[Congressional Record (Bound Edition), Volume 163 (2017), Part 14]
[Senate]
[Pages 20543-20545]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          VETERANS HEALTHCARE

  Mr. ISAKSON. Mr. President, I am glad to join my colleague Senator 
Tester from Montana on the floor for a discussion of our Veterans' 
Affairs, our accomplishments over the last 3 years and our challenges 
for the future.
  I want to start out my part of the conversation by saying this. Three 
years ago, the Veterans' Administration was making big headlines. Those 
headlines were that they weren't working well, our veterans were 
waiting too long for care, there were failures in our system 
throughout, and people were looking for an alternative to the VA system 
because it was in such a quagmire. Thanks to the work of our committee, 
which the Presiding Officer today is one of those members, we set out 
to fix a lot of the problems. No. 1 was the hospital in Denver, which 
is 40 percent finished. It was 3 years behind, and we closed in. That 
hospital is open today and operating because the Veterans' Affairs 
Committee of the Senate buckled its shoes, got to work, got the VA 
fixed, and got the hospital finished.
  The most challenging thing we faced were long wait times for 
appointments for our veterans and veterans' services for healthcare. It 
was longer than 30 days just for a routine appointment, sometimes being 
as long as 6 months to wait, and sometimes they were dying before they 
got called up from the waiting list, which happened in the Arizona case 
in Phoenix.
  We had some tragic stories that came through. Our committee came 
together and said: We are going to fix this. We are going to put our 
shoulders to the grindstone, we are going to work out hard, and we are 
going to make it happen. Like always, fixing anything requires one 
element, and that is hard work.
  This Committee has worked hard--Democrats and Republicans alike. They 
have been willing to get the new Secretary, Secretary Shulkin, 
confirmed. To all of his aides--Tom Bowman, who has been a great aide 
to our committee for a long time, and now is a direct aide to the 
Secretary. The committee has asked: What is it we need to do to get it 
fixed?
  We started out this year with 11 bills introduced for the Veterans' 
Administration improvements in terms of healthcare. Ten of those eleven 
have passed. There is one left. We are going to have a perfect 11-for-
11 year, if we get the votes before the end of this year, we get the 
CARE bill passed for our veterans, but even if that doesn't make it, we 
have dealt with long waiting lines for determination of benefits for 
the VA. Those long waiting lines are beginning to dissipate.
  We don't have hospitals being shut down because they can't be 
finished. We have CBOCs being opened because they are being finished. 
We don't have near as many cases of horror stories in a VA health 
facility because the facilities are being run better.
  Do we have problems? Sure, we have problems. Anytime you have the 
second largest agency of the Federal Government--which the VA health 
system is--you are going to have problems, but we are meeting them 
head-on. We are not running away from them. We have a Secretary who is 
really willing to work to make it happen.
  I cannot say enough about Secretary Shulkin. He has been fantastic. 
He has been a great worker. He has given President Trump the message, 
in terms of what our veterans need, the challenge that we need from the 
White House to join us, and the White House has substantially done so, 
to help make a lot of improvements.
  Working with our ranking member, we decided we would do a number of 
things: We would end the long wait times for determination of 
disability, and we have done that. That is in process. We wanted to see 
to it that the modern access to healthcare was available to all of our 
veterans, one way or another. We wanted to make sure we came up with 
creative ideas by using telemedicine and other techniques to deliver 
healthcare to our veterans.
  Most importantly, we knew the Choice Act we passed 3 years ago, led 
by Senator McCain--who is in our prayers and thoughts every day. I 
might add from the floor of the Senate today, we wish him the very best 
if he is listening. Senator McCain went to work and came up with the 
first aspect of Choice, which passed 3 years ago. I was on the 
conference committee. We had this crazy idea that we were going to let 
veterans choose where they want to go for their healthcare. We set up 
the system to do that. The system worked pretty well in some cases. 
Senator Tester will say in rural America it didn't work all that well, 
in some cases, but it was a good effort of ours to take the private 
sector in America and make it a force multiplier for the healthcare 
services delivered to our veterans and expand the access of healthcare 
to our vets.
  Well, now we have before the Senate what we call the Care Act. It is 
the finishing touches of what was originally in the Choice Act. We are 
taking the things we learned and repealing what was wrong. We are 
taking things we learned are right, and we are enhancing them. I hope 
every Member of the Senate who can hear my voice today will join me 
sometime in the next few weeks ahead to finish the job and pass the 
Care Act. Our committee passed it out 14 to 1, with Democrats and 
Republicans alike, shoulder to shoulder, voting for it. It is the right 
thing to do for our vets. We are hopefully going to do the same thing 
on the floor.
  The Care Act does a lot of amazing things, but it takes what we have 
learned in 3 years and applies it to the real world for our veterans. 
It says a veteran has a choice for his healthcare, public or private, 
VA or private sector. The veteran and his or her doctor may determine 
where they want to go. The physician providing the services who is 
outside the system will cooperate with the VA, so we have good medical 
records for that veteran, and they will work together to choose doctors 
who have the quality, the reputation, and the ability to deliver the 
service, whether they are in the VA or outside the VA.
  The veteran comes first in Veterans Choice. In the Caring for Our 
Veterans Act, the veteran comes first, not Members of the Senate, not 
employees of the VA. The veteran comes first, which is what we need to 
do.
  I hope everyone will join Senator Tester and me in seeing to it, when 
we get this to the floor--and we are trying every day--that they join 
us in helping pass the Care Act.
  One last thing I want to mention about the Care Act is it also 
contains the funding necessary to complete the year for the Veterans' 
Administration in terms of health services. More importantly, it 
consolidates the stovepipes of funding in the VA so we no longer have 
this Mickey Mouse game, which we have all experienced for the last 5 or 
6 years, where the VA is always running out of money.
  The Congress has never cut off the VA. When we had the biggest 
shutdown 5 or 6 years ago--or potential shutdown for the government 
that we had, we passed bills that exempted the VA to demonstrate long 
and hard that we would never leave our veterans in need of healthcare 
coverage waiting because we couldn't act in the Congress, and that 
would happen today if that was threatening us.
  I want to underline, this is not a matter of anybody threatening 
anybody. This is a matter of finishing the job for our veterans and 
seeing to it that the Veterans' Administration has the resources 
necessary to deliver the services to our veterans.

