[Congressional Record (Bound Edition), Volume 161 (2015), Part 11]
[Senate]
[Pages 15564-15567]
[From the U.S. Government Publishing Office, www.gpo.gov]




MILITARY CONSTRUCTION, THE DEPARTMENT OF VETERANS AFFAIRS, AND RELATED 
          AGENCIES APPROPRIATIONS ACT, 2016--MOTION TO PROCEED

  The PRESIDING OFFICER. Under the previous order, the Senate will 
resume consideration of the motion to proceed to H.R. 2029, which the 
clerk will report.
  The legislative clerk read as follows:

       Motion to proceed to Calendar No. 98, H.R. 2029, a bill 
     making appropriations for military construction, the 
     Department of Veterans Affairs, and related agencies for the 
     fiscal year ending September 30, 2016, and for other 
     purposes.

  The PRESIDING OFFICER. The Senator from Alaska.
  Ms. MURKOWSKI. Madam President, I am here this morning to speak about 
the issue that is before this body, the motion to proceed to H.R. 2029, 
or what we refer to as the MILCON-VA appropriations bill.

[[Page 15565]]

  I certainly intend to support closing off debate on this and moving 
to take up this important appropriations measure. This is important for 
a host of different reasons, not the least of which is that we need to 
get to the substance of this issue. We need to get back to a regular 
order process in order to advance the appropriations bills that we on 
the Appropriations Committee have spent a considerable amount of time 
and effort drafting.
  Over these past many months, we have worked to make sure that the 
bills were ready for floor consideration. We didn't want to find 
ourselves in a situation where, at the end of this year, we scramble to 
piece together an omnibus measure that has not had the considered 
debate and opportunity for amendment that I believe we all seek as 
lawmakers. It is important that we consider the Military Construction-
VA bill in regular order and do it now--not stick it on the back end of 
another measure, not incorporate it into an omnibus bill or into some 
fashion of a CR omnibus right before Christmas.
  I serve on the Appropriations Committee. I had input into this bill 
at the subcommittee level and again at the full committee markup, which 
is a lot more than can be said of many of my colleagues in this body 
who don't have that opportunity since they are not on the 
Appropriations Committee. But even after having the input that I have 
had, it is extraordinarily important that I have another opportunity to 
influence the bill, and I will illustrate why.
  I am going to speak about one very specific issue today that has 
garnered the attention, concern, and passion of Alaskans and veterans 
around the State, and that is the issue surrounding the Veterans Choice 
Card.
  In the view of many Alaskans, the Veterans Choice Card is an 
unmitigated disaster in our State, and there are many reasons that is 
the case. We don't host a stand-alone VA hospital in Alaska. So the VA 
has issued a Choice Card to every veteran in the State who is enrolled 
for health care. In order to use the Choice Card, you have to identify 
a provider that is willing to accept the card, qualifies under the very 
onerous Choice Card standards, and is also willing to put up with the 
bureaucratic strings that are attached to determining which care is 
approved by the VA over what period of time and for what price.
  In Alaska, we have a demand for health care providers that far 
outstrips the supply, and I have been on the floor many times speaking 
on that subject. We have many Alaskans that have private health 
insurance which pays the providers better, and it is certainly more 
efficient than the government-sponsored programs.
  Structurally, the way the Veterans Choice Card Program is currently 
designed, it does not provide Alaska's veterans with the choices that 
it promises. It is just as simple as that, and those are just the 
structural problems we are talking about. Many of our colleagues know 
that TriWest has encountered difficulties with implementing the 
program, and the VA has had trouble coordinating TriWest's work with 
the work of the local VA facilities. Unfortunately, these problems have 
led to some dangerous near-misses.
  We had one situation with a veteran who was scheduled for a fee-basis 
neurosurgery. He was going to receive this care from a community 
provider in the State. Then he was told by the VA that the VA had 
changed its mind. They were not going to sign off on paying for the 
care. The vet was told to call TriWest. The TriWest call center 
operator gave the veteran a list of behavioral health providers who had 
signed up to accept the Choice Card. The call center operator didn't 
