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. congress is currently in recess for the upcoming july 4 holiday.

lawmakers are taking the opportunity to travel back to their home state. the senate is not scheduled to reconvene until monday, july 7. this onl overturn tuesday, july 8. you can watch this live on c-span and2 the senate live on c-span2. president obama will request $2 billion in congress in response to this. homeland security jeh johnson recently spoke about this issue at a house home and to cure the hearing. he talked about the federal

government options in dealing with the matter. other witnesses included officials from fema and the u.s. border patrol. this is 2.5 hours. the committee is meeting today to examine the current crisis at the border regarding unaccompanied children. i now recognize myself for an opening statement. today on the southwest border we are facing an escalating refugee crisis. parents are handing over their young children by the thousands to cartels who are profiting by smuggling these kids to the united states. many are under the age of 10. including some barely old enough to walk. these children with no parents, relatives or legal guardians risk a perilous and sometimes fatal journey riding buses and trains from central america via

mexico. as a father of five, it's unimaginable to me that what would compel a parent to risk the lives of their children on such a dangerous passage. not to mention the risk of sexual assault, exploitations and the potential to be trafficked. when they arrive at the border, the children are simply turning themselves into the nearest border patrol agent. however, patrol stations are not set up to handle this massive and growing number of detainees. let alone children. shelters have been established like the one at lackland air force base in san antonio. we've all seen the photos of hundreds of children piled on top of each other, and the flow shows no signs of abating. every member of this committee including myself is gravely concerned about the safety of children, no matter where they come from. since october, 52,000, 52,000

unaccompanied minors have crossed into the united states from mexico. nearly two-thirds of those cross through the rio grande valley in texas. cdp estimates that next year more than 150,000 unaccompanied children may attempt to cross our borders. this is a crisis. it's a crisis that's been in the making for years. one that we should have seen coming. but few concrete actions have been taken. the department of homeland security and the united states government as a whole has been slow to act, turning a blind eye to the warning signs. the tragic fact is these children are making a dangerous journey based on misinformation and the false promise of amnesty. the first step is for the administration to acknowledge the cause of this problem. no one questions the fact that there are horrible economic conditions and violence in central america.

but these conditions are not new. what is new is the series of executive actions by the administration to grant immigration benefits to children outside the purview of the law. the relaxed enforcement posture along with talk of comprehensive immigration reform. it is beyond dispute that such a narrative shapes behavior and encourages people to come to our country illegally. in fact, newspapers in el salvador and honduras seem to be encouraging youth to head to the united states based on these policies. in recent internal dhs surveys, these childrenry ve reveal that than 70% believe they are going to stay in the country. this administration should send an unambiguous message that those arriving will be promptly sent home. i, for one, do not want to see another child harmed because we have not clearly articulated the

realities on the ground consistent with current law. yesterday i was glad to see secretary johnson's letter. an open letter to the parents of children crossing our southwest border, notifying them that there are no free passes into the united states. this is a good start. but a lot more needs to be done. in addition to a robust and effective public service campaign, we should also engage with the government of mexico to step up their efforts to secure their southern border. i call on the president of mexico and his interior minister to do just that. i'm very concerned that this recent surge is weakening our border security efforts here at home. border patrol agents and officers who are looking after these children are being taken away from their main duty, their mission of tracking down drug and weapon smugglers as well as criminal aliens.

operation control of the rio grande valley, the busiest sector in the nation, may be suffering. and cartels will no doubt exploit this situation. recently the state of texas announced that it would surge border security operations along the border to fill a void left by the federal government. securing the border is a responsibility of the federal government. states should not need to protect what is in the federal government's role under our constitution. the president needs to immediately send the national guard to the southwest border to deal with this crisis. we need to find solutions to this crisis, and soon. and while secretary johnson has largely inherited the current situation, i look forward to hearing now how he is planning to respond to this emergency. again, i want to thank the witnesses for being here today on such short notice. the chair now recognizes the ranking member. >> thank you, mr. chairman.

i want to thank you also for holding today's hearing. i want to thank the witnesses also for their testimony. on a daily basis, waves of children ranging from toddlers to teenagers are fleeing violence, oppression and economic desperation from guatemala, honduras and el salvador. many of them sent by their families. they are simply looking for a safe haven. as an intense and significant humanitarian crisis develops, we are finding it to be complex. it is irresponsible to attribute this crisis to one u.s. policy, or for that matter, one u.s. president. despite the demagoguing by many, this crisis is not just an immigration matter, nor is it just a foreign policy matter. this crisis is not exclusive to the united states. much of the western hemisphere is reeling with this crisis.