[[Page 20544]]

  For those who can hear this plea--and it is a plea--understand I am 
coming before us today to say three things: One is thank you. Thank you 
to every Member of the Senate who voted with us to get us where we are 
today. We have passed 10 of the 11 bills we brought in this year for 
veterans' healthcare services. Thank you very much.
  I say to Senator Tester, as the ranking member, thank you for your 
cooperation. We have worked together to find a solution to every 
impasse we confronted throughout the year.
  To the Senator from Alaska, who is presiding today and is a member of 
the committee, thank you for what you did for those veterans in need in 
our States that have limited access to healthcare, like Alaska. We need 
to make sure the Alaskan veteran has the same access and the same 
benefits they signed up for as one does in Georgia or in any other 
State.
  Senator Tester from Montana has worked so hard to see to it that 
rural America has the same type of access. There may not be as many 
doctors, there may not be as many VA facilities, but we can design a 
system that gives them the very best access and the very best care for 
that region where they choose to live.
  That is our challenge. Our challenge in the VA is not to say: Well, 
you should have lived somewhere else. Our challenge is to say we should 
have concentrated more in the VA to see to it that where you live is 
the right place to be in terms of veterans' services, and we are going 
to do that.
  Lastly, I thank Secretary Shulkin. He was approved 100 to nothing by 
the Senate. I believe I am right that he is the only Cabinet member who 
was confirmed by the Senate 100 to nothing. As everybody knows from 
watching us the last 8 or 9 months, we haven't agreed on much of 
anything. We haven't had any unanimous consent votes on hardly 
anything. We did with David Shulkin, and he has delivered, in response 
to that 100-to-nothing vote, time and time again, working for our 
veterans, helping to direct problems, helping to work with us together.
  I look forward to next year, as we bring a close to the Care Act and 
pass it, moving forward with those new things we need to pay attention 
to.
  I look forward to working with Senator Tester from Montana and the 
members of the Democratic Party and the Republican Party in our 
committee.
  Remember, we are veterans first. We are Americans first. God bless 
our veterans. May God bless the United States of America.
  I yield to Senator Tester.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. TESTER. Mr. President, I thank Senator Isakson for his words. I 
thank the Presiding Officer, who is currently sitting in the chair, for 
his work on the Veterans' Affairs Committee.
  I want to talk a little bit about Chairman Isakson before I talk 
about the Care Act. Over the last year, I have been able to work with a 
great man from Georgia who has done great work. When we started out, we 
talked about doing stuff we could agree upon and set the stuff we 
disagree upon apart, and it has ended up where we have agreed on a lot 
of stuff, and we have been able to get a lot of stuff done.
  I would just say, in a body that is full of impasse over this last 
year, Chairman Isakson has been a great guy to work with because the 
fact is, we have set aside the political labels, and we have worked for 
our veterans in that committee. It is not only Johnny and myself, but 
members on both sides of the aisle in that committee have worked very 
well together and communicated so very well to make sure we could take 
care of the needs of our veterans across this country, whether it was 
in rural America or whether it was in urban America, but our work is 
not done.
  The Care Act Chairman Isakson talked about is a very important piece 
of legislation. It is a bipartisan compromise. It is a bill we all 
negotiated on, so not everybody got everything. There are always things 
in it that you wish would be better, regardless of where you are in the 
spectrum, but this program does a lot of good things for our veterans.
  It, first of all, will eliminate the Veterans First Program and 
replace it with one that is much easier for veterans to navigate in a 
system that puts in place where the veterans can seek care. It puts 
that system in the hands of a veteran and their doctor.
  This is a bill that passed out of committee 14 to 1, and it has 26 
veterans service organizations, representing millions of veterans who 
have endorsed this bill. It is a good bill.
  I wish the Veterans' Administration, which we worked so closely with 
on this bill, would come out and forcefully endorse it. I think that 
would help a lot.
  What it does is it establishes a Veterans Community Care Program. It 
merges seven VA community care programs into one program, with one set 
of rules for both providers and the veterans. It puts the decision of 
where to seek care in the hands of the veteran and their doctor. No 
more one-size-fits-all eligibility.
  If a local VA doesn't have the equipment for a certain test and there 
is not another VA locally that can provide that test, the vet can go to 
the community doc. If the roads to another VA facility are closed for 
snow, veterans could go to their local doctor rather than waiting for 
the roads to clear, which is a big issue in rural America.
  If a nearer VA clinic has a type of doc a vet needs to see, but there 
is a community doc closer and the vet has a bad back, that vet can see 
that doc in that community, as an example. It offers convenient, walk-
in care so vets can get care closer to home for minor illnesses.
  Third-party administrators--also known as government contractors--
will have a smaller role at the local level, and the local VA will have 
the flexibility of when to use them for scheduling so what makes more 
sense for the local VA will not be decided by bureaucrats in 
Washington.
  The second thing it does is it improves accountability and 
transparency of VA's spending. It requires the VA to give Congress more 
notice when funding levels of programs that impact veterans are running 
low. It forces the VA to put together a businesslike plan about how it 
is going to spend taxpayer dollars, and it gives Congress more 
visibility in the VA contracts. It requires accountability at the 
medical center, regional, and the Federal levels. If the clinic isn't 
brought back up to snuff, we know who has failed to do their job.
  I could give you a timeline on what has been going on in the last 3 
years with the Choice Program--not having enough money, having more 
than enough money, not having enough money. That will end when we pass 
this bill. Congress will be able to have the oversight over the 
Community Care Program that it needs.
  It will give long-term certainty to our veterans because a lack of 
long-term certainty is devastating to those veterans, and it will give 
those who have served the consistency and the certainty they need. No 
more bandaids. We need a cure.
  The third thing it does is it improves VA resources in healthcare. 
Veterans tell me, time and time again, once they get through the door, 
they love the care the VA gives them. I have been told by a number of 
veterans that VA has saved their lives. The problem has always been 
getting through the door, and the biggest reason for those delays to 
get through that door is workforce shortages.
  So our bill incentivizes medical staff to work in rural and 
underserved areas and Tribal VA facilities. It deploys more mobile 
teams to provide additional care. It removes the barriers for veterans 
to access telemedicine, including mental health care, closer to home. 
It brings more nurses and heart and lung specialists to work at the VA 
and clinical staff to work at vet centers.
  The answer to the VA is not privatization. It is to build the VA and 
use the private sector to fill in the gaps that the VA cannot provide. 
That is what this bill does.
  It also expands the VA caregiver program to veterans of all areas and 
their

