three weeks ago, senator mccain and i hammered together a proposal to deal with the current crisis at the va. i think it is no secret we have different world views. john, is that correct? is that a fair statement? >> safe to say. >> but i thank him very much for working with me to move this legislation forward and to move it forward expeditiously. the sanders-mccain bill passed the senate with an overwhelming bipartisan vote of 93-3. in terms of funding by a vote of 75-19. the senate made it crystal clear that the current crisis in the va is truly an emergency and should be paid for through emergency funding. as everybody here knows, in the last four years we have seen a significant increase in the number of veterans utilizing va health care. in addition many of our veterans of world war ii, korea and vietnam require a greater amount of care as they age and further

an audit revealed more than 57,000 veterans on too long waiting lists to be scheduled for medical appointments and in addition to that there are other veterans seeking care at va who were never even added to these wait lists. this is clearly unacceptable and must be dealt with immediately. i couldn't agree mor with senator mccain when he said on the senate floor in the debate, and i quote, if there's a definition of emergency, i would say that this legislation fits that. it is an emergency. it is an emergency what is happening to our veterans and the men and women who have served the country and we need to pass the legislation and get it to conference with the house as soon as possible. end of quote from senator mccain and i fully concur with what he said. veterans in this country must get quality care in a timely manner and we need to provide the funding the va needs to accomplish that goal and to do it as expeditious a manner as possible. the simple truth of the manner is the va needs more doctors,

more nurses, mental health providers and certain parts of the country more space for a growing patient population and a letter sent to the house and senate veterans affairs committee june 17th and signed by virtually every major veterans organization, vietnam vets, iraq and afghanistan veterans, all of the groups, this is what they said and i quote. protect and preserve the va health care system. any legislative, regulatory or administrative changes designed to respond temporary or permanent must protect, preserve and strengthen the va health care system so it remains capable of providing a full continuum of high quality, timely health care to all enrolled veterans and the letter continues, quote, unless the legislation simultaneously sets va on a path to intelligently strengthen health care, ensure

that overall va funding matches its mission, the current problems confronting va and yvette rans will inevitably recur. end of quote from the veterans organizations and i agree with that important statement. to address the long waiting periods, the senate legislation says the veterans around the country if you cannot get into a va facility you're going to be able to go to a private doctor, go to a community-based, you can go to a federally qualified health center, dod base or indian health service and that means that veterans will have access in their community to the health care they need. this bill also says to veterans who live 40 miles or more from a va facility that if they choose they have the option of seeking care outside of the va. so, let me just conclude by saying this. we are all aware of the problems within the va and i think we'll hear very valid criticisms of the va today but there's one

point to make in closing is if anyone in the room thinks that the va is only health care system in the united states of america that has problems, they would be sorely, sorely mistaken. i don't have to give you the quotes. about 200,000 to 400,000 people dying every single year in hospitals around the country because of poor and errors made the hospitals or the 45,000 people who die each year because they don't have health care. i think we all know those facts. so my hope is that we can work together in a bipartisan way and to develop legislation which strengthens the va so what every veteran in this country who is eligible for va health care gets quality care in a timely manner. thank you all. all right. now we're ready to go and i think we begin with -- all right. with congressman michaud. >> thank you very much, senator sanders and representative

miller. as you heard earlier, it's well over a decade since lawmakers gathered in conference from the respective committees. this is a historic opportunity and we have i believe a responsibility to deliver profound changes in a way veterans services are delivered in a timely, safe and high quality health care way. we are all well aware of the incredible failures within the veterans administration. just yesterday, though systemic problems were compounded when the office of special counsel released findings to take va to task for not doing nearly enough to act on information provided by the whistle-blowers. we know that this inaction can directly harm our veterans. i urge all of us to see beyond the immediate crisis and take this opportunity to have real conversations on how we can fix the va. i hope as a group we can put

forward meaningful reforms that positions the department of veterans administration to provide high quality, timely and flexible care in the future. we have a responsibility to ensure that the va has the resources it needs and most importantly the a toiblt plan strategicallial for the future so that the needs of our veterans no matter what age they are or where they served are met. i'm proud to -- how quickly both the house and senate chambers responded to take action in this crisis. however, i do believe we could have made the amendment that passed in the house much stronger if we included a number of other bills aimed at strengthening performance outcomes and accountability within the va. and holding all va executives both senior executive service members and title 38 employees accountable. if you look at what happened in phoenix, arizona, and in florida

and some of the other areas, those were title 38 employees that were responsible for that in this performance measures that passed the house does not cover those employees. i also believe that it's important for us to look at how we can deliver flexible care for our veterans in their local communities. the odds program allows veterans to receive high quality care they need in their local communities with a built-in support network of family and friends nearby. i constantly hear from veterans in maine how much they love the arts program and i sincerely hope we can grow and expand the arts program through this conference. i will also note the fact that when cbo scores the arts program, they do not score the savings. in maine alone, the arts program saved well over $600,000 in travel costs. $600,000 in travel costs which is not considered in the cbo

score and i urge all of us to remember first and foremost that we are doing this for our nation's veterans. these are men and women who put their lives on the lines day in and day out for our nation and our freedoms. when they made their incredible sacrifice, to earn the well deserved benefits that they should be receiving, benefits they do so by working together in a cohesive and in a spirit of cooperation towards our national goal. we owe them the same as we move forward with legislation to address this health care crisis and i urge my colleagues on both sides of the ail and both chambers to work together in a collaborative way so we can get the best legislation to the president's desk for his cig signatu signature. i yield back. >> thank you. senator burr. >> chairman sanders, miller, thank you. let me at this time ask unanimous consent to ebt sbeer the record senator johanns

comments. he's sick and can't attend. >> without objection. >> i thank the chair. let me say to my colleagues, we owe everything to our nation's vets. everything. we owe everything that they need to be provided. we're all aware that there's widespread, systematic failures that plague the health care system. the culture that has developed at the va and the lack of management accountability is simply reprehencible. it's becoming increasingly obvious a cultural problem has taken deep root in va and simply increasing funding will not solve it. it could prove to only reinforce the culture. reforms are desperately needed within va and some of the changes can't be fixed through legislation. they must come from within va. but addressing the cultural problems within va won't provide relief for the roughly 100,000 veterans experiencing long waits across the nation today.

it is now time for us in partnership with the va to begin to repair the damage that has resulted from systematic failures that have undermined the trust veterans have always placed in the veterans administration. to begin to change the culture at va, there's reforms to pursue to ensure veterans have access to timely, quality health care. now, the start of an effective congress and a conference comes with accurate numbers. and since ranking member michauk mentioned cbo, let me talk numbers for just a minute. va is basically broken down in two sides. the veterans benefit administration and the veterans health administration. last year this congress for this year appropriated $55 billion for vha. veterans health administration. of that $55 billion, most members would be shocked to know that 48% goes to direct patient

care. we're talking about $27 billion of appropriated money goes to the delivery of health care to our nation's veterans. 52% goes to administration and other programs that emanate out of the vha budget. of that $27 billion, that's doctors and nurses, it's the delivery of care to all of our 8.4 million veterans who cbo has scored enrolled and active. now, it brings us to the house bill and the senate bill. the house bill was scored at $35 billion a year. and if fully implemented after the two-year period, scored it $50 billion. the house bill was scored at $44 billion. basic difference of timing on the wait times from 14 days to 30 days. now, i asked my colleagues around this table, is the cbo

product that they have produced reflective of anything sane? that the scoring of a bill that offers limited choice if one of two things is triggered in the house side and that's we have either gone past the 30-day established by the va or they live outside of 40 miles from any va facility, be it clinic, outpatient facility or major medical facility that it would exceed by $7 billion on an annual basis what we spend for the entire delivery system for our nation's veterans. to my colleagues, this is ludicrous. this is impossible for us to even start an intelligent discussion on what we put in legislation and when we have got number that is are this so go's thing grotesquely out of line.

let me give you a few other references. va estimated that of the 8 million veterans eligible for va but not enrolled, that if we passed this legislation they would automatically drop whatever coverage they have today. be it medicare, tri-care, private insurance, fehpb for those federal employees and when they dropped that they would immediately go into the va system for two years. i want to ask you to stop and think about that for just a second. to a veteran on medicare, they're going to drop their medicare, go into the va for two years? and then pay the penalty to get back into part "b" medicare? for an employee who has private insurance, they're going to drop their insurance and leave their spouse uncovered because they see some advantage to being on va? it's estimated that 90% of those veteran who is are eligible but not enrolled in va have less

than 50% disability rating. the threshold to where it's va care comes without a co-pay. these are individuals who have already made a determination that the coverage they're under is the best coverage they could have. if not, they would be enrolled in the va today. so, the fact that cbo now says with just the execution of this minor reform legislation it would trigger 8 milliillion peo in the system that exist and don't enroll is just as ludicrous as $35 billion or $44 billion price tag that cbo has put on the bill. cbo determined as you would imagine that only 3% of their cost is attributed to the 40-mile trigger that we put in the senate legislation. in other words, there are very few veterans around the country

living more than 40 miles from a va facility but like i have heard some of my colleagues say, when you've got something that makes as much common sense as this, that it's less expensive to let them get local care than it is to pay their reimbursement to a va facility, can't we accommodate the veterans once? his needs and the taxpayer's fiduciary responsibility to come out cheaper by doing it. this is the only place within the cbo score that they actually agreed that the impact is minimal from a standpoint of the number of people that are affected. so, it leaves one thing. how could cbo come to the conclusion that the va was at a point where it couldn't add any more enroll lees without a masse increase in providers? in other words, the va's full. don't knock.

