most of the time the way the choice payment is made. ..

we have a lot seeking service and the arts program has been very popular. i understand that the veterans access choice and accountability act allows for continuation of that, but could you address for me how that will happen? it's important for our rural veterans. they like it and it works for them and i just wanted to get clarification in terms of how it's impacted by the choice card. >> so the legislation extended the arts program. we have extended the contract temporarily while we are renewing the arch program so it will remain in place essentially as it has existed in the past going forward. >> okay. i appreciate that. i yield back, thank you. >> senator flores. >> mr. secretary i appreciate you joining us and i also appreciate the work that you and

secretary mcdonald and the team are doing to work with congress and this committee in particular to build the va at the 21st century. a few weeks ago there was an article about the business of research on returning war veterans and i will ask the chairman if he will introduce this into the record. i'm not trying to change subjects because we are still on the same subject in the subject is what is the underlying root cause of the issues of the va struggling with and it turns out it is a troubled culture that needs to be fixed and needs to have a change in personnel to do that and you are working on that. we are not necessarily happy with the direction you are going with that for the comments that has been discussed already. what i would like to do was talk about a couple of other things. one is this committee in my office requested a briefing with someone from the va regarding the center of excellence between

now and december 11 and i would like your commitment that you will do that. the second thing is the way it the center of excellence failed in subjecting to trying to find the underlying causes of tbi and ptsd and to try to help the va, with some research to address these critical issues that are facing today's warfighters. but it just utterly failed. not one mri was produced in order to assist with this project. and tens of millions of dollars were wasted in the process. a whistleblower brought to this hour -- brought this to our attention that whistleblower and some of the other whistleblowers who participated in letting america know about the problems faced incredible retaliation and we heard -- you saw the hearings we had back in the summer where when the waiting list issue came up the bureaucracy retaliation

against whistleblowers goes beyond the pale. and so i urge you to continue to work on that part of the culture as well. there should be no retaliation. they should be celebrated as people trying to make the system better. anyway said two things and i will be brief. one is your commitment to this particular incidence and two you will remember that we need to fix the culture of retaliation is part of our overall attempts to fix the culture of the va. >> we will have a briefing to you before the december 11 as your question and two i have said repeatedly and continue to say we will not tolerate whistleblower retaliation. i work closely with the special counsel of the united states first on restoring employees who have been a object of retaliation and ensuring that they are basically made whole in

that process and then coming in immediately behind that. they much aligned office of accountability review to conduct the investigations into the retaliatory behavior to ensure that we are holding these individuals accountable for that behavior. i agree with you that they should be put up on a pedestal and i have agreed to participate. i believe it's a third or fourth of december with the office of special counsel world they will be recognizing to whistleblowers from phoenix and i will be joining them enough for him. >> thank you for your responses. i yield back. >> thank you. mr. or work. >> thank you mr. chairman. mr. secretary i wanted to first start on a positive note. i hear from a number of veterans in my community that goes to the vha clinic in el paso that they receive exemplary care in a timely fashion and more importantly i'm beginning to hear from veterans who did not use to receive that care in a timely fashion and they're

telling me that they are now to get appointments. i appreciate your leadership in the va. >> leah both in working on that for a while. >> that's right so i appreciate that. i want to follow dr. rosalie and using an anecdote to describe the challenges that remain. i was recently at the va and while they are asking veterans about the quality and access to care that they have been receiving ran into a gentleman who was there for a mental health care appointment and he called the day before to confirm the appointment. i have no idea how many months in advance the appointment was made nor do i know how many miles you drove to be there. appointment was confirmed the day before. he showed up on the appointed day at the appointed time only to be told that the mental health care provider that he was there to see no longer worked at the va and had worked there for months and that was obviously deeply disappointing but what was then forgivable to me was

that he was told to go back home and call back tomorrow to schedule another appointment. luckily it was there and we were able to take them up to the third floor to to the executives we only waited for the tractors come out of the meeting and we weren't were able to obtain an appointment with him the next day. so that brings me to my questi question. you have 10 mental health care vacancies in el paso despite all of the good work and to the doctor mac's question getting doctors in underserved areas like el paso that have the worst wait times for existing patients in the entire country, fourth worst for new patients for mental health care, what are we doing to attract and retain those providers? you mentioned earlier that you are increasing what we are paying. we talked about gm needs. tell me more about how we can close the gap on mental health care. >> i think we have all of the

recruitment and retention efforts that we have underway for both physicians and for nurses. with respect to physicians, we have worked to get expert health care consultants and recruiters to help us bring in physicians. i think that the story that you tell of a patient who gets therefore an appointment and doesn't have a provider is just unacceptable. i mean whether there's a vacancy that somebody left are or not there should be contingency planning at every one of our facilities. we have been communicating that nhs should not happen. >> so i would love by the numbers to understand understand what you're doing and how much more you are paying to attract somebody to a clinic like el paso. i learned when you recruit a psychologist or psychiatrist into a clinic instead of a hospital they are earning less than being offered less so do we need to harmonize those levels so you are getting folks to the right place?

and i'm sorry to interrupt but it brings up the more important issue of accountability and the anecdote i just described a year ago would be unforgivable that happened after all the scrutiny and attention and focus we have brought to this issue power those people still there who are running the el paso va? so to the chairman's point and so many others who made this i won hundred% except secretary gibson's explanation and fully believe that you are doing the right thing to ensure that once disciplinary action is taken it as a stand-in is not over world and we don't reintroduce the bad actors into the system but having said that when can we expect to see these changes? it's straining credibility for us and the american public to know these folks responsible for such egregious malfeasance and negligence are still in their jobs. when are we likely to come

within this calendar year, within the next six months to see the firings we have been expecting? >> i will come back to you within 24 hours to answer your question definitively. i'm aware of certain actions but i don't know exactly where we are in a process so rather than give you a speculative answer i would rather give you a definitive answer. i would tell you the question in my mind remains in this particular instance whether there is malfeasance or misconduct or whether we have a situation where it's a really tough situation we are not bringing to bear the resources we need to be able to bring to bear but i will get back to you within 24 hours with a definitive answer to your question. >> thank you and i will share that with the committee. thank you mr. chairman. >> thank you. mr. huelskamp you are recognized. >> my colleague from texas said earlier i guess not a single va

employee had been suspended without pay. is that inaccurate statement that you made earlier? >> suspension without pay as a disciplinary action so i can't tell you -. >> in order to take a disciplinary action. >> i understood you to say earlier that not a single va employee had been suspended without pay. did i misunderstand a statement earlier? >> that that's exactly what i said that i said in the context of a question about suspending in the process of a disciplinary action being brought. i have 5600 actions that were referred to earlier. >> have any va employees lost bonuses as a result of this? >> in fact no fee a senior executive in vha will receive a bonus in 2014. >> respectively as the loss of their bonus?

