>> on ukraine does the administration have any doubt the plane was brought down by the separatists [inaudible] is there any doubt about that now at this point? the >> we have seen that there were heavy weapons moved from russia to ukraine but they've moved into the hands of the separatist leaders and they were traine iny the russians to use those systems. those systems include anti-aircraft weapons systems and according to social media reports, those weapons include the 11 system. ..

he did say whether it was a physical, weather was the russians themselves to pull the trigger or russian separatist trained by russians it's all the same and all goes back ultimately to vladimir putin. so that is an indication that based on somebody who has reviewed the classified intelligence assessment that president putin is responsible and that is why we are,

targeting russia for the actions. >> you are 100% certain, have no doubt a? >> that's sort of assessment would be something delivered by the intelligence community. so i'm not going to speak for them. i will let him do that. what i was able to review 40 was no intelligence that has been provided that i think painted pretty clear picture about what exactly happened and who exactly is responsible. that is an assessment that senator chambliss, somebody who has reviewed the classified intelligence on this matter, agrees with. >> pretty extraordinary statement i heard the in the direct way i've heard it from you. you just said vladimir putin and the russians are culpable. so that leads to the immediate question which is, what do you do about it quite you mentioned what the president did nine days ago. that was before the plane was downed. so what will be done to hold the

russians and hold president bush accountable for the downing of that plain? >> i think the fact the president impose this sanctions regime in coordination with allies the day before that jetliner was downed is an indication of how aggressive the president has been leading the international community to confront the bad behavior of the russians. so glad you mentioned that in your question. the question you're asking now is relevant which is what is the response going to be in light of this terrible tragedy. the president was pretty clear he anticipated this would be a head snapper for the international community in terms of paying attention to a troublesome situation that they present think in some countries had hoped they could get away with ignoring. it's apparent that continue to ignore this situation has had tragic consequences for at least 300 innocent civilians who are not even from either ukraine or russia. so with the president will

continue to do is delete the international response to confront this effort, and that means working with the international tender to impose additional economic costs in the hopes of changing president putin's calculus for dealing with this situation. >> that's one thing hoping to change his calculus going forward but as we talked about earlier this week, your u.n. ambassador said the perpetrators of this must be brought to justice. what is the idea -- what does that mean being brought to justice? does that mean more sanctions or is there something beyond that? >> i think brought to justice language is a reference to the investigation into what exactly happened in terms of the bringing down the jetliner. that's why we called for this transparent international investigation and for investigators to get unfettered access to the crash site, that i understand the ukrainians have given the authority to the dutch to lead that investigation.

that investigation will necessarily lead to a review and an investigation into who personally is responsible for downing that jetliner. >> the word you use was vladimir putin and the russians are culpable. >> culpable for the situation. that they've been responsible for supplying separatists with these weapons. >> you use that in conjunction with the downing of the plane, vladimir putin of the russians are culpable. >> because of the intelligence i laid out earlier that been released by the intelligence committee. you're asking a different question which is those who are directly responsible will be brought to justice and that is a reference to an ongoing investigation about who specifically targeted at that point and fired a weapon that brought it down. >> and if i can just, clarification on the border situation. your pessimism looks like congress is not going to act on the supplemental -- to deal with

this crisis. what will be the impact on that? what are the consequences? are you still going to be -- will not enter your ability to address this crisis? i assume it will to some degree, but what are the stakes we're talking about? >> i think the biggest consequence, jeff, one of our parties was to, well, was to prioritize the case of immigration cases of recent border crosses. that we're going to devote additional judicial resources in the form of judges and prosecutors and asylum officials to corporate -- quickly prosecute those who been apprehended so that we could more efficiently enforce the law. there are some resources that exist that we can dedicate to the effort and the president has made the decision to move some resources and focus him on the border but there are additional resources that we would like to get access to so we could just hire additional judges and prosecutor to put them on the cases.

>> what's it going to mean? >> that will extend the backlog that already exists and that something that we are concerned about. >> i haven't talked to in republicans during -- has been any direct contact with speaker boehner, with marco rubio, with of the republican leader, house or senate, to try to push this through? you would need bipartisan support to pass it. >> i don't know of any presidential of the vocals but there've been a number of conversations between white house officials and officials on capitol hill in both parties about this matter. we've been really clear about, there should be no ambiguity about what our request is. >> politics you have to engage, yet to push, negotiat negotiatot wondering what kind of direct negotiations, you know, shoe leather work with congress to get this done. >> again, speaker boehner said he is still discussing among his members what they felt like they could do. it doesn't sound like to me they're ready to begin negotiating. at least begin negotiating at the white house.

three weeks after we made request house republicans are still negotiating among themselves what to do. we are concerned about this because there's only one week left before they depart washington, d.c. for their annual flight week recess in august. and that means that this is a pivotal week that is coming up. there are a lot of priorities to remain undone, and we are pretty concerned about that. >> one more question on executive orders front. the president has been persistent over the last several years that he did not have the authority to stop deportation since 2010, this could lead to a surge, more illegal immigration and he would also go the millions around the world who are waiting in line to come here legally. refrained year after year from the president going back as long as we talk about immigration is you can count -- they will have to be done through congressional action. is this to the position of the white house that you do not have

the authority unilaterally on your own without congress? >> well, we certainly, the president doesn't have the executive authority that congress has to take the kind of steps that would confront so many of the problems that are caused by our broken immigration system. what the president has directed his attorney general and secretary for homeland security to consider is whether not there are some steps within the confines of the law that could be used to mitigate some of these problems. but these solutions that would be deployed through executive action are not as far-reaching as those actions that could be taken by members of congress through the passage of congressional legislation, particularly when you consider what the senate has done in terms of the legislation they did pass with bipartisan support. i would have a tremendous impact on the broader economy, on dealing with those, with the estimated 11 million individuals

who are undocumented ever in this country. >> i'm just asking very specifically. does the president still believe he does not have the authority without congress to slow deportation? >> again, we are trying to go to the assessment being done to the attorney general and secretary donley to get a, trying to determine what authority the president does have. what i can issue of in i think with the present was alluding to in those remarks that he's made in the past is that any steps he takes unilaterally will not be as impactful as the steps that congress could take by passing legislation that's already passed the senate. the only reason why hasn't is because it is blocked by house republicans. [inaudible] >> our goal is to try to address so many of the problems that have been created by a broken immigration system. if you listen to the rhetoric, the democrats and republicans,

many people acknowledge the are a wide range o of problems that caused our broken immigration system. what we want to try to do is pin point what problems can be mitigated through the use of executive authority in a solution were able to put forward will not be as impactful as congressional legislation. peter. >> on the sanctions. is the question whether, is whether still are just when? [inaudible] it said they agreed russia may not be a will to stabilize without occurring additional cost and the international committee will need to enact additional sanctions. that sells like there's no weather at this point but it just a matter of when spent it is for the position of the united states that additional cost should be imposed on russia and putin further action in ukraine. ultimately, our counterparts in europe will have to make their own decision about the steps

they're willing to take to do exactly that. we saw some positive indications yesterday and delivery steps they announced. i know there are meetings among european leaders next week that it set a deadline for the end of the month which is a week ago yesterday. for trying to come to a decision about what exactly they will do. so we do believe that additional steps should be taken but those are decisions that the to be made by those european leaders. >> this is not for u.s. sanctions. it's just a question of when and which ones the? >> i don't have a readout and for me. i'm not trying to dodge the question but i think the reference is to argue that additional costs in one form or another need to be placed on the russians to try to get them to change their tactics in the way they're acting and green. the obvious step would be for the europeans to take action, and the united states is also concerning -- considering additional action as well. >> health care, the rulings your

critics are saying in fact -- [inaudible] this law was not into giving subsidies would be provided. >> i do have, to think mr. gerdes said that even by his own analysis and rejection, he had always assumed that all eligible individuals would get tax credits and whether or not there state marketplace is run by federal officials or local officials. i would also point out mr. gruber filed a brief in the case taking the administration decide that all individuals should get access to those tax credits. as long as they are eligible to get them. so i think his views on this are pretty clear. i think he described those remarks as a mistake but i would refer you to his explanation for why he said those. i think what is clear is that he, like a congress government in for every eligible american

to have access to tax credits to lower the health care costs regardless of who was operating them. [inaudible] again i think it's a that's a mistake, those comments were mistake and didn't represent his views. i think there's ample evidence to indicate on its own projections and his own legal filings that he supports the administration's view that every eligible american should have access to those tax credits. >> earlier this week the administration is calling on israelis to take a greater steps to minimize civilian casualties, and you have these awful steps at the human school in gaza. not exactly clear who was responsible for that i don't believe, but, and then later in the week you had this outrage expressed in israel and here in the united states over the faa's decision to halt flights into tel aviv. i'm just curious, where are u.s.-israeli relations right