according to the united nations, these children are streaming into mexico, panama, nicaragua and belize as well as canada and the united states. from our perspective, we seem to be barraged on a daily basis by troubling images of vulnerable children, many still clutching their dolls and teddy bears, crossing the border into the united states and being immediately apprehended by border patrol officers. this fiscal year alone, the border patrol officers have apprehended and detained over 50,000 unaccompanied children at the southwestern border. the number of kids arriving at our border without their parents seems to grow by the day. the influx of these kids has certainly strained border patrol resources. but the men and women of the border patrol have risen to the challenge. in 2008, then president george bush signed a william we believe

force trafficking victims authorization act. t( law recognizes that special kay is demanded when dealing with the young and vulnerable. under these laws, the border patrol is required to take unaccompanied children who are not from mexico into custody, screen them and transfer them to the department of health and human services office of refuge resettlement. i would note for the record that during this challenging time, f even though border patrol has had to ramp up activities in the rio grande valley, the agency's effectiveness rate has improved. for those out there who are looking for simple answers, to lay the blame on president obama's policy on action for childhood arrivals or even the senate-passed comprehensive immigration reform legislation, i would note that neither would apply to these kids. hence the assertion that the recent surge on unaccompanied

children is due to lack of immigration enforcement does not pass the smell test. in a time of crisis such as this, mr. chairman, we need to get our priorities in line and find both near-term and long-term ways to address this situation. on june 2nd, the president tapped secretary johnson to establish a unified coordinating group to ensure federal unity of effort to address this situation. in turn, secretary johnson appointed fema's administrator fugate to be the fellow coordinating official and lead those efforts throughout the executive branch. looking out to the long term, we need to do more to turn the tide on this crisis by, among other things, fostering greater stability among our neighbors and dissuading families from taking such action. over the weekend, secretary johnson issued a public service announcement in various central american countries, debunking the myth about u.s. immigration

policy, and informing the parents about the danger of traveling from central america to the united states. today i want to hear from the department about the response and their work with other fellow agencies, including the departments of health and human services, defense and state in addressing this crisis. we need to organize all our fellow agencies involved, not just dhs, to effectively address the sudden surge. looking beyond dhs, there are questions to ask about hhs's resources for that matter. states' engagement through regional security initiatives such as the central american regional security initiative, do these programs have enough funding and personnel to be effective? i recognize that the panel assembled today may not be in a position to answer this question, but it is a question i will be pursuing. dehumanizing and labeling these kids and their parents will not

yield a solution. labeling this as an administration failure will not address what is actually going on in el salvador, honduras and guatemala that would cause a parent to hand over their son or daughter to a smuggler, or send that child through a perilous trek through central american and mexico to the united states. at this time, mr. chairman, we can use our platform to rise to the occasion and be helpful. or we can engage in political grandstanding at the peril of young lives. it is my hope that this committee, with its strong history of bipartisanship, can choose the former and be a model for effective leadership on this matter. with that, mr. chairman, i yield back. >> i thank the ranking member for his constructive comments. other members are reminded that opening statements may be submitted for the record. we're pleased to be here today to have a distinguished panel of

witnesses before us today. first, the secretary, jeh johnson, of homeland security was sworn on in december the 23rd, 2013, as the fourth secretary of the department of homeland security. prior to joining dhs he served as general counsel for the department of defense where he served as part of the senior management team and led more than 10,000 military and civilian lawyers across the department. as general counsel of the department of defense, secretary johnson oversaw the development of the legal aspects of many of the nations counterterrorism policies and spearheaded reforms to the military commission systems at guantanamo bay. you and i talked privately. you have traveled many times down to my home state of texas and seen this crisis firsthand. we thank you for doing that. he is accompanied today, this morning, by mr. greg fugate, the administrator of the federal emergency management agency.

