for expanded mental health services, including $150 million to 
treat post-traumatic stress disorder for counseling, as well as family 
therapy. Third, the amendment helps address the shortfalls that are 
crippling our regional VA networks. It provides $40 million to each and 
every VISN, Veterans' Integrated Service Network.
  This chart shows the 21 regional health networks. For each region, 
our amendment provides $40 million to spend on their priorities. For 
some areas it is going to mean erasing big deficits. For others it will 
help them hire more medical staff. In other parts of the country they 
will use it to buy medical equipment. That flexible funding that each 
VISN gets will allow each region to prepare their staff and facilities 
for our newest veterans. It will put a total of $840 million where 
these local communities need it the most.
  In short, this amendment will ensure that we can handle the health 
care needs of all the veterans who will seek care after serving our 
country in Operation Iraqi Freedom and Operation Enduring Freedom.
  The total cost of the amendment is $1.98 billion. Let me explain how 
we arrived at that figure. First, we looked at the number of new 
veterans who will return to the VA for care. We multiplied that by the 
average cost per patient and added the cost of reversing the deficits 
that are today facing our VA hospitals and the cost of meeting 
increased mental health care needs that everyone assures us we are 
facing.
  Some Senators may wonder if this is the appropriate vehicle to fund 
veterans health care, so let me talk about that for a minute.
  I would have preferred to fund this critical need in the regular 
budget process. I tried to do it several times last month in the Budget 
Committee and on the floor with Senator Akaka. Unfortunately, our 
amendments were voted down. But the need is not going away. The 
shortfalls are only going to get worse. So if we are not going to take 
care of our veterans from Iraq in the regular budget, then we have to 
take care of them in the bill that funds our war efforts. This is the 
appropriate bill because the veterans health care train wreck is an 
emergency, and because caring for our veterans is part of the cost of 
war.
  As I have been talking about this amendment and discussing it with 
our veterans, I have been pleased by the support it has received. This 
amendment is supported by the Veterans of Foreign Wars, AMVETS, 
Disabled American Veterans, Paralyzed Veterans of America, and it is 
supported by the VA workers who care for our veterans, represented by 
the American Federation of Government Employees, AFL-CIO. I thank all 
of these organizations and their members for supporting my amendment 
and reaching out to their Senators to call for its passage.
  Before I go any further, I want to note that veterans health care is 
a very personal issue for me. My father was a disabled World War II 
veteran. I grew up knowing the sacrifices that our veterans make. When 
I was in college, I interned in our VA hospital in Seattle during the 
Vietnam war, and I saw how important the services were to our soldiers 
who were returning. I became the first woman to serve on the Senate 
Veterans Affairs Committee. I know what the costs are and I know what 
the challenges are.
  The VA provides some of the best care, research, and treatment 
anywhere. Our VA employees have a unique understanding of the 
challenges that our veterans face when they return, and their 
dedication is unmatched. Like them, I want to make sure this system 
works for every veteran of every war and every generation.
  I will share some specific examples from throughout our country that 
illustrate the emergency in veterans health care today. These examples 
didn't come from me. They came from people who know our VA facilities 
firsthand. A couple days ago, I posted a form on my Web site, 
murray.senate.gov, where veterans and their advocates can share their 
stories and examples with me. I have been heartened with the things 
people have shared. I invite other veterans to share their stories with 
me and with their own Senators.
  For anyone who thinks this is not an emergency or it doesn't merit 
emergency funding, I invite you to listen very closely. I am going to 
talk about different places, but the overall problem is the same 
everywhere.
  For years, VA funding has not kept up with the growing demand for 
care and with the rising costs of health care. So VA networks around 
our country have held off making improvements. When a doctor or nurse 
left, they were not replaced. When equipment needed to be purchased, it 
was put on hold. When a clinic needed to be opened, it was held in 
limbo. When there wasn't enough money in the operating budget, they 
started taking money from their capital budget.
  Now all those years of chronic underfunding are coming back to roost 
at the worst possible time, as we are about to have a major influx of 
new veterans, men and women serving honorably in Iraq and Afghanistan 
today, when they are returning, our VA facilities across the country 
are facing deficits, staff shortages, and inadequate facilities.
  Let me give a couple of examples that have been shared with me.
  In Alaska, as of yesterday, they are starting a waiting list for 
nonemergency care for all new priority 7 veterans who are not enrolled 
in VA primary care. That means those people cannot get an appointment 
to even see a doctor.
  In Colorado, the Eastern Colorado Health Care System is $7.25 million 
short this year.
  In California, last year, the VA hospital there in Los Angeles closed 
its psychiatric emergency room.
  In Florida, the VISN 8 facilities were facing a $150 million deficit 
earlier this year. West Palm Beach Medical Center has a deficit alone 
of $6 million.
  In Idaho, at the VA in Boise, they are resorting to hiring freezes 
when we have soldiers coming home.
  In Kentucky, veterans at the Louisville hospital, who are having a 
type of bladder examination, have to lie on a broken table because 
there is no money to replace that broken equipment.
  In Maine, the Togus VA has a $12 million deficit.
  In Minnesota, at the Minneapolis VA, they have a $7 million 
shortfall. They have one of the VA's four sites for dealing with 
veterans with complex, multiple injuries but they are not hiring 
anymore staff for that specialized center because of the deficit.
  All of us who have visited our returning soldiers at Walter Reed or 
Bethesda know many of them are returning with these kinds of injuries 
that need to be treated at hospitals such as the one in Minneapolis.
  In Missouri, at the Kansas City VA Medical Center, they have a $10 
million operating deficit. I am also told that in Missouri there are 
not enough doctors and providers to see all the veterans. If a veteran 
is less than 50-percent service-connected disabled, he or she is put on 
a waiting list.
  In South Dakota, they are expecting to be $7 million in the red by 
the end of this fiscal year. The VA is proposing to save $2 million by 
not filling staff vacancies. I am told, in fact, they need 58 new beds, 
and that some of the bedframes in that facility are held together with 
duct tape and wire. So because of the deficits they cannot even buy new 
beds. That is unacceptable for our veterans who have served this 
country.
  I am also told that the Black Hills Health Care System is $3 million 
in the hole. They have had to use the capital budget to pay staff and 
other expenses.
  In Texas, at the Temple, Texas, VA, nurses in inpatient care are 
working 16-hour days several times a week because there is not enough 
staff. We know that nurses providing direct care should only be working 
12-hour days, because longer shifts lead to medical errors and unsafe 
care. This is not a way to treat our veterans who are returning.
  In Virginia, as of January 1, I understand that Virginia had a budget 
shortfall of $14.5 million.

[[Page 6054]]

  In my home State of Washington, we have problems, too. In Tacoma, at 
the American Lake VA, you can only get an appointment if you are 50-
percent or more service-connected disabled. That is not the promise we 
made to the men and women who serve our country.
  In Puget Sound, as of January, there was an $11 million deficit. At 
the Seattle and American Lake VA they are leaving vacant positions 
unfilled. There are about 16 new vacancies every month and those 
positions are remaining empty. They hope to reduce the workforce by 160 
full-time equivalents by the end of this fiscal year.
  This is having a huge impact on our patients. As of this month, the 
next appointment at the Seattle VA urology clinic is not available 
until August. I can tell you that conditions like these are breaking 
the hearts of our VA personnel who work day in and day out with the men 
and women who have served this country. They are frustrated at seeing 
so many veterans not get the care they have earned. Why? Because 
Congress is not providing the money.
  I share these examples not to criticize or cast blame. We have 
problems such as this in my State as well, as I have talked about. I 
share these examples because we have to look at what is happening and 
realize that our VA system is not prepared to handle a new generation 
of veterans. All of these examples, from more than a dozen States, 
point to one conclusion: The VA is having trouble taking care of the 
patients it has today. It is certainly not prepared to handle a new 
influx of veterans from Iraq and Afghanistan.
  Many of these VA centers are in the hole for millions of dollars. 
They are not in a position today to begin expanding care to meet the 
growing need. They cannot do it alone. We have to step in and help 
them.
  Before I close, I want to talk about one claim we made here during 
this debate. Some Senators have suggested that the VA doesn't need any 
additional funding because it has some kind of reserve for $500 
million. I was troubled by the idea that the VA has extra money it is 
not using while so many communities are struggling, so at a hearing 
last week of the Senate Veterans' Affairs Committee I got to the bottom 
of it. I wanted to share this chart with colleagues.
  At our hearing on April 7, I asked Acting Under Secretary for 
Veterans Health Care Dr. Jonathan Perlin:

       Is there a $500 million reserve?