now? do you feel that they were listening to your call, the white house called early this week to take a greater steps to minimize civilian casualties? what did you make of that outrage about the faa's actions of? >> first i'm glad you brought up the terrible violence that we saw in gaza history. i do want to note we are deeply saddened and concerned about the striking of the u.n. relief and u.n. agencies school in gaza. we convey our deepest condolences to those families killed and injured in this incident, as well as the u.n.'s death. we urge all parties to redouble their efforts to protect civilians. in terms of the faa's decision, those are decisions that are obviously made -- what i can toleddothough is the fa was in e touch with israeli officials as they were making those decisions. the decision that faa announced was made with their goal come

with a specific goal in mind and that goal is ensuring protection of the traveling public, particularly americans were traveling. the faa sought additional assurances from the israelis before making the decision to lift that ban. that's what they did. they got those assurances and they made the decision based on their own criteria and calculation. i think that is actually, jim, evidence of a close coordination that continues between the obama administration, independent audits of the obama administration and the faa and the israeli government. >> that faa decision though was canceled almost in the middle of the night after it was extended for up to 24 hours. was there political pressure that was being felt here at the white house in the administration to let that halting of those flights expire

early? >> well, this is a decision that was made -- >> political, no political, i guess considerations are being made in terms of faa's action but with a political consideration in terms of ending that faa action? >> the faa made its decision independent with one goal in mind which is ensuring the safety of the traveling public. the thing i want to point out about the time for it i think which is relevant is they put in place a 24 hour ban on flights into the international airport in israel. then they put in another 24 hour ban which i think is an indication they were serious about what they're trying to achieve in terms of ensuring the safety of the traveling public. when they received the mr. assurances from the israeli government to look at that ban immediately. i think, again indicative of, of a healthy working relationship and of the clos close coordinatn

conditions that exist between different elements of the obama administration and the israeli government. >> the second homeland ticket has said that if you don't get the border -- the money the request -- the money the president has requested you could run out of money to space the children down there at the border. how real is that prospect? and given that kind of dire consequence, why doesn't the president feel it necessary to call congressional leaders over your to the white house to work out some sort of compromise? it seems as if the problem here is that if republicans want to change that 2008 law, the democrats really want that money. you've also said you would also like to change the 2008 law. why can't the president broke or some sort of compromise? >> we would like to seek congressionacongressional actio. right now as i pointed out, it seems to me based on comments of speaker boehner that right now house republicans are still negotiating among themselves. that's unfortunate because the

administration -- >> democrats of all sorts of different ideas as well. they disagree about the 2008 changes to the law, and to our differences on both sides. >> i don't think that's a fair assessment because of increasing democrats innocent speak to take specific steps to try to advance, to advance and appropriations request along the lines of what we put forward. i think they made some tweaks to our proposal, but they are moving on the supplemental appropriations request. right now house republicans were in charge of house legislative process are currently focused on negotiating among themselves. what they really don't have been to negotiate is their focus on legislation next week that will allow the house to file a lawsuit against the president of the united states for merely doing his job. that i would posit is an indication that they have their priorities on little mixed up. >> dianne feinstein said earlier this was that i would not rule out impeachment as a possibili

possibility. do you really believe that the president could be impeached? >> well, i think there are senior members of the republican political party are certainly prominent voices in the republican party are calling for exactly that spent who is that? sarah palin -- >> someone mentioned earlier -- [talking over each other] >> i think sarah palin considers herself -- spent hanging on, john. this is my question. >> there've been a lot of fund-raising with the word impeachment. this sounds like a fund-raising ploy, a political ploy, not a real thing. usually think the president is going to be impeached, do you? >> well, jim, i think are some republicans including some were running for office hoping to get into office so they can impeach the president. that is apparently a view that they have a whole because that's one they have repeatedly expressed publicly. i think what's really important

-- >> just looking at this are you studying the possibility of being impeached? >> here's the thing i think that's important about this. and again are coming up on a pivotal week. next week will be the last week that congress is in session before labor day. there are at least two items of business that members of congress themselves have identified as important priorities. i do think that they are right in that the american people share the idea that these are priorities. the first is that supplemental appropriations request. everybody acknowledges that additional resources are needed to deal with this problem we have attaboy. both in terms of adding some element of border security but also adding some element of public health care in terms of making sure that those individuals were apprehended at the border get the hell could that be neat and they don't pose a public health threat to the communities where they are detained. there are a lot of resources into the in the resources

request, and, unfortunately, we have not seen action from house republicans on that. we have also not seen action from house republicans on the va reform and we spent a lot of this summer talking about. we saw a lot of congressional republicans raising the energy by television reporters asking them about the importance of reforms to our veteran administration system. consistently congressional officials, republicans, indicated that was an important priority. it's the least we could do for our veterans and their families but here we are one week before congress is about to leave town and there's no discernible path that congress is going to make progress on this. instead we see house republicans deity about the prospects of passing legislation along partyline votes -- giddy -- to pursue a tax payer funded

lawsuit against the president for doing his job. that's an indication us above and so have a clue about the priorities of the american people. and i hope that they will spend some time over the weekend thinking about it, maybe even talking to come -- to some of their constituents ar but with e parties should be, and hopefully we will see some actual think the democrats and republicans in washington and across the country agree need action. right now all we get from house republicans is a lot of talk and some action on a partisan taxpayer funded lawsuit against the president. >> josh, it seems the israeli cabinet just rejected secretary kerry's -- [inaudible] is a time for the president to discuss with the second or additional incentives, additional reworking of the proposal? and although it's never been a traditionally the way this administration feels about negotiating with terrorists, and

hamas is called, under these extreme extenuating circumstances that is a possible that secretary kerry may, in fact, meet with some leadership of hamas? >> i'm not in position to act to those reports apparently merged in the middle of the conversation we've been having. the way that secretary kerry has pursued this cease-fire ag agred in these talk about israeli and palestinian leaders. is also doctor number of other leaders, including those leaders of other countries, including those that have influence over the hamas leadership. we don't deal with hamas director but there are some other leaders and officials in other countries that do have a solid working relationship with hamas and it is through them that we engage in these kinds of conversations. but again the goal that the secretary of state is pursuing is a very clear one which is to bring an end to the violence as soon as possible.

april. spent a couple of questions. how concerned is the administration with the remainder of the lessons we have because that could translate into articles of impeachment they put forward. [inaudible] >> well, again, april, the are some prominent members of the republican party have articulated their support for articles of impeachment. that is the view they have articulated. but we're focused on is the visit the american people. the president has been through what his priorities are. is priorities involve advancing american inches around the globe, even in the midst of some tumultuous circumstances. the president is focused on his domestic agenda. that starts with expand economic opportunity for the middle

class. house republicans in particular seem to have different priorities but i'll let them try to cling to the mac what those priorities are and that will be very difficult. >> what is the concern this white house as relates to the -- [inaudible] spent the election still a few months would. our primary concern right now is the urgent priorities that are being blocked by house republicans. those parties include reforms to the va, include the additional requests for resources to do with the problem at the border. you know, house republicans are blocking commonsense immigration reform that is already passed the house t. al-shabaab mr. blocking measures to raise the minimum wage, a range of other important economic proposals. that really is the focal point of our concern at this point. >> and also --