don't come. well, let me suggest to you that the va just on one matrix and that's primary care panels sees 1,200 patients when non-va providers see 2,500 patients. the va sees 1,200 patients on a primary care panel when the non-va providers see 2,500 patients. when we talk about systemic problems, talking about cultural changes, this is not targeted at folks that veterans don't see every day. it's targeted at providers that for whatever reasons within the va don't conduct themselves at the same rate that non-va providers, in fact, experience. so, i say to my colleagues, i hope that the chairman and the ranking members will challenge

cbo on the score to start this process we need to know exactly what it is that happens when we begin to move the dials one way or the other and to start at the point we have started because of that score is, in fact, more challenging than anything i could ever think of. i thank the patience of the chairman. >> congressman? >> thank you. i would like to thank the chairman and ranking members of the house and senate va committees for the leadership on this issue. it's a real honor to be a member of this conference committee and i look forward to working with you all. the last of transparency at the va and the very nature of data manipulation and secret wait lists have made it very difficult to expose the true nature of the problems facing our veterans. there are almost 100,000 veterans living in my district. in an effort to find out a they're seeing, i've held conference leaders with local leaders, spoken with the facility directors in denver and

colorado springs to evaluate the quality of care and i've put out a call to veterans to call my office. we have subpoenaed documents and testimony, heard from numerous witnesses from the va. i've sent multiple letters demanding answers as i'm sure all of us and supported legislation to expand fee basis care and to give va leadership more flexibility to fire negligent employees. at first, the va attempted to down play the significance and extent of the problem. only through the efforts of whistle-blowers, brave individuals from across the country that have taken great risk to expose the truth, has the depth of the issues at the va come to light. subsequently, the interim va office of ig validated the claims and labeled them systemic. yesterday, the va's bimonthly access data said the electronic wait list in denver had more than doubled since their last report just two weeks ago. this problem is not getting

better. it is getting worse. we cannot kick this can down the road. we can't simply seek to create an assembly line to get veterans in and out faster without regard to the quality of care. ultimately, we must focus on changes that yield better health care outcomes for the veterans through timely access to quality care. in order to achieve this and ensure that these solutions are lasting, there are multiple items that have to be addressed. obviously, we must pave the way for the va to use non-va care to expand veteran access and clear the current backlog. but we can't just fix the problem by simply throwing more money at it. the va has had more medical care funding than it could spend during each of the last four fiscal years. to include $1.4 billion as recently as 2010 and was set to carry over $450 million this year before dipping into those funds for the current accelerated access to care initiative. this is led to multiple testimonies by both va and

non-va witnesses who have noted that the biggest issue is not a lack of funding but a welcome of accountability. for this reason, the legislation that we mold must hold individuals accountable who fail to meet performance standards and oversee mismanagement and neglect. the perverse incentives that led to the manipulation of scheduling data and secret lists must be eliminated. any incentives going forward must have an impact on improving patient satisfaction, outcomes and productivity. finally, the ultimate product must protect whistle-blowers that step forward to share the truth. the last thing they should face for standing up for the veterans is retaliatioretaliation. we can't seek to create a sy semibring line for veterans getting in and out faster. the efforts must lead to changes that yield better health care outcomes for our veterans. that's more important than metrics. this is what our veterans have earned and they deserve nothing

less. thank you, flchmr. chairman, i d back the balance of my time. >> thank you. senator rockefeller. >> i thank both chairmen very much as well as ranking members. it has been 15 years since we did this which is not a very happy statement in and of itself. it's a long time. anybody here remember the name jennings randolph? anybody? >> yes. >> you do? good. >> served with you. >> yeah. no. i took his position on this committee. in 1985. and i've been here ever since. i became chairman in 1993 and i want to give a little bit of context to this, too. how we've tortured our way along. i resolved to do anything that any chairman would resolve to do. we were faced immediately with

unresolved illness questions coming out of the persian gulf. and so we had -- started having hearings on gulf war illness, and the soldiers were told, men and women, to take something called predastitic bromide and not approved by the fda for animals much less united states military personnel. we had a lot of meetings and fights and still going on and nothing is totally resolved. at that time veterans told and some extent pretty much are and they're in their head and take an aprint and go home and sleep it off. it's amazing to me that the government could allow something like that to happen. that was gulf war. and it was a very special, painful experience for a lot of

us. then we moved on, actually began with -- first thing i did when i got here is atomic veterans dying from radiation in terms of exploding bombs in various places for the second world war. during the second world war. later we worked on veterans suff suffering from the effects of agent orange and i think we all remember the powerful testimony of admiral zimwold and how that testimony virtually turned the entire argument around as his son had contracted cancer from agent orange. and then, since 9/11, we have heard from soldiers exposed to burn pits and sodium dicromate. so everything has a history and everything is hard. i don't think anything underscores the vital need for services today and the veterans

administration more than ptsd. it's a simple word, so vastly complex. so vastly attacked. we make progress in cancer. we don't seem to be able to make enough progress in ptsd and people suffer horribly. you go back home and you listen, no press, no staff. and you listen to veterans. at first it was veterans wives when the iraq war was just starting up. and then veterans themselves. and the sheer terror of explaining their experiences, the advantage of a nobody except you and eight ptsd sufferers. discussing what they found that they had found themselves doing in horror, pushing children, sitting on the laps softly away from them so they wouldn't hurt them. not being sure what their reaction would be. i mean, the hurt is just -- it's so astounding and so

heartbreaking and yet we're still working on it. actually, there's very good work being done. some of it in vermont on ptsd. and i had a cousin who was killed recently very much a part of that. obviously, all of this is unacceptable but i want to be absolutely clear in what i'm saying, we need to improve the va, not tear it down. when the gentleman indicated we need accountability more than we need money, we need both. we need both. you can't get pediatricians, you can't get clinical psychologists or anybody else to come and serve their nation the way the veterans that they would treat, the mental health issue is overwhelming and not well understood. it's so deep because unless you've, you know, gone through what john mccain did, how do you possibly understand all of this? if i eve learned anything, it's

that we need to listen to veterans. we need to respond simply to what their needs are. in some ways, it is not that complicated. and i just don't want us to do what we have done to so many other generations of veterans with complaints who have died, the guy in the wheelchair sitting before us at my very first veterans hearing talking about what it was like to die from cancer, that he got because he went into a radiation area. this conference is a very important conference i need to say. thank you. >> thank you very much, senator rockefeller. senator roe. >> thank the chairman very much and would like to thank everyone in the room for their dedication to serving veterans on the respective committees. as i said last night in the hearing i think for the veterans who can get in there, they can get good care but the committee has an opportunity to elevate that to great care for all

veterans. i think that's one of the goals. i see two problems. one, the backlog easily fizzible. the other is the culture of the va which is going to be much more difficult to fix. i find it almost incomprehensible that people would place people, veterans, any patient, in a delayed status and then gain financially which is what happened in phoenix, arizona. it is unbelievable we let that happen and set up a system where that could happen and reward people for doing that. i am a veteran. i served in the second united states infantry division, 1973 and '74 in korea and senator mccain, thank you and the other veterans around this table for your service and i spent about two weeks ago about 30 minutes in the hanoi hilton. that was enough for me. i also trained at a va medical center. i'm a physician, i was in the medical corps and practiced in the private sector over 30 years a eni believe i have the unique capacity of a hospital to

operate efficiently and we need to look at best practices on both sides and streamline efficiencies to allow doctors to see more patients. as was stated by mr. lamborn, each doctor should be seeing as many as we saw on the private system and there are systems that stepped up at a call yesterday from memphis, tennessee, that in 72 hours, seeing any veteran on a primary care or a specialty consult, 72 hours. it took them less than a week to do that. our practice is right now ready to do the same thing. another xamplt of the amount of time for veteran, i was at my ophthalmologist yesterday getting examined and saw here in washington, d.c. a veteran in january who needed to be seen, didn't get seen and five months later, gets seen. has a retinal tear and probably going to lose some of the vision in the eye because of this delayed care. we all have heard stories like this. no matter how much the private

sector wants to help, they can't do it unless they get prompt payment from the va. and sometimes i've talked to providers taken a year to get paid for services they provide. the va is that slow in providing the services and can't expect the private sector to really shore up the va if you don't pay them for it. there's a simple way to do this. you allow and i think senator mccain had this idea several years ago. allow veteran to go out and see me as a patient, as a medicare patient. very simple. it's not a complicated deal at all. if the veteran is low income and can't pay the co-pay, the va covers it and medicare covers the rest. we can do this for our veterans very, very easily. and but i think also for this bill to be fiscally responsible we have to be sure and careful who we open va care up to. i don't need to be on the va care right now. i have adequate health insurance as a veteran. i don't need to be in line in front of a needy veteran and

millions of us that feel the same way so i don't think we can afford to expand coverage to every veteran. right now. and i really truly believe this. bottom of my heart that throwing more money at a system that's behaving like this would be the wrong thing to do. i think we have to change this system the way it's currently working or we're going to just make the problem worse. the backlog we can fix. we've got to change the culture. i said this a couple of weeks ago. if you ask anyone that works on a va campus who they work for, they'll tell you the va. the right answer to that answer should be i work for veterans. that's who -- that's the answer that should be. that's not what you will get on most va campuses so i've -- really appreciate this opportunity that everyone around this table has. we have been given a unique opportunity to change a va system for decades to come and we need to do this right and i certainly look forward to working with each and every one of you to do that.