and mr. ronald vitiello, deputy chief of the united states border patrol. mr. fugate and mr. vitiello will not be offering opening statements. they're here to answer any questions members may have. secretary has submitted a written statement. on behalf of those witnesses which will appear in the record. the chair now recognizes the secretary for five minutes for his opening statement. >> thank you, chairman. you have my prepared statement. i will deliver an abbreviated version of it. mr. chairman, ranking member thompson, members of this committee, i thank you for the opportunity to testify today about our efforts to address the recent rise of unaccompanied children and others crossing our border in the rio grande valley. with me today to answer questions are craig fugate, the administrator of fema, and deputy chief ron vietillo of the u.s. border patrol. to be clear we face an urgent situation in the rio grande

valley. last fiscal year, cdp apprehended more than 24,000 unaccompanied children at the border. by mid-june of this year, that number has doubled to more than 52,000. those from guatemala -- guatemala, el salvador, honduras make up three-quarters of that migration. on friday, i traveled to south texas for the fourth time in six months in office. this time to lead an interagency team to oversee our efforts there. while there, we met with officials at mcgown and lackland to review the situation and hear directly from those on the ground what their needs are. while there, i spent time talking with the children again. it is a vivid reminder that this is a humanitarian issue as much as it is a matter of border security. we're talking about large numbers of children. without their parents. who have arrived at our border hungry, thirsty, exhausted,

scared and vulnerable. how we treat the children in particular is a reflection of our laws and our values. therefore, to address this situation, our strategy is three-fold. first, process the increased tide of unaccompanied children through the system as quickly as possible. two, stem the increased tide of illegal migration into the rio grande valley. three, do these things in a manner consistent with our laws and values as americans. so here's what we're doing. first, on may 12th, i declared a level four condition of readiness within dhs. which is a determination that the full capacity of cbp and i.c.e. to deal with the situation is full and we need to draw upon additional resources across all of dhs. i appointed deputy chief vitiello to my left to coordinate this effort within dhs.

second, on june 1st, president obama, consistent with the homeland security act, directed me to establish a unified coordination group to bring to bear the assets of the entire federal government on this situation. this group includes dhs and all of its components. the department of health and human services, defense, justice, state and gsa. i, in turn, designated fema administrator fugate to my right to serve as the federal coordinating official for the u.s. government-wide response. third, we have established added capacity to deal with the processing and housing of the children. we are creating additional capacity in places. and we are considering others. fourth, dhs and hhs are increasing spanish speaking case management staff. increasing staff handling incoming calls from parents or guardians, raising awareness of the parent hotline provided by fema and operated by hhs.

surging staff to manage the intake of cbp referrals to track shelter bed capacity and facilitate shelter designations. here i must note from personal observation that our border patrol and other cbp personnel, as well as personnel from hhs, i.c.e., fema and the coast guard are doing a remarkable job in difficult circumstances. all of these dedicated men and women deserve our recognition, support and gratitude. fifth, dhs is building additional detention capability for adults who cross the border illegally in the rio grande valley with their children. for this purpose, dhs is establishing a temporary facility for adults and children on the federal law enforcement training center's campus in artegia, new mexico. the establishment of this temporary facility will help cbp process those encountered at the border and allow i.c.e. to increase its capacity to house

and expedite the removal of adults with children in a manner that complies with federal law. artegia is one of several facilities dhs is considering to increase our capacity, to hold and expedite the removal of the increasing number of adults with children illegally crossing the southwest border. sixth, dhs has brought on more transportation assets to assist in the effort. the coast guard is loaning air assets to help transport the children. i.c.e. is leasing additional charter aircraft. seven, throughout the rgb sector we are conducting public health screening for all those who come into our facilities of contagious diseases or other possible public health concerns. both dhs and hhs are ensuring that children's nutritional and hygienic needs are met while in our custody. that children are provided regular meals and access to drinks and snacks throughout the

day. that they receive constant supervision. and that children who exhibit signs of illness or disease are given proper medical care. we have also made clear that all individuals will be treated with dignity and respect and any instances of mistreatment reported to us will be investigated. eighth, working through fema's national response coordination center, we are coordinating with voluntary and faith-based organizations to help us manage the influx of unaccompanied children crossing the border. the american red cross is providing blankets and other supplies. and through their restoring family links program is coordinating calls between children in the care of dhs and families anxious about their well-being. ninth, to stem the tide of children seeking to enter the united states, we have also been in contact with senior government officials of guatemala, el salvador, honduras and mexico to address our shared border security interest. the underlying conditions in

central america that are promoting the mass exodus, and how we can work together to assure faster, secure removal and repatriation. last week, president obama spoke with mexican president pena net toe about the situation as has secretary kerry. this past friday vice president biden also visited guatemala to meet with regional leaders to address the influx of unaccompanied children and families from central america. and the underlying security and economic issues that are causing this migration. the vice president announced that the u.s. will be providing a range of new assistants to the region, including $9.6 million n( additional funding for central american governments to receive and reintegrate their repay treeuated citizens. and a new $40 million u.s. agency for international development program in guatemala over five years to improve citizen security. an additional $161.5 million