>> we have had this conversation in here before. there was one instance of one employee where a onus was paid paid in error and we were able to do usability language to claw that back but that actually itself has been appealed under statute. otherwise the bonuses that are paid come under the employee's property and we don't have the ability to take that property. >> had begun through the entire process to remove an employee at? >> yes, sir. >> if you can provide a list and obviously don't know the names but how many of lost their jobs as a result of this. i want to follow-up on the question of the va choice in how that was implemented. why did you exactly decide to implement that interface is? >> a fundamental concern was that if we send out 9 million cards to veterans on the fifth of november realizing that approximately 8.3 million of those veterans would not have an

immediate benefit under the act what we would do would be to create chaos and jam the phone lines with people calling to get explanations. that would prevent veterans who do have. >> i understand that but folks that were waiting for months you have chosen to make them wait even longer. why are those that were waiting that was the focus of so much much scrutiny and why did you make them wait longer than tho those. >> many of those people that have been waiting we have been working with those in the ordinary course of this. that is what access to care has been about. for the last five and a half months since the middle of may. >> what i'm not clear is what is the start day when you say okay that clock is now starting. does that continue to move back? >> the start date for the group in the 40-mile section?

those in the way time what has been posted in regulation is the fifth of december. our expectation is the historic date is going to be sooner than that and we will post that date within the next several days. >> if you don't get the cards out or you don't officially start them that day just waits and waits until you pick a start date? >> that group waits until we post in regulation to say we are now activating the 30-day wait times standard under the choice program. we don't necessarily wait for them to receive their card because as i mentioned earlier we are populating the veterans. >> i'm not worrying about when they receive the card so much open they get they care. i'm not remembering anything in the law that you get to pick the 30-day wait time becomes the start date for that second phase. if you could provide that. speak we could have rolled the program out in such a way that could have been a disaster for

veterans and we chose not to do that. >> is still a disaster for that matter. one other item and this has been a failure from the department. kansas which has a limited va facility not all servers as all services and you promised again and again to have a full-time doctor they are promised and never delivered. now if you are saying because they have limited services that if they want any services they still have to drive the six-hour round trip to amarillo to get those services when we have great hospital just down the street less than a mile away and you are saying no you can't reserve it there -- receive it there because of limited services available at the va clinic there. is there reason to to say it shows if you have that one in your community and all of a sudden you can't go to your local hospital and pick your doctor but can you describe how you came to that reasoning? there are veterans that would like to go to their local doctor

and you don't have a full-time clinic there and you don't have a full-time doctor too bad you still have derived -- drive six hours. >> i would ask the question it was congress's intent and if congress's intent was to make it 40 miles. >> why would congress wait until december to take care the way time is? >> we don't intent away. >> under the current lobby for this pastor had plenty of options for non-va care. you could have let them go before august 6 he could have let them go to a hospital. your va chose not to do that. don't you have that authority? >> we had a budget of $6 billion we spend it. >> but you do have that authority to allow them to go to the local hospital? >> within the constraints of our budget we do have that authority that for every team that's medically necessary to do so.

>> driving six hours, you don't drive six hours for care. we have got to fix that and i yield back mr. chairman. >> mr. walz. >> thank you mr. chairman deputy secretary gibson gentlemen for being here and i think it's important for you to hear each of our stories. we have heard heard both the bad of a good come out of it because we know our role is to improve upon what's working and to make those changes. i'd like my colleague mr. o'rourke and dr. roe had a gentleman waiting accessibly times of 75 days and continue to feel bad in one day couldn't take it anymore and drove to the mayo clinic where he was told he needed immediate prostate cancer surgery. the good -- that's the bad obviously that he the weighted accessibly times. the good is that we called and within six hours we had the fee-for-service agreement and the next day he was in surgery and two weeks later with his

family and now in our country. the family is incredibly grateful but i am embarrassed that they are grateful to me because that veteran should've been able to do that on their own. i think we all know here that's one veteran whose wife called, called the congressional office and got some action but i think we should know the responsiveness and the cultural attitude on the fee-for-service. and it's a challenge and you were right mayo clinic said it was that he might not waited for us in that initial appointment appointment. there just has to be a way to triage these apartments that are so critical and they convinced me that there are ways to do that to make sure it wasn't so pressing we could've put them in there. my question to you and i think this is a conversation that should be done in this committee is doing exactly what we should be doing asking how we should implement that and congress's intent is important. what i'm concerned about the implementation of this loss wears that intersection with the

restructuring of the va that we know needs to be done? is it promoting? it was meant to be a catalyst in that direction but i don't think anybody in this committee thought that this was the end. it was the first step so maybe if he could articulate to me how it fits into the broader restructuring and how it enables us to get to that? >> i think he gets that the very essence of creating focusing on the veteran experience and focusing everything we do around the veteran. but the choice program does is it basically allows us to accelerate care using additional resources in the community thanks to the funding that congress provided to be able to accelerate care while we are doing the internal capacity building. the points that have been brought up about primary care protocol and the number of treatments compensation issues associated with physicians and streamlining hiring practices while we are engaged in that activity.

the choice program gives it this time to be able to do that while we are still delivering the care that's veterans deserve. i see that as a central part of what we are doing. i think it's also clear that it drives us toward a more holistic view of va. we have been providing substantial amounts of non-va care and i think this pushes us harder to ensure that we are maintaining continuity of care for veterans and ensuring veterans were managing that care. this is beyond what a health plan does. managing the care and delivering the health care. >> we need to figure out a way and this includes that vso's and how you're communicating with them because this is truly the real challenge because fields the cost of this and to be very clear steve, he believes it he believes the too, he could have gotten equal care that he got the mayo clinic had he been able to get him. the question i have is i don't think your budget would allow

this if it has to go the way that this one was solved. how are we figuring out how to communicate that triage and mr. hall's campus issue is just like mine. he lived close to the nearest facility. it wasn't though he was willing to go. the mayo clinic was next-door but how do we come to grips with that with an honest dialogue? there's a great hearing we had were gentleman said he looks out his window and sees for private sector hospitals and he knows their 72% capacity every day that could be utilized in another way. are we getting at that? >> i think there's an important point and we have traditionally been a provider of care and we make a decision when we can provide it in a timely way to go out and buy it for somebody. but the choice program is done and we are having discussions right now quite frankly that are for many people very anxiety producing.

if our future is not about being a provider organization only we are entering a realm where we quite frankly are running a health plan. a patient decides what happens to them and where they go and how they get care in what care they get. this is a huge cultural shakeup quite frankly for us as an organization. i think we are now engaging in discussions about what does that mean for our future? what does that mean for traditional purchase care program? the choice program if the legislation expires in three years and goes the way it will have bought us time to build the capacity but it's proposing quite frankly much more significance. >> i couldn't agree more. i yield back my time and i suggest it was the quadrennial defense review so this is a small piece but i yield back, but thank you for that. >> thank you. mr. wenstrup you are recognized

for five minutes. >> bigness chairman and thank you for being here today. protect about veterans choice program. where can i get information specifically for providers or private sector providers that want to be providers at the va weathers the hospital system because i've had that question come to me in my district where hospital systems would like to help the backlog even if it's a short-term event and also they would be willing to do it at a lower rate than the standard rates from the procedures and things they can engage in. >> again the 800 number we have, there is a line there for veterans but also for providers who want information. we have been talking with the american hospital association with the ama. i have a meeting coming up with the american hospital association specifically to try to help use those two entities to get information out to providers that any provider that

wants to i'm sure can contrac contract -- contacts try care directly and i'm happy to have them contact me and i will serve as a functionary to make sure it happens. >> is there something you can get to me to provide details i will share it. >> i will be happy to be in that round. >> the other question i have is we are trying to do the independent assessment. how much information is being gathered or how much are we engaging with the private sector to really assess the va system? >> so as i mentioned earlier the campaign is working with other partners in the community so they are very committed to finding people with the right competencies to do those various assessments. there are some of them that they will do so their expertise quite frankly is in policy and modeling but they will have art

he reached out to rand corporation to do some of this work. the institute for medicine is doing part of the work and as i said they have put together a group of health care industry executives from around the country to really be private sector benchmark panel to help guide not only assessments of a put together a set of tools that can be used in terms of when people are doing these assessments making recommendations. how do we know what's good and what's bad coming out of this and that group is helping to affect that in will ultimately be the group of people that helped craft the final set of recommendations that come out of this process. >> i think that's important and obviously we have a lot of successful providers and systems in place from the private sect sector. thank you very much and i yield back. >> thank you. ms. brownley you are recognized