[inaudible] >> i have had a chance to review those programs in much detail. i know that the previous house of republican proposals have decimated the kinds of programs that are so critical to middle-class families and the sums were trying to get into the middle class. the republican explanation for why those republicans, those programs need to be guided is that you're looking for money so that they can increase tax cuts for the wealthy and well-connected. i am told to our sum totals included in chairman ryan's proposal that near some of the things the president is asking for. i know there's a proposal in their that would expand earned income tax credit benefits to some workers that don't actually have children. i know there's a proposal for criminal justice reform in there. there may be an opportunity for us to find some common ground to

advance some of priorities for middle-class families, but we will have to see how chairman ryan actually -- >> anything new on the commission on the u.s. africom summit speak with nothing new but i'm sure we will have more about it next week. >> in the second have homeland security have said that ice will run of money in august and bbc by september if no get emergency funding but what does it mean to national security and contingency plan are you making if you don't expect congress to come through by the end of next week? >> i refer to dhs for what impact congresses failed to act would have on the day-to-day operations. >> is the white house looking at that if they run out of money speak as i know white house officials come to those who were corporate omb are in real touch with agencies about the funding that's mrs. are for the agencies but in terms what the ultimate impact of congress go to act would be, i didn't check with us

agencies. >> the national guard, you like it to fit in with other law enforcement to make sure those no confusion together been conversations i've the president with follow-up with governor presents a time they work. any condition between administration at large with the governor's staff on this particular question since his announcement? >> i know there has been a couple of conversation between white house staffers and governor perry's staff office of a progression request that was purported to comment about governor perry's proposal to put additional natural -- national guard at the border. having ongoing conversations. >> easy feeling accountable and understanding more about? >> the practical consequences of those conversations is the governor staff has become better educated about what exactly proposal the administration has put forward or deal with these challenges. that kind of coordination is critical to addressing some of

these problems. i know there's already an ongoing and strong working relationship between the texas state department of public safety and federal border security officials as relates to coordinate those efforts. we want to make sure if additional resources are provided that their integrated into those relationships that already worked pretty well. charity, i'll give you the last one. >> i think your cynicism about congress has been primed to do. is the president going to be severely disappointed if he sees the c.r. proposal before the august recess to? >> say the last part again. i didn't quite get the question. >> if there's a continuing resolution pushed by the president -- the republicans and has come some democrats is that this be a bad idea jumping the gun before and there's still time to do that. with the president be disappointed in seeing a c.r. before the august recess because i don't know that we've taken a position on whether or not the house should act on this here before the congress recess. i think i've let what i think serve our purpose right now which are getting the subtle

appropriations because from cox and getting the va funds through congress. there's also talk of them taking some action even on a short-term extension of the highway trust fund. i would also be an obvious priority. i'm not quite as cynical or pessimistic about their efforts in that regard spent a couple times a day you quoted the speaker about immigration but the speaker said he's not interested in impeaching the president. so why do you believe what the speaker says when it comes to immigration but not when it comes to envision? >> i do believe decidedly the speaker on a number of occasions has said that they would not be steps taken by republicans to shut down the government over health care. he did say that that happened. you know again, -- maybe he can give you more of a detailed answer. there's no doubt there are other prominent voices in the republican party that have strongly advocated impeachment.

that's part of their agenda to the president agenda is not focus on those kind of political sideshows. it's a jenin economic opportunity for middle-class families. with that, i'll let you guys get outside to enjoy this beautiful friday afternoon. one second here. which day is that? good question. on monday the president will forgive the in the summer of the washington fellowship for young african leaders. april, you mentioned this. the firstly will deliver remarks earlier in the day. the three-day summit will cap off the washington fellowship, the flagship program of the present young african leaders initiative and get 500 of substance permit us to engage with you as government officials, entrepreneurs, civil society representatives as well as leaders of international develop and. in the afternoon the president will award the medal of arts,

national images medal at the white house. the first lady will also attend. april, we will have more information about the young african leaders summit next week. on tuesday the president will attend meetings at the white house before that evening, when he will depart for kansas city, missouri, where he will remain overnight. a fine city for the president choose -- for the president to visit. eric will be traveling with the presenpresident that they. it's a disappointment for me as well. [inaudible] >> i don't believe so. [inaudible] >> on wednesday while in kansas city the present will deliver guards on the economy. will have additional details about the presence traveled to kansas city, missouri, early next week. that evening, wednesday, the present will return to washington. on thursday the president will deliver remarks to the department of housing and urban development in the evening the present firstly will host a

celebration of special olympics and unify generation at the white house. to mark the anniversary of the special olympics. on friday next week the president will attend meetings at the white house. and with that i wish you all a very happy weekend. >> thanks, josh. [inaudible conversations] >> wrapping up today's white house briefing, and this item just moving on the ap, reporting via israel media israel's security cabinet has unanimously rejected secretary of state john kerry's proposal for a gaza truce. secretary kerry is in egypt working with u.n. secretary-general ban ki-moon and a number of officials in the nation of qatar to nation of qatar can have a temper a cease-fire between israel and hamas. during which the two adult indirect talks about easing the border closure of the blockaded gaza strip. hamas has demanded that gaza crossings be open as we get information about this we will pass it on to you. president obama is meeting with

the leaders of honduras, guatemala and el salvador on the ongoing problem of unaccompanied minors crossing the border. we have a camera crew at the widest to get any possible remarks from the leaders as they leave and we will bring those comments later on c-span. and on capitol hill u.s. house is in session today among other legislation and have been working on a bill concerning the war powers act relative to the situation in iraq. immigration also been discussed in congress, and those were on the hill today. at her weekly briefing, nancy pelosi address that subject among other issues. we will have for complete briefing limited but here's a brief portion of what she had to say. >> the president put forth a supplemental that met the needs of the emergency situation that we have on the border. it mitigated for some of the harm that could be done to children. it would -- it was comprehensive. it was about medicare

assistance, due process to protect our border it it would we be a treat safely by addressing their return to their home country. the senate has i think, less money, less resources but for short period of time so commensurate even a better bill, more assistance for representation and mortgages to get the cases more expeditiously. so either one of those two bills is what i would support. and again, whatever that is that comes forth will all be reviewed very carefully, but it's not a question of do you support this bill that would have any idea what else is in the bill? i can't answer that. when i see the belt i'll let you know, but i very firmly believe that it would be a mistake for us to to immigration law in a supplemental bill. we are now supposed to legislate on appropriations bill.

we hear that everyday on the floor and we tried to improve the legislation that they have put on. for them it's okay. for us it is not. but it's not a good place to insert a clause that has such ramifications on a bill that has nothing to do really with the values that put forth. so again let's just keep it separate. immigration and emigration. to want to have a separate bill, discuss it there. but again don't hold the children hostage to the cosmetics of how tough you are on the border. >> michele flournoy is our guest on this week's q&a. >> while in government you are dealing with a daily tyranny of the inbox. your focus on the quest of the day. part of my response post as

undersecretary of defense was representing the secretary of defense on the so called deputies committee which is sort of the senior level group that is working to the issues, developing options for the principles and the president. a lot of crisis management focus. when you're in a think tank you a real utility is not trying to second-guess the policymaker on the issues of the day but help to do some work there to raise their day, help them look over the horizon to see what are the issues i'm going to confront a year from now, five years from now, 10 years from now have had to think more strategically about america's role in the world? >> former undersecretary of defense and cofounder of the center for national american security michele flournoy on the creation of cnas come its mission and current defense policy issues. sunday night at eight eastern and pacific on c-span's q&a. >> forty years ago the watergate scandal led to the only

resignation of an american president. american history tv revisits 1974 and the final weeks of the nixon administration this weekend the house judiciary committee as it considers impeachment of the president of the charge of abuse of power. >> what you have here are questions about what the framers had in mind, questions about whether the activities that had been found out by the committee and by the senate, watergate committee, were indeed impeachable, and thirdly, can we prove that richard nixon knew about them and even authorized them? >> watergate 40 years later sunday night at eight eastern on an american history tv on c-span3. >> yesterday the house veterans' affairs committee heard from acting veterans affairs secretary sloan gibson on health care issues. other witnesses of legislative directors from various veteran service or position including

the american legion, disabled american veterans and veterans of foreign wars. this hearing is about four and a half hours. >> [inaudible conversations] >> angood morning and welcome everybody to today's oversight hearing entitled restoring trust. i want to ask unanimous consent also that representative michael fitzpatrick from state of pennsylvania be allowed to join us at the dies today and participate in this morning's hearing. without objection, so ordered. the committee is going to examine this morning what steps we need to take to help the department of veterans affairs to get back on track to meet its core mission, a mission to provide quality health care to our veterans. since the beginning of june,

this committee has held almost a dozen full committee oversight hearings, some of them as you well know have gone way in to the fight -- night and some in the early morning hours. we want to do a top to bottom review of the va and to delve into how we are now situated in a crisis. at the department of veterans affairs. while i hope to focus on the major themes we've covered and receive updates from va this morning, on the topics that we've talked about over the last few weeks, i can promise the department and the committee members that as we move forward to help mend the broken va system, the oversight done by this committee is going to continue. mr. secretary, in your written statement you state that the status quo and our working relationship must change. and that the department will continue to work openly with

congress and provide information in a timely manner. first, i agree that our relationship between the and this committee must change. we must go back to the way business used to be handled for decades when members and staff to communicate directly with va senior leaders about routine business we conduct with the department. using the phrase continue to work openly is, in my opinion, not a reflection of the current reality that we find ourselves in. members of this committee, other members of cars and our staff are still banks stonewalled to this day and you will hear several questions that relate to that information. for example, the day after our july 14 hearing from our colleague mr. jolly personally spoke to the director of the regional office and asked for information regarding the firing of mr. javier soto, a whistleblower who testified at that hearing. mr. soto raise very series of

concerns about both retaliatory action and mismanagement of the same beach our own. it is incumbent upon this committee to investigate those allegations. but instead being open and honest about the process about mr. soto's removal, va has indicated, stonewalled, changed its story and instructed members of this committee in what appears to be an attempt to cover up and i said appears to be an attempt to cover up be a retaliation about mr. soto. we are prepared to subpoena the documents if that's what it takes. we've got to get compliance over the multiple requests we've made to the department. i could not agree with you more that the department needs to earn back the trust of veterans, families, the veteran service organizations, members of congress, and the american people through deliberate, decisive and truthful action. the recent scandals that have tarnished trust in the va are reflections of a broken system

that didn't just happen overnight. nor can it be fixed overnight. stepping up as the acting secretary, you stated that there has to be change and there has to be accountability. but i have yet to see where the department has drawn the line at brought those people who have caused this crisis to justice. we have shows are many of our hearings that one could you're being factor to the current crisis is the va has clearly lost sight of its core mission. and that extra funding didn't go to improvements in patient care, but toward ancillary pet projects and an ever-growing bureaucracy, agreed to an article by former undersecretary of health, dr. ken kaiser in "the new england journal of medicine," vha central office staff has grown from about 800 in the late 1990s, the nearly