will be provided this year to the central american regional security initiative to further enable central american countries to respond to the nation's most pressing security and government -- government challenges. i will travel to guatemala on july 8 and 9. the government of el salvador has sent additional personnel from its consulate in the u.s. to south texas to help expedite re-pay treeuation to its country. tenth, dhs together with doj has added personnel and resources to the investigation, prosecution and dismantling of the smuggling organizations that are facilitating border crossings into the rio grande valley. 11th, we are initiating and intensifying our public affairs campaigns. in spanish, with radio, print and tv post to communicate the dangers of sending unaccompanied children on the long journey from central america to the united states. and the dangers of putting

children into the hands of criminal smuggling organizations. as the chairman noted, i have personally issued an open letter to the parents of those who are sending their children from central america to the u.s., which has been distributed broadly in spanish and english to highlight the dangers of the journey and to emphasize there are no free passes or permissos at the other end. we are stressing that the deferred action for childhood arrivals or daca program, does not apply to children who arrive now or in the future in the united states. and that could be considered for daca individuals must have continually resided in the united states since june 2007. seven years ago. we're making clear that the earned path to citizenship contemplated by the senate bill passed last year will not apply to individuals who cross the border now or in the future. only to those who have been in this country for the last year

and a half. 12th, given the influx of unaccompanied children in the rio grande valley, we have increased cbp staffing and detailed 115 additional experienced agents from less active sectors to augment operations there. i'm considering sending 150 more border patrol agents based on my review of operations there this past week. 13th, in early may i directed the development of a southern border and approaches campaign plan effort that is putting together a strategic framework to further enhance security for our southern border. finally, we will continue to work closely with congress on this problem and keep you informed. dhs is updating members and staff on the situation in conference calls twice a week. and we're facilitating site visits to border patrol facilities in texas and arizona for a number of members and their staff.

i have directed my staff to be forthright in bringing to me every conceivable, lawful option for consideration to address this problem. in cooperation with the other agencies of our government that are dedicating resources to the effort, with the support of congress, and in cooperation with the governments of mexico and central america, i believe we will stem this tide. thank you. >> thank you, secretary. chair now recognizes himself for questions. let me say, first, i commend you for your immediate response to this crisis. but we do have a crisis on the border. it's in our backyard. and it's affecting my state particularly probably the greatest. and when i see our military bases now turning into refugee camps here in the united states, i think that's something i never thought we would see in the united states. i talked with senior officials and border patrol down in the rio grande valley sector.

we have 250 -- over 250 children being apprehended every day down there. and i think the saddest thing about this whole story is the exploitation of these children. i think as you recently mentioned in your open letter, you said that it's dangerous to send a child on the long journey from central america to the united states in the hands of smugglers. many children are traumatized, psychologically abused by their journey. or worse, beaten, starved, sexually assaulted or sold into the sex trade. they are exposed to psychological abuse at the hands of the criminals. you know, we see these publications down in central america saying, if you come into the united states, you can stay. now, whether that's a misinterpretation of our policies, i think there's a lot of confusion out there. and i personally believe that this administration's policies

have contributed to this problem and have encouraged more people to come. when i talk to law enforcement, whether it's border sheriffs or cbp on border, they believe that this problem will continue until we provide a deterrence. a strong message that if you do come, you cannot stay. and so secretary johnson, what are you doing in that respect? what deterrence are we providing to stop this? because if we don't provide that deterrence, this problem will not stop. >> i agree, first of all. we need to stem the tide. these gentlemen here to my left and right are leading our herculean effort to deal with the current capacity, but we've got to stem the tide. i believe among the things that i listed here that what is critical is we correct the record. we straighten the

misperceptions. the smuggling organizations are creating a misinformation campaign that there's a permissos or free pass. i've even heard that you have to get here by may 2014 in order to get your free pass. so the smuggling organizations have an incentive to induce these kids to -- to have their families pay money to smuggle them up here. so their putting out misinformation, which we're trying to correct through our public awareness campaign. but we're also building, as i mentioned, increased detention capability for adults who bring their kids into the country to expedite their removal and return back to their home nations. the other thing that we in the department of justice are very focused on right now is going after the networks of smuggling organizations. through their financial transactions, through prosecuting the personnel, we've surged doj and criminal investigators into texas for that purpose. but i agree, chairman, we need