for five minutes. >> thank you mr. chairman and thank you mr. secretary for the work that you are doing and i know that my veterans at home are starting to feel hopeful that there is real change taking place and i appreciate all of your efforts. i wanted to ask a specific question on how is the va implementing section 401 and 402 and 430 educating servicemembers about eligibility to cpa care for sexual assault? >> so we have already reached out and started reaching out to guard units to educate them about the services available for military sexual trauma counseling within our organization. we have both outpatient programs and rehab inpatient programs around the country. we are currently, the part we

struggle with the most is really around the issues with active-duty servicemembers so we clearly believe it was the intent of congress that by providing the service available to the va as we create a safety valve for servicemembers who have military sexual trauma to be able to come to the va anonymously to be able to get that care. we have been in conversations with dod about how that might work. they have concerns that the care would be anonymous and they would not have information that i reflect on the sickness -- fitness of active-duty servicemembers. and patient might need to go to an inpatient unit for intensive therapy that they need and nobody knows about that. we are trying to work through those issues with the department

of defense now with a clear intention of being able to implement that part of the law in a timely way. >> so when you say you have reached out to set include training? >> right now the training for? >> the training for all of the folks that need to know and how to present you know this right to be able to receive treatment. >> for guard members we have begun that work. that was the easiest part of this to put in place. the harder part of this is for the active-duty people. >> on the dod side do you have a solution that you are trying to work through with dod? >> we are in constant ongoing meetings with them to try to work through these issues and try to figure out how this will actually. we were too many exchange medical record information. in fact when we did go to try it

they'll try care for an episode of care we would submit medical record documentation. we don't believe that is what you intended. what that is why we are in conversations to figure this o out. i don't think we have locked everything we need to down at this point. >> thank you another question regarding your process for implementing our long-term space plan and wanting to know the steps the va was taking to ensure that there are periodic updates based on new data in terms of what real rate -- wait times are and the increased demand on services. wanting to know the status and how that's going and should we expect, are we going to receive a new updated plan during the

next fiscal year? >> i would anticipate there would be a new plan. we are doing something, i've been in the system for 20 something years and this will be years and this'll be the first time we have done this so we are essentially adopting the tpp model used by places and federal government. for the first time this year we will be going out with a lot of planning data for every facility and asking them to begin developing requirements from the bottom up for their program. people, space and things they need to be effective and to close performance gaps. i think we have a hour and we have our and worldly health projection model which is a great actuarial tool to tell us how many people we are going to take care of and what services they need and what that's likely to cost but then we have to get to the next step of saying okay to effect that what are the requirements necessary to do that and what is that going to

take in each place in which we deliver care? people, things and space to be able to be effective. we have been piloting the tools in the process. we have been working actually with people from the department and the department of va policy and planning to do this work. i think it's going to really fundamentally change the planning process for us in terms of trying to get to the requirements that you are talking about. >> thank you mr. chairman. i yield back. >> thank you. ms. walorski you are recognized. >> gentlemen thank you for coming today and providing answers to our questions. i want to take a a second publica thank va secretary mcdonald who told us when we met him that if he could be of service to individually reach out and he reached out of my district the second district of indiana with a young couple

aaron and andy olson. he had been misdiagnosed in my district district and his health was degenerating in a rapid rate, no diagnosis whatsoever. i called the secretary and they moved on behalf of his family. he too was diagnosed with cancer and they moved him to research medical center in indiana which was close to the va hospital. he is under treatment right now and is beginning to improve and i appreciate your commitment to honoring that an echo what representative walz just said in some of my colleagues. it adds that scenario is good and bad. we are grateful when that happens because it saves the life of a veteran but we can't make calls on behalf of my district 57000 veterans and their families and two made sheds light on the fact that all of us in our district in america this is still a very urgent matter. i think america is willing to give a little bit of time so we understand the comprehensiveness

of this but if they want to see action at the same rapid rate that we do. as a clarifying question. for the senior executives that retire during a five-day and trim period that five day period in lieu of possible removal is 30 feet on the record to say they were slated for removal and was there some kind of a betrayal that folks left because of that or they were at least on that list? >> the proposed removal action was apart permanent part of their file so in a federal agency they were considering hiring this particular individual would see that as part of the file. >> by the question which again is a follow-up for many hearings we have had before is the issue of the va. i have a bill coming up in a couple of weeks that we will have a hearing on that the new law required a technology task force to conduct a review to look at the scheduling system.

the northern virginia technology council conducted visits to observe scheduling operations interviewed staff. do you consider the results of what they obtained to be representative of the entire system? >> i think as we have gone through the findings in the report i would say that it affirmed an awful lot of what we believed we knew already. also reiterated a fair amount of information that was part of the hamilton report done back in 2008. i think it was useful and very helpful. it's an independent point of health patient in many instanc instances. the point they came up that dr. roe mentioned earlier about the need for treatment was one of the things that showed up in the nctc reports he didn't have anything to do with the scheduling system. basically providing access to care obstacle is you have medical facilities that only

have one treatment room or provider. we will never make optical us use -- optimal use of our providers willing at that constraint. >> the 2008 report six years later have all the issues been addressed in that development report is part of the consistency and recommendations? >> you mean the 2008 report? >> the parallels. >> no. >> why haven't they have it's been six years? >> you may or may not recall that was a report where questions were asked back in may with thunder individual sitting here about the report and by and large the comment was folks were not even aware of the existence of the report. i had only been here for three or four months but that report got issued and basically was in someone's death story. >> as as you were called in some of the hearings going on since i've been here there was a lot

of information given to this committee that there was no problem whatsoever with the scheduling system in the va. nobody ever said it was a good system. they gentlemen in charge of the i.t. system sitting right there i said are you good to go and the answer was overwhelmingly guess even a budget time. here we are and 2014. the report was out there in 2000 is a mandate in the new law. where are the with the scheduling system in this whole idea of mandatory providers? >> the booze allen report went far beyond scheduling system as did the nctc. specifically in the scheduling system for different tracks, i will call at three different tracks underway right now. a whole series of patches to the existing system. we are on the tail end of that within the next couple of months we will have completed all those patches. he won a contract for major enhancements to the scheduling system. those are supposed to start

coming on line in the spring of 2015 so a near-term solution. those also include creating the ability for us to field some apps that have been created that will actually allow veterans to request appointment and one of the other apps allows veterans to directly schedule an appointment. we have to have the ability to catch it when the veteran since it and in parallel and we think we are literally a matter of days away from contracting action for the acquisition of a commercial off-the-shelf state-of-the-art scheduling system. now that system in all likelihood won't be up and running until sometime in 17 which is why we are doing these other things in the meantime. i should indicate though and it is reaffirmed in the report to schedule -- schedules they talked to said the scheduling system is in the impediment. it's the lack of appointment slots. they basically came back and said scheduler saves okay. we need -- we know it needs to

be replaced and it doesn't provide the functionality we need to have so they want to get that done but that's not the obstacle from a schedules perspective. >> i yield back mr. chairman. thank you. >> ms. titus you are recognized for five minutes. >> thank you and thank you for all you been doing to try to fix these problems and implement this bill. i would like to go back to the issue of the shortage of doctors in the private sector because this is very serious in nevada in las vegas. we are at the bottom like 50th or 45th or something for all different types of specialists. i would like to go back to that issue. several of us worked very hard to get the provision in the bill to create the new residencies. i heard you say you are given 300 year and you have arctic out 400 applicants. i want to be really reassured that those residencies are going to go to places where there is a need. i don't want them just to go to ucla because authorities has a