know that neurosurgery is not the same as behavioral health. By the 
time the VA had reversed itself, the neurosurgery that the veteran had 
initially scheduled was no longer available. The vet had to wait for 
one to become available.
  What happened in the interim? They gave the veteran pain medicine.
  In another case, we had a veteran sent to Seattle for a course of 
radiation therapy, and in the middle of this course of radiation 
therapy the vet was told to return home because his authorization had 
expired. He was told: The authorization has expired. Go home.
  It is not as if he could just get in a car and drive 20 minutes back 
to his house. He had been sent to Seattle from a rural community in 
Southeast Alaska for the care--for the radiation therapy. They said: Go 
home. Your authorization has expired.
  So there was a whole series of exchanges with TriWest and then with 
the VA itself. The vet began, basically, calling family members to tell 
them he was coming home to die and to start making funeral 
preparations. This is not how we treat our veterans.
  Now the Veterans Choice legislation provided that the Choice Card 
program does not displace any of the existing VA purchased care 
programs. It explicitly supplemented those programs, which for us in 
Alaska would be a good thing. In Alaska, the VA--and this was under 
Secretary Shinseki's leadership--established two purchased care 
programs to address gaps in VA capacity in Alaska. One of the programs 
provided for partnerships with our tribal health system to care for our 
vets in more remote areas of the State where the VA simply doesn't have 
a presence. It was innovative. It was innovative
at the time, and these partnerships worked. They really did help to 
facilitate the care. The other program called ``Care Closer to Home'' 
enabled the VA to purchase care from community providers in the State 
who performed medical services that the VA didn't offer--services such 
as neurosurgery and specialized forms of radiation therapy.
  Before this program was implemented, the VA forced veterans to fly to 
Seattle or other parts of the country for services that we would 
consider pretty routine. You have a 1,000-mile-plus flight to Seattle 
for an orthopedic appointment or for a neurosurgery appointment. This 
is what we are putting our veterans through. Imagine you are 70 years 
old, 80 years old, and you are told to go take a flight for 3\1/2\ 
hours to Seattle--get yourself to the hospital just for an orthopedic 
appointment. By the time the veteran is at this place and needs that 
appointment, you are not feeling well in the first place.
  I have talked and written before about a veteran on the Kenai 
Peninsula who died while fighting with the VA over urology care. He 
couldn't travel to Anchorage, which is about a 3-hour drive, much less 
to Seattle where the VA wanted to send him because he was in very frail 
condition, but the VA refused to purchase his care on the Kenai 
Peninsula where there are facilities that could have helped him. I 
think we would all agree that when our elderly veterans are in perhaps 
their final months of life, they have got a lot better things to do 
than fight with the VA and the bureaucracy.
  When the VA came to the hearings before the appropriations 
subcommittee, I asked them pointblank whether the implementation of the 
Veterans Choice Card would adversely affect the existing purchased care 
programs in Alaska, whether it is through IHS or further specialized 
care, and the answer was clear. There was no nuance; there was no 
doubt. The answer was no, it is not going to impact negatively the 
purchased care program. When the Senate Appropriations Committee marked 
up the MILCON-VA bill on May 21, the VA hadn't changed its answer. It 
is not going to negatively impact, they said.
  Then a week later, on May 28, I happened to be visiting the VA 
facility in Anchorage, and I learned there that the VA had spent all of 
its fiscal year 2015 purchased care money and was planning to suspend 
its relationships with community providers and the Alaska tribal health 
system.
  I had gone to the VA center to get an update, to check in with the 
new docs who were there and to see how things were going. It was 
basically a checkup with the folks at VA, and they laid this bombshell. 
They weren't trying to be coy with me or hide the ball. They had just 
learned themselves. I don't know who was in greater shock, me or the 
folks there at the VA and their military partners.
  We were also in a situation where there were a lot of rumors that the 
VA was going to pull out of the Joint Venture Hospital that it shares 
with the

[[Page 15566]]

