changes and so on that are based upon what is in that act, so we do not have a projection of a baseline without it which we can compare the affordable care act. the one exception to that statement is that for the

coverage provisions because those are really just getting started now the baseline for the last four years, they don't have those provisions in them. we start with stated that does not have those provisions in and build them and. for everything else in the affordable care act of our revenue provisions, medicare and medicaid provisions, we just have a baseline that includes the affects of all of those provisions as they unfold. so we cannot go back and do an analysis and any clear way of the fsx those provisions have been an isolated sense. a map is see if we can provide information that would be helpful. >> thank you. >> several times this morning you and others have said that you have basically two options for addressing this long term problem. one is reducing costs in our

retirement and health savings programs and the other is increasing revenue through taxation. but it does seem to me that there is a third way that we are not talking about nearly in half today, and that is growing the economy and actually reducing costs and improving the efficiency of the health care system that is so central to some of those projections. i just want to ask command and that you cannot give me specific numbers because there are assumptions that would need to exist he continued to assume that health care costs would rise at a rate faster than the economy will grow. >> that is right, congressman. i would suggest that i think congress would be crazy to allow that to continue to sit back as a powerless to address that. if we are able to give medicare a chance to negotiate for better drug prices, if we get a hold of the rampant fraud that is in medicare part d, continue with

payment reforms the rewards physicians who make people healthier -- there are all sorts of things we can and should be doing good dress the side of the problem. if we can do that and bring health care cost increases below the rate of growth what does that do to your projection? >> i think you are right that there are important opportunities in those areas that obviously private health care providers and insurers are pursuing and congress could pursue as well to try to push the health care sector along. if you can find ways that would produce substantial savings that would be good for the budget outlook and reduced the need to make other sorts of changes. i would say in medicare, for example, the rate of excess cost growth is excess of -- not saying it is bad necessarily, but the rate at which growth exceeds gdp, but it is low.

because of changes that congress has already put into law which means pushing that down further would be harder. >> even a little bit would translate to a big numbers. >> if you push it down a little bit over a long time that can make a big difference in the numbers. >> and again, it does not have to be a conversation only about slashing benefits but making health care more efficient. >> it certainly can be. whether you can make enough progress to avoid the other conversation, we are doubtful. everything helps. i do not mean to discourage the direction you're considering. i am emphasizing that the gap between spending and revenue under current law is really quite large. it's not that tremendous improvements can be made but the question is are there provisions you could put into law that

would accomplish changes beyond what has already happened under the laws in place and the work of people in the health care system. >> well, dr. douglas elmendorf, you are surprised by the efficiencies we have already seen through the affordable care act. if we could rewind, you have dramatically reduced your projection for health care costs increased to to reforms put in place. if u.s. and we stand still, i understand your point, but if you assume we are determined to continue down this road is it fair to say that we could be seeing similar upside improvement ? >> pavilion and we have been surprised by the efficiency achieved that is why and our analysis will look at the scenario which health care costs grow much more slowly. >> i want to ask you generally

and of the middle-class. as you know, democrats are concerned about the loss of middle class opportunity, the growing concentration of wealth and income disparity. what does this do to the economy over the next 45 years but if we do not address this and also if we do create middle class opportunity and address stagnant wages and if you could in your remaining time are there any assumptions about climate change in your projections? if not one out? >> those are easy questions. for any given level of gdp the distribution of income cuts in different directions. for example, more and come for high-income people. income distribution also matters for the cost of federal benefit

programs. the variety of direct budgetary effects. and we have seen now in the country for decades pronounced lightening of the income distribution, and these projections incorporate further widening. i think that has consequences potentially for the economy and society that we have not tried to quantify directly. on climate change there is no specific affect built into our projections for the next 25. >> i just as members, try not to ask a long question with four seconds left to go. >> thank you, mr. chairman. think you for being here today. i want to call your attention to page number three and also page number 13 and beyond. the sections i am calling your attention to address at least to

some degree the consequences of staying on the staff leon. i want to give you an opportunity to respond. and only had a cursory review of this. you have running room here. i am a businessman, and here i am. i am surprised and disappointed. have been serving for three and a half years in public service. the metrics are quite well-known all types of indices and know where you are and tell you if you are in almost a green, yellow, orange range. here it seems like you are struggling to try to articulate the real impact of our failure to address our fiscal situation. it does remind me a little bit

of lukewarm or room temperature of meal. i don't think you are doing this intentionally, but i don't think you're a pig is connect the dots on what will happen on a practical level two are working american family for stay on this path. and will ask you and give you an opportunity. >> congressman, we try to quantify the effect of the fiscal path we are on. overall gdp and then come for each family on average. so in chapter six which she may not have gotten to yet. a recognize it is a long and complicated report. we talk about the effects and quantify the effects of current path and alternative scenarios of real gnp per person. real income per person and 2039. and it read the report that under current law we think real

income per person would be $76,000.2039. if deficits were smaller than real income could be up to 78 or $80,000. >> i submit to you that it is -- as time goes on the severity of the impact on the hard working american family will increase, and i think each and every report you present to us, i hope we will give you good news as some point. absent that the risk to our country is taking on is tightening. i am not an alarmist, but i am realist. it troubles us greatly. let me prove it for a moment. i hear the call for a balanced approach. of was a strong advocate. as i have seen the last three

and a half years, there is a trillion dollars in tax revenue plan polanco and another 800 billion that came back as to the fiscal cliff. is there anything in your recollection that has looked like a balanced approach on the reforming mandatory spending side? all i see is almost 2 trillion in increased taxes. as i look and my democratic friends dollar for dollar, it was about 2 trillion justin mandatory reforms. a balanced approach means nothing less than dollar to dollar. >> as you know, congress has agreed out limits on discretionary. the budget control act which says it mandatory control a

little bit. >> my numbers are pretty good. we have had the affordable care act and about 800 billion on the fiscal clifford f. lee. >> we are supposed to follow current law. >> the provision. revenue as a result. we do have almost 2 trillion coming at us that we did not have 50 years ago i thank you for being here in the report you provide and yield back the remainder of my time. >> thank you. >> thank you, mr. chairman, and welcome back, mr. douglas elmendorf. a breath of fresh air, as usual. >> thank you, congressman. >> let's see where we are at.

have a lot of questions. correct me as i project some thoughts. we have got the lowest deficit since 2008, correct or incorrect? >> correct. >> we have the fewest amount of federal employees in nine years, correct or incorrect? >> i don't know offhand, congressman. >> well, the report last week in the "wall street journal," that is what is said. talking about the fact -- and you said it yourself, the general growth is not a major problem. when you say general growth i mean that to say everything but entitlements. mi correct? >> that's right. >> of the general growth has been -- it looks like it is in good shape. it is not a major problem. >> reducing spending relative to the size of the economy.