great program or johns hopkins but go-go where the natives. the second part is where there is a need is also worried they may not be able to support residencies at this time so it's kind of a double hit. that's true in las vegas. we are getting a new medical school and we have gotten a new hospital that we are not going to be able to apply busier. hopefully hopefully next year. can you explain how i've got a working group right now that's meeting to be sure we will be eligible for some of them and what you recommend to that group that you look at for qualifications? >> we can get -- i can get you specific information about what the requirements are. you personally have that information but you know i think the intent of the law you said those slots are to go to meet underserved areas and needs and

not go to ucla necessarily, not that there's anything wrong with that but i think the intention is there. there are many community hospitals that established family practice residency's and other residency programs that are not medical schools. we do not own residency slots. they are owned by an academic partner so those slots set up the program and get approval to the hec and made for those positions. we fund them and then return those residents come parent for it -- institutions and we provided training. a challenge is for place that clearly has not had a residency program to be able to recruit and retain faculty to be able to teach, to meet all the

accreditation standards that they have for those programs rated takes a critical mass of residents to be able to meet all the work hour restrictions and everything else they have and maintain a viable program. but i can certainly make sure that you get information that you can pass along. i think the best thing that you all can do actually is encourage hospitals or other institutions in their districts that are interested in that to contact her office to get information. >> if i get me with that group in las vegas that would be great. and then kind of related to that you also mention that you are worried about these middlemen organizations like triwest being able to find enough people in the private sector to be part of this program. i remember asking the director of that who is sitting right where you are if funding was going to be a problem and is it exact words were oh no we will

ask doctors to step up. they will just step up to help veterans. well if they are not there they can step up and i think that was a little optimistic anyway. can you tell me what you are doing to monitor those to be sure they are providing the service is? >> we monitor today the referrals that we make to triwest and rpc three contracts and we know how quickly they can place patients and we know how quickly or how often those authorizations are returned because they can't find a provider. good thing i think about the choice program we set up pc three to be our preferred provider network and triwest and healthnet established contract with those providers. under the choice program you have provided a think a really good tool in terms of the provider in the authority we have which allows -- the veteran will be able to choose any

willing provider that meets certain criteria. that could be a medicare provider federally qualified health care center etc. etc. but once that is done try to care or triwest will be able to reach out and get an agreement with that person for the choice program even if the provider doesn't necessarily want to be part of the network. i think the one issue that we have that really does need to be addressed expeditiously is the restructure and alaska, the medicare rate. there aren't many willing providers and alaska that are adjusted. i know you are aware that and your attention to that in a timely way would be very helpful. >> thank you and just really quickly as you were talking about expanding and improving and changing the va as mr. walz is suggesting this is just beginning and not the end i hope you'll look at the maps, all the different maps that divide the

country in two different regions. in nevada we are split into three parts for vha and the same time we are and what california for her the va. they just don't make sense. will you look at that? >> we don't think it makes sense either. >> okay, good. thank you. >> dr. benishek you are recognized for five minutes. >> thank you mr. chairman and thanks gentlemen for being here this morning. i think mr. o'rourke, the veteran that was told to go home and call back for an appointment just the fact that would happen to somebody really emphasizes to me the need for change in the culture. that is not assessed -- satisfactory thing to do to someone who has been waiting that long but i know you realize there's a lot of work to do to change that culture. i have been hearing there is still a backlog of colonoscopies

within the va. how many veterans have been waiting 12 month or longer for a screening colonoscopy? dr. tuchschmidt do have a number? >> i don't have a number but i can get you that number. >> yeah i wish you would and the associated numbers of cancers. the culprit of veterans we have a 50 age group are colon cancer i know in my own circumstances there are more advanced cancers that should've been followed because of the delay. is there anything in particular you are doing to address these backlog issues? >> there are two things. the first thing i would say is that under the choice program that you all generously gave us veterans will be able to go out for that care.

>> are they being told that? >> if you are in the 40-mile group you have already got your card and then informed of that benefit. we have pulled the list of patients who are waiting for appointments or procedures. >> i'm concerned about this 40-mile thing too. for example in my district with most patients within 40 miles of a va facility there may not be any doctors there are? is that type of thing and i'm concerned we are not going going to get the care yet because technically it's within the 40 miles but there's no provider there. will people get the care they need in a timely fashion? >> we can provide that care within it 30 days of the veterans preferred date they will go to the choice program. we will offer them that option. we are pulling people today that are waiting within 30 days

electronically and we will be providing that list. >> that's what i wanted to hear but let me ask you another thing. when i had a colonoscopy at the va they were doing. they. and i've heard they are doing 10 a day with the same amount of staff and everything? that kind of stuff is still happening within the va. so what is being done to make sure that the numbers in order to address these backlogs that people are doing things that this land effectively and have the tools to do that so we are not having these backlogs? what is happening now that's different than has been happening in the past? >> we have put a number of project management tools in place so we are training and educating supervisors on how to manage some of these kinds of issues. >> who is in charge of that? is that you? >> no. >> does it happen differently in each different is it?

>> we have a national program under philip makovsky to be able to develop the training materials to rollout this program. additionally we have our productivity -- in g.i. the productivity amongst gastroenterologist increased in the double digits. it was 15 or 16%. >> that's the type of thing that i run across talking to positions within the va. there seems to be a lot of inertia into getting change done that will affect the efficiency within the va. >> let me just touch on that for a moment. we are accelerating care across the department. every morning we didn't happen to meet this morning. every morning at 9:00 a.m. there's something called the axis care standout. senior leaders from vha and across the department are and

are integrated operations center and we are going through hard data about steps that are being taken to accelerate access to care across the entire organization. report outs on wait times and wait times in appointments and the like. once or twice a week we have the senior leaders from particular medical centers joined by atc and they deliver a specific report on the things they are doing to accelerate access to care. i was in birmingham monday and tuesday of this week and over the last couple of months they have gone in looking at their appointment blocks and they have created an additional minute hundred slots across 14 different clinics all using some of the productivity tools that dr. tuchschmidt is talking about to manage these requirements. this is a fundamental change for va managing to requirements as opposed to managing to the budget and somebody gets seen biggest thing. >> we have protocols in some of

our data but if you look at our completed appointment data today 90% of our appointments are completed within 30 days. >> i would like those numbers. >> i will get you those. >> thank you. >> you are recognized for five minutes. >> dr. tuchschmidt you may be aware that one of my top priorities as a member of the conference committee that produced the choice accountability act was the inclusion of residency slots and i was glad to see that 1500 slots were included. i also represent riverside county with dr. luis and i share the same issue that ms. titus has in nevada. just to be clear the process you have followed through this first year of allocating the 300 slots you have reached out exclusively

to those medical schools that have pre-existing academic affiliations with the va medical facility. is that correct? >> i am not sure that we only reached out to facilities that we have affiliations with. i think we put a general announcement out so that other partners -- i mean we were out looking and we are interested in having partners that are not currently affiliated. >> so you are interested in those medical schools that already have existing relationships with the va? >> yes. some of those medical schools like the program in the northwestern part of united states may in fact be supported by the university of washington but they run many rural residency programs. we are definitely looking for new affiliates. >> you said in thinking outside the box may be funding residencies that may address ambulatory care may not be

centered in the hospital. >> the answer is yes. as i said we know there are many community hospitals for example that will run family practice residency programs so we definitely aren't just in those kinds of partnerships. >> i'm very glad to hear that. where's the central office determining slots going to a whole and each medical facility or medical school. in other words will you be delegating this decision or we'd be making direct decisions? >> the office of academic affiliations awards specific slots to qualified applications. >> i like ms. titus would be interested in having folks from the va kamal. we have the newest at of the university medical schools established and as was mentioned