Air Force on the Joint Base Elmendorf-Richardson. Again, this was a 
bombshell of news. Now we know that the VA was not just out of 
purchased care money, it was out of money to operate its health care 
system, and without the emergency infusion of money we provided from 
the Choice Act fund before August recess, the VA would have run out of 
money before we had come back from the August recess.
  It was a situation that was a mess. We fixed the mess for 2015 but 
did nothing for 2016.
  What does the VA's failure to properly project the cost of purchased 
care in 2015 mean for its fiscal year 2016 appropriations? After asking 
the VA on several occasions, I am left with the impression that the VA 
once again will run out of money for purchased care and then will 
remedy this situation by shoving veterans who are seeking care under 
the Choice Card whether the care is meaningfully available or not. So 
we have been pushing the VA on this, and to Secretary McDonald's 
credit, he came to Alaska this summer. The Undersecretary for Health, 
Dr. Shulkin, visited Alaska. They weren't sheltered from the anger that 
our vets were feeling.
  My colleague Senator Sullivan conducted an incredible field hearing 
to create a record of how the VA, TriWest, and the Choice Card Program 
were individually and collectively failing Alaska's veterans. But 
here's the problem. We don't have a fiscal year 2016 solution locked 
down, and we may not have an acceptable solution locked down by 
Veterans Day, either.
  Without an opportunity to debate the fiscal year 2016 appropriations 
bill on the floor, I have limited opportunity to press this point, to 
demand that the GAO investigate what actually is going on and try to 
amend the bill to ensure that the VA has adequate purchased care money 
available so that it doesn't drop these veterans through the cracks 
when it can't serve their critical care issues, and neither can the 
Choice Card program. Without the opportunity to debate in regular 
order, I can't do what the people of Alaska have asked me to do in 
representing them the way I know that we need to in order to deal with 
this.
  I hear what the Democratic leader is saying, that the Budget Control 
Act needs to be addressed, but I don't agree with the tradeoff that we 
cannot consider appropriations bills in regular order while 
conversations are ongoing to address the bigger, broader question. 
Failing to consider these bills in regular order corrodes the influence 
of this body; it corrodes the ability of Members to fulfill the 
responsibilities that we have to the people that we work for. These are 
issues.
  Again, I chose to focus my comments this morning on one area within 
the MILCON-VA, on that implementation of the Choice Card in Alaska, and 
how it has so basically failed our veterans. But there is so much more. 
Again, if we don't have that opportunity to bring it up, to offer our 
amendments, to do our best to serve the needs of our veterans, we fail 
them. We fail the system.
  I do hope we will have the opportunity this afternoon to advance to 
these important measures. Remember, this is just the first of 12. It is 
very important work that we have in front of us.
  Madam President, I know my colleague from Connecticut has arrived on 
the floor, but before I yield the floor to him, I want to briefly 
mention a meeting that I had this morning in my office.

     Welcoming Members of The Anchorage Fire Department Honor Guard

  Madam President, I was able to welcome members of the Anchorage Fire 
Department Honor Guard to my office. They are making their way to 
Emmitsburg, MD, to be part of a ceremony at the National Fallen 
Firefighters Memorial, where they will pay tribute to and honor the 
firefighters who have given their lives in the line of duty during the 
year 2014.