11,000 in 2012. this further illustrates the va shift of focus to building a bureaucracy as opposed to filling its duty, providing quality patient care. as i said before, the problems that exist today will not be fixed overnight and it cannot be fixed by simply throwing money at those problems. to date that he has been given every resource requested by the administration. every year during our budget oversight hearing, members of this committee, and dr. roe in particular, has asked if the secretary had enough to do his job, and every time we on the committee were told unequivocally yes. this is why last week acting secretary said that an additional $17.6 billion was needed to ensure that va is available to deliver high

quality and timely health care to our veterans. and when he did that it raised some very obvious questions. where did the number come from? what assumptions underlie this request? how were they made. what effort was made to look within existing resources at the department to meet these new sources, or resource needs. i know many of my colleagues would agree that after multiple oversight hearings, outside investigations, countless accounts being made by whistleblowers, va numbers simply cannot be trusted. bas determination that 10,000 additional medical staff is needed is also surprising when the secretaries of written statement states, and i quote, va doesn't have the refined capacity to accurately quantify its staffing requirements, end quote. if they don't have the ability to accurately predict the

staffing needs, then how do we know that 10,000 more bodies is what is needed to solve the problem? i would also remind members that we don't have any type of grasp on how the department is going to spend a new funny that the requested. the president 2015 budget request, 1300 pages. you've all seen it. it's in your office. 1300 pages. a request from the department, the first request from the department i had been saying was a three-page request, and that request actually is a single page. but this is all we got. i hope all of you got a copy of this because this is how they in fact justify their request to have asked the senator on the telephone earlier this week if

he would delve into and give us a more complete review of what they requested and i was told that we would get a much more detailed request. we got two pages. that's all we've got. two pages. entitled working estimate as of july 222014, for $17.6 billion. yes, the number has been refined to about 13.5 billion, but still two pages for $13.5 billion? our veterans deserve the best, but throwing money at the department into a system that has never been denied a dime will not automatically fix the perverse culture that has encompassed the department. va can no longer consider itself a sacred cow that is not subject to rules of good government and

ethical behavior. veterans are sacred. va is not. ultimately we're talking about a system that has a long road ahead of it before it can get back to an organization deserving of our veterans and the sacrifices that they have made. i hope that today we received the needed insight from our veterans service organization. they and their members are on the ground. they need to be partners when the va try to rebuild the trust that is lost her i hope that together we can bring about true change to this broken system and a change, and a change that will fix the corrosive culture that has encompassed the department of veterans affairs for far too long. with that ideal to the ranking member for his opening statement. >> thank you very much, mr. chairman. good morning. i want to thank you, thank you

are holding today's hearing and for leading a rigorous oversight over these past few months. it's been a long road getting here. the hearings with held for the past few months have yielded difficult, disturbing but ultimately important information. with each hearing we have heard of a different aspect of the department of veterans affairs that this isn't working. we heard about some challenges like claims backlog, technology issues which we have been confronting for quite some time now. we learned of others like how the va treats whistleblowers and the reality of the va report, the new appeared the va is a good product. when veterans get to see a va doctor they like the care that they get. when veterans get the eligibility rating, start receiving the benefits, they find those to be useful and

helpful. but the business model for producing delivering and supporting the va product is fundamentally broken. we have heard this time and again over the course of these hearings. there is a clear cultural problem at the department of veterans affairs to asian. there are scheduling failures and technology problems, inconsistent office practices lead to a backlog that appears to be tackled at the expense of other services. the department of veterans affairs station is a sprawling agency that offers critical services to millions of our veterans. it's clear to me that we need a business minded approach to reform the agency. more of the same isn't going to solve the underlying problem. tweaks and band-aids around the margins are not going to sustain the system. we need a new model, a new approach and a new way of thinking about and looking at the department. we need immediate short-term

fixes but we also need a long-term vision and a new approach to the business of the department of veterans administration. and i like to thank you, secretary gibson, for joining us today, and for your efforts over the last two months. you've stepped up to the plate at the most challenging moment in the department of veterans affairs history. and you on the problem of the organization. that it has expressed over the last several years. and i thank you for increased effort to communicate with us on the hill, for your dedication to our nation's veterans and for exhibiting the courage to be the face of the department of veterans administration during these very difficult times. i would also like to thank bob mcdonald who i hope will soon be confirmed as the next va secretary. i'm looking forward to talking to mitch mcconnell about his vision for reforming the department of veterans

administration both in the short term as well as in the long term. like mr. gibson to mitch mcconnell is exhibiting extraordinary courage and commitment for taking on this role at this very important time. i also like to thank the veterans service or decision for joining us today. you have been strong and relentless advocates for the well being of our veterans. you've done an excellent job in holding all of us in congress and the department accountable. you are a key stakeholder to this whole debate with the department of veterans affairs. you need to be active, engaged in the process of long-term reforms for the department of veterans administration. i want to thank all the vsos as well for your continued effort that you've been doing and tv about what's happening with the department, and for joining us today. so it again, mr. chairman, i want to thank you for having this very important hearing. without i yield back the balance of my time.

>> thank you very much. before begin i want to recognize some dispense them in the audience with those, the american legion boyce nation choice or today. welcome to all of you. thanks for being you. we're glad to have you here with us. [applause] >> this morning we're going to hear from the honorable sloan gibson, acting secretary for the department of veterans affairs. to you sir, we owe a great debt of gratitude for stepping in as number two and then stepping up as my breaking member has said during a very trying time for the department and we appreciate you being here. he is accompanied by mr. danny pummill, direct deputy undersecretary for benefits at the department of veterans affairs, and philip matkovsky, since the director undersecretary for health and administrative operations at the

department of veterans affairs. as always, your complete written statement, mr. secretary, will be made a part of the hearing record. and with that you are recognized for your opening statement. >> thank you, mr. chairman. i'll get straight to this. concerning the health care we have serious issues. here's how i see the problems. first, veterans are waiting too long for care. second, scheduling improprieties were widespread including deliberate acts to falsify scheduling data. 30 come environment exist for many staff members are afraid to raise concerns for fear of retaliation. fourth, metrics became the focal point for some staff instead of focusing on the veterans we are here to serve. fifth, va has failed to hold people accountable for wrongdoing and negligence. and last, we lack sufficient resources to meet the current demand for timely, high quality health care.

as a consequent of these does the trust of the veterans we serve, the american people, and their elected representatives has eroded. we have to earn that trust back through decisive action, and by greater transparency in dealing with all of our stakeholders. to begin restoring trust we are focused on six key priorities. get veterans off waitlist and into clinics. fix systemic scheduling problems. ensure that veterans are the focus of all we do come in a culture where leaders ensure accountability, where transparency is the norm, and where employees live our va values every day. hold people accountable for willful misconduct. establish regular and ongoing disclosures of information. and, finally, quantify the resources needed to consistently deliver timely high quality health care.