  Dr. Perlin's reply was:

       No . . . I don't know where that might have been suggested, 
     but there is no $500 million reserve that is sitting there 
     for future projects.

  I share that with my colleagues to set the record straight. The VA is 
not sitting on any type of reserve it can use for medical care. That 
comes straight from the man who runs the program nationwide. We have VA 
centers that are struggling in every part of our country. They cannot 
deal with the caseload they have today. How in the world are they going 
to deal with all of the new veterans who are coming home from Iraq and 
Afghanistan?
  We cannot kick this down the road any longer. It is an emergency 
today and if we do not deal with it now, it is going to be a crisis 
tomorrow. This is not a partisan issue; it is an American issue. It is 
about whether we keep the promise to the men and women we send to serve 
us overseas.
  I am willing to work with anyone who wants to make sure our country 
is prepared to care for all of the veterans who will be coming home 
soon. They were there for us. We need to be there for them now. I urge 
my colleagues to support this veterans health amendment. If you are 
concerned about this--perhaps I mentioned your State or you have heard 
from your own veterans--let's talk about it and find a way to make it 
work.
  No matter what party you are in, we are all Americans first. We all 
have an obligation, as President Lincoln said, ``to care for him who 
shall have borne the battle, and for his widow, and for his orphan.''
  We need to pass a veterans health amendment and keep this promise to 
America's veterans. This amendment is the last opportunity we will have 
to make sure our veterans--the men and women serving us--are taken care 
of when they return home.
  The PRESIDING OFFICER. The Senator from Hawaii is recognized.
  Mr. AKAKA. Mr. President, I rise today with my friend Senator Murray 
to offer an amendment to address the cost of providing health care to 
troops serving in Iraq and Afghanistan. She has made an excellent 
statement about what we are facing in the country and the shortfalls we 
have. She has taken the leadership on this and I am supporting her. We 
hope we will be able to continue to help our veterans with their health 
care.
  Following the 1991 Gulf war, returning servicemembers began to report 
unexplained illnesses and ailments that many linked to their service. 
Only those who had been granted a claim for a service-connected 
disability or demonstrated a financial need could turn to VA for health 
care services at that time. Reservists and Guard members were 
particularly vulnerable as military health care is lost after 
separation from service.
  Back in 1998, this very body voted unanimously to ensure that no 
combat veteran would be caught up in stringent eligibility rules and be 
denied treatment. Today, any servicemember who participates in the 
theater of combat is eligible for free VA health care for 2 full years 
after separation or release from active duty, without regard for strict 
eligibility rules.
  This benefit is more important than ever, especially to Reservists 
and Guard members. Experts calculate that about 40 percent of the lower 
enlisted grades in these services do not have any kind of health 
insurance. Because TRICARE eligibility is lost after separation or 
deactivation, VA is the only place many of these service members can 
turn.
  My colleagues in the Senate have already recognized the need to 
provide funds that would allow VA to absorb an influx of new patients 
from Operations Iraqi and Enduring Freedom. In 2003, $175 million was 
added for VA to the supplemental appropriations bill. I point out that 
this amount was provided only 1 month after the war in Iraq began and 
before we knew about the level of troop commitment.
  This amendment we offer today allows VA to provide care for returning 
troops, without displacing those veterans currently using the system. 
We are now 2 years into this conflict, and VA has already begun to see 
real impact. Last year, VA spent $63 million on returning veterans. 
Using data from the first quarter, VA will spend an unbudgeted $120 
million this year. Yet, the lion's share of our troops have not yet 
returned home, are rehabilitating in the DoD health care system, or are 
pending separation.
  The amount of this amendment, $1.9 billion, is drawn from what we 
know about past use of the VA health care system, coupled with what we 
know to be the cost associated with shoring up the system for all 
veterans.
  This is what we know: VA tells us that 20 percent of returning 
service members are now turning to VA for care. Using this figure and 
VA's costs, we know that $600 million in additional funding will be 
needed for returning service members alone.
  We also know that right now VA hospitals are running deficits of 
about $40 million per each health care network. Let me share some 
specifics:
  Outpatient clinics have stopped seeing even the poorest of patients, 
sending them hundreds of miles away to other facilities. The Townsend, 
MA, clinic is only seeing a tiny percent of those who need care.
  In Network 20, which serves the Northwest and Alaska, we have now 
seen the beginnings of what could very well become a nationwide trend. 
Priority 7 veterans, who often make as little as $26,000 a year, are 
being denied care, as the Network is running about a $40 million 
deficit.
  Veterans in need of treatment for PTSD or addiction treatment will 
have one less place to go due to the VA budget. The Psychiatric 
rehabilitation program at the Chillicothe VA hospital is being shut 
down.
  Thirty nursing home beds at the VA hospital in Manchester, NH, will 
not be

[[Page 6055]]

opening. VA officials expect to save $1.3 million by not opening these 
beds.
  As my good friend Senator Collins has pointed out, the hospital in 
Togus, ME, is operating under a $14.2 million deficit. This Maine 
facility has a hiring freeze and cannot replace equipment.
  The Kansas City VA Hospital is short-staffed because they are already 
$10 million in the hole. The Denver VA Hospital and its affiliated 
clinics are $7.25 million short. The Maryland Health Care System is 
$14.5 million in the red already this year. The list goes on and on.
  The network that serves Minnesota, Nebraska, Iowa, North Dakota, and 
South Dakota is facing an overall shortfall of $61 million. South 
Dakota's facilities are $2.4 million short right now; Minnesota's are 
$25 million short; and Iowa's hospitals are at least $14 million short 
of what is currently needed. Bed frames are being held together by duct 
tape in some facilities, and cleaning staff cannot be hired to keep the 
facilities sanitary for patients. Health care provider positions also 
remain open, resulting in shortages of doctors, nurses and medical 
technicians, to name a few.
  Furthermore, Florida's facilities are $150 million in the red. And 
again, this has resulted in key health care specialist positions going 
unfilled. In a region where so many veterans and active duty service 
members reside, a shortfall of this magnitude is shameful.
  This trend towards hiring freezes and under-staffing of vital health 
care programs and services is one that is of great concern to me. I 
know that the American Federation of Government Employees is also very 
concerned about the measures being taken by many facilities to 
compensate for the numerous shortfalls around the country, and I 
commend AFGE for its support of this amendment.
  It will be impossible for VA to care for returning veterans in the 
midst of this kind of situation. As my colleagues can see, the amount 
we are asking for today is actually modest when compared to the very 
real deficits some parts of the country are being forced to deal with. 
While we know that many Members of this body have worked to see that 
their VA facilities remain in good condition, we must do more to ensure 
quality of care throughout the entire VA system.
  We also know that VA mental health must be improved if we are to meet 
the needs of returning service members. Experts predict that as many as 
30 percent may need psychiatric care when they come home. Yet, we are 
told that the system is nowhere near ready to handle this type of 
workload. Steady budget cuts over the years have diminished VA mental 
health care capacity.
  GAO recently found that VA has lagged in the implementation of 
recommendations made by its own advisory committee on post-traumatic 
stress disorder to improve treatment of veterans who suffer from this 
very serious mental illness. Furthermore, GAO concluded that it is 
questionable as to whether or not VA can keep pace with the demand for 
mental health treatment from veterans of Operations Iraqi and Enduring 
Freedom.
  While veterans' clinics now dot the landscape, they do not have the 
ability to meet mental health needs. Vet Centers, which provide vital 
outreach and readjustment counseling to veterans of yesterday and 
today, have seen their workload double, but not one additional nickel 
has been sent their way. There are large pockets of this country 
without any access to VA mental health care whatsoever.
  Fixing these problems requires resources of at least $525 million. We 
know this is a conservative estimate. Advocates believe that it would 
take more than three times this amount to bring VA mental health care 
up to what it should be, but this amendment gets us going down the 
right track. The National Mental Health Association's letter of support 
for this amendment states that ``. . . the nation has no higher 
obligation than to heal its combatants' wounds, whether physical or 
mental, and it has long looked to the VA health care system to carry 
out that obligation. To date, however, planning and budgeting for the 
VA health care system has been badly flawed and is failing America's 
veterans, and particularly the growing numbers from war.'' I ask for 
unanimous consent that the association's letter, as well as one from 
the National Alliance for the Mentally Ill, be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                         National Alliance for the


