[Congressional Record (Bound Edition), Volume 161 (2015), Part 12]
[Senate]
[Pages 16417-16418]
[From the U.S. Government Publishing Office, www.gpo.gov]




                 VETERANS' ADMINISTRATION MEDICAL CARE

  Mrs. MURRAY. Mr. President, next month our Nation will pause to honor 
the millions of men and women who have fought for our freedom and 
worked to advance peace around the world.
  Veterans Day is our annual way to say thank you and to honor those 
who have sacrificed so much on our behalf. While I would like to stand 
on the floor and say our country is doing everything we can for the 
people we owe the most to, that we are fulfilling the promise we made 
to them when we sent them off to fight for us, unfortunately that is 
not currently the case because our Nation is falling far short of its 
goal of honoring our veterans when it comes to VA care.
  Despite a sweeping bill intended to tackle some of the most pressing 
problems and give the VA new tools and a change at the top of the VA 
more than a year ago, I continue to hear from veterans across my home 
State of Washington about care that is inconsistent, outdated, and 
often downright dismissive of individual needs. I have heard from a 
number of veterans in my home State of Washington who are waiting on 
surgeries, MRIs, oncology appointments, mental health screenings--you 
name it--and far too often they say they are told it will be months to 
see a doctor or a specialist.
  I bring their stories today, to this ``other Washington,'' to 
continue to make clear this kind of outdated, inefficient care is 
unacceptable.
  This is a pivotal time for our VA, and the demands on the system will 
only go up as wars continue to wind down and the Vietnam-era veterans 
continue to seek more care for the injuries and illnesses they suffer 
from. As the daughter of a World War II veteran, I refuse to let 
substandard care be the status quo. I won't accept long wait times, 
redtape, and understaffed hospitals as a reality for our veterans. I am 
not going to stop fighting to make sure we have a system that works no 
matter how long it takes, no matter how many obstacles we face, and no 
matter who is in charge at the VA.
  The law we passed to give veterans more options for care has now had 
an opportunity to go into effect. We can see what is working, what is 
not, what we can build on, and what we need to tear apart.
  Last year I supported the inclusion of an independent assessment of 
the VA health system in the Choice Act, and recently that assessment 
validated what we have been telling the VA for years: There is growing 
bureaucracy, and there are problems with leadership and staffing, and 
massive capital costs. While the independent assessment identified some 
bright spots in the VA system, it also found that care and patient 
experiences differ widely across the system and that best practices and 
important policies are not instituted across the country. That means we 
all have more work to do because we have a responsibility to our 
veterans.
  Here is what we are up against. The VA still has multiple non-VA care 
programs, none of which talk to each other, none of which are 
coordinated. They all have different eligibility criteria, different 
procedures for patients and providers, and different reimbursement 
rates.
  I hear frequently from veterans in my home State of Washington about 
how difficult the Choice Program has been. From VA staff who don't 
understand the program, to confusion about eligibility, to getting the 
runaround from contractors, veterans are sick and tired of having to 
fight just to get an appointment.
  I hear how frustrating some of the bizarre rules and restrictions on 
Choice are. For example, an authorization for care only lasts 60 days. 
Well, if you are a woman veteran and you are pregnant, you are going to 
need more than 60 days of care.
  At the VA, we are still hearing that the wait times are far too high. 
But with long wait times in the private sector and the burdensome 
process to even get into the Choice Program, veterans are finding they 
actually would have gotten care sooner if they had stuck with the VA. 
If the solution to the wait time problem takes longer than going to the 
VA, it is not working.
  It is no wonder that veterans and providers alike turn their backs on 
the VA. The system is so complicated, it is impossible to get good 
health care.
  It is time for the VA to implement one--one--non-VA care program for 
the future. As we now approach the end of this trial period for the 2-
year Choice Program, the VA has to use this opportunity to finally get 
it right on non-VA care. It needs to design a new system that truly 
meets the needs of our veterans.
  I believe that system must have five fundamental characteristics:
  First of all, it has to be veteran-centered, with clear eligibility 
rules so veterans know what they can do and what they can expect and 
where they can go for what care and how that system works. It also 
means the experience for veterans trying to use the system has to 
improve. For example, veterans should never be turned away with a 
dismissive ``We are not taking new patients.''
  Secondly, it has to be easy for our providers, with simple and 
consistent procedures for them to deliver care, report back to the VA, 
and get reimbursed quickly. The contracting system needs to be simple 
and clear so that private providers can step in where the VA cannot.
  Third, a new system must provide high-quality care that includes 
effective care coordination, and that requires that electronic medical 
records be returned to the VA. That includes oversight of the quality 
of care being delivered in the private sector. We have to know our 
veterans are being appropriately cared for.
  Fourth, the new system has to be flexible enough to compensate for 
local needs, types of care where VA is deficient, or locations where 
the VA does not have a presence. Whether working with community 
providers to increase certain specialty appointments or seeing where 
the VA needs to move resources to hire more VA staff, the system has to 
maintain flexibility to adjust to new trends and new needs.
  Finally, it has to be cost-effective for the VA and not shift the 
cost of care onto our veterans. Earlier this year, the VA nearly ran 
out of money, and they threatened to shut down the health care system. 
Well, we should invest whatever we need to to make sure our veterans 
are getting care. The new non-VA care system must be more efficient, 
and the VA needs to be clear with Congress about what it needs. Without 
a change, I would not be surprised if next year we don't find ourselves 
in the same position where we have underfunded the VA and need to come 
in and transfer funding to keep the VA operating. I will work with 
anyone and stand behind no one when it comes to getting veterans the 
funding they need.
  Perhaps most important, when implementation begins, it simply must be 
better than what we saw with the Choice Program. VA staff have to be 
trained and proficient, and third-party administrators in charge of the 
networks of private providers have to be efficient and responsive. 
Veterans deserve a system that works, not one