[[Page 20545]]

caregivers. Right now, the VA caregiver program only applies to post-9/
11 veterans. We have a whole lot of veterans--especially the folks from 
the Vietnam war--who are getting a lot older, and this caregiver 
program expansion to the veterans before 9/11 is absolutely critical.
  So the bottom line is this: We have worked well on the committee. We 
have put out a good bill. We put out a bill that works for the taxpayer 
and, most importantly, for the veterans.
  This bill is a long-term solution. We don't need another bandaid fix. 
The Care Act is our long-term solution. It provides the VA what it 
needs to hire staff for top-notch care. It provides an integrated 
network of community providers to fill in the gaps for that care. It is 
a balance between those two, and the veterans win.
  The VSOs are on board. They were part of the discussion on this bill. 
We talked to the VA extensively to make sure this bill would work for 
the VA, and they agreed.
  As I said earlier, I would love to have the VA come out forcefully 
for this bill. I think it would help get it passed in this body.
  One thing in closing. We are going to pass a temporary stopgap 
measure for our budget, and VA Choice funding will probably be a part 
of it. I will tell my colleagues that this is the last bandaid that I 
am willing to put on the Choice Program. We need a long-term solution, 
and if we don't get that long-term solution, we are not doing right by 
our veterans in this country.
  With that, I would again like to thank Chairman Isakson for his 
leadership and for his good work on the VA Committee. When we come back 
here in 2018, hopefully we can get this bill passed early in the 
session because it is the right thing to do for our veterans.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. FRANKEN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. FRANKEN. Mr. President, I ask unanimous consent to speak for as 
much time as I may consume.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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