>> if we were to cut anything else in the future since that growth, the general growth under control, not my word, we have to look to entitlements in order to make further cuts. correct? >> that is why -- that logic is why most of the analysts focus on changes in the mandatory programs. and i like what your report does in september to link the amount of growth in terms of revenue, how much revenue the government is bringing in and how much we have. that seems to be borne out in your latest report to us. now, aside from the decrease in spending on federal health programs not a lot has changed in this report since september.

that is not for lack of trying. i am a member of the ways and means committee. we have reported 14 separate bills that would make various temporary tax extended permanent . 1,205,000,000,000 counting. none of this has been paid for. on like the chairman's preferred vision for tax reform which for all its faults, i think, was at least revenue neutral, not a single dime of that has been offset, not a single dime. these extended baseline that your report is based upon assumes that all of that tax expenditures expire horsetail

expired, correct? >> yes, that is right. >> your total projection of over seven and a half trillion dollars between 2015 and 2024 does not include that 825 billion in additional red ink still counting which would be added to the deficit if the majority have their way plus any other extenders they may choose to make permanent. >> it does not. >> these are not just extended for ten years, mr. douglas elmendorf. they are made permanent, completely and paid for. can you talk of little bit about what kind of impact that policy choice would have on our deficits and economic growth over the 40 year time frame which you report refers to.

>> if those were enacted into law and nothing else changed at the same time the deficit outlook would get worse. the larger debt we project would lead to further reduction in future income relative to the numbers we have here. >> mr. douglas elmendorf, compared to september's report he lowered your projection to gdp in 2039 by 4%. i understand that part of that is due to lower inflation expectations, but part of that is a reduction in your expectation on the inflation adjusted to gdp. can you explain your reasons for the lower projection of our economic growth? >> seven seconds or less. you've got it. so that reflects a change we made in our 10-year projection in what we published in february and is a combination of data about productivity growth and capital investment that comes to

us to bring down a projection of real inflation adjusted gdp. >> thank you. >> thank you. i would like to follow up on my colleague's last question. if you could please compare their growth of the economy since 2007 and compares that 23rd growths in the economy after the recession in the 80's, both in the time of recovery and the rate of recovery. >> this recovery has been quite slow relative to all of the post war to a post-world war two experience. we and others have concluded most of that is slow pace.

>> to use see any other policy differences with the recession back in the 80's versus year that have contributed to the slow growth other than what you say the initial cost was for the housing bubble? you just indicated that there is capital adjustment that has been less. in the 80's verses what you have seen here or not seen him that may have contributed to this. >> we have not tried to quantify the policy influences directly. we have looked at the experience of other countries that have gone through financial crises and have generally found slow recoveries. waif to boost spending and cut

taxes to provide stimulus low interest rates , they helped to boost the economy but are just not enough to overcome other forces. >> i doubt if you have looked at it. probably not part of your analysis, but i would say that the uncertainty coming from washington has contributed to him that i visit with business centers in my district, they have capitol, want to expand, and grow their business, but because of the policies coming out of here, including the unaffordable care act, high energy costs, overregulation, that has caused them to hold on to capital and not grow and expand. has that been taken into account? >> so we have written this book

lula and, an effort by economists to try to quantify the effects of policy and certainly. >> switching gears, the national security concern with the rising debt can you expand under concerns? >> as you and your colleagues look for ways to take an unsustainable path and make a sustainable one of the things you might push on his federal spending for defense. we cannot speak to the money required the concern is squeezing that amount of money may create vulnerabilities on an

ongoing basis but if the debt is high, having so much debt me make it more difficult for us to then take the actions that he would like to take under those circumstances. >> that needs to protect our citizens. we will have the smallest army before world war ii, and the smallest navy. i don't think we want to go there. i appreciate your raising that concern. >> just how much of the force structure would need to be cut to meet the targets we're trying

to provide information. >> thank you. >> thank you, mr. chairman. welcome back. i want to return to an aberration for just a second. did you discuss the impact of that proposal on social security specifically? >> i do not recall. i might be wrong. >> would you -- i will postulate t you what i assumed to be the case, immigration reform, you would have a significant number of younger people in the workforce who would be cantor being the social security and not -- and medicare and not collecting benefits for 35-40 years.

>> that think that is right. did break out the increased revenues. i don't think we put that together. there is not much change. i think it must be right. >> thank you. from time to time i raise my concerns about how the methodology, not being critical of it, but the methodology combined with our restrictions, the country and the taxpayer, one of the things i am interested in now relates to saving performance contracts.

eventually a lot of money. it is my understanding that this legislation now would extend for two years and contribute to the cbo score and that you have a different perspective on this. could you explain how cbo scores and whether they're is a chance to get together to move forward? >> i am sorry, i am not aware of the few of the omb. well look into that. we are working hard and doing another set of estimates trying to explain more clearly than we have in the past. you are one of a large number of members who are dissatisfied. i think there are issues and

budget procedural issues. the way these contracts work, the savings up front, meaning for a number of years well past the 10-year budget window go to the people who are installing the new equipment so that the substance, the savings and to come long term. you're right to be concerned. focus on a certain budget window may be distorting in some way. there are also procedural issues . they have made a commitment. the full cost appears as direct spending. those are categories not because of less but the way the budget committee in process works. >> a number of opportunities like this long term.

we need to be allowed to figure out how to do that. thank you very much. >> thank you. >> thank you for being here. let me ask you a couple of quick questions. background, how does cbo score or evaluate? the federal reserve has over 4 trillion in assets. how does that figure into your long-term what? >> it affects our revenue projections over the coming decade. as you know, the federal reserve turns over to the government any extra money that it turns. it beyond the coming decade it does not matter directly. we basically take the federal reserve receipts as a share of gdp. >> i should say it this way,

your assumption is the federal reserve holds that using it for income basis. >> we presume they will be changing the size and composition of the portfolio over the coming decade. the projections we released and then your area and the update in august, we will try to be specific. not only does it affect revenue but the actions affect the economy. >> the assumptions of how you assume there will try to move. >> a lot more detail. >> will this be the expectation of how much we will pay in interest? they're is a change in your interest projections and what that would be. would that be as well. >> i'm sorry? >> switching over to the budget as a whole.

$880 billion. our single year nominal dollar interest payment. how does that change with the updated numbers? >> we do not change anything in the first few years. a real think about projections beyond that. in our august update we are revisiting all of our projections specific about the new estimate. i don't know what direction it will go caboclo we will be explicit in nominal dollars of the coming decade. >> and that will come out when. >> under cbo extended deadline.

>> we don't change anything in the window in this report. >> this same thing on page 104 and 105. time frame, h0105. disability. another demographic variable is the rate of disability incidents defined here as the rate which people become eligible. the people that worked long enough an average of five and half will qualify each year. kaelin side that with the chart. we did a rate per 1,000. walk me through those numbers.

>> that is the mortality decline people live longer overtime. disability incidents, the same number reported in the text. and this projection of disability is higher than the rate predicted by a social security trustees and is a change we made last year, the same projection, but different than the year before and that the evidence suggested the rate would be higher. >> i yield back. >> thank-you. >> thank you, mr. chairman. >> good to see you, doctor. appreciate your report and diligence and trying to be as

straightforward as possible with your answers. when it comes to raising the sentiment i have a question about what may be the ramifications for the u.s. and global credit market. >> we think that a failure to raise the debt limit when we are bumping up against it poses significant risks. we do not know what would happen because we have not done and as a country. we have not let that lapse. if it were to happen, that could be very large and negative as far as ramifications for the u.s. and may be global economy. >> when you say maybe a global cap economy is that because we are so interconnected? >> the economy -- the global economy is interconnected and we play a particular role,

especially treasury debt because eight is viewed as such a state asset. it is that safety being called into doubt which would be disruptive to a lot of financial institutions around the world as small as potentially costly put the u.s. treasury in future borrowing. >> now, when it comes to health care, when someone asks you about projections, in 2009 the cbo estimated spending from medicare and medicaid would reach ten and a half percent of gdp. in this year the cbo estimates that combined federal spending for medicare and medicaid covers expansions.