                                          Mentally Ill (NAMI),

                                    Arlington, VA, April 11, 2005.
     Hon. Daniel Akaka,
     Hon. Patty Murray,
     U.S. Senate,
     Washington, DC.
       Dear Senators Akaka and Murray: On behalf of the NAMI 
     Veteran's Council, I am writing to thank you for your support 
     of an amendment to increase the veteran's health care budget 
     by $1.98 billion, with $525 million earmarked for mental 
     health enhancements.
       Like all Americans, we feel that caring for the men and 
     women who serve our country is the commitment we make in 
     return for their sacrifices. It is critical that they know we 
     will not abandon that commitment upon their return from the 
     battlefield. Treatment for mental illness is as important to 
     their future, if not more important, than treatment for 
     physical illness.
       The Department of Veterans Affairs (VA's) current working 
     statistics reflect a crisis in the making that Congress has 
     the power to avoid. While it is estimated that at least 30% 
     of veterans returning from Iraq will have mental health 
     treatment needs, this is likely a conservative number. We are 
     very encouraged that this amendment includes an extension of 
     time for these needs to be assessed and treated, since we at 
     NAMI know that often the symptoms of mental illnesses arc not 
     apparent immediately following trauma. People who have the 
     personal experience report that months or even years may pass 
     before veterans and their families are finally able to 
     determine that treatment is needed, and to seek help.
       It is especially important to support the Veteran's 
     Centers, where it is very likely a veteran or family member 
     would initially seek information and assistance. Expansion of 
     mental health care in VA community-based outpatient clinics 
     (CEDCs) is already a VA priority, and an excellent plan, but 
     current limited resources will not support the Operation 
     Enduring Freedom/Operation Iraqi Freedom expected caseload.
       We also know that many VA hospitals and clinics are 
     experiencing major funding crises (small increases in their 
     budgets simply do not match spiraling costs of service). As a 
     result, there are site closings, unaddressed maintenance and 
     equipment needs, personnel freezes, and stoppages on needed 
     expansions. This amendment would help alleviate those 
     shortfalls.
       We strongly urge the Senate to adopt the provisions in this 
     important amendment. Let us keep our part of the bargain.
           Sincerely,
                                                     Jane E. Fyer,
     Chair, Veterans' Council.
                                  ____

                                                   National Mental


                                           Health Association,

                                   Alexandria, VA, April 11, 2005.
     Hon. Daniel K. Akaka,
     Ranking Minority Member, Committee on Veterans Affairs, U.S. 
         Senate, Hart Senate Office Building,
     Washington, DC.
       Dear Senator Akaka: On behalf of the National Mental Health 
     Association and our 340 affiliates across the country, we are 
     writing to offer our strong support for the Murray-Akaka VA 
     health care amendment to the FY 2005 Emergency Supplemental. 
     We applaud the leadership you and Senator Murray are 
     providing in advancing this important initiative to enable 
     the Department of Veterans Affairs to meet veterans' urgent 
     health needs, and particularly those of veterans from 
     Operations Iraqi and Enduring Freedom.
       With a grueling war taking a frightening toll on our men 
     and women in uniform, this nation faces a stern test: will it 
     meet its obligations to its warriors? Surely the nation has 
     no higher obligation than to heal its combatants' wounds, 
     whether physical or mental, and it has long looked to the VA 
     health care system to carry out that obligation. To date, 
     however, planning and budgeting for the VA health care system 
     has been badly flawed and is failing America's veterans, and 
     particularly the growing numbers returning from war.
       This important amendment squarely tackles the major funding 
     gaps facing VA at this critical time. Among those gaps, it 
     has long been clear that VA lacks sufficient capacity to meet 
     veterans' mental health needs. With carefully-researched 
     studies documenting the growing mental health needs triggered 
     by a grueling war, Congress must make VA mental health care a 
     major funding priority. This amendment would do so, and would 
     close the critical gap that stands in the way of meeting a 
     fundamental VA obligation.
       VA has long had a special obligation to veterans with 
     mental illness, given both the prevalence of mental health 
     and substance

[[Page 6056]]

     use problems among veterans and the large number of those 
     whose illness is of service origin. In furtherance of that 
     obligation, Congress, to its credit, codified in law special 
     safeguards to assure that VA gives priority to the needs of 
     veterans with mental illness. Notwithstanding that step, 
     however, the VA health care system has had an uneven record 
     of service to veterans with mental health needs. Years of 
     oversight by the Senate Committee on Veterans Affairs and 
     other bodies have documented the enormous variability across 
     the country in the availability of VA mental health care, and 
     the relatively limited capacity devoted to rehabilitative 
     help. With the nation at war--and studies finding an already 
     high percentage of returning veterans showing evidence of 
     post-traumatic stress disorder and other war-related mental 
     health problems--VA's special obligation to veterans with 
     mental disorders has special poignancy. VA has taken 
     important steps to make mental health a greater health-care 
     priority, but given the wide gap between VA's mental health 
     capacity and veterans' needs for treatment and support 
     services, real change will require major new funding, 
     particularly to meet war-related needs. Veterans and their 
     families cannot wait. The failure to intervene early 
     increases dramatically the risk that war-related mental 
     health problems will become more severe and chronic in 
     nature. As your amendment highlights, the time to act is now.
       Established in 1909, the National Mental Health Association 
     is the nation's oldest and largest advocacy organization 
     dedicated to all aspects of mental health and mental illness. 
     In partnership with our 340 state and local Mental Health 
     Association affiliates nationwide, NMHA works to improve 
     policies, understanding, and services for individuals with 
     mental illness and substance abuse disorders.
           Sincerely,
                                      Michael M. Faenza, M.S.S.W.,
                                                President and CEO.