[[Page 16418]]

that is torn apart and weakened over time.
  So the answer isn't just to dismantle the VA and leave veterans to 
fend for themselves, as some proposals would do; the solution starts, 
finally, with a real conversation about what is going on at the VA, 
what the problems are, and then pursues an ``all of the above'' 
approach that finally strengthens the VA system, uses community 
providers to fill in the gaps where the VA cannot get the job done, and 
continues to make the best use of other Federal help programs, such as 
DOD and federally qualified health centers--all in an effort to truly 
build a veteran-centered VA health care system.
  I stand ready to work with anyone to do this, and I hope my 
colleagues on both sides of the aisle will join me and not make this a 
Democratic or Republican issue. Veterans issues have never been 
partisan, and, in my mind, there is no place for that when we sit at 
the table to solve a complicated problem. I hope the administration is 
ready to fundamentally reshape this program. I hope bureaucrats who 
spend more time defending the broken system are ready to get to work 
implementing solutions built around the needs of our veterans. And I 
hope providers--those who work with the VA and DOD and TRICARE, as well 
as those who currently do not provide care to veterans--play a role to 
improve veteran care.
  The wars may no longer lead the nightly news, but that doesn't mean 
the cost of these wars is gone too. Our veterans are still there, they 
still need health care and services, and we will not forget them.
  I expect the VA to do better. Our veterans have already sacrificed so 
much. They should not have to come back and fight the VA to get the 
care they have earned. Let's act and let's do something that truly 
honors our Nation's heroes.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I want to thank the Senator from Washington 
for her very thorough and passionate explanation of the problems with 
the VA. It is time we got it straightened out. We have a new director 
because there was a problem. We gave them more money because there was 
a problem. We did the Choice Act because there was a problem. I think 
the VA is kind of fighting the Choice Act because they want to make 
sure they keep it within their own clutches. But it is time that we got 
it straightened out and that we got some action.
  All of us are getting calls from veterans we should never get. We 
could go into a variety of them. But I would like to work with the 
Senator, and I appreciate the comments she just made. I thought they 
were very bipartisan and very much needed.
  Mrs. MURRAY. I thank the Senator very much.

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