24 percent increase, decrease. that outlook for federal health spending much improved from the pre affordable care activase. >> i don't have the 2009 projections. the outlook is a good deal better. we have seen slow growth for a number of years. we have taken some of those on board. >> that is a significant reduction. >> a little below.

hideo that has come and pray a and b of medicare and also how the private sector. we look ourselves very closely at what has happened in medicare the entire health care system, and the conclusion is that the weak economy plays some role in the national health care spending, but much more than that. in fact, we do not think that they believe much of a role at all. when we talk to people in the health care system they are clearly working hard to make their operations more efficient than they have been. the question for us and everyone is whether they can keep that it

going, whether they will under the current incentives provided by law and whether that process will wrap up. in the late-1980s ago we saw was a marked slowdown. but then it came back up begin. we do not know at this point how persistent the slowdown will be. it our best projection is it will persist for a while which is why we have taken down health spending, federal health care projections a lot in the decade. >> the major significant apology to the policy changes the affordable care act. >> we do not know how bigger roles will play. >> thank you. >> congressman. >> always a learning experience to hear from you.

i want to pick up on what was -- what is indicated on page five of your report about the idea that to solve the problems you have testified, a combination, perhaps, of raising revenue and increasing spending. the wording indicates that we could raise revenue, a decrease spending, or do a combination of both. so clearly i understand how we can decrease spending and reduce cost to get as back under control. i am under the impression that we cannot just increase revenue and solve problems.

>> well, it depends on what this says. the next 25 years. the ratio of debt to gdp. >> what does that look like? the same change for the next 25 years. an increase in revenue or cut in spending and increase in revenue

. that would -- >> well with that look like going forward. >> just over 1 percent of gdp. the way it is defined by people in the business to do this kind of analysis, the fiscal gap is the change in something to misspending indoor revenue that would require each and every year to achieve some target at the end of the time. the same share it yesterday. we also did estimates of what it would take parliament which would be discovered two and a half%. >> and what are those?

>> about $460 billion. in increase next year growing with gdp, more than 5 trillion of it coming decade and more beyond that. >> in your expert opinion is that a large magnitude? >> it is a large change, congressman. >> to do it in any way is a large change. as we reported, to reach that goal and bring that down to a historical average 25 years from now would require an increase of about 14%. >> ten or 20 years.

>> an eye on transparency especially regarding your entitlements accounting using the accrual basis accounting the data,. >> primarily cash based accounting and offer projections debt and deficit in the future in the imbalances in the

medicare part a trust fund that is done on an accrual basis. >> thank you. i apologize for coming in after you're prepared remarks. was over at the financial-services committee. there are a number of questions asked with no opportunity for the chair to answer. while i might not agree with the implications, being able to answer the questions, i appreciate the way our colleagues have handled this hearing, at least by my reservation. i appreciate the complexity of the questions. i have been trying to figure out cbo scoring. i assume it takes more than a

year-and-a-half to complete end to figure out. i do understand that the analysis you provide is based upon a clear assumption none of the decisions we made operate within the confines of what one would call a zero sum game. so i am curious about your questions, some of the actions of the house recently in enacting and paid for taxing standards that absent some other corresponding increase in revenue or production spending will have implications this may be something off the cuff, but is it your -- would it be likely

your conclusion that this type of spending through the tax code that is on paid for or has a net positive, fiscal position. >> you are right. in particular in terms of the longer term budgetary economic effects but presumably conclude that costs and tax revenue not offset in some other way would lead to larger deficits, debt and would be a drag on the future. >> this is where i think we get into a conundrum. presumably those tax cuts would have an impact not only immediately on the deficit but on either our ability to invest in long-term investments that have a payback or simply explode the deficit. if those results -- and let's

take a couple of examples, pell grants and other forms of support for higher education and blows up our ability, for example, to fully fund on the ongoing basis the highway trust fund, what would you think the likelihood would be that you would have a negative score for that set of policy decisions? >> now you have a more complicated scenario, congressman. >> i will say that in our analysis that channels the focus on on the effects of federal debt, marginal tax rate is the changes in transfer programs and federal investments. we take very seriously. >> take the decision to find or not find, how would you evaluate that? >> we think and said a couple of

months ago that if the projected shortfalls and trust funds or addressed by limiting spending that reduction would probably have significant negative consequences for the condition and performance of the nation's highway and mass-transit structure. their reaction was slow employment relative to what it would otherwise be. >> thank you and i appreciate that. have you offered in the recent discussion or commentary on the effects of extension of federal unemployment benefits and the effect that has long-term demand for federal services and long-term budgetary effects of that decision. >> we have not come to my knowledge. we have done some analysis of

the shorter term affects on output and jobs and have found that the extensions of higher benefits in place last year would be good in the short term for economic output and jobs. >> thank-you very much. >> thank you mr. chairman, and thank you, mr. douglas elmendorf. i will follow this same line of questioning. long-term budget aspects have significantly challenged our current rate of expenditures and population shift and the graying of america find the most balanced approach to resolving the highest degree of certainty

a path toward so that we are doing our jobs with your expertise chest coffee we need a long-term investment strategy. we ought to have a long-term investment strategy, and i agree. in a "washington post" article titled cbo rigid form holding the u.s. government back scoring patterns, they like the federal highway system. if we know that and spurs economic growth and research at nih in the department of defense that have clearly identified some of those great breakthrough schering is a return on investment and technology that cost money at the front end on that federal balance sheet.

similarly changes in health policy that make the health care delivery system more efficient and integrated chemical were needed often when you know they are investments that will yield savings in the future. so mr. douglas elmendorf, like you to talk a little bit about how you scored these health care proposals and insurance companies in particular have developed a series of tools to develop health care costs. >> congresswoman, my colleagues and i share your concern about the longer-term effects a number of things to try to give you and your colleagues more information that includes -- i work on the

affordable care act, regulation of reform, federal budget. we are interested because you are on the longer-term effects. i respectfully disagree, but the challenges to be able to quantify those facts in a reliable way. we draw on the research literature, dated from actuaries >> you do not hire or employee, particularly on the health care side this kind of experts? that is an area that we have to clearly understand short-term and long-term impacts. >> ongoing contracts with outside actuaries, a panel of televisors and might have that

expert in to talk with us. one example, a detailed analysis of the ethics of raising the cigarette tax and the federal budget over 65 years and looked at the weight changes will affect smoking behavior today and people's health conditions and longevity. >> i appreciate you taking that. a great example. can you show me and others? particularly on the health care side. >> we can do that analysis and are currently doing or on the effects of obesity, but i caution you, the benefits to health are often quite positive. a facts of the federal budget may or may not be positive in the way our estimates are. it is not always the case that prevention saves money.

it is almost always the case that it is good for people. there are certain tests done. >> i would argue that we are doing all of one in nine of the other. sphere says in 99 see that and in exploring and encourage you to keep looking at that, otherwise we cannot do our job. >> thank you very much. thank you for it your indulgence this meeting is adjourned. [silence] [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> acting veterans affairs secretary testified