here's what we are doing now. vha has reached out to over 173,000 veterans to get them off waitlist and into clinics. we are adding more clinic hours, recruiting to fill clinical staff vacancies, deploy me -- deploying medical mobile services and expanding the use of private sector care. in the last two months between mid-may to mid-july, we've made over 570,000 referrals for veterans to receive care in the private sector. that's up more than 107,000 over accountable period a year ago. each of those referrals will on average result in seven council appointments and visits. so that produces an increase of more than 700,000 appointments and visits per care in the community above last year, just associated with the increase in

referrals over a two-month period. vha is posting regular updates to keep veterans informed about progress we're making in excess. as part of the effort to improve transparency i recognize, mr. chairman, with more work to do in providing complete and timely responses to congressional requests. you all are keeping us very busy in that regard right now. we are moving to improve our existing scheduling system and simultanesimultane ously pursuing the purchase of a modern commercial off the shelf system. i've directed medical center and others to direct -- inspections of clinics, schedule practices edited by any related obstacles to timely care for veterans. to date over 1500 of these visits have been completed. we are putting in place a comprehensive external audit of schedule practices across vha, and we are building a more

robust system for measuring patient satisfaction. i have personally visited 13 the medical centers in the last six weeks to her directly from the field, how we're getting veterans off waitlist and into clinics. ..

in messages to the entire workforce and numerous face-to-face meetings with employees and leaders i've made it clear that we will not tolerate retaliation against whistleblowers. furthermore, i committed to caroline lerner when i met with her several weeks ago that we will achieve compliance with the office of special counsel certification program and she and i have agreed to streamline the process by which we work together to assure appropriate whistleblower protection. we've also established internal processes to assure appropriate actions are taken or retaliation has been documented. i have made a number of leadership changes including the

interim secretary for health. new to the va she is spearheading efforts to accelerate the veterans access to care. doctor jonathan has become his short-term assignment as the advisor to the secretary. doctor perlin comes to us on loan from the hospital corporation of america where he's the chief medical officer and president of clinical services. he's alshe is also the chairmanf the american hospital association. to help us bridge the period that we have a confirmed undersecretary for health, a position who once held. doctor jerry cox has been appointed to serve as the interim director and a career medical navy officer and a former assistant inspector general of the navy for medical matters will help ensure that we

provide a strong internal audit function helping to ensure the high standards of care quality and patient safety. they were negligent to support the critical work lead bradley has begun a four-month assignment of the council of the foreign secretary. secretary. ms. bradley is a former counsel at the va and a senior member of the general counsel team at the department of defense where she has direct responsibility for their fx portfolio. shifting gears in the area of resources i believe the greatest risk over the intermediate long-term is additional resources are provided only to support the increased purchases of care in the community. and not to remedy the shortfall and the internal capacity. such would be even poorly positioned to meet future

demand. the staff in the space capacity are strained. between 2009 and 2013, the number of unique veterans we treat in italy is increased by over half a million. the typical veteran we treat today has on average nine major diagnoses. in just the last three years, 40 veterans health care facilities have experienced double-digit growth in the number of patients that have come through their doors. as an example in fayetteville north carolina medical center which i visited several weeks ago, the number of patients being treated as growing the 22% in the last three years. resources required to meet the demand covering the remainder of the fiscal year 14 through 17 total over $17 billion. while the amount is large it represents a increase in annual expenditures. the annual expenditures. the funds would address clinical staff, space, information

technology and information technology necessary to provide timely high-quality care. let me briefly address benefits since arriving at the va i've been very depressed with the ongoing transformation. i doubt that any major part of the federal government has transformed so much in the past two to three years. and i believe that because of this transformation, we are on track to eliminate the disability claims backlog in 2015. having said that, the veterans still way too long to have their claims decided. and it still isn't up to our own standard. a portiostandards. a portion of our request for additional resources will be to accelerate accurate and timely claims decisions for veterans. in closing, we understand the seriousness of the problems we face. we have been. we are taking decisive action to begin to resolve them. the president, congress, the

veterans committee american people into va staff all understand the need for change. we must always seize this opportunity. we can turn the challenges into the greatest opportunity for improvement i believe in the history of the department. furthermore, i think that in as little as two years the conversation can change. the va can be the trusted provider for the veterans health care and for benefits. our ability to do that depends on our willingness to seize the opportunity, challenge the status quo and drive the positive change. i deeply respect the important role that congress and the members of the -- we will work hard to earn your trust. we will not succeed without the support of the veteran service organizations. i conducted some 20 meetings and calls in the last two months

with readers and other stakeholders to solicit their ideas for improving access and rebuilding trust. and i look forward to hearing testimony on the panel that follows. last, i appreciate the hard work and the dedication of th dedicaa employees. the vast majority of whom i continue to believe care deeply about the mission, what to do the right thing come and work hard every day to care for veterans. because of their work today, thursday, today, hundreds of thousands of veterans will receive great care and in facilities all the way from maine to manila. in the midst of the crisis is all too easy for us to forget that simple fact. mr. chairman, i'm prepared to take your questions. >> thank you very much mr. secretary. and it is an honor to have an opportunity to work with you and to call you a friend. we have some great questions we are going to ask today on both sides. we will have some pretty appropriate questions. and i think -- we appreciate the

actions that have been taken off the department moved the veteranveterans off the wait lid i think probably the one of the significant questions that needs to be asked right now is how many veterans currently are on the waiting list over 30 days for appointments? >> do you want to take the wait list question and i will address the broad issue lacks the veterans on the ewl electronically to store about 30,000 nationwide down from 57,000 on the 15th. >> the new enrollee appointment request list -- which was another focal point for this overall effort -- started at roughly 64,000. it is currently sitting on what's really going to be a permanent level of about 2,000, because there's flow in and out just about every single day. when you look at the number of veterans are waitin waiting thae

scheduled, but waiting longer than 30 days for their improvements, it's about 640,000 total. we see the number of the veterans waiting longer than 90 days as we release information every two weeks. we see that coming down steadily, but not precipitously, not fast enough. >> if we can talk a little bit about the funding request that you byou be eluded to in your og statement, is this a formal request being made by the president or emergency request, supplemental request? >> but i am trying to do here is to articulate the requirement as best i can possibly articulate. from white perspective, it is a formal request for funding. >> from the administration? >> that's my understanding, yes, sir. >> is anybody aware of how the supplemental request was made by the white house in regards to the process crisis that exists on the border right now,

3.4 billion? >> i'm not aware of the method by which it was conceived. >> -- a supplemental request from the white house. so i'm trying to figure out -- because everybody keeps dancing around the word "request," even yesterday into the secretary did on the hill, and i'm trying to find out what are we -- is a desire, but ordinarily it would come through the white house, and so walk me through the -- how did this come up right now? what was the impetus that began you looking at the need? we already got 35 billion on the table, and so now during the negotiations on the conference committee reportcoming youth injected 17.6. >> i think as we launch into now over two months ago, we launched into an effort to accelerate care for those veterans are

waiting the longest. we undertook simultaneously a process of evaluating the adequate resources in the field in order to be able to meet that standard of consistent high quality healthcare. as we worked through that process, using the information systems that we have available to us, we developed an initial set of requirements and begin working with the office of management and budget. as my testimony last week to the senate came closer and closer, there was an increased effort to try to get the process to closure so that during the testimony as well as the testimony that i would be able to present that statement of requirements. >> so, the memo that you gave to the senator sanders on the 16th of july says per your request, attached for your information is

a summary for additional resource needs through 2017. so, was it senator sanders request, a combination or yours? >> senator sanders requested the information. the requirement is being communicated here come into the requested url is the request. you come from the banking background. if somebody came into your bank with three pieces of paper and asked for a million dollars would you give them a million dollars? >> answer there is a probably would depend on who the borrower was, but i understand your point. the committee needs additional information. >> and we have set a goal of trying to wrap up the conference committee by the end of next week, before we leave, so that we can get something to the president for his signature coming of the three pieces of

paper to justify a request that senator sanders clearly wants to put into the scope of the conference making it very, very difficult for us to be able to do our job is always get our sheets of paper that basically says they are working documents. at some point they have to say this is the document. with that, you are recognized. >> thank you very much committed to returning. once again i want to thank you mr. secretary for being here. you stated in your statement the va doesn't have the resources that it needs. and your view thaand/or view ths lack of resources, number one command when was this under resourcing identified? and my third question is why did the department actually request in their budget? the reason i ask that question is when i first became a member of the committee when i was elected and the secretary is

sitting where you are sitting and we asked him as he was defending the president budget question was can you deliver the service for the veterans i furtq and afghanistan and in the current. his response was that he requested an additional $1.2 billion didn't receive it, but he will make do with his budget. so i would be interested in knowing what the actual request was when you originally submitted your budget. >> first of all, as i have come into the department, five months and six days ago i formed the opinions about what you see and hear. my general sense is that what we have done historically as we have managed to a budget number. as opposed to managing the requirements which is what you do in the private sector. we have sort of model our way along and not been able to meet

the standard of care that the veterans deserve because we did not manage to requirements. the exercise that we have gone through and frankly continue to go through as we work to ensure that we are ringin ringing "it e that we can out of the existing resources is really about managing the requirements. i would tell you that process as i mentioned in response to the chairman's question has really been underway for the last two months. i've been in places the acting now for seven weeks. in the private sector this would be a routine part of the business. you would be managing the requirements. to prove that you have the

resources to meet of the existing demand that is simply that the department has historically been. we manage the budget instead. i can't answer your question about what the specific budget request was in relation to what was actually finally approved. about we take that one for the record to get you an answer. >> i appreciate that. and i appreciate your comments because that was my same response to the secretary at the time was i don't care how big of a budget increase you received. i want to know where you taking care of the veterans. that outcome is so critical over the years through several secretaries that sat here and listened to, i believe that they have always operated the department based upon the budgets they had come and not to take care of the veterans and hopefully that will change.