  Mr. AKAKA. The costs of the war we are fighting today will continue 
to add up long after the final shot is fired, mainly in the form of 
veterans' health care and benefits.
  I urge my colleagues to join us in this effort to see that they are 
provided the care they are currently earning.
  The PRESIDING OFFICER. The Senator from Mississippi.
  Mr. COCHRAN. Mr. President, we appreciate the comments of the 
Senators from Hawaii and Washington concerning the situation in our 
Veterans Affairs Department and the concerns that they expressed about 
returning veterans who are now moving into the VA system and 
questioning whether there are sufficient funds available to take care 
of the needs in Veterans' Administration hospitals and other different 
health care facilities throughout the country.
  The subcommittee that has jurisdiction over veterans affairs held a 
hearing recently during which they questioned the Secretary of Veterans 
Affairs on this subject. They were assured that the Department is not 
in a crisis requiring emergency appropriations. The fact is, less than 
1 percent of the veterans population is made up of new eligibles who 
are entering into the Veterans' Administration system, and most of 
those who are requiring health care assistance and hospital care are 
older veterans who have already been in the system for a number of 
years.
  Because of that, the Department has not asked for any emergency 
appropriations to be included in this bill. The administration says 
that sufficient funds exist now in the Department of Veterans Affairs 
budget to take care of this fiscal year's needs.
  We are now in April and a new fiscal year will begin in October and 
we are already considering the request for the administration for next 
year's funding. We have had a budget resolution adopted. Some of these 
issues were raised during the consideration of this issue by the Budget 
Committee. I think the Senator from Washington offered an amendment to 
the budget resolution along the lines that she is urging the Senate to 
consider today, and the committee rejected the amendment.
  That committee reviewed the issue closely and they have included in 
the budget resolution authority for funding for the fiscal year 
beginning next October. This Senator's amendment suggests the funds 
appropriated in this amendment, $1.9 billion, should be made available 
until expended, which means not only is this a suggestion that an 
emergency appropriation is needed--although the amendment does not say 
on its face it is an emergency appropriation--it sounds as if this is 
in addition to this fiscal year's budget that will go on into next 
fiscal year. So it is an amendment to this fiscal year's funding 
authority as well as to the next fiscal year and the next. ``Until 
expended'' is the way the amendment reads.
  I am suggesting that the Senate should look at the information we 
have before us from the administration: The Secretary of Veterans 
Affairs, the Department of Defense, which is caring for injured 
veterans now in the military hospital system. These are not veterans 
hospitals, where those who have been injured in Iraq or Afghanistan are 
being cared for. Some may later be cared for there, and may be later 
cared for as part of the veterans system. But those who are returning 
now are at Walter Reed Hospital or other hospitals in the Department of 
Defense system.
  I am not the person in charge of the Veterans' Affairs Committee who 
monitors veterans' needs on a regular basis. The Senator from Idaho, 
Mr. Craig, is chairman of that committee. I have discussed the 
amendment with him. I expect he wants to be heard on the amendment. The 
Senator from Texas, Mrs. Hutchison, is chair of the appropriations 
subcommittee that has jurisdiction over the Veterans Affairs funding, 
and she is available to discuss the merits of the amendment. We have 
talked informally with her.
  At this time I hope the Senate will certainly consider the arguments 
that have been made by the Senators from Hawaii and Washington. I 
respect their concerns. I know their concerns are shared by other 
Senators. I share them. I don't know of any Senator who wants to come 
into the Chamber and vote against an amendment to fund veterans 
programs. It is hard to go home and explain to veterans why you voted 
against an appropriation for veterans health care.
  What we are being told by the administration is the funds are not 
needed, we have the funds available to care for the veterans 
population. There may be problems in the system that need the attention 
of the administration and administrators of individual health care 
centers and hospitals, and certainly they ought to be addressed and we 
urge that they are. But it is not a matter of not having the money. If 
there are problems that need to be addressed we can do that, but we are 
assured that none of the funds being asked for in this amendment are 
needed for that purpose.
  Mr. President, awaiting the arrival of other Senators, I suggest the 
absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. KERRY. Mr. President, I ask unanimous consent that the order for 
the quorum call be dispensed with.
  The PRESIDING OFFICER (Mr. Burr). Without objection, it is so 
ordered.
  Mr. KERRY. Mr. President, I ask unanimous consent that the current 
amendment be temporarily set aside so we can take up two amendments 
quickly.
  Mr. COCHRAN. Mr. President, reserving the right to object, may I 
inquire of the Senator? We were in the process of considering the 
amendment of the Senators from Washington and Hawaii on Veterans 
Affairs and funding for that Department. The chairman of the committee 
has arrived on the floor to speak to that amendment. I had told the 
Senator from Massachusetts I would have no objection to offering his 
amendment and then setting it aside.
  I inquire: How much time will Senator Kerry require?
  Mr. KERRY. Seven minutes very quickly, and then I am happy to set 
those aside.
  Mr. COCHRAN. Is there a problem with the Senator from Idaho?
  Mr. CRAIG. How long does the Senator plan to speak?
  Mr. KERRY. Seven minutes.
  Mr. CRAIG. I would like to make my comments. I think we are under 
unanimous consent to close down at 12:30.
  Mr. COCHRAN. The Senator is correct.
  Mr. KERRY. Mr. President, I ask unanimous consent that I be permitted

[[Page 6057]]

to proceed, and after I have completed the Senator from Idaho be 
permitted to make his statement before we recess.
  The PRESIDING OFFICER. Is there objection?
  Mr. COCHRAN. I have no objection.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Massachusetts.
  Mr. KERRY. Mr. President, I thank the Senator from Mississippi.


                  Amendments Nos. 333 and 334, En Bloc

  Mr. KERRY. Mr. President, I call up amendments numbered 333 and 334.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Massachusetts [Mr. Kerry] proposes 
     amendments numbered 333 and 334, en bloc.

  Mr. KERRY. Mr. President, I ask unanimous consent that reading of the 
amendments be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendments are as follows:


                           AMENDMENT NO. 333

   (Purpose: To extend the period of temporary continuation of basic 
allowance for housing for dependents of members of the Armed Forces who 
                          die on active duty)

       On page 169, between lines 8 and 9, insert the following:


 extension of period of temporary continuation of basic allowance for 
housing for dependents of members of the armed forces who die on active 
                                  duty

       Sec. 1122. Section 403(l) of title 37, United States Code, 
     is amended by striking ``180 days'' each place it appears and 
     inserting ``365 days''.


                           AMENDMENT NO. 334

    (Purpose: To increase the military death gratuity to $100,000, 
effective with respect to any deaths of members of the Armed Forces on 
                   active duty after October 7, 2001)

       On page 159, strike line 6 and all that follows through 
     page 160, line 22, and insert the following:
       Sec. 1112. (a) Increase in Death Gratuity.--
       (1) Amount.--Section 1478(a) of title 10, United States 
     Code, is amended by striking ``$12,000'' and inserting 
     ``$100,000''.
       (2) Effective date.--The amendments made by this subsection 
     shall take effect on October 7, 2001, and shall apply with 
     respect to deaths occurring on or after that date.
       (3) No adjustment for increases in basic pay before date of 
     enactment.--No adjustment shall be made under subsection (c) 
     of section 1478 of title 10, United States Code, with respect 
     to the amount in force under subsection (a) of that section, 
     as amended by paragraph (1), for any period before the date 
     of the enactment of this Act.
       (4) Payment for deaths before date of enactment.--Any 
     additional amount payable as a death gratuity under this 
     subsection for the death of a member of the Armed Forces 
     before the date of the enactment of this Act shall be paid to 
     the eligible survivor of the member previously paid a death 
     gratuity under section 1478 of title 10, United States Code, 
     for the death of the member. If payment cannot be made to 
     such survivor, payment of such amount shall be made to living 
     survivor of the member otherwise highest on the list under 
     1477(a) of title 10, United States Code.
       On page 161, line 23, strike ``$238,000'' and insert 
     ``$150,000''.

  Mr. KERRY. Mr. President, many of us in the Senate have had the 
privilege of traveling to Iraq where we have visited some of the most 
remarkable young men and women our country has produced. We have met 
with hundreds of American soldiers, airmen, Marines and naval 
personnel, all of whom are doing a magnificent job under, obviously, 
very difficult conditions. I support this supplemental bill and for the 
obvious reasons.
  The election and increased training and the clarity of a plan that 
has been put forth and the increased effort of the Iraqis themselves 
combined provide an important opportunity for the transformation of 
Iraq. It is obviously vital in these circumstances to make sure our 
troops have the ability to be safe but to also be able to get the job 
done. We have always said that. But also I believe we need to do more. 
Supporting the troops means not just supporting them in the field and 
in the theaters, but it also means supporting them here at home. It 
means understanding that their lives, both as warriors fighting for 
their Nation and as spouses, parents, brothers, sisters, sons and 
daughters struggling to see that the needs of their families are met--
the fact is that too many military families suffer when duty calls. 
Thousands of reservists take a very significant pay cut when they are 
called up. Suddenly, single parents are left to struggle with the 
bills. One in five members of the National Guard don't have any health 
insurance at all. That is devastating to their families. It is damaging 
to troop readiness.
  I believe that everyone here understands the simple tenet that the 
Government has to keep faith with our troops. To do that we need to put 
in place a comprehensive military family bill of rights that puts 
action behind the promise to support our troops. I understand that the 
supplemental bill is not the place to ask for the full consideration of 
that military family bill of rights, so I am not going to propose the 
entire bill as an amendment here. But I am bringing two amendments to 
the floor that are broken out of this bill of rights that I believe we 
could all agree on and which would make an enormous difference in the 
lives of our soldiers. In agreeing to these, we can take an important 
step in demonstrating our support for a military family bill of rights 
which is long overdue.
  More than a year ago, I proposed increasing the benefits paid to 
surviving military families to $500,000 through existing insurance 
benefits and an increase in the death gratuity. I am not alone in this 
effort. Members on both sides of the aisle have introduced legislation 
to improve these benefits, and with very good reason.
  Today, families receive only $12,420 to supplement whatever insurance 
a loved one may have purchased. That $12,420 is completely inadequate. 
In fact, it is a disgrace. We do right by our fallen police officers 
and firefighters in America. Their families receive $275,000, and it is 
time that we did the same for our soldiers. Their survivors' lives 
remain to be lived, and though no one can ever put a price on the loss 
of a loved one, it is important for us to be as generous as we can and 
as realistic as we can as we help people to be able to put their lives 
back together. I was heartened when the administration embraced a 
formula to reach the $500,000 threshold, and I am glad the 
Appropriations Committee has included a benefit increase in this 
particular bill, but the bill needs to go further and eliminate any 
distinction between combat and noncombat deaths.
  This is important for a number of different reasons.
  First of all, the benefit, as matter of principle, ought to go to any 
American who loses their life while serving our country, and we 
shouldn't draw a distinction between that kind of service. The fact is 
that the uniformed leadership of our military doesn't believe we 
should, either.
  GEN Richard Myers, Chairman of the Joint Chiefs of Staff, testified 
on this matter before the Armed Services Committee, and a number of 
other leaders. Let me share with colleagues.
  GEN Richard Cody said:

       It is about service to this country, and I think we need to 
     be very careful about making decisions based upon what type 
     of action. I would rather err on the side of covering all 
     deaths rather than trying to make a distinction.