with that i yield back my time. >> thank you. senator isakson. >> thank you, appreciate what everybody's done. i want to particularly acknowledge senator mccain, a committed person to veterans that rolled up the sleeves in the senate, worked as chairman sanders and saw to it a product out of there and senator coburn who's a practicing physician and an absolutely committed oversight member of the senate with solutions included in the senate version and hopefully in the final product. i very much support the accountability. i very much support the choice. but i also think we all need to recognize that while it is an emergency, chairman sanders, over time the solutions are permanent. and they're going to cost permanently and we have to be sure we're paying for them. i think senator burr is absolutely right. i made the comment at a dinner the other night i've always been mad at cbo not doing dynamic scoring in terms of positive

revenues from positive tax policy. this is dynamic expenses in the way they scored this and, chairman burr, ranking member burr made excellent observations we need to work on. the improvements in this bill are great. the veterans need them but we need to make sure we're committed as members of the united states congress and united states senate to do the oversight so culture of corruption is culture of accountability and account tonight the veterans that served and because of their service we are all here today in this committee. my personal experience with accountability and oversight and the va and i'll hush after this, took place in august of last year when i called a hearing in atlanta because of the three suicides that had taken place. we had a hearing. the doctor was there. everybody but secretary shinseki. fox care railroried it on tv an changed. a recent report i called on the ig for six months ago just relowe'sed on friday showing the marked improvement of atlanta in terms of accountability, in

terms of transferring people not doing the job, tracking the veterans, particularly those in mental health and the security necessary in the hospital to see to it the drug overdoses happening in the past no longer happened again and that specimens taken for the purpose of diagnostic had the type of security we have in most hospitals you see and certainly the clinic here in the united states capitol. change can take place and take a culture of corruption and make it a culture of excellence if you know somebody's looking over the shoulder so as we finish this conference committee, make a report to the congress and pass a bill that hopefully deals directly with the problems, make sure we don't go home, turn off the light and say we have another job next week. we have the job of oversight to see to it veterans health care the best it can be not just today but every day with authority in the united states house and senate. thank you, mr. chairman. >> thank you, senator. congressman takano. >> good afternoon, co-chair sanders and co-chair miller.

thank you for the work you have been doing and also thank the ranking members. it is an honor to serve on this conference committee. in the wake of reports of misconduct within the va learning so many of our veterans aren't receiving the care they need in a timely manner and allegations some veterans died as a result of long wait times and the deaths may have been covered up, i look forward to us all working together to pass a bill that will give us -- that will give our veterans access to the health care they need and deserve. it is clear that any solution must include accountability mshls for va employees, improve vha scheduling practices for appointments and prevent future abuse and provide our veterans with timely access to quality care. it is also clear especially in light of yesterday's allegations about cover-ups at the phoenix va that we need to re-evaluate the culture at the va and take steps to ensure that the department truly is veteran

centered. our goal should be to strengthen the va health care system, not dismantle it. by and large, once they're in the va, health care system, veterans say they're happy with the care. our final legislation should break down the barriers to entry. we have learned about in our hearings. we must also remember that what works for one region of the country won't necessarily work for all. giving veterans the opportunity to seek non-va health care may be a solution in areas where private care is plentiful. in districts such as mine with a shortage of health care providers, i don't know how much a difference it will make. every member of this conference has service areas, populations or health facilities designat i as professional shortage areas by the depth of health and human services. for primary care that means the physician to people ratio is 1 to more than 3,500. for mental health, a specialty

we know is critical for veteran population, that psychology is 1 psychiatrist to 30,000. further more, the va's internal audit found front line staff members said the single biggest barrier to care is lack of provider slots and that's why i believe increasing capacity should be a key component to the final legislation. yesterday, i joined representatives titus and o'rourke, fellow members of the house veterans affairs committee introducing legislation to increase slots at va medical facilities by 2,000. i hope that this committee's final legislation will include modified language from the amendments section on health care recruitment and appointment based on the bill to establish new residency positions at va hospitals. finally, as we expand choice for our veterans to non-va providers, we must ensure that there is continuity of care.

the non-va providers should maintain electronic health records through a system interoperable with the va system and at least encourage that inner opinionerability. we know the problems with the electronic health record systems. i don't want to see that mistake repeated as we encourage more non-va care. thank you, mr. chairman. i yield back. >> thank you. senator murray. >> thank you very much, mr. chairman. i believe that when it comes to caring for our nation's heroes we can't accept anything less than excellence. so while the department generally offers very high quality health care and does many things well or as well or better than the private sector, i'm very frustrated to be here once again talking about these deeply disturbing issues and allegations. it is extremely disappointing that the department has repeatedly failed to address wait times for health care.

jao and the inspector general reported on the problems many times over the years and last congress we did a great deal of work around wait times, particularly for mental health care. we learned then that the va has no reliable or accurate way of knowing if they're providing timely access to mental health care and i think the va is starting to see that business as usual is not acceptable. so i'm very glad to be serving on this conference committee. calling for a formal conference committee is rare step on veterans issues and i think shows how severe the problems facing the va are and how serious members are about fixing them. there have been major bipartisan efforts in both the house and the senate to move legislation addressing these probables. many of the members here have been part of those efforts and i commend them all for their commitment to bipartisanship and putting the needs of our yvette rans first. i personally want to thank chairman sanders and senator mccain for work they did over

the last few weeks to get us here. i appreciated working with you over those weeks and look forward to where we can make compromises to pass a bill and ensure that the veterans get the care they need and deserve. i also want to commend chairman sanders and chairman miller for bringing this conference together. as it shows how serious the two of you are about getting to the heart of this matter and addressing this critical issue. working with both of you over the last years i know how dedicated both of you are when it comes to taking care of our veterans and i appreciate it. now it's vit ral to build on the bipartisan momentum to address the concerns plaguing the va and fix its deep-seeded structural and cultural changes. bills before us have some important provisions to help address the very complex problems. first and foremost, caring for our veterans is a commitment we make as a nation when we go to war. our service members have sacrificed much and we need to make sure that their country is

there for them when they come home, no matter what it takes. i know memberless here have a wide change of concerns and helicopter to work with everyone here to address the concerns responsibly and in a way to put the veterans first and give it is va the tools they need to address the challenges that we face. that means building and strengthening the va system so it delivers the best care over the long term. so it is very important for us to act quickly to start making these changes. and as more problems are uncovered and as the investigations proceed, we will need more action from the va, from the administration and from this congress. because the government made a promise to the men and women who answered the call of duty and one of the most important ways we uphold that is making sure the veterans access the health care they need and deserve so thank you very much, mr. chairman. >> thank you, senator. congressman florez. >> thank you for calling this committ

committee. i thank each of the members for joining us in this important cause. i'm humbled to serve working to finalize legislation to help our nation's veterans. when our military men and women return to civilian life we owe it to them to keep the promise and provide them with the best health care services and benefits as possible. the va health care system is plagued with poor performance and an unresponsive bureaucracy. over 57,000 veterans have had to wait over 3 months to receive their first medical appointment. and additionally, nearly 64,000 veterans never receive the requested appointments. having just one veteran denied an appointment or waiting longer than necessary for care is unacceptable. we must focus on creating a more accountable va with a smaller bureaucracy. as original co-sponsor, i'm pleased to see the legislation come closer to reality. this legislation provides those veterans waiting for care the ability to see a doctor, health

care provider outside the va health care system immediately. it will make sure that fewer veterans suffer as a result of va's inability to provide timely care. it's been disheartening to learn the va is failing to do the primary job and veterans suffering because of va's misconduct and mismanagement. also look forward to a positive resolution on the bipartisan bicam real language of accountability for va management. i believe the new va secretary will need the tools to cut through the mounds of red tape to discipline and remove senior leaders that cultivated a culture of sub standard behavior. the culture lost the way and need of leadership to restore focus toward the core values of integrity, commitment, respect and excellence. it is time to put the interest of americans veterans ahead of the interests of federal bureaucrats to keep our promises to the brave men and women that provided freedom and liberty. the department is failing to do