>> we are here in des moines, iowa. many and varied interests. one of the most notable legacies , his amazing collections in terms of art work a mass culture, a library connection -- collection, the first edition marks, many of the manuscript. it is incredible. they collected the books not only because of the important

historical works but because he believed that books themselves were works of art and had a worth beyond the words on the page. he collected almost every edition. now, this changed over time. it was the art of collecting. he also collected a variety of first editions of ernest hemingway's works. published in 1935, and a great piece because it illustrates the personal relationship that existed. this, very best wishes. >> explore the history and

literary life of the morning, iowa saturday at noon eastern on c-span book tv. >> canal acting veterans affairs secretary talks about some of the changes under way since he took the temporary position in may after shin sect he was forced to resign. this committee is chaired by bernie sanders of vermont. to w think will be an important and productive hearing. we lookorward >> let's get to work. welcome to what i think will be an important and productive during.

bagram sloan gibson, the acting secretary of the department of veterans affairs who will be discussing with us what has been done and what i perceive to be inactive six weeks since you have held that position. proble the months and years to come. i would want to mention to the members of the committee that next week on the 22nd we and i want to mention to members of the committee that next week for bob mcdonald's the president's nominee for the secretary of va. last week -- not last week, last month, despite a partisan environment here in congress, 93 senators put their differences aside to vote in favor of a significant piece of legislation which we hope addresses many of the immediate problems facing the .

which we hope will address many of the immediate problems facing the va. i want to thank everyone for their support. it is my hope that legislation and the conference committee briard having will be completed by the time that we leave here for the august break. it is clear to all of us that the va faces many, many challenges that are well documented. the concerns that i have that have been well-publicized, we have many, many, many veterans in many parts of this country who are unable to access va karen a timely manner. significant problems in terms of accountability. all of us find it totally unacceptable that peoples have manipulated data in terms of waiting times, treated to the whistle-blowers in a contemptuous way.

people have lied, and that is unacceptable. we want to hear from mr. sloan gibson in terms of what he is doing to address those problems. the issue of want to focus on is why we are determined to do everything we can to make the va which is a huge institution, we want to do everything we can to make that agency each option to and accountable. there is another issue we have to address. zillow legitimate leads, the real lisa facing the veterans in this country and allies in congress are we responding to those needs? number one, there va has to be accountable, efficient, and address the problems we have all heard.

secondly, we have to ascertain what the problems facing the veterans community and families are and do everything we can to make sure that va is on the kind of position it needs to be to address those problems. let me mention some of them. of the 2 million men and women who served our country, but their lives on in afghanistan and iraq studies suggest wanted to 30 percent have come home with ptsd or td i. that means those have created some five. thousand mentally wounded american veterans and as a result there are serious problems regarding suicide, and this committee will deal with that issue. substance abuse, and ability to hold onto a job, divorce, the emotional problems. it is not just the veteran, the

wife, the case. .. kids. the number receiving special mental health is up from 900,000 to 1.4 million in fiscal year 2013. this means in fiscal year 2013 over a quarter of those receiving were being treated for mental health conditions. in other words, va currently provides 49, 315 outpatient mental health appointments a day! a day! 49,000 mental health outpatient appointments a day. imagine the challenge if we had endless supplies of money and if we had endless supplies of

money, if we had the best adequate numbers of psychologists and psychiatrists in this country which we do not have this would be an insurmountable problem and if we are where we are. that is the cost of war. in sharing timely access to high-quality mental health health care is critical for our veterans and for their loved ones and the stakes are high. as i have said we are aware and i know johnny isakson among others has taken a hard look at suicide. it's a tragedy beyond words not easily dealt with but it's one that we have got to address. and like most americans, we are all concerned about the user ran this waiting periods and i know that's mr. gibson is going to be talking about that in his testimony. let me just go to the numbers. understand the scope of the issue we are dealing with. over 46,000 veterans are on lists awaiting to be scheduled

for medical appointments. over 80,000 of them have waited over 120 days. we can have argued argument although i don't think there's much about whether 14 days was an appropriate number. i think it was not. i think it was overly ambitious. a good goal but we don't have the resources to do with it but i don't think there's much argument that when you have over 8000 veterans waiting over 120 days to receive an appointment, that's 120 days before they are told when they are going to be seen and that's unacceptable. more than 600,000 veterans have an appointment that is more than 30 days from the date that the appointment was initially requested both from the date that was desired and that's not acceptable. etc. etc.. the numbers are staggering and that is an issue obviously that we are addressing right now and we will hear from mr. gibson asked to how he is going to go forward with that. i think the goal of every member

of this committee and i would hope and expect every member of congress and of the american people is that the veterans of this country people who have suffered so much deserve quality health care and they deserve it in a timely manner. what i look forward to hearing from mr. gibson is some straight on this talk about the need for the va in achieving that goal. if we are talking about the staggering number of veterans coming home with ptsd or tbi how many mental health workers do you need and how are you going to get them? we don't have enough doctors in this country. how many primary care physicians do you need? how many specialist a unique? at the goal is to provide quality quality timely health care in a cost-effective manner we need some answers and i hope we began to get some of them today from mr. gibson. needless to say the other issue and i know members of the committee are going to be asking

is what actions the department has taken to reprimand employees who have lied or manipulate data. that's something that nobody on this committee tolerates. what has the department done to ensure that such manipulation to longer occurs? what is the department done to improve other areas of concern identified by the inspector general the gal and other organizations. with that let me give the mic over to ranking member senator burr. >> thank you mr. chairman and ranking secretary gibson welcome. since our last hearing, there have been several developments related to the scheduling irregularities across the va and its negative impact on patient care. the va has began to take the steps to address the systemic problems in the corrosive culture that have been identified and substantiated by

several independent sources. however these changes will not happen overnight and this committee must provide the critical oversight to ensure those changes occur and are effective. even with the steps of va has taken to improve access to many veterans there will continue to be reports and allegations regarding va health care facilities and workers. these reports will not only highlight critical areas of needed reform but identify the magnitude and the breadth of the systemic issues facing the va. the ongoing internal evaluation by the va as well as investigations currently being conducted by the office of special counsel and the das office of inspector general are essential to rebuilding not only veterans trust but also the trust of stakeholders and employees. to undertake the needed reforms within the va the role of the office of special counsel and the inspector general are even more crucial now than ever

before. both offices have been essential in identifying systemic issues facing the va. i would like to highlight a few critical reports that have been released since the last meeting. at the time of may 15 hearing there were several stakeholders who did not want to rush to judgment until the allegations surrounding it had been substantiated. since that hearing the ig released an interim report regarding allegations of scheduling irregularities and a secret wait list at the phoenix va health care system. not only did the eiji substantiates scheduling irregularities in the secret waitlist in phoenix but the i.t. identified roughly 1700 veterans who are waiting for an appointment that were not included on an appropriate electronic waiting list. the ig found scheduling irregularities are systemic issue across the aids health care system and that this was not an isolated event.