the largest veterans county -- population by counting the country. we would appreciate the ability to locate some of the slots at the public university medical school subsidized by the taxpayers that ostensibly would offer less expensive education. further inducement for those medical students to locate at the va. >> i would be happy to have that done. >> and just a question that the shortage of psychiatrist within his district, is there a medical facility in now the currently trains va doctors? >> that i can't answer but i can tell you there's a shortage of mental health practitioners both psychiatrists and mental health advanced practice nurses and social workers in the country in general. we went through enormous hiring

process a few years ago hiring about 3000 mental health practitioners into the va organization. i live in oregon and i can tell you that i know we have recruited most of mental health practitioners out of some of those counties. we have actually about a year ago took the kind of caps off the hiring of psychiatrist in terms of salary so we could make much more competitors decisions with psychiatrists. >> this whole issue is very salient here because there's a 60% greater chance that physicians will locate where they do their residency so it's important we privilege the pre-existing agreements of medical schools within the va hospitals that we look to alternative so we can get physicians to locate in communities where there are gma choices and how we deploy the

slots will be very important. thank you so much. >> think you and mr. jelly you are recognized for five minutes. >> thank you mr. chairman thank you all for being here today and secretary gibson i want his say thank you for the spirit with which you have tried to bring change and secretary mcdonnell has as well. i have a question more on the vba side so i apologize for coming at you from left field. we have all heard the stories of vha weightless in the human consequences of those. i can tell you in our district is sheer number of concerns are on the vba side and the wait times not really a specific question but a question about changing culture since you arrived and secretary mcdonnell. with all the focus on vha my concern is nurses pending,

although said we are talking about vba a few months ago. what is being done on the vba side or is there a plan for future action? >> sure. we continue to be very much on track or eliminating the backl backlog. that is disability claims more than 125 days since submission by the end of fiscal year 15. i remain confident that that's going to happen. and we continue to refine processes, centralized mail, the imaging processes and some of the automated decision tools that we are able to bring to bear to expedite that. the growth of fully developed claims. almost 40% of our incoming claim volume is for developed claim and that is really not being felt fully in terms of our productivity because we continue to work all their claims before

we worked newer claims, so i think that his palaces -- positive on the disability claims site. brechtel you i am concerned is an the nonrating dependency claims and the like. fiduciary relationships on behalf of veterans and claims in the appeals process not necessarily that have been sent to the board but they are still in vba because that's where the majority of the claims it. we have a laundry list of initiatives trade automation initiatives and staffing initiatives and the like that we are executing within the context of the resources we have got but you may or may not recall when i came in on the 20 4th of july and said we need $17.6 billion there was actually $360 million in there for vba for us to be able to hire staff with claims

appeals and fiduciary work. >> it's still a person on resources issue. >> is still a resource intensive issue for us. >> is there any room to sign presumptions in certain cases based on an mls or where someone was deployed? there is some use of that right now but we have parked -- talked here before the number one benefit application being hearing loss and can we increase the presumptions based on mos perhaps as a way as expedia being? >> that's a good question. i don't know the extent to which that specific idea has been aired out and we'll take a look at it and come back to. >> the last one i would bring and i know its resources are not expecting an answer today. the sheer number now that got to the point where even the congressional backlog and in the regional offices are being very honest and working well with us that they are happy to share with us that now i don't know if

the numbers are exactly right but i think 1700 congressional's in our region so i understand how the staff balances those congressional's but then it's changing the model of casework a little bit and congressional offices because constituents are coming back saying what really is the benefit now of coming to a member of congress were historically they have seen the benefit. we are able to work closely with the regional office and improve the timeliness and also some specific cases certainly together with the va. i would just bring to your attention as well as the department looks at the vba side. again the stories on the vha side but the sheer number of calls out of frustration are in the vba side. >> i really hadn't heard that. >> right now given some of the news stories folks go to their

member of congress rightly so. that's our job to fight for them and that's increasing the volume we are bringing to the regional office. >> thank you very much. thank you to each of you. >> yes sir. ms. brown you are recognized for five minutes. >> thank you mr. secretary and thank you in spin a real joy working with you and also at the secretary when he visited florida. we went to the medical school together and anti-talk to those residents and they were very interested in the program. i think you all talk to the medical school. they were very engaged in very interested in participating. i just want to clear up a few things since there has been a lot of discussion about what constitutional rights does the va employee have as it relates to their job? understands the united states

supreme court has ruled that you have to have post action process of appeals or else they can throw the whole case out. can you elaborate on that a little bit? >> i don't know that i'm familiar with the supreme court decision but i do believe congress is the ultimate decision to provide an appeal mechanism and authority that was passed i think reflected the body of case law that existed in the conclusion that you would need to do that in order to withstand judicial scrutiny. >> you have cut down. i think he is belonged what now it's five days but that process has to be in there in order for it to be legal. >> the case law is very clear about providing a federal employee an opportunity to respond to charges so that really happened. under title v it's 30 days and

as i mentioned earlier trying to adhere to the spirit of congress's intent. we have shortened that to the minimum amount we thought we could and still meet the requirement to provide a reasonable opportunity to respond. and that van is not really an appeal. that's just an opportunity to respond, final decision is made and then the appeal process happens after that. very expeditiously in line with provisions of the law. >> one of the concerns in the process in the orlando area, their clinic, their hospital some attention was brought to it because of the scheduling process. not that there -- not that they hadn't been trained or didn't have the equipment. they were doing part of it on paper. have you address that issue? >> that absolutely has been

corrected, yes maam. >> one of a thing. think it's very important we have a comprehensive program when you think about the mental health which we are all interesting in making sure we have adequate providers but it's not just the mental health. it's also the housing issue. what are we doing to work with our stakeholders to make sure we have the partners we need to address some of the homelessness or some of the problems we have experience in the system? >> that's a great question. i oftentimes point to the work going on in veteran homelessness as what i would characterize as really best in class collaboration across the federal government, up and down government through federal government states and local government and then a cross into the nonprofit sector in the private sector. when you get inside of the work that's going on on veteran homelessness it's really remarkable the way that the

government has come together with the private sector. true partnership collaborative effort and i think that's the reason we are getting the traction in reducing homelessness. still not as fast as we want to reduce it so we still have more work to do but we are making progress there. >> those stakeholders, where we talking about? they are coming to the table and i want to thank you for bringing this because that's making a difference in how we address the needs of veterans. we all know november the 11th celebration but the point is we have got to work together with our stakeholders. >> yes maam you're absolutely right. my perspective there are three areas where we have to rely on that broad collaborative engagement. veteran homelessness is certainly one of those. mental health is one of those and i was at the u.s. chamber of commerce last night career transition. those are the three who are looking for these private-public

partnerships that are essential if we are going to meet the needs of our veterans. >> once again thank you for staying on and thank you for your service. i think it's a misnomer to let the veterans think we are in a crisis mode. i appreciate the leadership and the fact is they should be confident that we are going to work together as a team and make sure we address the issues. >> yes maam, thank you. secretary bob said i cannot leave so i'm not going anywhere. >> thank you. representative lamas that you are recognized for five minutes. >> thank you committee members and mr. secretary and colleagues for being here today. you have a hard job. another frustration and anger directed for new people on the block there is a context there but hang in there. when you look at the map of america especially the red and

blue you see much of america most of it is very rural not in population but in its geography. we have many veterans that live in those rural areas. a big part of the choice act was to give some of them the opportunity to have a better opportunity to get the care they need that is proximate to them. northern california for example. when we see ms. kirkpatrick was talking about -- in the reading area they're threatening to close a mail processing center. all the mail would go to sacramento to an area that's probably the size of illinois. so we know the mail is going to slow down. this is one factor. you see that facilitates veterans need for specialty care are generally going to be in sacramento or the bay area. if they are going to go to the va said -- facility.