>> i committed to the veterans and i will not hold back. as i think the resources are required, i'm going to ask for them. and i have told the internal staff don't ask for 1 penny more than you can justify. i am not looking here for some kind of a blank check. but i am not going to sit here -- in my meetings with individual employees as they raise issues about the need that theneedsthat they have and the s that they lack, i've come to understand what my job is. my title may be the acting secretary, but my job is to create the conditions for them to successfully meet the needs of the veterans that they serve. and that is what i am obligated to do when i cut here and sit in his seat. >> do you think that the business operating model that the va currently operates is sustainable in the long-term? and getting what the chairman mentioned when you look at the fact that at the business level

they've excluded with management, and i think that the va definitely has to be reorganized. and in a better format to do you think the current business model is sustainable in the long term? >> my sense is that there are opportunities for us to structure differently. i don't like bureaucracy. but i understand that in an organization as large as this one, you have to have some of it. the challenge is making it work for the people that are serving veterans day in and day out and i don't think we are doing it very well. so i think there are opportunities. there has been concentration at the division level into the va central office level. part of that was positively done as part of taking and consolidating the activities either act v. central office level beer they can be performed more efficiently and effectively

can scan scatter 150 different locations. >> thank you mr. chairman for being here today. i want to follow on something brought up earlier by chairman miller. a very important issue i would like to get more information on that has to do with. we quantify the staffing requirements and yet in your $17.6 billion resource requirements you requested $8.4 billion for about 8,000 primary specialty care physicians that other clinical staff. given that you said that to the department is able to quantify its staffing needs how can a number like that even be arrived

at? they address the fundamental questions. i would've told you generally thinking wha of the half as i sd earlier we haven't been working to solve the requirements. i think earlier today some of the stuff participate and the congressman may have participated in a briefing that we deliver about the operation of the ophthalmology specialty. and in spite of that model when you look at some of the productivity tools rolling out in the organization you get what will give the kind of granularity. you are going to find as we exercise that model there's some locations that have enough staff. there are some other locations that may need some additional support resources from either some additional support staff for additional space. and then there will be other locations of the look and we say we have enough providers here.

and it's going for that kind of bottom up highly granular process that's going to give the precise answer. we are working on doing that right now. but as we go out into the field of -- as i go out into the field and we look at the top-down requirements. >> we try to use a bottom-up approach at the veterans waiting 30 days for care. about the improving efficiency over the years, then we gave the definition of the account of appointments that we needed to excavate and thaexit the race at in the model and we worked with the assumption that in year number one of your going to be purchasing of care in the private sector. then we blended over time and sustain it using internal staff. but the way that we cam we camet that is estimating the number of the veterans and their

appointments that would be deliberate in a timely manner but costing that and turning it into the 8.2 billion. >> that sounds like it is a work in progress. so i would question how specific you can actually be. but a follow-up question is are there a lot of spot that are sitting empty right now that you haven't been able to find someone to fill either a doctor or other healthcare professional? >> i would say there are thousands. all across the vha roughly 28,000. and in some instances, those are not all being actively recruited to fill and i would tell you we have been pushing particularly on the clinical staff to accelerate some of that. if you have 28,000 open spots and you have 10,000 or so more

open spots are you ever even going to be able to fill those spots under current requiremen requirements? the current productivity requirements you have but i understand in the testimony is different and in the private sector. >> organizations will always have a measure of organic vacancy if you have turnover in the staff but what it allows us to do is raise the floor so that the floor into the fully encumbered positions grows with additional staff brought in. so, i think there will be staff that leave the organization and if they retire and move on to other jobs there will be a vacancy rate. the rate now is about 10% and the reflect to her turnover rate. so as that occurs you have a certain vacancy rate. the other thing we are looking at her with the same time we are doing this is looking at the physician management practices rather than hiring to the requirement, which may require in certain cases that we have

fully encumbered staff as opposed to where we are today. but to your point, i think the additional staff allows us to raise the floor of the onboard fte. >> thank you mr. chairman. i yield back. >> thank you very much. was mr. brown here? you're recognized for five minutes. >> i want you to know i was here before the chairman. [laughter] as you know i've been on the committee for 22 years jessie gibran was the secretary and his model was putting veterans first and i've been through all of the secretaries. and some of them left a lot to be desired and some -- but the point of the matter is. at one time we were certain of

the count of the veterans. now we have expanded it to the veterans. i don't want to say that they are sicker but the conditions are different because of the war they come back with different ailments. they want the services at the va. i want to make sure that the va is there for them. and it's a lot more complicated than what we are saying because they will have ten additional things as opposed to the one time it was made a lot more simple than it is now. >> we have an actuarial model that we use to forecast. part of that looks at the past practice and forecast the future. the best part of it that i think is to start introducing more bottom-up planning. and having the field gave us if you will the statement of

requirements. if this is the number of the veterans you think you can serve, i also think that and neglected to mention that it's for the congressman's question. if we improve performance that is if we were better at providing high-quality and timely care, it is going to affect the veterans coming to the va. they will come to us more and if they can care more timely. so having the approach and working with our medical center leadership and the network leadership to give us a bottom-up operating plan of what they are -- with the financial requirements are in the out years i think it will help us to be better pair to adjust for where we are succeeding in how we succeeded. >> we have given everything that is requested. now i guess if the institution of memory should be because i remember that in 2007 and 2008, it was the first time that the veterans were able to get the budget that they requested. that was under president barack

obama. i know that i'm the only one that remembers that. but it's important to remember how you got where you are. and as we move forward you need to remember that many of us talk the talk, but we didn't walk the walk or roll the role, so i think that's important for us to remember how we got where we are. at the va, we are having problems that we are no but we e point that we need to destroy the system. and i feel very strongly about that, and i don't want to be the only one saying that the va should have -- i think that we should work with community partners and community stakeholders and how do you feel about that? we have teaching hospitals that we should partner with. we could share a quick read. but i still want to va to be in charge. >> yes-man. as i travel around the --

>> you just returned from gainesville. >> yes-man. medical center after medical center we are impressed with the academic affiliations we have with local partners in the community. and the benefits -- all of the many benefits and the extraordinary care that is made available for veterans that the expert clinical staff that we are able to recruit in part because of the strong affiliations is one of our opportunities to continue to pursue. >> thank you very much for your service. >> i yield back the balance of my time. >> thanks very much mr. chairman and mr. secretary for being here today and for your service in this tough time. i agree with your opening statement. i said this in the beginning one of the problems the va had his

lost trust. i said this at the very beginning with the motto should be is we work for the veterans. i don't work for the va but i work for the veterans. and i think that cultural change will help. when i came on this committee ce five and a half years ago there were a quarter of a million people that worked, 250,000 people and the number i saw in the testimony was 341,000. that's more people that work for the dav in any city in my district. and it's huge. i'm not convinced that it's getting any bigger is going to solve the problem. i think getting better will solve the problem and getting more efficient .-full-stop the problem. i don't think that getting larger will make it worse. i honestly believe that. and when you see an office over 800 people to 11,000, that is mind boggling to me.

but that's many more people could be immediate. when you don't have that many more employees. so i think -- i think that you are looking internally. i truly bb that. a question that i have is as you mention accountability has anyone been held accountable yet and terminated packs of >> there were three actions announced about two months ago. there is an additional individual is placed in the senior executive manager that's been placed on a leave of absence. >> anybody that doesn't have a job that had a job quick >> i understand what being fired means and i'm also learning the hard way how you do that inevitable government. and so, it starts when you create a massive piece of information that's documented. i got the end of june.