to stem the tide. >> and i think that -- that -- i know in 2006 we had a brazilian crisis. and we provided mandatory detention. and it worked. so i think -- i think the administration needs to look at that. i think the national guard -- i know d.o.d. doesn't like that option. but i think if they could help with the influx and allow border patrol to do their job on the border, i think that would be helpful as well. in the limited time i have, i want to focus on what i think could be a very good solution to this problem. in addition to deterrence. you and i have talked about this issue. and it has to do with mexico. and mexico's cooperation with the united states. they are allowing this to happen in their country. the drug cartels are exploiting these children as they come through mexico. we know mexico's southern border is completely wide open. i know we have offered assistance to mexico that to date i don't know whether that has been accepted.

but my information is that it has not been. i would like to commit my efforts to work with you to get that problem solved. because i think as you look at these children, they're all coming from central america. if we can close the southern border of mexico, that stops 99% of our problems here. so if -- if, mr. secretary, if you would -- wouldn't mind commenting on that issue. >> well, first, as i mentioned in my opening comment, i want to hear every legally available option for consideration. whether it's from my own staff, whether it's from the interagency, or whether it's from members of congress. or former government officials who write op-eds. i want to hear every available option. clearly, the key -- a key to this is what the government of mexico can do. i agree with your assessment, mr. chairman. we need to engage the senior

most officials and we've begun that in president to president discussions. i've had discussions with my counterpart. i think that mexican -- the mexican southern border, our shared border security interest, is the key. i also think that engagement with the government of guatemala is the key which is why i'm going there personally next month. so -- but no doubt, we've got -- this is a critical way to stem the tide. >> all right. i encourage you. i think you're right. central america as well. with the secretary of state, state department has a role to deal with central america in this crisis coming out of there. with that, chair now recognizes the ranking member. >> thank you, mr. secretary. how often have you had a discussion with secretary kerry or burwell on this situation? what i'm looking for is, right

now the microscope's on you. but there are some other players in this effort also. are you having discussions with -- with other officials of the cabinet? >> yeah. oh, yes, definitely. on june 1st, as i noted, the president established a -- a government-wide effort pursuant to the homeland security act to deal with this and set up a unified coordination group, which i oversee. administrator fugate is in charge of it, which brings to bear the resources and assets of not only dhs, but hhs, doj, department of defense. and so we have an effort which fema, day-to-day, craig and his staff day to day coordinate and support. in addition to that, we're in routine -- i'm in routine conversation with my cabinet counterparts about this issue.

i'm having a meeting with my cabinet counterparts right after this testimony, as a matter of fact. last friday i brought a group of interagency colleagues down to mcgowan and langley myself. not langley. lackland myself to see the situation. so we're in good consultation with all these other agencies. >> yeah. just trying to make sure that there's an understanding that it's not just jeh johnson who's responsible for this issue. but there are other players also who actually we need to have conversation with. one of the conversations that i think would be important is under existing law, how long would the children be in custody of dhs before they're passed off to hhs? >> under existing law, we are required to transfer the child within 72 hours to hhs.

from the point at which we identify the child as an unaccompanied minor. i know that the provision in the law says there's an exception for extraordinary circumstances. but in general the legal requirement is 72 hours. >> and i guess my question to administrator fugate is, have you been able to coordinate the resources so that 72 hour pass on is working? >> at this time, with the number of children coming in, we're not meeting the 72 hours. but since june 1st, we've added over 3,000 beds to the health and human services office of refugee resettlement. including the three military bases that previously were referenced. in addition to that, we wanted to get these kids as quickly as we could from the detention facilities to a bed, even if we could not get them to hhs's custody.

so custom and border protection has built out one processing center. another one is coming online in mid-july. so at this point, we have not reached the 72 hours. but we're building more capacity to get children in beds. but also health and human services is stepping up placement for the longer-term care of these children. our other hope is, is that the quicker we can place children long term, either reunited with legal guardians or parents or with foster families while they await further proceedings, the fewer beds that will be required. we have increased capacity. but the number of children coming in have increased as well. and we have not reached the 72-hour mark. >> and i guess the follow-up to that is, in your coordinating role, do you feel that the resources necessary to be successful have been made available to you? >> yes, sir. the challenges again in building out facilities and bringing on additional foster care