                        Remembering Jeff Bayless

  The firefighter whom Alaska is recognizing and honoring is a 
gentleman by the name of Jeff Bayless. He died at the age of 51 on 
March 7, 2014, during a strenuous training exercise in Anchorage.
  How Jeff Bayless lived his life as a fourth-generation Alaskan, and 
as one who had not only a love for the outdoors but a love and care for 
people, is something that we want to pay tribute to, and we want to 
honor and recognize him.
  This weekend, on the campus of the National Fire Academy in 
Emmitsburg, MD, the name of fallen Anchorage firefighter Jeffery Edward 
Bayless will be inscribed on the National Fallen Firefighters Memorial. 
A total of 87 firefighters will be honored, and 84 of those 
firefighters, including Jeff, gave their lives in the line of duty 
during 2014. Three died in previous years. This week, I welcome members 
of the Anchorage Fire Department Honor Guard to my office, as they make 
their way to Emmitsburg to celebrate Jeff's life and his contributions 
to the fire service.
  I wanted to reflect for a moment on the life of fire hero Jeff 
Bayless. Jeff died at age 51 on March 7, 2014, during a strenuous 
training exercise in Anchorage. Heroes are remembered for the way they 
lived their lives and this is how we should remember Jeff Bayless.
  Jeff was a fourth generation Alaskan. He grew up in Copper Center, 
attended Alaska Bible College in Glennallen, and then became a 
paramedic through the Oregon Health Sciences University training 
program. Jeff was also trained as a Registered Nurse. After serving as 
a paramedic in Oregon, he returned to Alaska to work as a first 
responder in Matanuska-Susitna Borough. Ultimately he found his home at 
the Anchorage Fire Department, first as a paramedic and then as a 
firefighter. He excelled in both roles. Working his way up the ranks, 
Jeff was a Senior Captain at the time of his passing.
  As would be expected of a fourth generation Alaskan, Jeff had a love 
for the out of doors. From an early age, Jeff put his mastery of the 
outdoors to work in the service of lifesaving. As an older teenager, 
Jeff and his buddy happened upon a flash flood in the Yukon that swept 
vehicles off the road. Using their wilderness savvy, they roped up and 
rescued every person.
  Later in life, as a member of the Anchorage Fire Department's 
whitewater rescue team, he plucked several victims from dangerous 
waters. One of these rescues was particularly memorable. On September 
16, 2012, Jeff's Station 11 was called out to rescue a kayaker on the 
Eagle River who was lodged against a tree after his kayak overturned. 
The kayaker was in the water for about 90 minutes when a bystander 
called for emergency assistance. First the tree had to be cut, then the 
kayaker plucked from the water
by his lifejacket. The kayaker was hypothermic by this point. While a 
number of units from the Anchorage Fire Department responded, Jeff was 
senior on the three-man jet boat team that plucked the victim out of 
the water. Jeff's team won the American Red Cross of Alaska Wilderness 
Rescue Heroes award. Jeff characterized the rescue as one of the most 
challenging successful rescues his team had ever been involved with. 
The team was well trained to perform the rescue and in spite of the 
dangers ``everyone went home,'' including the victim.
  I cannot characterize Jeff's life in words more touching than on his 
National Fallen Firefighters Foundation official biography. He spent 
his life simply doing what he loved, completely engaged, lost in the 
moment. Without any consciousness of the impact his own life was 
having, he left behind a great legacy of life, encouragement, 
accomplishments, and friendship.
  That, my colleagues, is the definition of a fire hero.
  He would say he was one of the guys who was just doing his job, but 
as one of those men who was just doing his job, he needs to know that 
we view him as one of our heroes.
  Our thoughts and our prayers are with his family and all of his 
brother and sister firefighters as they gather this weekend in 
Emmitsburg.
  Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.

[[Page 15567]]




                           Zadroga 9/11 Bill

  Mr. BLUMENTHAL. Madam President, I thank my colleague from Alaska for 
yielding and giving me this opportunity to discuss two measures that 
ought to be beyond debate or discussion on this floor as well as in 
America--two issues where Americans ought to unite and be together 
without controversy or contention.
  The first relates to the emergency responders who rushed to the 
rubble of the World Trade Center in New York in the wake of that 
horrific attack on America on September 11. I want to join and thank my 
colleague from New York, Senator Schumer, who just spoke on the floor, 
and associate myself completely with his very eloquent and powerful 
explanation for why this Nation must meet its obligation to provide 
critical health care for those emergency responders, firemen, police, 
and medical personnel who went to that site, even as it continued to 
smolder with poisonous chemicals and fumes, risking their lives in the 
face of peril that they little understood and could not know. They 
never asked whether that place was dangerous, but, in fact, as we now 
know, it has caused countless cancers, blood diseases, and lung 
problems, which have manifested themselves in the years after.
  Yet at midnight last night, the beginning of this day, the programs 
designed to provide critical medical care and compensation to the 
victims were permitted to expire. That is unconscionable and 
unacceptable.
  I join my colleagues from New York and New Jersey as a leading 
cosponsor in urging this Congress to act--and to act immediately and 
urgently--to make sure that we do what is right for those emergency 
responders who served and sacrificed in the wake of 9/11. Failure to do 
so is absolutely outrageous. The fund still has some money, and it will 
continue to function. But this Congress should act to pass the Zadroga
9/11 bill immediately.
  Madam President, the second area where I think we ought to be all 
agreeing relates to doing what is right for our veterans, and that 
means restoring the $857 million that has been deleted from the 
President's request for veterans in the Military Construction, the 
Department of Veterans Affairs, and Related Agencies Appropriations 
Act, 2016. This bill essentially shortchanges our veterans and 
straitjackets the Veterans' Administration.
  Madam President, I ask unanimous consent to have printed in the 
Record a letter from the American Legion.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                              The American Legion,


