>> good afternoon, everybody. thank you for being here. before we begin, i would ask unanimous consent all the statements would be added into the records, all would have five legislative days to revise and extend their remarks. without objection, so ordered. today we meet to begin debate and negotiations regarding the house an employment to the senate amendment to hr 3230, the veterans access to care act of 2014. i'm going to recognize myself first and then recognize our co-chair senator sanders. following that conferees recognized in order of seniority alternating between the house and senate and majority and minority bodies. eef will have five minutes at a maximum for brief remarks and absent conferee recognized the next available slot from his or

her chamber. though i recognize we have a lot to discuss, i would ask everybody to please be cognizant of the five-minute time limit so each one of us has an opportunity to be heard on this matter. first time in 15 years the veterans affairs committee have, in fact, engaged in a formal member conference. i would like to acknowledge senator rockefeller and our colleague corinne brown of the 1999 conference and here. miss brown is on her way, as well. i thank you both for the continued service of the veterans of this great nation and alongside chairman sanders and each of you working to address the long standing deficiencies the department of veterans affairs has that has negatively impacted the care provided to america's veterans. by the department's own admission the va health care system is suffering from widespread wrongdoing.

veterans by the thousands have been left to wait weeks, months and years for the care they deserve. tragically, intoller bring, some died before receiving the care they required. for them, the work we begin today is too late. but for those veterans still waiting our work begins not a moment too soon. the bureaucratic failure that is brought us to this point are legion and can only be solved by nothing less than meaningful reform. that reform enacted after close and careful consideration in a face to face deliberation of both bodies. the work done by the house and senate veterans affairs committee is historically bipartisan and i expect this work here today will be the same. we may have differences to address moving forward all of us share the same primary goals. first, to ensure our nation's veterans have timely access to high quality health care and

secondly to ensure that va leaders and employees are held accountable for actions that harm veteran patients. the work we do in this committee will impact the way in which this country's second largest bureaucracy operates in the manner in which veterans throughout the country receive needed care for years to come. and there's no doubt that hard work and tough decisions await us in the days ahead. however, those of us gathered around this doois bring years of diverse experience in government, law, medicine and a variety of other disciplines, some of us are even health care providers. several are veterans including our friends senator john mccain who sacrificed to our country, a few of us can fathom. and senator -- [ applause ] senator, the gavel that i use over in the house was taken from the deck when the ship was sunk off the coast of pensacola but

this was part of the deck of a ship you know very, very well. >> less landing than takeoff. >> yes, sir. all of us share a passion for making the va a better place, a better service. together, we will more than meet the challenges ahead of us. we'll be responsive to the needs of both our nation's veterans and her taxpayers. and we'll live up to the example set by those who wear her uniform. i'm committed to nothing less. i want to thank senator sanders, senator bur, ranking member isho and each conferees for the work done so far and the work to come. i look forward to hearing your comments as we move forward and with that, i yield to chairman sanders for any open comments and introductions he may make. >> well, thereas co-chair of th meeting and the guy to wield the gavel, in fairness for people down on the list, i very much

appreciate if all members kept their remarks to five minutes. let me begin by thanking chairman miller and ranking members michaud and burr and all of the members of this committee for their hard work on veterans issues. despite a very partisan environment here in congress, i am confident that we as democrats, republicans and independents will come together to pass a significant piece of legislation which addresses some of the very serious problems currently facing the va. both pieces of legislation, the house bill and the senate bill, are focused on two main issues. first, the need to provide access to health care for veterans in a timely manner. and the need, also, for holding dishonest or incomp hent senior officials at the va accountable. nobody around this table, i

believe, will accept va officials lying about wait times or falsifying data. nobody around this table will accept the fact that honest whistle-blowers, people who want to improve the system, are having their legitimate concerns ignored. i am pleased that in reality there are more similarities than differences between the two bills and i'm confident that we can reach an agreement that will be satisfactory to everyone and, frankly, that is what our veterans deserve. i think everyone in this room understands that the cost of war does not end when the last shots are fired and the last missiles are launched. the cost of war continues until the last veteran receives the care and benefits that he or she has earned on the battlefield. war is as everyone here knows is a terribly expensive proposition in terms of human life, in terms

of human suffering and in financial terms. and in my very, very strong view, if we are not prepared to take care of those men and women who went to war, then we shouldn't send them to war in the first place. taking care of veterans is a cost of war. period. in terms of iraq and afghanistan, the human cost of the wars is almost 7,000 dead. the cost of war is 530,000 veterans seeking care at the va in 2013 for ptsd alone. not to mention those who were struggling with tbi. the cost of war is too many service members coming home with missing arms and legs, lost eyesight or lost hearing. the cost of war includes veterans each and every day dying by suicide, struggling with high rates of divorce, wives trying to rebuild their lives after losing their husbands. kids growing up in one-parent

homes and too high rates of unemployment for returning home service members. those are some of the costs of war that none of us should forget. 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, test test test test test test test test test test test and no 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 >> thank you. senator coburn? >> thank you, mr. chairman. appreciate having the opportunity to serve with each of you on this conference committee. i'm finishing my 16th year in congress, and i've seen this story before. and michal leng to ea-- my chal each of us is to fix the symptoms. i want to share with you a couple statistics from the president's 2015 budget submission. current estimate for