  Admiral Nathman said:

       This has been about how do we take care of the survivors, 
     the families and the children? They can't make a distinction, 
     and I don't think that we should either.

  GEN Michael Moseley of the Air Force said:

       I believe a death is a death and our service men and women 
     should not be represented that way.

  --i.e, they shouldn't be distinguished as to where it took place.
  If you are a pilot flying in the Navy off an aircraft carrier and you 
are not in combat and you have a catapult failure and die, that family 
faces the same crisis as a family of somebody who is shot down. We need 
to understand that. I'm glad the bill addresses that situation, but 
there are other circumstances it does not.
  GEN William Nyland of the Marine Corps said:

       I think we need to understand that before we put any 
     distinctions on the great services of these wonderful men and 
     women, they are all performing magnificently. I think we have 
     to be careful about drawing any distinctions.

  The amendment I offer today with Senators Pryor and Obama expands

[[Page 6058]]

this benefit to every member of the Armed Forces who dies on active 
duty.
  I have a second amendment at the desk to help military families 
lessen the disruption that a death brings to the family.
  At the present time, the survivors of those killed in action have to 
move out of military housing in 180 days. But for those with young 
children in school, that becomes entirely disruptive often with respect 
to the school district kids are able to go to, and it is a very 
difficult burden in many cases for widows and widowers to have to try 
to confront all of the difficulties of that transition, including the 
efforts of finding housing. The 180 days may mean starting a school 
year in one State and finishing it in another. I don't believe that is 
a message we ought to be extending to the families of those who give 
their lives in service to our country.
  Given all of the disruption the loss of a parent brings to their 
lives, I propose allowing survivors the option to keep their housing 
for a whole year as they deal with the countless other challenges. It 
may seem like a small change, but I have heard from enough different 
folks on active duty in the military about the significance of this 
particular need, and it can make a huge difference for a family who is 
struggling with the loss of a father or a mother.
  Investing in our military families is not just appropriating the 
money for the equipment or the latest technology for the deployment 
itself, it is investing in the families themselves. And it is not as an 
act of compassion, it is a smart investment in America's military. Good 
commanders know that while you may recruit an individual soldier or 
marine, you retain a whole family. That is the way we ought to look at 
our policies.
  Nearly 50 percent of America's service members are married today. If 
we want to retain our most experienced service members, particularly 
after we have invested millions of dollars in their training, then it 
is important--especially for the noncommissioned officers who are the 
backbone of the military--that we keep faith with their families. If we 
don't, and those experienced enlisted leaders begin to leave, we as a 
nation are weakened.
  The two amendments I have proposed today are the beginning of a 
larger effort to do right by our military families. I believe it is a 
strong beginning. By joining measures to take care of military families 
at home with legislation to take care of those remarkable young men and 
women serving abroad, we are going to take a firm step toward putting 
meaning behind the promise to support our troops. I hope these 
amendments are agreed to.
  I yield to the Senator from Idaho.
  The PRESIDING OFFICER. The Senator from Idaho is recognized.


                           Amendment No. 344

  Mr. CRAIG. Mr. President, I thank the Senator from Massachusetts for 
his cooperation in the unanimous consent propounded that allows me the 
flexibility to speak. I will be brief. We are at the lunch hour.
  The chairman of the appropriations subcommittee on MILCON and 
Veterans Affairs is also on the floor with me. Let me speak for a 
moment about the concerns we have in relation to the Murray amendment.
  First and foremost, let me say for the record that in no way do I 
question the integrity of the Senator from Washington. She and I have 
worked very closely together on veterans issues. She is a valuable 
member of the Veterans Committee, as is the Presiding Officer.
  Without question, our dedication to veterans I hope is unquestioned. 
The reality is are we dealing with an emergency in an emergency 
supplemental, or is there a very real need out in veterans land and 
with the Veterans Administration and the systems that it funds and 
operates to meet current veterans' and incoming veterans' needs? I say 
certainly without question that there is always a need. We could expand 
budgets well beyond where they are today to meet needs, but by what 
definition? Critical, necessary, important for the moment, dealing with 
the most needy veterans, the most handicapped, or simply spreading it 
out and making it more available?
  Those are some of the tough choices you and I and members of that 
subcommittee and certainly members of the subcommittee on 
appropriations have to make. The Senator from Washington has 
appropriately challenged us to look at a variety of other aspects that 
have value. The question is, Are they an emergency at the moment? Do 
they serve veterans who are not being served? In some instances, that 
would be arguably yes. But are those veterans of critical service in 
the sense they can find health care elsewhere in the sense of priority?
  Let me talk briefly about what we are doing. We have just finished 
trying to shape through a budget resolution the 2006 budget. We 
included $450 million more than the President's request, and we have 
increased the 2006 budget over the 2005 budget by about $1.2 billion--a 
substantial increase by anybody's observation. We have also done that 
without turning to veterans in the less needy categories and saying 
they will have to pay more for their services. We have been able to 
assume and bring into the system a good deal of that, which is 
important.
  I find the number of $1.98 billion additional, not spread out over 
fiscal year 2006 but spent now in 2005 and the balance of 2005 in this 
emergency, a dramatic increase. Can the Veterans' Administration 
effectively and responsibly spend that kind of a bump up in money? I 
question that.
  It is important to look at what is necessary. According to VA, they 
have seen approximately 48,000 OIF and OEF veterans since the war 
began. With Senator Murray's $2 billion, it would be $41,000 per 
patient, an extraordinary amount by any measure.
  The PRESIDING OFFICER. Would the Senator suspend? Would the Senator 
request unanimous consent to extend past 12:30?
  Mr. CRAIG. Mr. President, I ask unanimous consent I be allowed to 
continue. There are three Members in the Senate. I ask unanimous 
consent we extend to no later than 12:45.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CRAIG. Mr. President, I have given a figure of $41,000 per 
patient. That is an extraordinary amount by any measure. The VA's 
average cost per patient is about $5,000.
  My point in making this an issue is I want to work with the Senator 
from Washington. I am never going to argue that there aren't real needs 
in the Veterans' Administration. I am not going to argue that there 
ought to be some priorities--mental health and those things that the 
Senator from Washington and I have shared as a common interest and a 
common concern.
  Let me yield time to the Senator from Texas. She will take a few 
moments and give the Senator from Washington adequate time to respond 
before the 12:45 time.
  I am willing to work with the Senator from Washington, to examine her 
numbers, but a $1.98 billion or $2 billion bump-up to be spent before 
close of business in September--I am getting signals from the Senator 
we are dealing with a 2-year appropriation. Let's look at those 
numbers.
  I close by saying, in my opinion, there is not an emergency in the 
VA. This is an emergency supplemental. I will work with the Senator to 
see where we might go. It is wrong in an emergency to talk about things 
that are long term in character and necessary to finance.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.
  Mrs. HUTCHISON. Mr. President, as the chairman of the Veterans' 
Administration appropriations committee, I certainly want to look 
further at Senator Murray's numbers, but adding almost $2 billion to 
the Department of Veterans Affairs for the next 6 months, we have to 
look very carefully where we would spend that money and what the 
emergency nature of the request is.
  In fact, we had our appropriations hearing with the Veterans' 
Administration Secretary. I asked the Secretary specifically--we would 
certainly be looking at supplemental appropriations in the near future; 
then we would