i got the first results from the ig finally released on monday location. a thousand pages of transcripts are sworn testimony. and in the midst of all of that, there still wasn't all the information needed so we had to dispatch investigators to take additional money. we reviewed all of that and we pulled the traffic and then we go through the process i have to delegate authority for proposing the official into the deciding official to reveal all of the information. there are two things going on right now in the accountability space. >> let the interview because my time is short. you have t had to go through a d pages. creating more inefficiencies i think more people are making this bigger before we trim it down and make it better is in the right direction. and i very briefly i don't have a lot of time left but we have to try to make some decisions

that involve a lot of the taxpayers money. and $17 billion, that is a request. and as the chairman pointed out, i've asked every time we had a budget hearing i've asked if you have enough money to carry out your mission and the answer is each time as we have enough money to carry out the mission. so how will i know this is enough money when i've been told before that you have enough money? i voted for every single budget. that's one of the things that i will never apologize for is to spend money on our veterans. i will never do that. we will not have this country believe that it is. and i enjoyed. that isn't an issue but i don't want to take the money that hard-working veterans go out and pay taxes and not spend it wisely so can you tell me how this $17 billion -- that's

$17 billion. where i'm from that's a lot of money. >> it's a lot of money where i'm from, too. >> do i know that it will be spent wisely and it would be better to take some of that money and look at building a bigger bureaucracy that the veterans that want to if they veterans as i would like t to go to see my doctor outside, just let the veteran do that. would that not be cheaper for the infrastructure and the hospitals are already out there. today they express a desire to do that and have the capacity to do that. would it be easier and more efficient to do that? >> one of the points that was made earlier is the fact that her and are pleased with the care they get. once you get it, it's hard to get it. >> i agree they are pleased with the private sector for the most part. >> the other thing that's been interesting to me is we have been working down the list and we call the veterans waiting too

long for care and ask them do you want us to refer you out to the community sometimes the answer is yes but more often than not, the answer is no i want to wait for my appointment. >> mr. chairman, one thing i want to tell you i had a sergeant in my office this week. i'm not going to tell you who but he canceled hithat he cancet and was on hold for two hours. he walked in on his offic out oe doing his job. and then later when he had an appointment, you all have done something. i will tell you that. he said he got eight different phone calls from eight different people about his appointment. is that efficient or inefficient? >> it doesn't sound very efficient to me. >> thank you very much. you are recognized for five minutes. >> mr. secretary, point blank is there that the va what areas are the shortages?

of >> i would say the short answer is yes there are shortages and there are shortages in the primary care and specialty care and mental health. all three. >> i have heard that there are problems referring people to specialists. are there certain areas of the specialty into deficit. what is the va's most successful tool and does the va need stronger tools? >> i think that we have a number of strong improvement tools. one of the areas we've done a lot of work is in the surgery programs that have made significant use to actually look at the practice process and then to identify that efficient seas. the program runs nationally and is able to support both at the regional level, national and local level tracking and trending. >> i'm sorry, congressman.

what is the area that had come up before would we look to have a tuition reimbursement and other kind of authorities like that provided and i think looking at the cost those are valuable and i think we need to look at the -- of >> but that kind of reimbursement presupposes a supply that is adequate to recruit from. we know that they are more likely to stay and practice in the place where they completed the education. they seem like one of the best recruitment tool's hospitals have. are they using it effectively quick >> i think we are. where we find we do not have a good strong academic affiliate sometimes we have challenges and where we have developed a strong affiliate, we have a good pipeline of quality providers who want to work for the va. they don't work ithey've been wd they were introduced. they understand the mission. they love our mission and come to work with us.

>> would you welcome the funding for the program lacks the formerly been ten to 20% around the education of medicaid and medicare taking the other 90 or so present. we have frozen its members since 1996. i have to think that is contributing to a short series of doctors generally. >> i would have to look at that and say that conceptually we would support, but i did have to look at the details. >> le >> would this help address the position if we were to be able to get more timely care to our veterans if we were to increase the number of medical school education spots at the va? va? of >> i think so. >> is my time up, mr. chairman and? of >> would've the current system -- hasn't the level of the ability in the health track records at the va providers been a very year to providing the

high quality continuity of care to the veterans? of >> one of the things that separates us when we talk that the private sector and other fee-for-service for instant medicare is the requirement that we have i have been the in the o maintain continuity and coordination of care that it has. i think in some of our contract options, we have the ability to exchange electronic data and that is written into the contract so we actually get the political organization back. >> i think that many of us support the idea of the access given the emergency situation cooperation with both public and private. we support that a lot of the democratic side of the concern about the solution that is the focal point of the funding is the potential lack of continui continuity. is that part of your plan going forward? >> we are looking at one of the major contracts we have in place

to look at further making the data that we share back and forth. today it isn't computable when we have the authorizations for the care it will come time into paper. in the contracts we get the pdf and when we need to make the data -- >> we need interoperability between the care to really make the outsources to the providers more feasible. they said that the best efficient seas are going to be to own its own doctors and to keep the care and its system. the system whether public or private wants to outsource out of nowhere because usually there is a huge charge to go out of the network and i think they have the same sort of challenge. but in this emergency situation, we do want to make sure that when we do outsource that there is continuity of care. >> as we look at the purchased

care in the community in terms of extraordinary geography and extraordinary technology and demand, we are in a period right now of extraordinary demand that we are dealing with as we accelerate the care to veterans waiting too long and extraordinary geography there will always be communities we can't justify building. and so, we are going to have to provide a timely and appropriate access to care for those veterans. and there will be a patience of very highly specialized procedures that won't make sense to do those in-house. >> the want to set the parameter so that it's possible and so that it really does work. mr. turn and i would heal back. >> thank you mr. chairman and secretary gibson. in your testimony you said we would work hard to earn your trust. and your trust being the trust to congress. your background and my background or similar we are both senior-level officers and

the organizations into the u.s. chief financial officer and chief executive officer. now, in those positions each of us have to report to the boards that were responsible in the fiduciary matter for the oversight of the resources of those organizations. so, i'm going to lay out the following sort of environment to see that you are the cfo of an organization that looks like this in the culture. it has performance measures that aren't trustworthy and senior executives that manipulated information to receive bonuses and past financial projections include a request for funding that caused them to be higher and we are not actually in this case by billions of dollars and then most of the funds were programmed in other purposes without letting the board no then you have a system that isn't accurate. so why do you think the board of reaction would be i need a whole bunch more and i'm only going to

give you three pages to explain? so, that is the first part of the question. would it have been wise to say we need a small amount and we are going to come back to you in a few months and show you what a great job we did in this small amount and then say in light of that we would like to make a large request because we are on the right track clicks that is my first question. >> i think the sense is that we need to provide those is the conference committee was considering other appropriations we need to provide our best estimate of the requirements to meet the current demand. >> thabut you turn those requirements into a request. and i don't think that was wise. i think it would have been smarter to come back to us and say this is the down payment that we need. and if we are successful in turning this around and putting

the veterans health-care first, then we are going to come back to you for x. y. and z. but you asked for the whole enchilada at one time. and that is causing a lot of us to struggle. then we have other folks trying to latch onto that. i don't think that is a good idea. let's go into a little bit more regular information. in the healthcare model that the va uses its cal it's called thel the projection model. that takes into consideration the projected number of enrollees and the workload and the projected unit cost of providing the services. and fiscal 11 and 12 the va estimated the resources for about 83% of its health-care budget estimates. and in 2014 and expanded the use to develop the cost estimates beyond that. over the years we've identified

many problems and in that sense it isn't a very trustworthy product. so that is an issue. and now the administration is requesting $17.6 million which wasn't a wise request without proving that things were going to get better so here are my questions and i'm going to run out of time, but you can answer these hopefully before the end of today. number one is what it used to estimate the additional $17.6 billion needed to clear up the current backlog in the vha? number two, why did it fail to predict the demand on the system? and is there a way that it can be adjusted to incorporate a reasonable way to times? number three at this is the most important, should we continue to advance and appropriate the va health care funding is clearly the method used to predict the funding so far in advance isn't working and as i said earlier in my testimony, the va

overestimated and then used the funds for other purposes without talking to the congress or the board if you will. and so, the model goes all over the place. now you are saying that it needs $17.6 million. let's ask the first question. did you use it for the $17.6 billion budget estimate? >> indirectly. we used the cost d. arrived from the model but we looked at the appointment of a tiny and used the data greater than the 30 days but that is different than the model. >> said the model is the unit cost and everything else was starting -- >> looking at the data that we had at the time. >> do you know why it failed to predict these estimates in the past? >> i don't know that it did. i yield back.