additionally the eiji has received numerous allegations regarding and i quote mismanagement in appropriate hiring decisions sexual harassment and bullying behavi behavior-based mid-and senior-level managers at the facility unquote previous allegations speak to the corrosive culture that has taken deep root throughout the entire department. within a three-week. map the office of special counts are released a on va whistleblower reprisals and sent a letter to the president regarding pas lack of responsiveness to osc requests. in this letter the office of special counsel described the office of medical inspector consistent use of and i quote harmless errors unquote. this is their defense. with the department acknowledges the problem and claims patients, their cases were unaffected. the letter details 10 cases of

egregious patient care provided by va facilities in which the omi substantiates errors and patient care but dismisses potential patient harm. in one case, tibetans were admitted to an inpatient mental health ward at the brockton va facility and didn't receive comprehensive evaluations for more than seven years. after being admitted to this facility. another case in a letter describes how pulmonologist copied previous provider nodes in more than 1200 patient medical records instead of recording current ratings for these patients. i want to be crystal clear. the culture that is developed in va and the lack of management and accountability is simply irresistible and it will no longer be tolerated. secretary gibson you have taken several actionable steps in the last month and a half and i

commend the work that you have done however what has happened over the course of years is a harangue this blemish on the va's reputation and much more work will be needed to repair that damage. sba continues to move forward in improving veterans access to care in changing the culture that has taken deep root with them is apartment this committee has a lot of work to do. the committee needs to take an active, vigorous oversight role to ensure that the problems that have been identified over the last several months and i might say over the next several months as a hosted ig reports come out, are effectively and appropriately addressed and they aren't allowed to happen again. again, secretary gibson, thank you for being here and mr. chairman and mr. chairman i thank you and i yield back. >> thank you senator burr. senator murray.

>> mr. chairman thank you for holding this hearing. this is a critical time for the department. the va is struggling with systemic problems. there are vacancies in key leadership -- secretary gibson as he talked about yesterday appreciate your stepping up during this crisis. the department needs strong leadership right now because the va is facing serious challenges. rob neighbors reviewed several of these issues which we have been discussing for some time. a corrosive culture is developed in the department one that is unworthy of va's many dedicated and talented medical providers who do want to help veterans. management failures, lack of communication is a problem at all levels of vha and va needs providers, more space and modern i.t. systems. as we continue to work in a conference committee to craft a final bill i hope an agreement will be rich reached so we can send it to the president and

start making the changes needed at the ace of veterans get into care to create transparency and hold people accountable. the compromise bill will be an important first up is more reviews are done in more problems found we will need to take additional steps among the continue working on these problems we cannot lose sight of many other pressing issues. too many veterans still die by suicide each day. sexual assault survivor still need help. the va has to continue to make progress towards the commendable and even more challenging goals of eliminating veterans homelessness and reducing the claims backlog. on a positive note secretary gibson i really appreciate your help and finally getting the money to build build the wall-to-wall state veterans home. we have been working on this issue now for very long time and now hundreds of veterans in that area will be able to access the long-term care that they need. as i've said repeatedly here in this room when the nation goes to war it also commits to taking

care to veterans when they return home. their needs are a cost of poor and we will provide for them no matter what. we know many veterans will need va care for several decades to come. others will come to the va for the first time in many years after their service has ended so today i'm hoping to hear about solutions to the systemic problems in smart ways to strengthen the va for the long-term because the va does need to be there for veterans ready to help right away every time. thank you mr. chairman and i yield to senator isakson. >> thank you senator murray. secretary gibson thank you very much for accepting this interim responsibility. you are brave and courageous manner while i'm encouraged by some of the serious steps you have taken i'm still not satisfied. we have tremendous problems. as indicated by a letter from special counsel to the present president of united states from which i want to quote.

i remain concerned about the department's willingness to knowledge and address the impact of these problems getting the whistleblower's problems. the health and safety of veterans in the va office of medical inspector has consistently is the term and i quote harmless error as a defense where the department acknowledges problems patients have been affected. this approach has proven a day from acknowledging the severity of systematic problems and taking necessary steps to provide quality care to veterans. the letter goes on to delineate specific cases where veterans health suffered because of agency looking the other way. i have become personally convinced that this begins and ends with the failure of senior leadership at the va for years to overlook or to look over the manipulation of numbers to make things look better than they really work and hope that congress would not come in love. i think congress is partially to blame for not coming in looking enough. i said when i have my kids if

you open the door and look inside of a better behaved kids and if you don't look inside. the pervasive culture of cooking the books for personal benefit such as pay raises is absolutely inexcusable. lastly i hope in your remarks which i'm looking forward to it will address how the memo was written by mr. show on our august the 26th of 2010 that delineated specifically many of the problems we are now discovering. this was four years ago. how a member -- memo to senior leaders across the network could've gone totally mucked up by anybody in the va in the problems we are trying to fix lasting four more years because there was a culture of just looking the upper way when they were sick criticism or accountability in place a a while i appreciate it very much or willingness to come forward as a citizen and take on this responsibility and appreciate the steps you have made i'm not

satisfied the va's culture is any different than it has been and they will have to see to it the culture of the va va changes and we have become ability from top to bottom but in particular the senior leadership and management of veterans management and health care. >> i would say a vote has been called to a number of senators are going to be leaving. we will go to senator tester moran corona and johansson -- johanns. >> thank you senator murray and i want to thank senator sanders and burr even though they aren't here for their work on this committee. access to health care for veterans did not pop up overnight. it's a topic that many of us have been working on for years. solutions must be based on good information. it can make good decisions without good information. hopefully the conversation today will be straightforward and frank so that we can get down to some solutions. it's going to require tough decisions and it's going to

require creativity. it will require focus of engagement for folks on the ground in washington that go beyond the media span. veterans deserve better than to have folks jump on the latest crisis or to and then you never hear about it again. they want answers and they want solutions. they want the benefits that they have earned not press releases. i'm a president veterans every time i go home weathers the grocery store the service station. they are direct, they are straightforward and they give me the best view of what's going on on the ground with the d.a.. in fact we will be holding another roundtable this time in the capital city of montana to hear from the va in the services they are getting in the difficulties they're having along with the successes. since her last hearing the va conducted a nationwide out of impound the biggest obstacle to time he cares a lack of service providers.

a lack of service providers. i'm looking forward to hearing from the va on this audit and follow-up actions moving forward. since their last meeting the white house is also completed a review on issues impacting access to care. this review provides high high-quality health care once veterans given the door. the review also found out that the va scheduling technology is outdated i believe 30 years old and it's secondary to the need for additional resources such as doctors nurses and other health care professionals physical space in a properly trained administrative support personnel. since our last hearing the senate passed a comprehensive bipartisan bill that would address major issues impacting access to timely medical care at the va and passed by an overwhelming magnitude of votes. we celebrate 93 votes for anything in my state senate. right now we are in the fourth week. there is a monster show for it. those questions would be good to get answered today too.