[[Page 6059]]

be looking at our full budget for next year--I asked if there were 
enough resources to meet the needs of all returning veterans from Iraq 
and Afghanistan for the current year, 2005. The Secretary said, yes, 
the VA does have the necessary resources in 2005 to continue meeting 
the needs of all returning veterans from Iraq and Afghanistan.
  The key is when people return from Iraq and Afghanistan, we want to 
make sure their medical needs are met. That is something we all share. 
Most of the people returning from Iraq and Afghanistan are still in the 
Department of Defense. They are either on active duty or they are 
activated as Guard and Reserve. The bulk of them are still treated for 
their medical needs in the Department of Defense, not in Veterans 
Affairs. We have to look at how many people are returning and how many 
people actually go into the VA system, how many people actually are 
leaving the military service. The number comes down significantly. We 
have to look at this number.
  All Members have the same goal, that we are going to ask for the 
amount of money we need to give the medical care to our returning 
service men and women and to people leaving the military. That is why I 
asked the question of our Secretary of Veterans Affairs, Do you have 
enough? Then I further asked if the 2006 budget was adequate for the 
returning veterans. The response was, yes.
  I certainly want to do everything we need to do for the purpose of 
providing the care these veterans who have served our country, who are 
protecting freedom, deserve from our Government. But we have to look at 
the fact that is an emergency not in the 2006 budget. That would start 
October 1 of this year. Then we need to look further down the road at 
that budget, which our committee certainly intends to do.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. I ask for regular order.
  The PRESIDING OFFICER. The Senator's amendment is now pending.


                     Amendment No. 344, As Modified

  Mrs. MURRAY. I send a modification to the desk on our amendment.
  The PRESIDING OFFICER. The amendment is so modified.
  The amendment (No. 344), as modified, is as follows:

       On page 188, after line 20, add the following:

                               CHAPTER 5

                     DEPARTMENT OF VETERANS AFFAIRS

                     Veterans Health Administration

                            Medical Services

       For necessary expenses for furnishing, as authorized by 
     law, outpatient and inpatient care and treatment to 
     beneficiaries of the Department of Veterans Affairs and 
     veterans as described in paragraphs (1) through (8) of 
     section 1705(a) of title 38, United States Code, including 
     care and treatment in facilities not under the jurisdiction 
     of the department and including medical supplies and 
     equipment and salaries and expenses of health-care employees 
     hired under title 38, United States Code, and to aid State 
     homes as authorized under section 1741 of title 38, United 
     States Code; $1,975,183,000 plus reimbursements: Provided, 
     That of the amount under this heading, $610,183,000 shall be 
     available to address the needs of servicemembers deployed for 
     Operation Iraqi Freedom and Operation Enduring Freedom; 
     Provided further, That of the amount under this heading, 
     $840,000,000 shall be available, in equal amounts of 
     $40,000,000, for each Veterans Integrated Service Network 
     (VISN) to meet current and pending care and treatment 
     requirements: Provided further, That of the amount under this 
     heading, $525,000,000 shall be available for mental health 
     care and treatment, including increased funding for centers 
     for the provision of readjustment counseling and related 
     mental health services under section 1712A of title 38, 
     United States Code (commonly referred to as ``Vet Centers''), 
     including the staffing of certified family therapists at each 
     center, increased funding for post traumatic stress disorder 
     (PTSD) programs, including funding to fully staff PTSD 
     clinical teams at each Veterans Affairs Medical Center and to 
     provide a regional PTSD coordinator in each VISN and in each 
     Readjustment Counseling Service region, funding for the 
     provision of primary care consultations for mental health, 
     funding for the provision of mental health counseling in 
     Community Based Outreach Centers (CBOCs), and funding to 
     facilitate the provision of mental health services by 
     Department of Veterans Affairs facilities that do not 
     currently provide such services: Provided further, That the 
     amount under this heading shall remain available until 
     expended: Provided further, That the amount provided under 
     this heading is designated as an emergency requirement 
     pursuant to Section 402 of the conference report to accompany 
     S. Con. Res. 95 (108th Congress).

  Mrs. MURRAY. Mr. President, let me make a couple of comments. I thank 
the Senators from Idaho and Texas for working with us on this critical 
issue. I know both of them have worked very long and hard on veterans 
issues and care deeply about making sure the men and women who serve 
are taken care of when they return home, as we promised.
  Let me remind everyone, of the 240,000 men and women separated from 
our services since the beginning of the war in Iraq, 50,000 have 
already asked the VA for services. Many more of them will continue to 
do that as they come home and as they get back into their homes and 
look for services, especially mental health services, as all know who 
have worked with veterans for a long time.
  This is an emergency. If any Members work with veterans in our 
States, talk to our directors at home, and talk with soldiers who have 
returned home, we will realize the long lines they are waiting in, the 
clinics that were promised that have not been opened, the tremendous 
services that are not being provided.
  As I discussed in my opening statement, beds are held together by 
duct tape in our facilities. This is not how we should be treating our 
veterans. It is an emergency because more veterans return in higher 
numbers with the care not available for them.
  I am willing to work with the Senators from Idaho and the Senators 
from Texas over the next several hours, or whatever it takes to come up 
with a number. If they believe $1.98 billion is too high, I would like 
to talk to them about that. We can work together. I know both care 
about this issue, and we want to find a way to make sure our veterans 
are taken care of.
  I remind everyone when we send our men and women overseas, one of the 
promises we make to them is we will have the care available when they 
return. When we have veterans who are in beds that are held together by 
duct tape, when we have veterans who have to endure long waiting lines 
for simple services, that is an emergency.
  I clarify, the money in this bill will be used until it is expended. 
It does not have to be expended this year. It will be used until 
expended, allowing our veterans and our veteran services to put in 
place facilities they need for our men and women coming home.
  I close at this time, and I will work with Senators from Idaho and 
Texas and the chairman of the Appropriations Committee because I 
believe this is an emergency. I believe we have a responsibility. I 
will make sure our veterans get the care they need.
  I yield the floor.
  Mr. AKAKA. Mr. President, the Department of Veterans Affairs has been 
a recognized leader in the treatment of Post-Traumatic Stress Disorder, 
PTSD. With its outreach efforts and expert mental health staff, VA has 
made great strides in its treatment of those suffering from the 
psychological wounds of war. Unfortunately, VA still has a long way to 
go before it will achieve the level of PTSD treatment our veterans 
deserve. Demonstrating this fact is a February 2005 GAO report, which 
found that VA has not fully met any of the 24 clinical care and 
education recommendations made in 2004 by VA's Special Committee on 
PTSD.
  Titled ``VA Should Expedite the Implementation of Recommendations 
Needed to Improve Post-Traumatic Stress Disorder Services,'' this 
report raises serious concerns about VA's ability to treat our 
veterans' mental health. In fact, I would like to quote one of the 
report's most disturbing points: ``VA's delay in fully implementing the 
recommendations raises questions about VA's capacity to identify and 
treat veterans returning from the Iraq and Afghanistan conflicts who 
may be at risk for developing PTSD, while maintaining PTSD services for 
veterans currently receiving them.'' Further adding to the seriousness 
of this statement is that GAO reported in September 2004 that officials 
at six of