the primary job for the best health care and benefit services to the veterans. it is time that the underperforming senior leaders are fired or disciplined opposed to status quo of ignoring mismanagement and rewarding misconduct. the nation's heroes deserve better. i look forward to coming together to iron out the differences between the respective bills to ensure that our veterans receiving proper, timely care. longer term, we in congress need to chart a path to build a va for the 21st century. a va that is focused upon putting veterans first and following the core values. this new va should be smaller, more agile, less bureaucratic, more responsive to america's veterans and a better value to hard working american taxpayers. we need to adopt a moon shot approach to do this in the near future. thank you. i yield back. >> thank you. senator brown. >> thank you, mr. chairman. chairman miller, thank you. it's an honor to serve on the

committee and thanks to senator mccain and senator sanders for their work in shepherding a very good bill through the united states senate. i've served on this committee for eight years in the senate and never seen anything but people in both parties, ranking members, chairs, whatever, that always put veterans first in both parties and we should all be commended for that. congressman roe said something i thought was particularly apt. it's the care, once in the va, the care has been very good for the 6.5 million american veterans who have been in that system. it's access to that system that's the problem. we have veterans waiting too long for care. we need to fix that. we have a culture at far too many facilities problems were hidden. that's why we're here today. for the so-called choice card, we have seen this before. in september of 1993, president clinton addressed a joibt session of congress. several of you were there that day. for those that weren't or don't

remember, let me remind you. the president talked about reshaping the country's health care and holding up a card that looks like the card that we will see, a choice card. he said every american would receive a health care security card for a comprehensive package of benefits over the course of an entire lifetime. instead of privatization schemes, we should make the va simply make the va better. va provide care and services unmatched in the private sector. there are questions of diverting money from care to profits. there are significant questions of medical privacy as veterans would be shuffled between the va and the private sector. and we know what happened in the last ten years. a dozen years ago, we went to war without paying for it. a dozen years ago when we went to war we failed to scale up veteran services and ensuing decade we have seen because of agent orange, presumpbltive eligibility, hundreds of thousands of more people demanding and earning services from the veterans

administration. some of have launched an un -- what i think is an unfair attack on the vast majority of va employees who are dedicated public servants to the nation and the veterans. these employees chose a career serving veterans, many, many of these employees as you know and each of your districts and states are veterans themselves. these employees whether it's a police officer at the dayton va, whether it's a claims of -- it's a claims processor at the cleveland's va or whether it's a nurse at the toledo community-based outpatient clinic, these employees are on the front line of care, their ones reducing the backlog, they're helping to eliminate veterans homelessness. they're the one senator isakson talks about trying to prevent suicide and create new ways to serve the veterans. 6.5 million veterans used the veteran health care system in 2013.

85 million patient visits. we shouldn't castigate those innocent and condemn va employees at large for the wrongs for a few and same time make everybody at the va accountable. thank you, mr. chairman. >> thank you, senator. congresswoman brimly. >> thank you, mr. chairman. as the proud representative of ventura county, in california, home to naval base ventura county and prouder representative of the 40,000 veterans who live in my district, i want to get this right. we must get this right and i know my colleagues here today also want to get this right. problems at the va are not new. they have spanned decades. congress has promised to take care of our veterans, the american people want us to take care of our veterans and our veterans and their families have earned and deserve to be taken care of. they have sacrificed for our country and now our country must sacrifice for them.

we are here today at a pivotal moment for the va and for our veterans. we must act decisively and fix what must be fixed. as i sit here with my colleagues both republican and democrat, i know all of you care deeply about our veterans and i know that all of you truly want to fix the problems currently plaguing the va. i also know that what happened in phoenix was intolerable. that the va must undergo a complete cultural and systemic transformation. and that individuals at the va should and must be held accountable for their actions. but i also see this terrible tragedy as an opportunity to make real changes. an opportunity we must seize. an opportunity for this congress to show the american people that it is not -- that it not only has the will but the way forward

to make the va better, to provide the resources our veterans not only need but have earned and to live up to our purpose. our purpose to serve our constituents, to serve our country, and to serve those who have served us. our veterans deserve no less. the american people expect no less. and we can do no less. i look forward to working with all of you in good faith and to put aside ideology and partisanship so that we may find the courage to do whatever it takes to seize this moment, this opportunity, this purpose for which we are all here. and that is, to put it very simply, to help our veterans receive quality care in a timely manner. it is not too much to ask. i yield back the balance of my time. >> thank you. senator mccain. >> well, i thank you, mr.

chairman. i thank you for your kind words and those of other members. i'm very appreciative of that and i would like to thank you for the very vigorous discussions and compromise that we we reached. i would like to thank senator bure for his work and senator coburn. in fact literally every member of this committee had a role to play in bringing about this legislation. i think other members have described, i think in moving terms the dimensions of this scandal and this include just today we learned of allegations

in the phoenix, that records of dead veterans were altered to make the wait times look better. frankly, i don't think that's the last shoe to drop. i'm afraid there's more, and i think it gives you a great you are sense of urgency to act. i would like to just for a minute say somebody about the cbo scoring. i think if anybody looks at that scoring in a rational viewpoint that it is wildly inaccurate, and i think it's important for all members on both sides of the aisle to really understand how that is a totally unrealistic estimation of the costs involved here, and i think we ought to look for ways that we can pay for the -- these expenses. but i would also argue that if

there's ever such a thing as an emergency, it is this issue. i don't know any other obligation that we have to any of our citizens that's greater. so i appreciate especially the work that dr. coburn did that's available today. it's a report that he's releasing called friendly fire, death, delay and dismay at the v.a. an in-depth study of some of the additional problems he has overcome. so i guess finally i would ask my colleagues. we are all going to be going out of session here the end of this week. i hope we can as a minimum lay off the parameters of what needs to be resolved. i don't think this issue can wait, and i appreciate the participation of all members who are here today, and i thank my colleagues.

>> thank you, senator mccain congressman benishek? >> thank you, chairman and fellow members. at we have an opportunity -- the things we can accomplish here will mean the world for the veterans. together we have to fight for them and help ensure they have the access to the care they have earned and deserve. the reform bills passed by the house and senate represent a historic assault on the culture of complacency and mismanagement. as a doctor who served at the v.a. in iron mountain for 20 years and as a father of a veteran, i take this issue personally. our veterans deserve much better than what they've been receiving from this v.a. whatever you're differences may be, i believe i'm saying in say we all believe the v.a. must emerge from this process much

more responsive to the needs of our veterans. i believe we have two chief responsibilities on this committee. first we have to give the v.a. the tools it needs to succeed and institute real, lasting accountability. second, we have to provide for the immediate care of all our veterans, who have been forced to wait too long, as well as those who have lived long distances from v.a. facilities. we need to put the v.a. on a path to permanent success. this cannot happen without a detailed look at what exactly went wrong. and a strong plan for accountability moving forward. we know that many of the front line care providers are some of the best out there. and we know that layers upon layers of bureaucracy are keeping these care providers from doing their job. but much more is yet to be uncovered. a key component of the house bill lays out a detailed independent assessment to be

carried out by a private sector contractor. this contractor must have the knowledge of the v.a. system, and most importantly a best health care delivery practices in the private sector. we should be tapping the best health care minds that we have in this country to go step by step through the vha system and write us a blueprint for the lean, smart 21st century v.a. that serves our veterans. >> the isolated records have been done in the past, parsing out specific problems, this reform should be an historic opportunity to look at the veterans health administration as a whole and compare it directly to the highest performers in the private sector. there is much we need to know. we need to know exactly why past attempts at implementing physician staffing standards have failed. we need to understand the big reasons for making improvements and as new opportunities for veterans to receive care outside

the traditional system emessage, we knee to ensure the v.a. will properly collect the resources owed to them, not continue to leave money on the table that could be reinvested in veteran care. the house language helps address these issues, but more needs to be done. i'm just not confident we will get the information we need and the goals accomplished if we don't look outside the v.a. too proven leaders in the health care industry. before we get to planning for the future, however, immediate steps need to be taken to get or veteran off waiting lists and into exam rooms. on this basic point both of house and senate agree. i believe we can do this in a responsible and effective way. i don't want veterans having to jump through hoops to qualify to see their local doctor. our veterans have been through enough. no longer should they return from fighting the enemy just to find themselves in a brawl with the v.a. bureaucracy. the language is written so that veterans need to wait for the

v.a. to first put them on an actual waitlist and wait 13 or 14 days before they're eligible to even begin looking for private sector care, then we haven't done our job here. if the authority we grant the v.a. looks eerily similar to the authority they have, but choose not to use, we could be risking being in this situation all over again. the authority has to be specific and clear. veterans can't be allowed to wait endlessly on lists anymore form the v.a. has to be forced to stream did not line this process. of course both the items i brought up this afternoon will only be effect i have been if the v.a. is held accountable in the future. i futurely support the accountability provision for ses employees and appreciate the senate bill leans in that direction as well, though there are more questions to answer. when the v.a. concurs with an