in redding california he could do much of the same things. let's say you live in an area which the federal government incentivized world war two vets to settle after the war and you are a long ways from anywhere so minder standing one dr. in a broom closet there may may be enough to go to medford go to med for torino. all of those are at least an hour and a half away with geographical and whether another challenge is for that veteran to go to -- they're in when they get there could have the facilities to do specialty care such as chemo or the more difficult things to administer. what we are looking at as we are hearing the interpretation by the va is that congress didn't write this wide enough for narrow enough or whatever it is to define that the veterans have more choices. and so we are frustrated because this is the intent. it certainly wasn't the intent

of the committing of the house for veterans within 40 miles of the facility but there's no specialty care that somehow we will take california. there's a va facility here so that means you are within now the va web that you don't have any chance of getting what you need and you have to go to another va one and you are then as the crow flies 40 miles an hour in the category where you have to go to the bay area which the five hour drive for which a speed and a veteran of their 80s may drive them if they can get the shuttle bus at 4:00 a.m.. as you see where we are going here, the interpretation of what we are looking for is i always think they should go to the veteran is served honorably and they are still being put through these. is there timing to get this open up and get the cards out but what can you tell me today and going backwards under the old blog law and the new law how

often did the va used that authority to allow that veteran to go to a private service nearby? >> a couple of comments and dr. tuchschmidt may have a pointer to data. a couple of times in my opening statement i mentioned at every turn and what we were interpreting actions under the law we were looking to do the right things for veterans in the best taxpayer resources. we haven't seen the final numbers on fiscal year 14 appointments completed in the community but i'm going to guess somewhere in the neighborhood of 18 million. 18 million appointments completed in the community. not at the va that were referred out of va into the community. >> you said you were limited by $6 billion in the budget to do that? is that what you are saying the real limitation is? >> correct, yes. first of all we are referring in awful lot of veterans including

rural veterans for care in our community. secondly as we look at the act and we try to understand the intent of congress and we talk with the congressional budget office to learn how it was scored clearly the legislation was scored based on 40 miles distant from the nearest va medical center. >> as the crow flies. we don't have a lot of crows and tulane. >> one of the things we did was we were trying to make the right decision here. he said okay how can we evalua evaluate, is there some way that we could afford to open the aperture here and interpret this differently? so we took for example and i will get jim to help me with the numbers that he recalled. we took for example and said okay how many veterans have we got that live 40 miles from a level to medical facility? still not at level 1, still don't do everything at a level to medical center but we do a

lot of things a lot of specialty care. it was somewhere -. >> we have a veteran that has to go 15 miles and it said will be required to go 85 and 15 minutes five days a week. this level to include chemo? >> level 2 i expect would include chemotherapy and he will correct me if i say something wrong. >> what happens when you do that is to then open up and forth of your veteran population for eligibility for that care. round numbers we are talking somewhere in the 30 billion-dollar range being able to see that care. >> i have to stop here because of time but i would like to concur with you on that because the stat we have this 438 veterans in the northern half of california the staff is that they would be the ones to be able to use this card in this

context here which is not going to do anything for the backlog so i would like to clarify that with you at a later date and a moment on due process for employees. we have had a veteran that came to his door and two agents seized his dd-214 and cut off his benefits. he and his wife are in their 80s and they need this. this document is somewhere now without a receipt and also they have not had their day in court. meanwhile their benefits are cut off. they have been accused of something and they have a right to have that day soon because the benefits are done. >> please provide the veterans name. >> anyway thank you and appreciate it. >> the member yields back, correct? representative thank you for your patience. >> appreciate the opportunity to come back and ask questions. as a follow-up to the pittsburgh

nightmare which goes on. the pittsburgh va hospital had a problem with legionnaires disease were several people died and several were sickened. part of the problem that occurred as a business director received a bonus of $60,000 we raise questions about that even though it was being investigated at that time. they still went ahead and the word was for infection control of all things. other things have come up the former head of the hospital -- permanently that there was another problem that occurred in the deputy secretary, excuse me the deputy director of the hospital david cord was involved in a chain of e-mails which they found where decisions were made to withhold information from the media while legionnaires disease was discovered and found in the water system. a time that would have been important to notify the public view that the symptoms and up

into the va tell us. instead the attention was on information. we found him elsewhere bob casey of pennsylvania myself as if asking question was wrong as opposed to asking what did they do wrong. now we find out david cord has been promoted to the head of the va. i think that's incomprehensible and sends a terrible message to the employees of the va system that if you hide information even though people died they are going to get promoted. even terry was told the court don't withhold this information. let me tell you mr. cord called me along with director was who was with director would have who was on the phone to matt but he told me we disappointed no there's no waiting list at pittsburgh pa. i said first of all i'm not sure i believe it because you withheld information before but secondly why are you calling me out of the blue to tell me this? somehow i don't trust this information. i began to name every possible

medical specialty if you think of oncology dermatology. no wait list, no wait list. we get to everyone within 30 days. i said something still doesn't smell right. i got a call from mike doyle and he said that he heard about the waitlist? they had 700 names on the list that went back two years for the near list and i guess they didn't call that a waiting list because they were waiting for the appointment because they didn't have an appointment yet. would you call the time between the time they first call in the time you get back to them? >> i call it a waiting list too. >> exactly who just promoted him. the disparaging comments he made to the senator and me as if we are doing something wrong by a investigating. people died and he is involved in a chain of people withholding information to the public and this is well where he directly misled me on information.

i want you to look into that because if you're trying to change the moral of the va and hold people accountable it's an conference about of all that a man like this is promoted. the comments i've heard for employees of the va is what are we supposed to do? whistleblowers get fired. whistleblowers get promoted. we get disparaged and here is someone who i will be a witness if you want me to testify who has been lied to. i hope you will look into this. it's an important issue. >> i will look into the allegations that you raise about the waitlist conversation. i obviously am not aware of th that. i will also tell you very early on if i'm not mistaken i believe it was shortly after i became the acting secretary, i went back to pittsburgh and asked folks to go back and look at all of the investigative material.

there they were as you might expect thousands and thousands of pages of material ig review criminal review fbi and the li like. the question i was asking was whether instances where there was misconduct or management negligence or accountability action that should have been taken that have not been taken? and what i was able to determine what is in instance where there were some culpability identified there had been some action tak taken. i would tell you i might not have agreed in all likelihood i would not up agreed with the nature of those actions but i had no the way to go back and address those because those actions have been closed up completely. i had no new evidence to used to be able to pursue this particular instances except in one instance and that's the one instance that you referred to just a moment ago. >> i hope you will continue to

review these things. i sent a letter a year ago asking give us some information what are some other problems people had. we have yet to hear back on those and it's been a year. i would love to have that information. >> we will go back and look at the response to that because i'm not aware we have had any congressional responses that are outstanding for that perry of time. >> the chairman has been gracious enough to let me ask questions. there are some things i would like to discuss with you to make recommendations. i am a lieutenant commander in the navy and i work at bethesda hospital. we have continuity between dod and va and sometimes people are kept in the military beyond retirement or their date of separation to continue to get them care because they feel in the va system they will be lost. we should have a system that is a smooth easy handoff for people are comfortable about their ca

care. with that mr. chairman that mr. chairman i thank you and i yield back. >> thank you. if there are no further questions -. >> i just want to make one comment on what you just said about dod and the va. we have worked a long time to get that continuity between the va and dod. i don't know necessarily if necessarily the va's resistance that we in congress keep pushing for it because it needs to be seamless. that is one of the problems. for a long time the veterans couldn't get the service because they can get the files because they burned up someplace so it's not necessarily the va's problem with the system. can you respond to that? >> i think that's a fair statement and i would tell you in the past several appears it's it's clear there has been a vast amount of progress made but i would also tell you there is still a gap in too many

servicemen and women fall through that gap and we are committed to do everything we can working with the department of defense to close the gap. >> thank you and i yield back my time. >> if the ranking member has no further comments the panel is now excuse. thank you very much mr. secretary for your testimony. >> thank you mr. secretary. >> i ask unanimous consent that all members have five legislative days to advise or extend their remarks and include extraneous material. without objection, so ordered. once again i think our witnesses and audience members for joining in today's conversation. this his hearing is now adjourned. thank you. [inaudible conversations] [inaudible conversations]