[[Page 6060]]

seven VA medical facilities said they may not be able to meet an 
increased demand for PTSD services. Moreover, the Special Committee 
reported in 2004 that ``VA does not have sufficient capacity to meet 
the needs of new combat veterans while still providing for veterans of 
past wars.
  This is further proof of the need for increased funding for VA health 
care. If we do not give VA the necessary funds, how can we expect it to 
properly care for the flux of new veterans when it cannot even care for 
those it currently treats? In fact, VA officials have cited resource 
constraints as the primary reason for not implementing many of the 
Special Committee's recommendations.
  In all, GAO found that based on the time frames in VA's draft mental 
health strategic plan, 23 of the 24 recommendations may not be fully 
implemented until fiscal year 2007 or later. The remaining 
recommendation is targeted for full implementation by fiscal year 2005, 
4 years after the Special Committee first recommended it.
  Additionally, the GAO report found that ten of the recommendations 
are longstanding, as they are consistent with those made in the Special 
Committee's first report in 1985. VA agreed then that these 
recommendations would improve the provision of PTSD services to 
veterans, yet the changes still are not scheduled for full 
implementation for another two years at the earliest. These delayed 
initiatives include developing a national PTSD education plan for VA, 
improving VA collaboration with DoD on PTSD education, and providing 
increased access to PTSD services.
  PTSD is caused by an extremely stressful event and can develop years 
after military service. Mental health experts estimate that the 
intensity of warfare in Iraq and Afghanistan could cause more than 15 
percent of servicemembers returning from these conflicts to develop 
PTSD, with a total of nearly 30 percent needing some kind of mental 
health treatment. While there is no cure for PTSD, these experts 
believe early identification and treatment of PTSD symptoms may lessen 
their severity and improve the overall quality of life for individuals 
with this disorder.
  Congress required the establishment of VA's Special Committee on PTSD 
in 1984, with the original purpose primarily to aid Vietnam-era 
veterans diagnosed with PTSD. One of the Special Committee's main 
charges is to carry out an ongoing assessment of VA's capacity to 
diagnose and treat PTSD and to make recommendations for improving VA's 
PTSD services.
  In addition, a March 20, 2005, article in the Los Angeles Times 
pointed out how concerned veterans' advocates and even some VA 
psychiatrists are with VA's handling of PTSD services, saying VA 
hospitals are ``flirting with disaster.'' The article highlighted the 
situation at the VA Greater Los Angeles Healthcare System, specifically 
the Los Angeles VA hospital, which last year closed its psychiatric 
emergency room. A decade ago, VA hospitals in Los Angeles had rooms to 
treat 450 mentally ill patients each day. After a series of cutbacks 
and consolidations, however, the main hospital can now accommodate only 
90 veterans overnight in its psychiatric wards. During the same 10-year 
period, the overall number of mental health patients treated by the VA 
Greater Los Angeles increased by about 28 percent, to 19,734 veterans 
in 2004. If this is how VA handles PTSD care for our veterans at the 
Nation's largest VA hospital, how does that bode for the rest of the 
nation?
  VA must make strides in its provision of mental health services and 
outreach efforts to servicemembers returning from Iraq and Afghanistan. 
If we are not careful and do not give VA proper resources, progress 
will be impossible. As Ranking Member of the Committee on Veterans' 
Affairs, I will work to ensure that does not happen. As such, I am 
pleased to tell you that today I am offering an amendment to the 
Supplemental to partially fix this problem. Our Nation's veterans 
deserve the best care possible, for both their physical wounds and 
mental.
  I ask unanimous consent that the article from the Los Angeles Times 
be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

              [From the Los Angeles Times, Mar. 20, 2005]

    Mental Health Care for Veterans Disputed; While Need Has Grown, 
    Inpatient Services Have Been Drastically Cut in the Last Decade.


           Critics say outpatient programs can't do the job.

                         (By Charles Ornstein)

       As troops return from Iraq and Afghanistan--including 
     thousands with combat-related mental disorders--they enter a 
     Veterans Affairs healthcare system sharply divided about how 
     to care for them.
       In the last decade, veterans hospitals across the country 
     have sharply reduced the number of inpatient psychiatric 
     beds, replacing them with outpatient programs and homeless 
     services.
       The new offerings, officials say, cost less and are just as 
     effective.
       ``It used to be with mental illness that once you got it, 
     you never got rid of it,'' said Dr. Mark Shelhorse, a 
     national VA mental health official. But ``mental illness is 
     perceived as a disease now just like hypertension and 
     diabetes. We have medicines to treat it. We know that people 
     recover and lead fully normal lives.''
       But veterans' advocates and even some VA psychiatrists say 
     the hospitals, including the massive Veterans Affairs Greater 
     Los Angeles Healthcare System, are flirting with disaster. 
     They say the facilities are ill-equipped to deal with 
     veterans who need the most extensive help for psychosis, 
     substance abuse, suicidal impulses and post-traumatic stress 
     disorder.
       Last year, the Los Angeles hospital closed its psychiatric 
     emergency room, a move that heightened the anger of the VA's 
     critics.
       ``We were too easily swayed in the past by the argument 
     that after a while, it [PTSD] will go away,'' said Jay 
     Morales, a Vietnam veteran who chairs the mental health 
     consumer advisory council at the Los Angeles hospital. ``But 
     there are Vietnam vets walking around today, 30 years after 
     the war ended, having these problems.''
       Dr. William Wirshing, a psychiatrist for 23 years at the 
     Greater Los Angeles VA, agreed. ``It's absurd how much 
     they've cut--and it's absurd how much they continue to cut,'' 
     he said.
       A decade ago, VA hospitals in Los Angeles had rooms to 
     treat 450 mentally ill patients each day. After a series of 
     cutbacks and consolidations, the main Wadsworth hospital on 
     Wilshire Boulevard can now accommodate only 90 veterans 
     overnight in its psychiatric wards.
       During the same 10-year period, the overall number of 
     mental health patients treated by the VA Greater Los Angeles 
     increased by about 28 percent, to 19,734 veterans in 2004.
       The VA hospital in Los Angeles, the largest veterans 
     hospital in the nation, treats 80,000 veterans annually with 
     a budget of more than $450 million. It includes the hospital, 
     nursing homes, a domiciliary, three main outpatient care 
     sites and 10 community clinics. There are an estimated 
     510,000 veterans in Los Angeles County alone.
       VA officials say that despite the cutbacks, the Los Angeles 
     VA hospital offers more mental health services today than 
     ever. Instead of keeping patients in locked wards overnight, 
     the VA offers them outpatient programs and temporary 
     accommodations in partnership with nonprofit groups, 
     officials say.
       ``It's not like we went into a hospital that was fully 
     occupied and we said, `We don't need this unit anymore,''' 
     said Dr. Andrew Shaner, the hospital's acting director of 
     mental health. ``We built programs that kept people 
     relatively well and therefore out of the hospital, and that's 
     why we were able to do it.''
       The question remains: Are the current offerings enough?
       A report last fall by the U.S. Government Accountability 
     Office cited estimates that 15% of service members stationed 
     in Iraq and Afghanistan would develop post-traumatic stress 
     disorder. As of December, about 1 million troops had spent 
     time in one of the two war zones (about one-third have done 
     more than one tour).
       The GAO determined that the VA did not have enough 
     information to know if it could meet the increased demand.
       Shelhorse, the VA's acting deputy consultant for patient 
     care services for mental health, said the agency is 
     monitoring the situation carefully and is pumping millions of 
     dollars into mental health programs.
       The shift from inpatient to outpatient mental health 
     services has become a controversial issue throughout the VA 
     system. A 1996 federal law prohibits the VA from reducing 
     specialized treatment and rehabilitation for disabled 
     veterans, including mental health services.
       A VA committee has found that the agency hasn't abided by 
     that law. While VA hospitals may be treating more mentally 
     ill patients, they aren't spending as much money doing so. At 
     the West Los Angeles VA, the amount spent on mental health 
     has decreased from $74 million in fiscal 1997 to $64.4 
     million in fiscal 2003, according to a national monitoring 
     system.