inspector general recommendation, who is responsible for following through? what action is taken when a manager fails to address the issues raised by the iismt g? why are they still getting bon uses if they don't comply? thank you, mr. chairman, and both i thank you for your continued leadership and look forward to working with you. >> thank you. senator testa. >> i would like to thank everybody on this committee, as everyone has said, it truly is an -- i go back to montana, where the per capita is second highest in the country only second to alaska, with the veterans, and they give me an earful every weekend i go back, and they're upset for all the reasons stated today, but i also like what was said. one member said improve the v.a., don't tear it down. another member said deal with the back did log and deal with the culture. thank you for that. deal with best practices. they should be givens, and

prompt payment for private sector providers is critically important or we won't get it done. but i also think we need to be careful. we will not be able to increase recruitment unless we put something on the line. i think we ought to be taking caps off student loan programs for nurses and doctors, and no doubt about it, recruitment is a problem. i can tell you the private providers don't have docs either, so we have to figure out how to solve this problem. i think removing the caps is one that can help with that commitment. project arch, which is mentioned by the ranks member on the house side, is a program that senator mccain supports and i do, too. i hoe we can fund that program. it's been a program that worked very very well. we need to make it real. i want to talk about the 40-mile access rule in the bills. i think that we talk about the

number of patients that are seen in the v.a. versus the private sector, and i would say this -- we've got to be careful not to make this an assembly line. many of these folks have issues that the private sector patients do not have, and they need time. i think if we're running them in and out like cattle through a squeeze chute, we're going to create a big problem and we're not going to have the health care that they need. when it comes to mental health, providers, i think we have one east of billings to the border. that's about 250 miles, and there's a lot of veterans in there. so the private sector doesn't have any providers, either. so we've got to figure out ways to meet they needs, because we all know that mental health issues are the number one injury coming out of iraq and now afghanistan. the last thing and it's very, very important, is we need to continually analyze, if we do this program, its effectiveness not only to the veterans, but the effectiveness for the taxpayer. there is no ifs, ands or buts

about that. if it costs more money and that treatment isn't significantly better, we have a problem. i want to thank the chairman and ravening members once again, and i yield my time. >> thank you. congresswoman kirkpatrick. thank you, chair sanders and miller. i want to thank our senior senator mccain for his hard work on this issue. my colleagues on the house veterans affairs committee have heard about so many issue that is plague the v.a. in hearing after hearing. the latest report from the office of special counsel, the reports of additional cover-ups in the phoenix v.a., and reports of retaliation against whistle-blowers are damning. and only increase the urgency for this committee to act quickly and adopt a version of the senate's expansive reform legislation. we can address these issues now by agrees to an expansive reform rather than piecemeal

legislation that only addresses some of the problems. we can enact comprehensive legislation that does more. sweeping reform of the v.a. can start today. last night i asked our v.a. witness if the v.a. was capable of innovation. they want yes. we must demand innovation in the v.a. by passing comprehensive reforming. we can solve the patient access problem, stop the deceptive appointment scheduling practices, mandate transparency, and hold the v.a. employees accountable by adopting comprehensive reforms. we can empower the v.a. to transform itself into a world-class health care system. my top priority is solving the v.a. access to care crisis. our veterans must receive timely world-class care now and in the future, so that we never again face another patient access crisis in the v.a.

we can do this in two ways, by solving the v.a.'s own access and capacity problems, and by expanding access to non-v.a. care. first, the v.a. must have the authority to expedite hiring of health care professionals, so that the v.a. facilities are adequately staffed to meet the growing number of veterans in need of care. second, the v.a. must have the authorization to lease more facilities so that the providers have the space to care for veterans, and so that facilities exist closer to our veterans. senator tester, i represent a very large rural district in arizona, and everyone has trouble getting access to health care. you're right about that. >> clinics must be fully staffed. phoenix arizona needs another community-based outpatient clinic. third, well-must expand access to care for, and for veterans who have waited too long for

care. it only makes sense to give veterans a choice card that allows veterans to receive their health care through medicare providers, and at federal health care facilities if they live too far away or have waited too long. we must strengthen the partnership between the v.a. and the indian health services, a partnership that is working on the navajo nation in my district. the senate proposal does just that, and it is also less expensive than the house's version by $16 billion. i highlight only a smart part of the senate's v.a. overwhat you will legislation will do to help our veterans. i urge all my colleagues on the committee to championship sweeping reform of the v.a. today. the v.a.'s reformings good for my district, and veterans across the country. thank you, and i yield back. >> thank you.

senat senator begich. >> thank you. i know we have all talked about the systematic problems. i want to be very clear, as we work through this, i want to see a piece of legislation that ensures accountability and restores public trust in the v.a. system. my state is one fifth of the size of the mass of the united states. 0% of our communities are not accessible by roads. we have no v.a. hospital. we have a clinic in seabox, and we have the highest per capita of veterans in the nation. we have a unique situation in trying to create access. once people get into the system, they like their doctors, but access is one of the biggest problems. in alaska, it is more apparent the problem. veterans in alaska have unique

needs. the sheer size of the states creates challenges of delivering health care and many live off the road system. with air transportation as their own system, which is heavily dependent on weather conditions. most of them do not get their care needs they also knew we needed to take care of veterans in places that did not have a v.a. or private doctors. we did that by working directly with the secretary shinseki anded tribal health providers. each provider has a unique agreement with the v.a., with the goal of provides care to veterans who sometimes travel thousands of miles. to date there are 25 agreements with alaska tribal health providers, and agreement with the federally qualified health centers. alaska v.a. has made great

progress. in the last four years by expanding outreach, tele medicine, and reducing wait times, sometimes in just less than a week. in our private facilities that are tribal health providers and our federally qualified health centers, if they're on the list, they get service the same day. given alaska's unique challenges of making health care accessible, i believe alaska serves as a unique model as we try to resolve access. we have in our tribal health provider system, we have an internationally recognized system, which is designed to deliver health care with results, not just processing people through the system. for the purpose of this conference, the committee i would like to put forward the model of alaska hero card, expanding the rural areas around the country. if it works this alaska, as i tell people, can can work anywhere in the country. as for the shortage of providers such as wasilla, where there was no primary care physicians, the alaska v.a. worked on an agreement with the veterans who

choose to now access and go across the street to a brand-new clinic run by the tribal provider and get their primary care with no wait time. for mental health my bill with the co-sponsor, would authorize the v.a. to recruit a select number of psychiatrists with 50% being from rural areas by offering loan repayment incentives. according to the president's fiscal year 2015 budget, requests more than 1.4 million veterans received specialized help. initial more than 55% of the post-9/11 veterans have a mental health diagnosis, and nearly 6,000 veterans commit suicide each year. the need was for more psychiatrists to meet the mental health and substance abuse treatment needs of our veterans. as for construction, i know this bills looks at construction to look for a way to build v.a.

buildings and that facilities for future buildings, and to ensure that they are built on time, within their budget, and save taxpayer money. a it's not perfect, but we are an extreme rural frontier, so to deliver health care in alaska is a great effort, but these agreements in many cases have created better access for our veterans, no matter where they live, and i think it's an effort we could expand and see around the country. thank you, mr. chairman. >> thank you. congress m congressman cou maman coffman.

>> it's an honor to be on the committee. i fully understand the obligations this nation has to those who have made tremendous sacrifices in defense of our freedom. having served in the army and marine corps, our first gulf war and the iraq war. i've seen republicans and democrats come together with literally no daylight in between them, and i think the american people should be proud of that as well. i am shocked of what i learned, the systematic bureaucratic incompetent and culture of corruption that seems to permeate the leadership of the department of veteran affairs,

but i want to tell you about so many of the men and women who i believe are so dedicated who work for the department of veterans affairs. many of them have had the courage to step forward and to be whistle-blowers, and we would not be here today if not for them, because the leadership of the veterans administration has never identified any of the problems that are before us today. it is the rank and file who are on the front lines of the veterans administration who have been the whistle-blowers who have come forward, because they want to honor our nation's commitment to the men and women who again have sacrificed so much in defense of our freedom. i think the fundamental answer that i hope comes out of this conference committee is choice, is giving choice to our veterans, and i know that we're defining that by distance from a veterans facility, as well as the length of wait times that

one has to wait before they receive care, but i think that will make not only the veterans health administration better, but i think also obviously it will improve access and care to our nation's veterans. i'm reminded by a sign that was above the barracks store in my first assignment in the military that was in the united states army that was -- it said lead, follow or get out of the way. i would ask the president that, at the end of the day, no matter what we do, if there is not adequate leadership in the department, that we fundamentally will not change it. i think membsomebody has to get