because some members of this body i think in the conference committee -- we just shipped 800 folks to iraq and i didn't hear one person talk about cost. back in 2003 when we invaded iraq, was not here but i certainly never heard anybody talk about the cost and making sure there are offsets for that costs. these folks went to war. they performed incredibly well. some of them came back missing arms and legs and some of them came back with mental health conditions that they didn't have when they left. health problems that they didn't have when they left. it is very frustrating from my perspective when i come from a state where we are 22 -- to hear folks on the conference committee a few weeks back say what we need to do a schedule more patience for the doctors and that will solve the problem. that will not solve the problem. we need more health care professionals on the ground and

slow and i hope to hear from you today on those issues on what those efficiencies -- deficiencies are. it's incredibly important to get arms around as a committee so that we can move forward and provide accountability that needs to happen within the va to make sure the veterans get the care they deserve. i will tell you something right now. i am very concerned that this conference committee voted to titicus step backward on this health care position. that cannot happen. veterans deserve better. they have earned their health care. we need to make sure we step up to the plate and give them the resources they need and hold them accountable for the job that they do. veterans deserve our best. they have demonstrated their best in the field. we need to demonstrate our best as policymakers and you folks as leaders of the va and without i yield the floor to my friend senator moran. >> thank you very much. mr. secretary thank you for joining us and thank you for

having a conversation with me on the phone several weeks ago. it's been one of the experiences that i've had in recent years with the va is just no ability to convey the concerns of kansas veterans. we have the ability to convey that information to the department took virtually no response time and time again so i appreciate the fact that you took time to have a telephone conversation with me. i want to present to you today or shortly a letter that i have compiled addressed to you. i heard the testimony from from the house veterans affairs committee last week in which some of the topic was about whistleblowers and the apology that the department made. what i've discovered as a result of what is transpired over the last several months is that many kansans veterans in particular but also many employees at the department of veterans affairs are presenting me now with stories of problems within the va and they are reluctant, in fact declined to present that

information to a whistleblower as a whistleblower in a formal way because of fear of recognition and concern about their future and their employment. so mr. secretary we will be providing you an outline of things that we still consider significant challenges and problems in my home state of kansas. i indicated several months ago that i have been a member of the veterans committee since i came to congress 14 years in the house, four years in the senate and there have always been challenges at the va. there are always always challenges and health care. with seems to need to be different today mr. secretary and it has occurred over time, is the recognition that the va was shrugging and shoulders no real attention to the problems and what they were assaulted and were veterans telling me that they no longer had faith in the department of veterans affairs to provide the services that they are entitled to as military

men and women of our country. so i thought a change in leadership at the department of veterans affairs was required. it is now taking place. i look forward to meeting mr. mcdonald this morning -- this afternoon in my office with what i know is that the only changing the secretary, only changing the top leadership is insufficient to solve the problems that exist. and so i look forward to working with you at your time at the veterans of -- the perfect veterans affairs on big things we can all be proud of and the commitments we have made are kept for our veterans. most of my conversations with secretaries of veterans affairs i think there have been nine of them in my time have dealt with rural issues and i want to explore that with you today in your testimony but i'm very anxious to hear about the steps that you are taking to change the nature so doesn't matter

whether you are urban and suburban or burr rural veteran of veterans affairs department is something different than it has been over the last several years. then i'm happy to get to the specific issues we face in the rural state like ours. after secretary as we know change is necessary. i want to do everything i can to make certain that the department of veterans affairs has the tools necessary. it's been my commitment since i came to congress that made the commitment from the department of veterans affairs that those resources are provided in the tools they are giving are going to be used to make cost-effective compassionate caring way that there is added to that the perfect veterans affairs that there is no higher calling than to take your the men and women who have served our country. thank you sir. >> thank you senators are moran. senator ron know. >> thank you acting secretary for being here and chairman sanders and ranking member burr

on the continuing challenges facing the va. when the issues relating to -- i want this committee in congress to continue the sense of urgency and to continue import as these other issues maybe we owed it to the veterans to stay the course. i share the sentiments of the chairman and many of the member statements this morning that we need to hear from you as you are short-term solutions in addressing the issues at hand and over the long term to address the systemic problems and challenges basing the va. i like so many of my colleagues

i've been visiting with the veterans in my state frankly long before the particular crisis arose and of course they have shared their concerns about the lack of doctors and a big changeover of doctors. those are some of the practical considerations that they have freeze -- raised with me. most of those, i think all of us have had the opportunity to talk with veterans in our communities one-on-one. we have a commitment to make sure that we continue to stay the course. that to me is the most important thing that this committee can do and i think the chairman for allowing us to move on to other matters that may be pressing about what could be more pressing than to make sure that i veterans receive the care that they need and deserve. thank you mr. chairman. >> other members will be filtering back but i would like

to hear from the acting secretary now and customarily we give five minutes but people may have more time. this is a serious discussion and we want you to have the time you need to make a case and we want the members here to have the time they need to ask you the questions. senator burr suggest maybe we should wait a few minutes to make sure other members come back so let's take a very quick recess here. okay. [inaudible conversations]

[inaudible conversations] >> with that reconvened. senator johanns i think we are up to you in your opening statement. >> thank you chairman sanders and ranking member burr for convening another very important hearing to address the issues at the va. it's critical that we continue to have these oversight hearings to do everything we can to hold pac to the fire and make sure that accountability is there. we know some things now that we did not know what the last hearing. we know for a fact that the a's waitlist manipulation and access to care issues is impact

systemic. report after report has confirmed this. in fact 77 facilities are currently under investigation by the va inspector general. it's an astounding number. i believe the scheduling problems are the tip of the iceberg. now we have allegations of whistleblower retaliation and improper payment of claims. the cancer doesn't seem to stop. but it must be stopped. while i appreciate your efforts secretary gibson i think you have done some things and they are recognized and acknowledged but i think we would all acknowledge there are so much more to be done. there has to be accountability for wrongdoing are these issues will continue and the senate will have more hearings not only next week or the week after but

in five, 10, 20 years from now. there is a serious lack of leadership. the white house needs to have been more visible role in addressing the crisis. we collectively have the ability to fix this agency. we just have to find the willingness -- languishing on secret unofficial waiting list. the bill recently passed by the senate gives greater flexibility and treatment options for veterans faced with long wait times are lengthy travel. the choice card and jackson much-needed competition in my opinion into the process and the demands of the va that they get their act together. and the accountability and transparency pieces of the

legislation are not only important. they are critical. the notion that employment should be tied to performance might seem elementary to most people but this is not been happening at the va. there've been several instances in which senior va executives who were involved in mismanagement or negligence or not reprimanded but instead received bonuses and positive performance reviews. shameful. and while senior executive service employees can be disciplined and fired under current law, it's a very long and drawnout process. again that doesn't work. the secretary needs the authority this bill provides to cut through bureaucratic red tape and most importantly to hold individuals responsible. we have to root out the culture of corruption that is contributing to nearly all the

va's most pressing issues. it's a huge challenge that we can and must get the va back on track and focus on their core mission of providing quality health care to our veterans. they deserve nothing less. thank you mr. chairman. i yield back. >> thank you senator johanns. now we want to take this opportunity to welcome mr. sloan gibson acting secretary of the va. thank you very much for joining us to get a set update on the department of veterans affairs and we look forward to hearing your testimony. secretary gibson is accompanied by mr. philip matkovsky the assistant deputy undersecretary for administrative operations. in your prepared remarks will be submitted for the record. secretary gibson, senator tester

you have 40 major statement. secretary gibson please begin. >> mr. chairman forgive me if i dispense with the traditional niceties and get straight to business. as has been recounted this morning we have serious problems. here's how i see the issues. first and foremost veterans have waited too long for care. second, scheduling improprieties were widespread including deliberate acts to falsify scheduling data. third, environment it has forced many staff members are free to raise concerns or offer suggestions for fear of retaliation. fourth, an attempt to manage performance at a number of metrics have become the focal point for staff instead of focusing on the veterans we are here to serve. fifth, the va has failed to hold people, both for wrongdoing and negligence. at last, we lack sufficient

clinicians direct patient support staff space, information technology resources and purchased care funding to meet the current demand for timely high-quality health care. furthermore we don't have the refined capacity to accurately quantify our staffing requirements because historically we have not built or resource requirements from the bottom up. we have instead managed to a budget number. as a consequence of all these failures to trust that the foundation of all we do the trust of the veterans we serve and the trust of the american people and their elected representatives has eroded. we will have to earn that trust back to deliberate and decisive action and by creating an open transparent approach for dealing with our stakeholders to better serve veterans. to begin restoring trust we focused on six key priorities.