>> i had arrived on september the 11th morning. i write to my home in los angeles. i woke up at 6:00 a.m. to seeing the second airplane hitting the tower live. i was traumatized because that was when i knew that this was not just one airplane accident so i went to the phone and i called other people in egypt. i wanted them to comfort me especially after i learned mohamed atta the leader was from cairo, the same city i came from and i called around eight peop

people. they all said the same thing, even though some of them don't know the other. they told me how dare you say that this was done by arabs or muslims. don't you know this is a conspiracy? you did it. i hung up the phone and i suddenly felt they cannot salute to my country of origin anymore. it was a very hard feeling when you can't relate to the people you love and are brought up with for many years of your life, that they don't see the reality.

after increasing their majority in the midterm elections house republicans held their leadership elections giving john boehner another two years as house speaker in a voice vote. other leadership positions remain largely unchanged. majority leader kevin mccarthy

majority clip steve scalise conference conference chair cap lima morris rodgers conference vice chair lynn jenkins and national republican congressional committee chair rick walton were all reelected to their posts unopposed. on "washington journal" we talked to former house speaker dennis hastert about house republican leadership and what they plan to do over the next two years. this is 45 minutes. >> host: our next guest was sworn in as republican speaker of the house back in 1999. this is a bit of dennis hastert from back then. >> to my republican colleagues i say it's time to put forward the major elements of our legislative program. we will succeed or fail depending upon how sensible the program we are far -- we offer into my democratic colleagues i will say i will meet you halfw halfway, maybe more so one occasion.

cooperation is a two-way street and i expect you to meet me halfway too. the president and a number of democrats here in the house have been saying it's time to address several issues head-on. i will buy that but i think we should agree that stalemate is not an option. solutions are. [applause] and to all my colleagues i say we must get our job done and done now. we have an obligation to pass all the appropriation bills by this summer and we will not leave this chamber until we do. [applause]

[applause] i intend, i intend to be a good listener but i want to hear ideas and the debate that flows from them. i will have a low tolerance for campaign speeches masquerading as debate whatever the source. >> host: joining us on the set of "washington journal" former speaker of the house republican from illinois dennis hastert. good good morning. guess good morning. good to be with you. >> host: were there any thing from those words for the next session coming in? >> guest: i said newt was a dynamic guy. he did a lot of things with the speaker's task force. i wanted to get regular order. you have to have the preparation process and budget appropriations so you have your budget done by the 15th of

march in the up reconciliation by the 15th of april and you start to do your appropriation bills and get them done and then everything else flows from that. you set a rhythm up so things get done. let committees do their work and not bypass the committees. we had dissension back then too. we didn't have homogeneous parties. there were different ideas even on our side that he had to on our site that you have to give people a part of the process and let them become part of the solution instead of part of the problem. that is how i operated. i always said you need to under promise and overproduced and basically that's what we did. >> host: as far as the process now as an outsider looking in what you think about the process? is of? is of this stray from what you try to process back in? >> guest: i think the process has been somewhat deadlocked. look, we haven't had a budget in 10 years really passed so we don't have a budget and everything is jammed up in the end, jammed up with ongoing

resolutions to try to fund the government. nobody has a really definitive idea on how things happen. that is the way the process is set up. without having that type of cooperation not a lot of stuff gets done. you end up in a gridlock. >> host: on the house side is part of the reason because within the republicans on the house side there is disagreement on issues and i'm talking about those that came under the tea party banner and compared to what establishment republicans? >> guest: the nine to majority we got a lot of those people came in and basically where the backlash of the movement. there are a lot of people that were conservative and opposed to business as usual but you know as i said before you have to make them part of the solution. you can't isolate them. we tried to do that. we did our reach and then we did

a lot of things on the budget. i remember there was a very strong feeling that we didn't spend interview surplus. we spent down the surplus. the first four years i was speaker weise spent down public debt. never been done before and hasn't been done since. we really got some things done because we could work together. >> host: our guest with us to talk about the time in the senate this time as speaker and the republican agenda going to the next congress dennis hastert the former speaker of the house. >> people are tired of gridlock

>> guest: there was a dissatisfaction with where the summit was. i think that's where the big difference was. there were 12 or 14 seats on republican side which i think reflects on the president more than it does on the congress. reagan did and clinton did and bush did and this president has had that problem as well. it's something you have to work through. i think there are solutions and there are ways to work the budget out but you have to have cooperation. you have to have people who want to come together and share ideas. >> host: how would you advise john boehner going forward? >> guest: i said along time ago i'm not going to advise john boehner. he has his own leadership problems and he understands the problems better than anyone else. >> host: do you talk about?

>> guest: john and i talk a little but not a lot. >> host: about issues going on? >> guest: what we have talked about israeli the palace politics and how things happen inside and some of the things we have to do. >> host: what would you tell him generally? >> guest: that is between he and i. >> host: specifically moving forward on issues like immigration. the house brought it up and there's a story about executive action. do you think the house republicans should work on this? >> i think it's an issue. i think it's a national issue. i think there are solutions. we have nobody who knows whether it's 10 or 12 or 14 million people embedded in this country. they are here undocumented. they work and by and large pay taxes and pay into the system. i think there is a role and the

bad word on this thing is to give this some type of a quick citizenship. at least you get to legitimize the state of affairs. .. care if it is a red card or a purple card. they are here, they are paying taxes, and if they want to be a citizen, they have to get to the back of the line and become citizens. on the other side, you also have to fix our borders. one of the things i did a lot, before he became speaker, was the anti-drug, illegal drugs come into the country. 75% of them come across the southwest border. will fix the border if

you're going to fix immigration. >> what you do currently? isaiah the law firm in d.c. -- i have a law firm in d.c. lng.y and i do not lobby a lot, but i'm up on the hill. i touch base and i'm really thinking about the bigger issues. how do you move these issues, energy is a big issue for us. we also have allies around the world such as the largest consumer of gas in the world. >> >> host: the first call

comes from texas democrat line. >> caller: i have a question about the schumer democratic immigration bill? >> guest: i could not hear you. >> caller: i have not seen the most recent bill. >> guest: i am not with legislation in any more i looked at the bigger issues not the particular but anything that happens is the product of negotiation so it is the end not the beginning that is important. >> host: the independent line. >> caller: good morning. my question is if america is

to be held accountable to the same law, how was it that the representatives of this country can allow people to illegal into the country be treated differently than regular taxpayer? then how are we supposed to respect the law when it isn't working for us the people that should not be here? >> guest: i will say what i said before we don't allow people but they do get across. the border is boris. that is the first thing we have to do. to immigration reform is to fix the border. to have to stop people from coming across. they're coming across legitimately carrying drugs in their bag.