there and clean house at the top, with that, el yield back, mr. chairman. >> thank you, mr. chairman. >> i appreciate the chance to serve on this conference committee with each of you. i'm finishing my 16th year in congress. i have seen this story before. my challenge is to fix the real problems, not the symptoms. the likelihood is we're going to spend a bunch of money, and i wanted to share with you a couple standards from the president's fiscal year 15 budget submission, current estimate is 6,616,000. 11 thousands primary care doctors, 12,000 nurse practitioners and p.a.s. that figures out to 287 unique

visitors per provider. per year. the averages private care physician in this country sees five times that. so when i hear about we need more providers and more money, i just go nuts, because what we need is exactly what you want, representative coffman, we need leadership, and we need what the ravens member from the house said. we need the ability to control those that manage. if you don't fix the real problems, you'll be back here again and the commitment to the veterans will be wasted. the most important thing is we will have wasted an opportunity to actually make a difference in our lives, which is our commitment to them. i look forward to working -- i issue add report today, and mr. chairman, i'd like a copy of that report to be placed as part of the minutes. >> without objection. >> it paints a dismal picture of the v.a. if you take the time to read it,

you will become incensed. we have lots of great hospitals. we're better in certain areas than anybody in the world, but we've heard the statement several times today, the v.a. care is good. if you cook the books on appointments, you have no idea whether the v.a. care is good. so what we -- we don't know that it's bad, but we don't know that it's good, because there's no true transparency in terms of quality outcomes in the v.a. so if you really want to fix the v.a., you have to make it totally transparent, give the management the capability to truly hold the people accountable, and if we'll doug that, we'll make a big difference and live up to the commitment that abraham lincoln promised them. >> thank you. congresswoman brown.

i've been on the v.a. committee for 22 years and let me just say that the v.a. is one of best systems in the united states of america as far as veterans' health care is concerned. now, i want to start out with that i sent a her to my colleagues for their suggestions as to how we can improve the system, but i want to be clear that i am not going to be a part of dismantling the system. yes, the system has problems, but i've been on this committee long enough to know that for the first time in a number of years we built any v.a. hospitals. 15 years, we have not built a

single one, and in fact, the vietnam veterans, when they came back, each one had to prove that their ailments. now it's opened up, we've opened the system and let thousands of veterans come in. so we certainly have to have accountability for the system, but i will not be a part of dismantling the systems. the veterans are satisfied with the system. yes, there are problems with the system, but it's not just the v.a. it could be the v.a., it could be the department of defense, it could be all of the other stakeholders. we haven't built a v.a. hospital in the system in 15 years. i've been working to get one built in the orlando area. well, it's not just the v.a. it is the contractors. it's the stakeholders.

so it's a team effort. i'm hoping that we can work together to improve the system. but i will not be a part of dismantling a system. recently in the house of representatives, we passed a bill saying that in those states that marijuana is legal, the v.a. doctors cannot write prescriptions. hmm. explain that to me. if they have pain and the doctors feel it's necessary, then why can't they write the prescriptions? so there are a lot of things that we need to do. when you look at the educational system, one of the best, with this new g.i. bill. well, what's wrong with it? i saw them on television talking about it. well, we work with stakeholders. the institutions have to verify that they were a student and that that they were registered,

now all of them get transportation. they get their tuition paid. they go ahead daycare, but it has to be verified with the universities. so it's not just the v.a. it's a team effort. the army motto is one team, one fight, and i'm hoping that we're here to make sure that we improve the system, and i repeat, i will be not a part of dismantling the v.a. system. for many, many years the v.a. was not receiving the funds they needed, and don't sit here and tell me, well, it's not like the system in the streets. well, the system in the streets is not working either. so we need to look at the entire health care system in this country. but the veterans are satisfied with their system once they get into the system.

i am here to make sure their voices are heard. i've asked my colleagues for any input, any comments that you want to make, how can we work together to make it better? i really do believe to whom god has given much, much is expected, and they expect us, like the first president said, whether or not people are going to join wars, we always want to send them off to fight. let's make sure when they come back, we take care of them. that's my position and i stand by it. thank you, mr. chairman. >> thank you. senator rubio. >> thank you senator sanders and williams for the work on this legislation. i'm grating to be a part of this conference committee. to bring us to this point of our ironing out the differences between the two proposals and hopefully the president will have a -- will have a final v.a. reform bill that he can sign boo

law. let me bring -- first, i represent the state of florida, which is home to almost 2 million veterans. we have numerous v.a. -- and recently we have seen some major problems uncovered at some of these facilities, where six are among the 112 being investigated nationwide, potential manipulating patient schedules in order to conceal long wait periods. seeing these v.a. scandals in florida and around the country have disgusted my, as i know it's disgusted many of you. and we owe or veterans than this. our veterans deserve state of the art care in a timely and dig 234i filled manner. we offer what will be the final step, to correct the sad state of afarce in the fashion's v.a. system. my second major interest in this committee is that both the house and senate have passed bills

that include to varying different degrees a measure we we introduced earlier this year. it's also included in this proposal. this bill that we've proposed is pretty simple. it says that the v.a. secretary should have the adviser to fire or demote executive service or equivalent employees based on performance. if v.a. firms are not doing their jobs and deliberately trying to conceal how poorly they're doing their jobs, they should be fired. most people have been surprised that you even need a law to make this possible, because it's common sense in practically every other workplace in america. it sends a terrible message to our veterans, taxpayers and the vast majority of employees who are doing a good job to let incompetent officials get away with poor performance. worst of all, poor performance at the v.a. doesn't just hurt employees more real, it

engangers the lives of veterans. i'm hoping with all the issues were dealing with that this particular measure won't become a sticking point. i'm hoping that the final bill ultimately enshursz that going forward incompetent will be dealt with fairly but swiftly. in closing let me say that american veterans deserve our administration and appreciation for all they have done to defend or country and interests abroad. the most tangible way we can do this is by ensure their needs are met with timely, qualified and dignified health care. reforming the v.a. is long overdue. the truth is it shouldn't have taken the scandal to get to thissh to finally act. so let's do it. our veterans have waited long enough. >> congressman waltz. >> thank you, senator, chairman

miller, and ranking members. thank you to each of muir colleague. you came to congress and chose to serve on this committee, and that says much about your character, and i'm grateful for that. as so many people have said the triage dpi is spelling itself out and there's no adjectives to describe it. don't underestimate the american public's willingness to get this right. , and again i would ask each of you to understand, each of us will be judged by the product we produce, as we should be, by vet advance. like so many of my colleagues, this is an opportunity to think big. i think senator coburn was getting at it and thinking like a physicians, you have to diagnose first before you can prescribe cures. we node to know what will be there and be willing to get it out there. coming from a family of korean -- son of a korean war

era veteran, and myself in adult life, i can tell you restoring the faith of the veterans is critical. the service organizations sitting here listening today, it matters. it matters that we get them back on board. they've seen this before. they've seen the yellow magnets that are now faded. so i would encourage my colleagues, let's have vision on this. let's triage and get the care done right now, but there are issues we can set a legacy, we can change the culture, change the trajectory. i would put out there that we do need to have the details. there are physician shortages. there are accountability. those things will be handled. i think what's missing here is i've never quite understood, in against over 24 years in uniform and eight years having the honor

to serve on this committee, why is there no overarcing strategy, no quadrennial review in why is that not tied to the budgeting process? we wouldn't accept that in the dod, yet we accept it here? i would argue that would set the stage for accountability. thwarting what we think. when i asked yesterday senior v.a. officials what our strategy was, they want the timely care of our veterans. that's a goal, that's not a strategy. you can't get there unless you have that. so i'm encouraged by the folks who showed up here. it's obvious this is serious, and we have the american public's attention. they're busy, they have lives, they're working, doing all. that. now's the time. let's not miss the opportunity to get this right. i'm confidence the folks have

possess the ability to do that. with that, i yield back. >> senator blumenthal. >> thank you, mr. chairman, chairman miller, as well as ranking members for your leadership, and to all of my colleagues here today for this very bipartisan and cooperative approach which is quite remarkable to me. as a veteran of all of 3 1/2 years in the united states senate, and i hope it bodes well for how we will work together on the challenges that continue to face us. especially the 683 veterans in connecticut who are waiting more than three months to see a doctors, and veterans coming back from afghanistan who have to wait 18 days or three weeks for a mental health appointment. many of them have come to me.