>> you are recognized for five minutes. >> you are recognized. >> i think we agree the purpose of the hearing and of the proposed reform is to increase service to our veterans. and to their families. these are services that they have deserved, and i thank you mr. secretary for being here and all that you have proposed to make that happen. we have heard of all of the many problems. and if the problems exist for the veterans i think the problems are perhaps even worse for the lg bt women's entrance and that's where i would like to address my concerns. i would ask you mr. secretary, do you believe that veterans and their spouses should have equal access to federal benefits in the va regardless of their current state of residency? >> yes ma'am, i do.

>> thank you for that answer and i ask this because last month the va announced that your agency has exhausted all avenues in the wake of the decision by the supreme court in windsor versus the u.s. that struck down for getting the benefits to the lg bt data veterans. until they act, those that live in the states that don't recognize the marriages will be denied access to the earned benefits; is that correct? >> that is correct. >> that is most fortunate that because of that, i recognize the need and after visiting court decision i introduced hr 2529 that is a very simple bill that would correct that language problem in the statute. we had a hearing on that last march and nobody came forward to oppose it. we have been speaking in favor of it.

nobody is working against it and i would ask you do you support our efforts here in congress to make that change so that all of our veterans that have all warned that uniform and serve equally and served the united states, not a particular state could have access to those benefits? >> i'm not familiar with the legislation specifically, but my old policy decisions at the department has been to provide equal benefits to all veterans to the maximum extent permitted by the law. >> as for the win and i would like to ask about that. some of the recent reports have highlighted some very disturbing statistics about the low quality of care our women veterans face. and they are less likely to seek care. they are often called the silent veterans. but when they do, we found that the va served 390,000 female veterans last year, yet nearly one in four of the va hospitals doesn't have a permanent

gynecologist on staff. and one out of every two female veterans received medications that could and was determined could have caused birth defects even though they are at an age where they might want to have children. now these are unacceptable statistics and they really address the question of quality of care. i sent a letter along with 50 of my colleagues here in the house asking that this would be addressed. i know that you've been busy. i haven't heard back from you, but i wonder if you could speak to that this morning. >> well, i go you an answer first of all. apologies. we will get you one. we are quite frankly playing catch-up. the growth rate of those coming radically outstrips the overall growth rate in the number of the veterans that are coming to the va for care. we haven't historically been well positioned to provide that

care. we are doing things with training existing providers and hiring additional providers as well as -- i know what a big deal it is every time we are able to cut the ribbon on a new women's center because i always get invited and i attend as many of those as i can. so, it's a really big deal that we are playing catch-up and we have work to do. >> i appreciate that, and i thank you for your answers because sometimes we are looking at this and the big picture and we forget that there are certain veterans that are perhaps being overlooked. and i want our improvement of services to go for all of our veterans because they have all served and sacrificed as have their families. so, thank you very much. i yield back. >> thank you very much. it looks like you are recognized for five minutes. >> thank you, mr. chairman. and if mr. secretary. frankly you are story of coming

into the interim like this take up the pieces of the system that's obviously been under a lot of stress is admirable. i appreciate what you're doing but i have a couple of quick questions that i hope you will be able to help me with. first of all, i just want to address a personal issue. it's been scheduled to be increased in size for years and actually the money is in your department and all it needs is a signature when you get that to happen so i would like to get your signature on the two of my districbydistrict that has beeng for this for years. the money has been appropriated and it is in the budget, but we have been trying to get this to happen for a long time so i hope that you can fix that. >> we will dig into that. >> i've been trying to get this

to happen for a long time. >> when i'm out in the field i run into all kinds of instances. >> the fact that -- >> before i leave the room. >> i appreciate that you are out there yourself seeing what's happening on the ground because my problem with management is when somebody is sitting back behind their desk and listening to the supporters tell them how bizarre that is when trouble happens. and i think that's what happens in the past quite frankly. the question some of the members brought up earlier is what does the secretary needed to do his job? we know how difficult it is to enough people so what would your recommendations be as to what power should the secretary have that he doesn't have now to make sure that change happens? >> isn't an easy question to answer. i've said repeatedly i will use whatever authority i've got to the maximum extent to hold

people accountable. there are different proposals and if those are provided then we will use them. we recognize to the extent those are targeted at the department of veterans affairs that has an impact. >> you are explaining a lot but you're not giving us an answer. what do you need to make this happen better? >> somebody asked a question earlier is that how it worked in the private sector? lets work like we do in the private sector, but that ignores a century of -- >> let's take that a step forward. but for the number one things that make it easier for the secretary to do his job and for more accountability action? >> i think the flexibility to expedite personnel actions would

be a big deal. stick with me ask you another question, and that is we are trying to get the patient is off of the waiting list and into the private sector. so, you know my experience at the va is that it's difficult to make that happen because there's so much paperwork they have to go through but what have you done in this emergency situation take it easy for them to get out of the private sector and make it happen so they get paid and it's all happening quickly now? what have you done to make this happen? >> that is a good question. one of the things we have done is we have created these new tools. it is in the referral referralst occurs up a bit faster but what it also allows us to do is for the first time we get to get that referral through all of its stages and we get to manage it so we get to look at when will

the referral be created and when was it authorized? did we sit on it too long after we authorized? when was the appointment scheduled, how much time passed and finally when was it delivered into the documentation returned? that's helping us. it's not perfect yet. we still have work to do. stick what are you doing to get them off of the waiting list and into the private sector. tell us how that works. >> the phone calls to the veterans asking them if they would like to be seen in the private sector. if a word, we could coordinate using our partners -- >> isn't in place for the most part. >> about where it is, it would be coordinated i in that appointment and where it is not pr working with the veterans if they want to work with their own provider and we can set up that appointment if we have been. there is a scripted process we did at this time and i think it is a little bit better. we still have work to do to get that done right. actually, we have even talked to

some to help us look at the process from the veterans perspective. is it easy to understand and easy to follow through? i think that we have work to do. >> i'm going you think so. thank you. >> doctor reese cummings or recognized. excuse me ms. kirkpatrick you are recognized for five minutes. >> esther secretary thank you for being here today. on monday i was out on the navajo nation and by district and talking with lots of folks and we had a lot of veterans. many of them live in areas with no cell phone coverage or broadband coverage. and i know one of your goals is to expand telemedicine and that is a great opportunity for my district. with my first question is in your budget did you have money for expanding broadband infrastructure in those areas where we have the veterans that have no access? >> i think it is one of the things we will have to look at.

we did have additional support to include hardware and bandwidth for the expanded care. i think we need to look at that specifically. i don't want to give you a false answer. >> i would love to be part of the conversation because it is going to be so critical to get the care they need. my other question is for the secretary. the inspector general reports have been a very valuable to the committee in trying to unravel the problems that the va would come up with real solutions and i would like to know what you have done and what you have put in place since the interim report from the inspector general in may. >> and there were a series of findings and recommendations that were included in the report. most of them having to do with the first working of the list of 1700 veterans that they have turned up in their process which

we have reached out to every single one of those i think roughly a thousand appointments or appointments for the veterans had been scheduled as a result of that particular process. there were recommendations in the report about producing the new enrollee appointment request producing that the medical center level and distributing that so that it can be worked wd and that's happened as i mentioned earlier. the list has gone from 64,002 it was 2100 the last time i looked which wilto be about the bottom. >> are there other items that i am not remembering it seems like there were one or two others. >> each one of them became a specific action plan. and i think that we closed them. we've implemented the recommendations in the interim and whatever the -- >> there was also a recommendation regarding the review would waitlist

nationwide, which obviously we are producing them in publishing every two weeks. and those are the four or five recommendations that we have vigorously pursued. >> thank you for that effort and i visited recently with the doctor at the flagstaff medical center and be entered into a contract with the va to treat the local veterans and they were very happy and pleased to do that. with that i yield back mr. chairman. >> thank you very much doctor. you are recognized. >> thank you mr. chairman and mr. secretary for being here today and for your many years of service in the country. let me just start by -- let's take the assumption that the goal of the va is to see all of those that are eligible for care as soon as possible and provide quality care. care. and that's i think should be the assumption. but what i find is the

motivational factors that are needed to accomplish that and to achieve that on a regular basis and to comply with human nature don't really exist. in other words, the incentives aren't necessarily there that would exist in the private sector, etc.. and i'm curious how you would propose in this mass bureaucracy that we are dealing with from administrators to physicians and nurses to those that are supportive how do we create an environment where truly seeing the veteran patient is an asset rather than a liability to the system? >> interesting way to frame the issue. as i mentioned in my opening statement, i continue to believe when i go out into the field it was in phoenix for several weeks ago and visited with a roomful of employees that is clearly our

most troubled location based with what i character-based as leadership failure, mismanagement, chronic underinvestment and get a person after person raised their hand and talk about the things they were doing, the things they had to overcome in order to be able to take care of their veterans. ..