                             Office of the National Commander,

                               Washington, DC, September 30, 2015.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     The Capitol, Washington, DC.
       Dear Majority Leader McConnell: Last May then-National 
     Commander Michael D. Helm called on Congress to pass a budget 
     for the Military Construction-Veterans Affairs Appropriations 
     bill that won't shortchange the Department of Veterans 
     Affairs (VA). On April 30 the House of Representatives had 
     passed a funding bill which unfortunately underfunds VA's 
     medical care, major construction and Information Technology 
     accounts by more than $1.5 billion below the Administration's 
     request.
       We were pleased when the Senate Appropriations Committee 
     remedied that shortfall somewhat, but because they were 
     tasked with making an unworkable allocation workable, the 
     Senate version of the bill still underfunds veterans by 
     approximately $857 million. This comes at a time when the VA 
     is faced with an unprecedented demand for services, in terms 
     of both numbers and complexity.
       We need your help to ensure that VA is fully funded so it 
     can provide the care and services veterans have earned and 
     need. An inadequate VA budget will have a negative effect on 
     the timeliness and quality of care that veterans will 
     receive. Fully funding VA must be a very high priority for 
     Congress.
       The American Legion is the largest veteran service 
     organization in the nation and we take our responsibility to 
     analyze and evaluate veterans' healthcare options very 
     seriously. As VA, Congress and The American Legion move 
     forward together we must ensure that America's veterans are 
     provided with the healthcare and services they have earned 
     and were guaranteed.
           Respectfully,
                                                     Dale Barnett,
                                               National Commander.

  Mr. BLUMENTHAL. This letter emphasizes the challenges that the VA 
faces in meeting the unprecedented and increasing demand for services 
that our veterans need and deserve. This obligation for our country is 
not a matter of discretion or convenience, it is a promise that we have 
made and we must fulfill to provide medical care, skills training, job 
opportunity, and, most especially, the mental health care that our 
veterans need so that we can stop the 22 suicides every day in this 
country--the greatest, strongest, country in history of our world, 
where 22 of our Nation's heroes commit suicide every day.
  They suffer from the invisible wounds of war, post-traumatic stress 
and traumatic brain injury. Many of our veterans suffer the more 
visible wounds, and they need care as well. Many of our veterans in 
increasing numbers will be coming out of the service needing jobs and 
skills training, not only through the VA but the Department of Labor. 
Just yesterday, the nominee for the Veterans Employment and Training 
Services position in the Department of Labor testified before the 
Veterans' Affairs Committee as to the importance of services provided 
by the Department of Labor, and yet they too will be shortchanged by 
this budget.
  So I urge my colleagues to provide sufficient funding to restore that 
$857 million and to make sure that we meet those needs of our veterans. 
Failing to do so is as unacceptable as failing to meet the needs of the 
emergency responders who went to the 9/11 site. This bill underfunds 
the VA's medical facilities by $100 million, reducing the VA's ability 
to keep pace with the need for critical facility maintenance. This is 
upkeep that is vital for basic repair and maintenance. Facilities will 
decay and downgrade without that funding. It is an investment in basic 
infrastructure.
  We ought to be investing in the personnel of the VA--the doctors and 
nurses and other professionals--so that we recruit and retain the men 
and women who will really do the work on the ground in the trenches to 
make sure that the VA provides the best care possible--world-class care 
to our veterans. They deserve no less. Fully funding the VA honors the 
service and sacrifice of men and women who have risked their lives to 
keep our great Nation free. Freedom is never free, and this Nation 
ought to be keeping its promise to those veterans, which, 
unfortunately, sadly, reprehensibly, this measure fails to do.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. FLAKE. Madam President, I ask unanimous consent to enter into a 
colloquy with the Senator from Wisconsin.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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