get veterans off of wait lists and into clinics. fix systemic scheduling problems. address cultural issues, hold people accountable where will fill misconduct or mismanagement as document established disclosures of information and finally quantify the resources needed to consistently deliver timely high-quality health care. here is what we are doing now. vha is reached out to over 160,000 veterans to get them off wait list and into clinics and made over 543,000 referrals for veterans to receive care in the private sector. 91,000 more than in the comparable. a year ago. this is in the last two months period and i would point out here that for each of those referrals on average they were sold in seven visits to a clinician.

vha facilities are adding clinic hours aggressively recruiting temporary staffing resources and expanding the use of private sector care. we are moving rapidly to augment and improve our existing scheduling system while simultaneously pursuing the purchase of a commercial off-the-shelf state-of-the-art scheduling system. i have directed medical center in visiting director to conduct monthly inspections and person of their clinics to assess the state of scheduling practices and identify any related obstacles to timely care for veterans. to date over 1100 of these visits have been conducted. we are putting in place a conference of external audit of scheduling practices across the entire vha system. we are building a more robust continuous system for measuring patient satisfaction which i believe will be central to our measurement processes in a

future. i have personally visited 10 va medical centers in the last six weeks to hear directly from the field on the actions being taken to get veterans off weight listen into clinics. i leave later today for albuquerque and el paso. being a perfect 14 day access measures been removed from all individual employee performance plans to a lemonade and a motive for an appropriate scheduling practices. and in the course of completing this task over 13,000 performance plans were amended. permissible conduct as document appropriate personnel actions will be taken. this also applies to whistleblower retaliation. i am sure we will talk about that further. i have frozen vha central office headquarters hiring as a first step to ensure that we are all working to support those delivering character equate to veterans read vha has dispatched

teams to provide direct assistance to facilities requiring the most improvement including a large team on the ground right now in phoenix. i'll vha senior executive performance awards for fiscal year 2014 of them suspended. vha is expanding her use of private sector health care to improve access. i sent a message to all printed 41,000 va employees and have reiterated during every single visit to va facilities the whistleblowers will be protected. i've conducted over a dozen meetings and calls with senior representatives and vso's and stakeholder groups to solicit their ideas for improving access and restoring trust. i've named dr. carolyn clancy and from secretary for health. she will spearhead our immediate efforts to accelerate veterans access to care and restore the trust of veterans. dr. jonathan perlin former undersecretary for health that

va currently on leave of absence from his duties as chief medical officer and president of clinical services for hospital corp. of america has begun his two month assignment as the a senior adviser to the secretary. dr. proven expertise judgment and professional guys will help bridge the gap until va has a confirmed undersecretary of health. dr. jerry jerry cox is jerry cox has agreed to serve as interim director for office of medical inspector. a navy medical officer for more than 3030 years and a former assistant inspector general of the navy for medical matters. matters. he will ensure a strong internal audit function. as we complete reviews and fact finding, we are beginning to initiate personal allegations to those who were doing wrong. ms. bradley is a formal general

council at va and a senior member of the general coun council team at the department of defense and had direct responsibility for the ethics portfolio. let me address the need of additional resources. i believe the greatest risk for the veterans over the immediate and long-term is additional resources are provided not to remedy the historic shortfall of va capacity. such an out come would leave va more poorly positioned. we have been working with the office of budget for several weeks to request refunding. while the amounts under the consideration are large under the context of scope and represent moderate expenditures.

they are non-reoccurring and wouldn't be reflected in long-term rates. resources to meet the demand for fiscal year 2014-2017 total $17.6 billion. these funds address only the current shot short falls in staff, space, technology. we are taking the action to own the problems we face. the president, congress, veterans, the american people, vso's and va staff all understand the need for change. we must, all of us, seize this opportunity. we can turn these challenges into the the greatest opportunity for improvement in the history of this department.

i believe in as little as two years the conversation can change. that va can be the trusted provider of choice tr hilary clinton and benefits. if we are successful who wins? the growing number of veterans that turn to va for health care each year. the 700,000 veterans who are currently diagnosed with ptsd. the million iraq veterans that turned to the va since 2002. and the average veterans who turns to the va who is older, sicker and poorer than average patients in the private sector. these are the veterans who win when va becomes the trusted provider of care and benefits. that is what and where we want to be in the shortest time possible. our ability to get there depends on our will to seize the

opportunity, challenge the status quo, and drive status change. the vast majority of whom i believe care about the mission and want to do the right thing and work hard to take care of the veterans. i appreciate your partners, community stakeholders and volunteers. i respect the role the members of the committee play in serving veterans and i am grateful to you for long-term support. i am prepared to take your questions. >> well, mr. acting secretary, thank you much for not dealing with nisities and dealing with realities. i understand we are talking in a broad sense about two very serious problem areas. number one, i trust every member of the committee understand we

have an immediate crisis. that we have hundreds of thousands of veterans on wait list and those folks must get the medical care they need in a timely manner and am i pleased to see you have acted aggressively in that area. but if i understand you correctly the second point you made it is important to put out the current fire unless we effectively deal with the long-term capacity issues facing the va we will be back here year after year with similar type problems. you mentioned the number. and i want you to get into some detail. what are we talking about? how many in phoenix, other areas of the country there are long waiting periods. the goal of this committee is to end those waiting periods so veterans get quality care in a timely manner. let's start off with personal.

how many doctors, how many nurses, how many other types of medical personal do you need to achieve that goal? be as specific as you can and how much is that going to cost? >> mr. chairman, of the 17.6 billion approximately $10 mill billion is allocated for purchase care and hiring additional staff. the blend of that will change over time as we ramp up that capacity and we are successful in hiring people. >> is it fair to say that to the degree that we stregthen the va we become less dependented on expensive care? >> it is absolutey true. >> continue. i interrupted you. >> that $10 billion is allocated in a portion to purchase care probably more on the front end than the back end as we are

successful in hiring. our ability to develop highly refined bottom up estimates of physician requirements is limited. our best estimates at this time is that this would -- closing this gap requires hiring 10,000 additional clinical staff. those are divided among primary care, specialty care, and mental health care. of the 10,000, roughly 1500 are physicians and others are nurses and nurse practitioners and other direct patient support staff. >> you talked about space. >> yes, sir. >> i trust you are not talking about building some las vegas-type expensive building. what is the relationship between

space and the emergency that we currently have in terms of waiting periods. >> i will tell you, mr. chairman, in every medical center i visited except one and that is augusta, the number one problem is space. fayetteville, north carolina is growing at 7.8% annual rate and when it takes five years to get a building on the ground it doesn't make long to fall behind. so where we are today as a department is we are behind in the in terms of the space required today to serve patients. there are $6 billion in the $17.6 billion that is designed for infrastructure. >> do you have those projects? >> there are -- i will ask phillip to go into some details.