we really face an emergency, a crisis. in fact, it is a -- an emergency that gives new meaning to that word. i'm hoping that we can honor both the commitment of our veterans to our nation and our obligation to keep faith with them in regarding it as an emergency in a crisis and treating it that way as a matter of funding. time is not on our side. this tragedy is a growing, unfolding burgeoning one. we're literally learning day by day about its new dimensions. the office the the medical inspector dismissing real health concerns as not impacting patient health, and dismissing those concerns. the story about whistle-blowers. for me, as shocking as cooking the books and covering it up, is

retaliation against our whistle-blowers. they are the ones who are telling truth to power. i know as a former prosecutor, you can't make cases, you can't reform the system if whistle-blowers are victims of revenge and retaliation, and lose faith in the system. and so i would invite members of this committee to join senator mccain and i, and others of our colleague, in asking for the department of justice to investigate not only the reports of fraud and destruction of documents and obstruction of justice, but also retaliation against whistle-blowers. i would predict, mr. chairman, that we're going to see this tragedy continue to unfold, particularly as concerns our female veterans. there are reports that women veterans are far mo likely to be dumped into the v.a.'s electronic waiting list for an

appointment. 140 community-based clinics serving in rural areas do not have a designated women's health care provider, despite the goal that every clingic would have one. only 1 in 4 v.a. hospitals -- only 3 in 4 have a full-time gynecologist. 1 in 4 does not. so we are lacking not just in terms of delays, but the quality and the availability of health care to our veterans although, again, it's not addressed in this bill, employment opportunities, still training for me one of the most outrageous statistics in society today is the unemployment rate among our young veterans, particularly as compared to their contemporaries who did not serve. so i think we have a lot of work ahead of us. i am very, very encouraged by

the way this committee has so thoughtfully and seriously addressing these issues. we know that america's longest war is going to continue to cast a shadow across our nation for years, maybe decades to come, and we face that emergency and crisis, and i hope we continue to do it. thank you, mr. chairman. >> thank you very much. congressman winstrom. >> thank you all for being here. you know, our world has a lot of things going on today, and the news cycle changes fast. i encourage everyone here to stay focused on this issue, because it's a very important issue for our country. as a physician, as a surgeon, i practiced for 26 years before coming here last year. served in the army, i was in iraq for a year as a surgeon at

a combat support hospital, so i have had the honor of taking care of our troops not only in theater, but stateside, and also like many docs throughout the united states, i trained at a v.a. through those experiences i've been able to see the inefficiencies and bureaucratic barriers that exist, and we can't ignore them. i've seen the difference between a v.a. system and private system, as has been pointed out several times today. there are some issues that i think are treated much better within the walls of the v.a., because they're troop specific, and i think they can be handled by and large. in the v.a. i know we have tremendous caregivers. we do, but what we are lacking in the v.a. is efficiency. and we're lacking seemingly administrators that have scruples, and that truly care about their patients. so before all this broke with phoenix, there were several doctors on the house side,

bipartisan, that were seeking to take action about the inefficiencies of the v.a., because we know, because we've come from private practice and know the difference. it book about a career to finally get a meeting and then this broke. it's a shame that it's taken -- a disregard to our receipt ran as patients, because the inefficiency has been there a long time. in my own practice, two orthopedic surgeons go to the v.a. once or twice a month, because they want to take care of veterans, and they will tell you i can do two cases all day, and in private practice i'm doing eight to ten of similar procedures. as we moved forward we have to have the input of practices physicians, not physicians who have never seen patients, not physicians who have been in academia or administration, they're the ones who know how to get it done inside the clinics. our administrators have to know

what it means to be a provider. just building buildings does not provide access to care. when a patient becomes a liability to the system, that's a problem. patients need to be seen as an asset to the system. that's what we have to create. the stakes are too high. they're too high for those who have sacrificed so much for our country. these are people that at a moment's notice said i will go and i will take action on behalf of our country. now it's our turn to do that for them. they responded in a moment's notice, now we need to. our work here will reflect who we are as a people and who we are as a nation. i'm honored to serve on this committee. it's a very important task for all of us. let's go to work and make our nation proud. let's go to work and make our veterans produce. let's go to work and make abraham linking proud who tasked us with the response to care for

him who have have borne the battle. thank you, and i yield back. >> thank you. senator horono. >> this committee has an important task in the coming days ahead, to finalize legislation that in my view should focus on three things. first we have to address the emergency circumstances that have been uncovered. two, ensure all our veterans receive access to the dare they deserve. begin the longer-term work of restoring trust not only in the v.a., about but in congress's ability to effectively oversee the v.a. and provide the resources needed to care for our veterans. listens to my fellow colleagues, and conferrees today, i believe we can come to an agreement on

this bill. chairman sanders, you got it exactly right when you said that the situation at the v.a. is an emergency, and senator mccain, today also described the situation as an emergency. a recent audit of the v.a. in hawaii found that veterans are waiting over 140 days to receive care, the longest in the country. a more recent update found while progress is being made, that number is still over 100 days. nationwide, nearly 60,000 veterans are waiting simply to get an appointment. of course that is unacceptable to all of us. nearly the entire senate agrees that this is an emergency and that congress has to act to provide the resources necessary to provide care immediately. i'm hopeful that we can all agree on that point. however. while el hope we agree and we will provide the resources necessary, i hope this committee

will not ignore the task of addressing long-term needs. that they receive from the v.a. when they receive it. i hope we will include provisions in the senate to pass legislation that provide for 26 major medical facilities leases, and provide for the resources and authority to expedite hiring of v.a. doctors and nurses. in addition, while i agree that accountability of executives is needed, we should avoid politicizing the non-appointed civil service process and allow due process for v.a. employees, even as appropriate disciplinary actions are taken. our veterans rely on the services of qualified committed professionals at v.a., and we should be doing more to attract move of these people. i hope this commit aye will

recognize the long-term benefits of attracting a high quality workforce for the v.a. and we can improve accountability in a carefully balanced way. a quality work fork and quality facilities are long-term investments in our veterans, investments we feed to make sure that all veterans have access to high-quality v.a. care. 1re6789 in the v.a. is an essentially step towards buildings back the trust of our veterans. i recognize that expanding access to non-v.a. providers is needed to immediately address the emergency. with this expansion, we must ensure every veteran in our country, whether rural or urban, can easily get the care they need if the v.a. is not available form for hawaii veterans, that should include being ability to get care from community health centers, department of defense facilities, or from the native hawaiian health care system. that doesn't mean they're getting care outside of system is a long-term solution.

i do not support a proven that will tread to atrophy of the vex a. i do support congressional leadership and action that addresses the current emergency, ensures or veterans can access the care that they deserve, and lays the groundwork. this is important that we stay the course so the v.a. can effectively address long-term needs. i thank you. i yield the remainder of my time. >> thank you, senator. congresswoman? >> thank you, mr. chairman. it's an honor for me as well to start the process of legislation to help our veterans. we owe it to the men and women of our country to get this right. i'm grateful this has not been a partisan issue. all of user affected by the waitlist. many of us here today who have constituents that are directly impacted. there's a potential wrong death case in my area that is being investigated. we have to get this right.

attempts at reform before were oftentimes met with stories from inhere, resistance, deception, whistle blow retaliation. now we're hearing medical center has also been alter the records of veterans who died waiting for care. while bad actors put their own careers above the health of -- the department turned a blind eye and rewarded these bad actors at the heart of this disaster with financial incentives and bon uses. this insular and self-protection attitude is at the core of the problem and is one of the things that has to change. there will never be an incentive to change if people aren't held accountability for their actions. we need to get the care that veterans need and fast. there's no question we must give veterans the care they deserve, whether it comes from inside our outsi outv.a. i agree with what senator coburn was saying, the need for the legislation is great.

however, simply providing a financial boost for an agency that has repeatedly demonstrated awful management practices is not going to solve this problem. there's no point to spending an additional $50 billion a year in non-v.a. care if we don't do this right. my commitment as we work on this legislation is make sure bad actors can be fired, to makes sure we do whatever we need to do to pay for this, to make responsible reforms. now is our opportunity to take the first step. they problems are multilayered, and getting to the bottom of it has been like peeling apart an onion, piece by piece. however, i'm confidence that the proposal is positive steps in the right direction. i look forward to working with all of you, as we hammer out a final version of this legislation that responsibly addresses timely access to care. i thank you for holding this

hearing. i yield back my time. >> as a former member of the house, i do note that members of the house speak more briefly than member of the senate. i thank you for that. there's a vote going on in the senate, so some of us will have to leave. i wanted to thank all of you. i think there is a constructive discussion. i think there's a strong desire to rise, and address the very, very serious issues facing the v.a. i know there's a commitment on the part of the members in this room, so i just want to thank you owl. we have a lot of work to do, and i hope we'll do it as rapidly as we possibly. >> i will say this. i tried to get charm sanders to go on to the vote and told him the house would be more than willing to put the conference reporter together and prepared it for his signature, but he denied that opportunity. thank you very much. weft a lot of work to do, we cannot fail.