[[Page 6061]]

       Experts disagree on whether outpatient care can replace 
     inpatient treatment.
       ``I don't think that intensive community treatment can take 
     care of all the people that no longer have the availability 
     of inpatient beds,'' said Dr. H. Richard Lamb, a psychiatry 
     professor at USC.
       Lamb said the trend has led to an increase in homeless 
     mentally ill and those in jails.
       But Dr. Robert Rosenheck, director of the VA's Northeast 
     Program Evaluation Center, said changes in the VA system have 
     not produced those results.
       Studies, he said, have not shown an increase in jailed 
     veterans after inpatient psychiatric beds have been cut. Nor, 
     he said, have there been significant increases in suicides or 
     veterans showing up at non-VA hospitals for care.
       ``Veterans very much preferred coming in and being in a 
     supportive environment for an extended period of time,'' 
     Rosenheck said. But ``when you look at objective outcomes, we 
     don't see scientific evidence of adverse effects'' because of 
     the cutbacks.
       Even so, veterans' advocates and psychiatrists have been 
     complaining for years about cutbacks at the Greater Los 
     Angeles VA.
       For many, the final straw came in May when the hospital 
     closed the psychiatric emergency room and shifted mental 
     health emergencies to the main ER. Troubled patients are now 
     cared for by nurses and other staff who, according to the 
     critics, are not adequately trained to handle psychiatric 
     emergencies.
       Critics point to several instances since the transition in 
     which psychiatric patients were admitted to inpatient wards 
     without any written orders or treated with disrespect by ER 
     nurses who didn't understand their disorders. At least one 
     female patient with PTSD attempted suicide.
       ``This is a dangerous situation,'' said Guy Mazzeo, a 
     veteran and member of the L.A. mental health consumer 
     advisory council. ``None of us'' was consulted before the 
     change, he said, referring to advocates for veterans and the 
     VA's outside advisory groups. And none agree with it, he 
     said.
       The veterans and their doctors have been joined in their 
     criticism by Rep. Henry A. Waxman (D-Los Angeles), whose 
     district includes the VA health center.
       He asked the VA in January to hire a full-time psychiatrist 
     for the emergency room and arrange for specially trained 
     psychiatric nurses to work there, among other things. The VA 
     declined his requests.
       ``I'm disappointed that the VA has not responded more 
     aggressively,'' Waxman said in an interview. ``With Iraq and 
     Afghanistan war veterans returning, these demands are only 
     going to increase.''
       VA officials say the criticism is unfair. Care in the main 
     ER is more coordinated than the care given in the stand-alone 
     psychiatric emergency room, they say. Patients can get their 
     medical and mental problems treated in one place, instead of 
     having to be shuttled between two.
       Administrators say ER staff members have received extensive 
     training. And they say that there's no evidence that patients 
     are receiving inferior care.
       Dr. Dean Norman, the hospital's chief of staff, said the 
     closure of the psychiatric ER made sense because the number 
     of patients using it had been decreasing for years, and the 
     hospital did not have enough staff.
       ``One of our goals is to be good stewards of taxpayer 
     dollars,'' Norman said. ``We didn't make this in a 
     precipitous or reckless fashion. This was well thought out, 
     and we had good reasons for doing this.''

  Mrs. BOXER. Mr. President, I am pleased to join Senator Murray in 
cosponsoring this important amendment to increase veterans health care 
funding. We owe it to our veterans, who have so bravely served our 
country, to give them the best medical care possible. It is 
disappointing that funding for veterans programs, especially veterans 
health care, has not kept pace with either the increased number of 
veterans in the system or medical inflation. This amendment is crucial 
to providing veterans with the services they have earned.
  As I have talked to veterans in California--and as I have met with 
returning soldiers from Iraq and Afghanistan--I have come to one 
disturbing conclusion: we are not serving all of the needs of our 
veterans now and we are not prepared to serve the tens of thousands of 
veterans who will be returning over the next couple of years.
  Senator Murray's amendment begins to address this situation. It will 
increase veterans health care funding by almost $2 billion. This 
includes $610 million for new veterans returning from Iraq and 
Afghanistan. Funding for these veterans is not included in the current 
VA budget. In addition, each of the 21 veterans regions will receive 
$40 million to address their budget shortfalls. This will allow each 
region to determine how the funds can best be used to benefit their 
veteran population.
  I am especially pleased that this amendment includes funding 
designated for veterans mental health care. Specifically, $525 million 
is designated to expand mental health services, with $150 million 
targeted for the treatment of Post Traumatic Stress Disorder--PTSD. The 
VA has estimated that 30 percent of men and women currently serving in 
the Armed Forces will need treatment for mental illness or readjustment 
issues. That is why this funding is so critical.
  This amendment has the support of many veterans organizations, 
including the Veterans of Foreign Wars, AMVETS, Disabled American 
Veterans, and Paralyzed Veterans of America. They realize, as I do, how 
crucial it is that this funding be made available. Without it, the VA 
will not be able to meet the needs of the men and women who have so 
bravely served our country. I urge my colleagues to support this 
amendment.
  Mrs. LINCOLN. Mr. President, today, I rise in support of an amendment 
to the emergency supplemental to provide an additional $1.98 billion 
for veterans health care. I am a cosponsor of this amendment because I 
believe that when we talk about the costs of war, we cannot forget the 
brave men and women who are returning from war every single day.
  In the past couple months, my home State of Arkansas has seen the 
return of over 3,000 brave men and women from the Army National Guard, 
who answered their Nation's call to serve in Operation Iraqi Freedom. 
Many of them will need ready access to health care as they attempt to 
transition back to the civilian lives they knew before the war.
  I am troubled because they are returning to a veterans health care 
system that is underfunded and overburdened. Increasing health care 
costs and an influx of thousands of new veterans each month makes it 
essential that we do what we can to provide for veterans health care, 
and we do it now.
  This amendment would enable the VA to absorb the new veterans being 
added to the system and would reverse many of the critical budget 
shortfalls that have left many VA facilities without the medical staff 
or equipment they desperately need. It would also provide $40 million 
for every veterans regional network so they can better meet their local 
needs.
  My father fought in Korea and I was raised from an early age to have 
tremendous respect for the unselfish service of the men and women of 
the Armed Services. As a United States Senator, I believe we have an 
obligation to provide them with the health care they were promised and 
to honor the benefits they have earned. I urge my colleagues to support 
this amendment because it is the right thing to do, it is our moral 
responsibility, and it should be a priority for each and every one of 
us.
  Mr. JEFFORDS. Mr. President, the Bush administration has decided that 
all funding for the conflicts in Iraq and Afghanistan be requested as 
supplemental emergency funding. I believe, therefore, that we must 
include in this supplemental funding legislation, additional monies to 
cover the cost of the war incurred by the Veterans Administration.
  The President's budget did not request sufficient funding to cover 
the significant increases in medical costs of veterans wounded in Iraq 
and Afghanistan. While severely wounded service members are remaining 
longer in the Department of Defense health care system than in past 
conflicts, the VA provides all care for these men and women after they 
are released from the military, and provides care to Guard members and 
Reservists beginning immediately after they return home from a 
deployment.
  We must cover these expenses. We cannot turn away these veterans. We 
also cannot turn away other veterans and deny them care in deference to 
the newest veterans. That would not be right either.
  I am pleased to join Senators Murray and Akaka in offering this 
amendment to provide $1.9 billion in additional funding to the Veterans 
Administration. Passage of this amendment would go a long way to 
covering existing shortfalls and allowing the VA to

[[Page 6062]]

ramp up to meet the current and expected needs for the coming year. I 
am pleased that this amendment addresses the critical issue of mental 
health by providing $525 million specifically for mental health care 
and treatment.
  Unlike prior wars, where soldiers were expected to lay down their 
guns upon returning home and forget about the war, service members 
returning from Iraq and Afghanistan understand that it is very 
important for their mental health and the well-being of their family, 
that they deal with both the mental effects of the war and the 
emotional effects on their families of a long and stressful separation. 
Vet centers exist all across the country to help veterans and their 
families deal with the ghosts of war and manage the transition back 
home. These centers do a phenomenal job, but they are generally very 
small and have been handling a limited case load. With veterans 
returning from Iraq in huge numbers, particularly members of the 
National Guard and Reserve who do not live on or near military bases 
the job of the Vet centers has increased more than a hundred-fold. The 
Vet centers need an increase in both staff and resources commensurate 
with the demands now placed upon them.
  We have learned from prior wars that much can be done to ease the 
transition back to civilian life if it is done immediately. Immediate 
mental health care can prevent the onset of more difficult diagnoses, 
such as post traumatic stress disorder. The VA has developed expertise 
in the diagnosis and treatment of PTSD, well beyond that of the private 
sector. The challenge now is to spread this expertise throughout the VA 
system. This takes resources. We also have learned that those soldiers 
who have suffered physical wounds will often need ongoing mental health 
assistance to face the challenges of life with a disability. We must 
not turn our backs on them.
  The bill before the Senate is designed to cover the costs of these 
two conflicts. We cannot say we have done so if we do not cover the 
costs of the physical and emotional wounds from these conflicts. The 
only way that this can be done with the funding provided by the 
President's budget is if our obligations to other veterans are set 
aside. This would be wrong. The only way we can truly honor our 
obligations to all of our veterans is to support the amendment by the 
Senator from Washington, Mrs. Murray.
  I urge my colleagues to support the Murray amendment.

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