there are 77 lease projects for outpatient clinics that would add about 2 million square feet and 4 million appoiappointment and minor construction and occurring maintenance that would add 4 million additional outpatient visit slots there. >> we have heard time and time again that the dysfunctional for the appointments at the va is due to an outdated computer situation. can you say a word on how you will deal with that? >> there are four parallel issues. 11 existing defects in the system being patched as we

speak. there are four different interfaces in the process of making it easier for schedulers to access and provide the opportunity for veterans to access the schedule. on the 11th of july we led a contract for the existing system that will remedy maybe many of the most problems we make it hard to deal with and parallel with all of that we are pursuing the acquisition of a off the shelf state of the art system that is probably two years down the road in terms of having that functionality in place which is why we are pursuing. >> let me conclude. if we don't have the resources at the va to address the issues with the ptsd folks, space issues, what happens in years to come? >> the wait times just get

longe longer. we don't meet any standard of quality health care. i have committed to the president, veterans, the staff at va -- i will not hold back for asking for resources because we have not been managing to requirements as department. this would never happen in the private sector. you would fail as a business if you did this. i am not holding back now and won't in the future. but i told these folks that worked on the number i don't want a penny in there we can't justify. not one cent. >> senator burr. >> mr. chairman, thank you. and secretary gibson, i commend you, again. you have sort of made us go back and ask about numbers because it hasn't been that long ago we

wrote off $127 million for the new software to do scheduling and then there is the $14 billion in the construction and maintenance account that means projects are on a 7-10 year timeline. so it is good to see one that va has a sense of urgency and that omb is recognizing the reality of the set of needs. i have a set of questions for you but i want to send them to you and ask you to respond and i would ask for all members to have an opportunity. >> without objection. >> i want to focus on data integrity. ...

all of these. are not realistic and comprise light data integrity issues unquote. quote we are receiving a number of serious allegations with regarding manipulation of days of claims and other data integrity issues in the baltimore philadelphia los angeles oakland and houston va regional offices and today we received an additional allocation and a little rock regional office and we are concerned the number of offices with allegations is growing. vba removed all professional creative claims from its pending inventory. vba's process misrepresented the actual workload of pending claims in its progress towards eliminating the overall claims backlog unquote. quote an office of inspector general teams sent offices to to

manipulate an input incorrect dates of claims in the electronic record. incorrect application of data claim provides his data integrity related to timeliness of claims processing unquote. then there's this exchange that took place between congressman bilirakis and the assistant ig and the halliday. mr. bilirakis bilirakis said your mark in your opening statement at vba self reported decrease in the national backlog by more than 50% since march of 2014. do you trust those numbers? ms. halliday, this point i would say no i can trust those numbers. i think we have a lot of work ahead of us to address the allegations we have just received. they all seem to focus on data integrity and they need to be looked at very carefully. i don't want to say i trust them. near the end of the hearing

congressman o'rourke asks ms. halliday and i quote one of the things he said in your opening comment that struck me was that some of the success may be comprised by data integrity issues. anything that secretary hickey has said tonight that alleviates those concerns that you raised in your opening statement. ms. halliday, simply responding, no. also on the issue of whether vba's quality metrics are reliable to the general accounting office provided this testimony and i quote. in prior work with document shortcomings in pas quality assurance activities and recently concerns have been raised about the lack of transparency related to the changes in the agency's national accuracy rate for disability claims unquote. quote in several basic areas they are not following general statistical procedures. doubtless this in their methodology translates to numbers that aren't accurate and aren't very helpful in terms of looking at trends over time in

terms of performance accuracy and/or comparing opposites in terms of relative performance. that is not good metrics unquote. simply the inspector general's office testified that they and i quote continue to identify a high rate of errors in regional offices processing of claims decisions. now under secretary hickey was the one that testified for the va and despite her testimony, which was refuted by the inspector general, the gal, va put out a press release the next day saying b.a. touts it as reduce the backlog by 55% reduce the number of days it takes to process claims and has improved their rate to over 90%. now listen, you said that you

have got to gain the trust of the committee of the veteran of the country. let me ask you how smart was that press release? did you sign off on a press release and how can numbers that were refuted by the people that are actually doing the investigations of va facilities, how can they refute the numbers in the next apa comes up with the same numbers and tally? >> senator, i think as you have noted trust is the foundation of everything that we do and where there are questions about data integrity i think we have got to look at those deeply. there are numbers of issues that have been raised there. i can sit and go through and pick out and i pick out an item or two but the fundamental issue remains, that there are questions about whether or not we have got good data integrity

there and just as we are undertaking independent reviews and apha side we will undertake those in the vba site. >> mr. secretary, much initiated by members of this committee with the inspector general and with the general accounting office and you have good knowledge the shortcomings on the vha side. this is fresh. this is this weekend still that press release stresses that the va will continue to post these performance data on its web site. how does publicizing suspect data increase the integrity and the trust? >> senator burr i will tell you that i come into this organization from the private sector and i look at the transformation of the vba over the last two to three years. i defy anybody to show me any major part of the federal government anywhere that has transformed that much in that.

of time. i think it's amazing looking at it from a private sector perspective much less doing it in the context of the federal government agency. there is room to improve. i got it. we have got to restore trust they there. i got it. they pulled 100% provisional provisional ratings out and those didn't get counted in the backlog. i got it. my recollection is the numbers is about 12,000. i may not have that's exactly right. the backlog is down 350,000 brown numbers so i get it. we need to make sure that the data integrity is there but i'm not going to pull back from standing by that department the good work that has been done. we can't have back and forth between ig ig. igs ig. ig has findings and we have got to embrace those findings. >> well, i appreciate the chairman's leniency here. i'm not sure you are embracing those findings especially in comparison to how you have embraced the vha findings.

it concerns me because these are veterans that are waiting for their determinations to be made, in some cases as the ig has pointed out in the gal, it involves overpayments. overpayments by the taxpayer that are due back to the va to help fund other things. it just strikes me and i realize this was the vha hearing, it strikes strikes me a test money like we had had a monday night and you turn around to put out a press release still stating the same numbers the next day when everyone at the investigators found that those numbers couldn't be trusted. i will work with you. it's an area of great concern. it's as big if not bigger problem at the vha because the budget is the biggest budget at the va. >> thank you mr. chairman. mr. secretary the va has removed the way time criteria from the performance contracts of network and center directors and i do

understand the need to be wary of creating incentives for people to gain -- gamed the numbers but we also have a serious accountability problem. how will you still hold medical center directors accountable for wait times if it's not in their performance contract? >> i think the first step that we have got to do is get the integrity and the data and so the idea behind pulling that out at this stage of the game is to eliminate any questionable motivation. i think as we move forward what we are going to find is that average wait times are very poor gauge for timeliness of care for a large integrated health system. we don't really find that in the private sector. that's one of the reasons we are boosting our patient satisfaction measurement activities.