>> host: republican line go-ahead. >> caller: hello. i heard and you mentioned a speech the e. made years ago as speaker of the house and to great applause that you will not adjourn until you have the appropriations bills voted on that sounds like appropriations spending but did you say today they should work across the aisle since america is $16 trillion in debt why would you recommend more spending in any form? that is my question. >> guest: i am not. you have to do discipline yourself the way you discipline your spending. with the household budget or a business plan you have the

budget and udall go over. them to establish the spending process. we spent down $650 billion in the first four years i was speaker. that is not spending more money on the national debt. >> host: illinois is the next call from the independent line. >> caller: and do you remember me? [laughter] >> host: this is ohio. go-ahead. >> caller: how are you? i have some questions i know you talk politics but the community than i've lived in before one example is my

utility company is ripping people off that i charged almost $300.1 month for septic day water bill instead of committing it was their mistake i have to pay for all of it. and henry still drive on streets. if at least will they rip us off could they six the streets? my family has been victimized by a lot of people in this town and law enforcement is participating >> guest: talking a little bit of how that works obols sides of the aisles. >> guest: we talk about

$650 billion with the balanced budget agreement between president clinton of myself. so i remember the discussion with the senate had spent more money than we had. so we had to get down and realistic to the agreement. the president was in africa. sova i was trying to get ahold of secretary louis who was in charge of operating a the budget and i said we need to sit down with the president to close this down. the president still is in africa. finally he said he will be an anchorage tomorrow morning at 10:00 you have

that window. so that is 2:00 in the morning in turkey. so i in my office at 2:00 in the morning and i dialed the white house switchboard and they put me into the back seats of the limousine of the president. ice said u.s. had a successful trip to africa congratulations though we have a couple of things. we have to get this budget doesn't. we are $100 billion over. he said 1% that is a lot. we need to work it out. i said what do you think? he said 0.25 but i said that would not get us there.

even 0.86 but the issue is a sweet kid hit the agreement if we engage. but there has to be engagement on both sides. there are other things we work together like columbia that was set off on this country that was the democracy with that role development. there were things that we could do together. so you have to find success. >> host: how often reread personal communication with president clinton? >> guest: about every week and as speaker of with have

others tuesday meet. >> host: does president obama have a different relation going forward? >> guest: i don't know what type of conversation he is doing but you have to put those ideas for word but i'll lee said called the listener not speaker. you have to listen to the people and though white house. >> host: from kentucky the democrat line. >> caller: how are you doing this morning? i want to talk about some things but the policies of

today but mexico, canada, but how was it working? >> guest: survey there is a difference than thought of what the republicans want to go with environmental issues and the president wants to go. that is the difference of philosophy but not policy. as long as he is president he will direct the epa to do what he wants if the presidency changes and said he will have a different philosophy. people elected him twice. that means they endorse his philosophy. and tell this changes you will have that.

so there is the middle ground and do have to bring capital back to this country and we cannot bring back because if you practice in england or germany or japan than they have to pay another tax. we have spent trillions of dollars we need to bring back capital back here. and reinvested so people can buy pickup trucks. >> caller: i watched the news and in israel they have a good as your reporter. so what is the real reason

we cannot put up the fence to keep people out? the real reason? please? >> guest: sometimes a lot of opposition but i did it because of the drug issue to keep illegal drugs out of this country. you cannot do it. it to be physical or virtual with radar and the technical things that we have but we need to let the border patrol do their job. we can do it if we have though will. sometimes it is the local governments sometimes they do want it but it is not uniform all the way to use in diego california.

and we have to authorize as lee come through the caribbean or the canadian border. but that is where we have to start. >> host: the next question is in my opinion in the house they were young democratic to go against democracy. can you explain what that is? >> guest:. the hastert rule is with 280 votes you can move it on the floor so this whole idea is a misnomer you have to have a majority. but let me say that if you

let the other side controlled the process you will not be a leader very long. so most things they have to pass you have to have a majority of their own people. >> host: on the florida democrat line. >> caller: i don't understand why our veterans have nothing to come home to. they're not getting what they deserve. and what you called middle-class, we are the core.

>> guest: the best thing we can do is we have to work together. some can gather wealth but to use the capital and the resources. the middle-class women's. -- wins. but talk about medicare we should move people out of the core class into the middle-class need to create well so everybody can share in that. >> host: talk about cooperating. with those efforts to repeal the affordable care act?

>> but there is the difference between philosophy and not necessarily policy. they will provide everything for you but also make decisions what pharmaceutical shoot dead or what doctor or hospital. those decisions are between the patient and the doctor. that is very personal with the health care system. so the people that tried to take apart the affordable care act you need to change the philosophy. we should not have big brother deciding. people ought to make that decision. it is a personal choice. party that is clearly unconstitutional.

>> host: that house republicans made so many efforts. >> guest: there is the different -- a difference it is the philosophical issue if you really believe government should not be there being big brother then you need to change it but quite frankly as long as he has veto how are you will not get much change the only way is the reconciliation process. you could pass it in the house to get the 51 votes now. but it is dollars and since - - cent. but it could be moderated. but with outright appeal? that would be difficult to

do. >> host: former speaker of the house dennis hastert and serving in the house as a representative from illinois the next call is from illinois independent line. >> caller: it is not a philosophical it is very real i have a fantastic insurance from my police job in california and we can speak about it because we don't have to worry about it. and as a mexican when people talk about immigration i have to correct people. agribusiness in california started the immigration and through their program. is spread out the mexicans are used to working the field now they are from central america or honduras or nicaragua. mexicans are taking of the

industries and moving east. that is what people tell like. they were stuck in home health care doing unpleasant jobs, hotel, according you would not hear a complaint out of anybody but now they are ingrained into society it will keep going so those people that think it will change i'd have to correct them. get used to it. >> my a congressional district was 23 percent hispanic. but the whole nation was made up of immigrants. and then with economical or freedom. it is that natural processes of immigration.

you have to control the borders but it was a real process. >> caller: i appreciate your service even though i am from the opposite party progress look back on your time and do look like gandhi compared to them now. but the reason i am calling i did not hear a definitive answer there was an accusation that you had a highway where you got the property with your son and you made millions and did not respond at the time. did you profit from the highway to be moved from property that you want? >> guest: no. the proposal was never built i sold the farm. people there did not want the highway nadab an issue

but we've never profited. it was 5 miles away from any piece of property and had. >> host: republicans nine go-ahead. >> caller: i am a student of hamilton and he said a national debt is a national blessing why can't we turn this debt into a blessing simply by discontinuing the payment of interest and using that as the fund to offset any deficits or surpluses in the budget? if we pay interest on the debt. that seems to be excessive. with our good faith and credit why would we give

them interest besides? as a fund '02 mitigate the budgetary issues. if there was a deficit you deduct. but you remember in the 30's when we went off the gold standard. they can now with the $100,000 bill. it was a lot easier to carry. when you are on the run it seems like the right thing to reduce. >> guest: simple economics you will pay interest on inflation. so nobody will lend money to the federal government unless it is individual bonds or the foreign country.

there has to be an interest on the play -- the payment. but the first thing we did was paid down the debt that frees the country up. but not beria back into interest but spend it on real things. and create jobs soulfully. >> host: former speaker of the house joins us on "washington journal". you did an interview with the "christian science monitor". use said when it comes to people the workforces are nice. >> can you explain? >> some like to get in front of the camera to talk of the time. i was one of the lowest name recognitions of the speakers that left but i spend a lot

of my time sitting around the table to bring people to gather. as we work into that legislation, they are not the doctors or the show horses. there are some and those who are great technician with that tax system and you don't and do that by being 5 miles wide. it takes a lot of work and study to be an expert in certain areas. >> host: how would it uss out coverage has changed but when i left it with the speakers we were pretty much

cable tv but the old network system but today with msnbc or c-span or fox or whenever you can pick a fight you want to hear. with that political stripe stripe, they have to have this dues to get people to stop over andover and you kind of fan that in the flames.

but sometimes i turned to a station that is neutral. i just want to hear a set of real news and to share what takes place but in the meanwhile way have a conversation with former speaker hastert. [no audio] --. >> caller: i have a couple of questions. but now the family has gone completely away because of everything going on.