today is primary day in five states -- utah, colorado, oklahoma, new york and maryland. in addition there are runoff elections in south carolina and mississippi, where incumbent that had cochran is up against tea party challenger chris mcdaniel. there's also a special election in florida to replace trey radell, who resigned. we'll have more from the mississippi race, as well as results from all the voting whenle polls close. that plus analysis from reporters and your calls, tweets and facebook comments, all tonight on c-span2. where live coverage, here on c-span3, we complement that coverage by showing you the most

relevant congressional hearings and public affairs event. then on weeends c pan 13 is the home to american history tv, with programs that tell our nation's history. including six enuke series. american artifacts, touring museums and historic sites to discover what artifacts reveal about m.a.s.h. es past. history bookshelf, the presidency, looking at the policies and legacies of our nation's commanders in chief. lectures in history, with top college professors, and our new series "reel america" features archival films. c pan 3, created by the capable tv industry, and funded by your local cable or satellite provide. watch us in hd, like us on facebook, follow us on twitter. more now on the veterans' health care issue. yesterday the house veterans'

affair committee continued to look at delays in treatment. republicans and democrats expressed frustration as officials from the veterans health administration acknowledged they had work to do. separately on monday, an out of of special counsel report showed one veterans waiting eight years before getting a full psychiatric evaluation, another that spent seven years as an inpatient but had one psychiatric note in his records. this is just over two hours. the committee will come to order. welcome to tonight as full committee oversight, evaluating the capacity of the v.a. to care for veteran patients. during our proceedings this evening, we hopefully will assess the department of veterans affairs efforts to increase capacity and efficiency

of medical facility operations and ultimately improve access to care for veteran patients wo have been facing unacceptable wait times. importance to that is is the initiative, the initiative was launched in late may in response to the department's current wait time crisis and information released last thursday suggests that it in coordinate with v.a.'s other efforts has led to the scheduling of approximately 200,000 appointments from may 15 to june 1st. i'm glad to see the department seems to be taking its access failure seriously, and is taking steps accordingly to improve the timelyness of care for veterans patients. however, i do have serious concerns about v.a.'s efforts to date. one of my concerns is the continued lack of detailed information that consequence has received about the initiative.

making this yet another in a long and continually increasing list of examples of v.a. failing to act in an open and transparent matter. the committee requested a briefing from the department on the accelerating access to care initiative on june 2nd. i followed up this request with a formal letter to acting secretary gibson on june 5th, requesting an immediate briefing on the initiative. it has now been 19 days since that request for an immediate briefing, and no further information or acknowledgement of our request has been received. it baffles me as to why the department failed to provide this committee with the information we requested on a program of this side and this importance. if v.a.'s world has indeed lulled to 200,000 more appointments so far, was there to hide? more importantly, over the last several we're, investigations

have proven that the health care data manipulation and patient waiting times was for you to be widespread, and given that, hows and the american taxpayer and our nation's veterans and families have any confidence in these latest numbers that the department has released? furthermore, if you were there actions that the va could have taken to increase access to care for veteran patients, why were those actions not taken long before now? as part of this initiative skrchlt a claims to be taking steps to, in the department's own words, systematically review clinical capacity, ensure primary care clinic panels are correctly sized achieving the desired level of productivity. extend the clinic hours on nights or weekends and increase the use of care in the community and reach out to veterans to coordinate and acceleration of their care. each of these actions should

have been operational components of regular va business long before now and va has had the statutory authority to use these options previously. we know that at least 35 veterans in the phoenix area alone died while waiting to receive va care. so i suspect that number may rise in the coming weeks and months. 57,000 veterans nationwide have been waiting 90 days or more for their first appointment and 64,000 veterans enrolled in the system over the last decade never received the appointment that they requested. it's too late for those 35 phoenix area veterans and it may be too late for other veterans who have been waiting for weeks, months and in some cases, years. so i ask again, if there were actions that v.a. could have taken to increase access to care for veteran patients, why were those actions not taken long before now?

where that, i yield to the ranking member for his statement. >> thanks for this hearing tonight. providing timely, quality, safe care to veterans is the primary mention to veterans fairs integral to accomplishing this mission is the ability to successfully measure the capacity and capability of the organization. mr. chairman, at this point in time, i do not have much confidence that va has been able to do that analysis. i firmly believe that if you do not have good numbers on which to base calculations, then you cannot possibly begin to accurately measure the capacity or demand. anticipating capacity and demand is central to good strategic planning. clearly, va is struggling to get a handle on how many veterans are undergoing or waiting for treatment. it seems to me having a significant number of patients on the waiting list indicates a system that is overwhelmed and

unprepared. the vha with not handle the increasing number of veterans with whom we have an obligation to provide sound treatment. the testimony on march 2013 that vha office of productivity, efficiency and staffing conducted studies in 2006 of 14 specialty care services. the report had nine recommendations. on the recommendation, one of the recommendation was to have the vha develop relative value unit productivity standards and staffing guidance for the field. i recognize this as a complex process in va health care has continued to change over the years. but eight years to develop this system is too long and is unacceptable. while dr. lynn states in testimony by the end of september, 2014, all vha any cigaretteses will have productivity standards in place. i'm skeptical of the usefulness of those standards due to the

current crisis. today, i'd like to hear from va how they are measuring capacity in a timeline for when this will be done? and most importantly, any additional resources that may be needed to ensure va is fully fulfilling the primary mission of providing health care our nation's veterans. mr. chairman, i know that the vast majority of the department employees are hard-working and dedicated to caring for our veterans. for that i applaud them. but we still have a responsibility and duty to take kay of all of our veterans and i look forward to hearing from the va tonight. i want to thank you for coming. with that, i yield back. >> thank you, we're honored to be joined this evening by dr. thomas lynch, the assistant deputy undersecretary for health, for clinical operation and he's accompanied by dr. carolyn clancy, the assistant deputy undersecretary for health for quality, safety and value.

we appreciate you both for being here tonight and dr. lynch, we appreciate you coming for your return engagement for an evening function. you're recognized for your opening statement. >> good evening, chairman miller, ranking member michelle and members of the committee. thank you for the opportunity to discuss the provision of timely, accessible and quality care for veterans. i'm accompanied today by dr. carolyn clancy, assistant deputy undersecretary for health, quality safety and value. at the outset, let me address the significant issue that's been the focus of the committee, the va, and the american public. that is, the issue of wait times. no veteran should ever have to wait an unreasonable amount of time to receive the care that they have earned through their service and their sacrifice. america's veterans should know they will receive the highest quality health care from va. while we realized the timeliness

of the services is in question, va acknowledges and is committed to correcting the unacceptable practices in patient scheduling. as my colleague stated on june 9th, this is a breach of trust. it is irresponsible. it is indefensible and unacceptable. i apologize as he did to our veterans, their families and loved ones. members of congress, veteran service organization, our employees and the american people. these practices are not consistent with our values as a department and we're working to fix the problem. va has a physician workforce of more than 25,000 physicians. representing over 30 specialties. the va now has comprehensive information about the staffing levels at each medical center and the productivity of our physician workforce using a standardized relative measure of relative value units. rvu consider the time and intensity of medical services

delivered. optimizing physician productivity is critical to our ability to determine clinical capacity and mobilize our clinical assets to rapidly address unacceptable delays and service. supporting a productive workforce provides brooimpbt staff ratios and the capital infrastructure to ensure the clinic is run as efficiently as possible. the difference between the estimated capacity and our current workload represents the amount of additional care we could provide to address veterans waiting for care. va is accelerating adoption of productivity standards because they're critical in determining the vra capacity and improving timely access to quality care for veterans. we're about a year ahead of scheduling completing action plan based on the recommendations of oig in plate 2012. we'll have productivity standards in place for all physicians and vha by the end of this fiscal year. like all of health care, va has

transitioned to a system in which outpatient care is increasingly important, especially for the management of chronic conditions. the va has established the nation's largest medical home approach to primary care. where people receive care from teams. and in addition, to face-to-face visits, they receive advice and consultation which can be provided through technology, through telephone calls, secure e-mails and telehealth. lefring these capables to deliver veteran centric care requirements investments in care, training and ongoing valt evaluation to make sure services are focused to the veterans. since the majority of u.s. physicians receive some training a va facility, we've also invested in contemporary approaching to undergraduate and graduate traping that re-enforced the importance of teamwork and technological sk s skills and ensure the promise of these models achieves the goals of personalized veteran-centric

care. the health and well being of the men and women who have bravely and selflessly served this nation remains the va's highest p priority. he will have staffing standards for all specialties and have access to high quality efficient care available to our inflation's veterans. we must regain the trust of the veterans we serve. va leadership and dedicated workforce are fully engaged. this concludes my testimony, my colleague and i are prepared to answer any questions you and the other members of the committee may have. >> thank you very much, dr. lynch. how quickly ask va hire clinical staff under current authorities? >> mr. chairman, i don't have the answer to that question. i know that our current processes, particularly in human resources, are slow. we are putting processes in place to speed those processes. to speed that process so that we can hire physicians more

efficiently and more quickly. >> are there any impediments that we as a legislative body can do to assist in removing some of the barriers? >> at the moment, mr. chairman, i can't think of any. >> i would simply add that -- >> sorry about that. i would add that some part of the reason it takes a bit of time is the credentialing and privilege process which i think you would all want us to be rigorous about. we're investigating ways to try to speed that up but the human resources part is probably one. >> what is the expected cost of accelerating access to the care initiative and how are you funding it currently? >> right now the expected cost that we have invested is approximately $312 million. it is being funded based on monies that we had been able to recover from