former somebody leader -- senator majority leader tom daschle. >> politics is supposed to be about finding a way to overcome some of those differences through extended discussion, a real legislative process, through compromise. it wasn't supposed to be about one party winning on their own. the times in history when one party has been able to do this , mayber own are very few 1933-1934, fdr with the depression, lbj 64-65. even lbj reached out to republicans, and fdr had republican support the first two years. >> watch "afterwards sunday night, on c-span twos book tv. > during a budget hearing, david chilton was asked about the gut -- a trip to europe last

year. dr. shulkin testified before the house and veterans affairs committee. a congressman, who called for the secretary to resign, spoke with reporters after the hearing. [captions copyright national cable satellite corp. 2016] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]

>> the committee will come to order. thank you all for being here to discuss the president's fiscal year 2019 budget submission for the department of veterans affairs. holds 19.8 6equest million -- billion. that is a huge number. it is even more striking when you compare the growth in the be a budget to the overall federal spending and the economy. it illustrates his point. since 2006, the v.a. budget is

up 175%. overall federal spending increased by 54% and gdp grew only 40%. given the aggressive expansion of the a resources, i appreciate the secretary's testimony. the department must stay focused on the core mission to ensure resources are properly utilized and veterans care prioritize. the able take action on many important items in 2019. some examples include the implementation of the forever the start of will be a costly and lengthy replacement of the v.a.'s electronic health record. because we cannot possibly cover these important issues in length in today's hearing, in the coming weeks our subcommittees will hold hearings on specific aspects of the budget proposal within their jurisdictions. we will discuss the proposed

budget to help ensure department providing better quality and more timely services to our nation's veterans. we want to consolidate and improve the a community care. fromcommittee has heard veterans, v.a. employees, and industry leaders about the many -- from effectively partnering and providing in-house healthcare services. [captions copyright national cable satellite corp. 2016] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] consolidating this into a program that will help veterans, dollare every all -- spent count. another priority is an assets andnt of va infrastructure review process to help the department repurpose or billings, $11 to be spent where they make the most impact.

as is crucial to ensure success. i was glad to see this in president trump's plan. folio is for pot -- challenging. every v.a. bill is approaching 68 years old -- i know something about that number -- and was designed for model -- patient model care. out of the real estate, nearly 6 million square feet are vacant, many more underutilized. we need a methodical and data-driven review to figure out how to adapt this physical footprint to meet the needs of the future. the implementation of a modern commercial health record. while this effort is necessary, it is very expensive. a contract has a price tag of $10 billion. that doesn't include the cost of

updating infrastructure to accommodate, support and sustaining the vista until it can be turned off. after visiting a spokane, washington air base, i'm not sure if can ever turn this off. we have to resolve the question interoperability capabilities. it's unthinkable that va could potentially spend billions of dollars on a project that doesn't increase the department's ability to share information or -- to share information. if the v.a.appen fails to proceed in a careful, deliberate matter. it was a relief when secretary schultz paused the awards look forward to discussing -- and i look forward to discussing any updates. the department of veterans affairs has a sacred mission to serve those who have served our country. is entrusted with

significant resources, outpacing those of nearly every other agency. with substantial resources, substantial responsibilities to spend dollars wisely. before i yield to ranking member walls, i would like to discuss the general psych -- the yesterday.eneral like many members, i was disappointed in the allegations raised. alongside ranking member walls and senator isakson, i was briefed yesterday and have instructed my staff to request additional documentation from the ig. i've gotten to know you well over the last two years, and i believe your intentions to serve in care for our nations veterans are well clear. , as public officials, we are all expected to be held to a higher standard, and be good stewards of tax dollars. ice -- hope you will -- i hope

you will take any changes necessary. we cannot allow distractions like these to keep us from doing our work. i look forward to seeing your response. two members today, i incurred you to remember the importance of the topic at hand. many of you will ask about the ig's findings. keep in mind that we are reviewing a budget request of nearly $200 billion. that should inspire discussion today. we have a responsibility to taxpayers for a third review as well. me and the secretary will testify that this is not " business as usual, the a budget." budget.orward -- va i look forward to seeing how this will transform the v.a.. all eager tore receive the secretary's testimony, so i will leave it at that. i will turn it over to ranking member walls. >> well, thank you chairman. i we get chart -- started,

want to say, heartfelt thoughts and prayers. our actions go out to our fellow citizens in florida, the tragedy that once again has befallen them. i appreciate the chairman on this. mr. secretary, i have gotten the opportunity to know you. your intention to help veterans is clear. the trust you have on this committee is strong, but we do need to address these allegations. report, ite an ig would be appropriate, and i appreciate that the chairman is moving forward. you had 3.5 days to respond, a little unusual. usually, longer time is given to address these. i will just say, before moving onto the budget, the allegations of a potential hacking of a v.a. computer system is a serious matter. i would ask you come mr. secretary -- we are prepared to ask the distrust -- the department of justice to look into that. we will follow up to see that

the appropriate action to go on. budget reflects the president's priorities. many of these we are going to agree upon. some of them are going to be contentious, rounding down. we know those are there. i would address, and i have been here for much of that increase from 2006. i would note several things have happened. 12 years of war. in 2003, the budget was so underfunded, they came back on in 2009. this committee had the courage and moral clarity to tackle the lemur claims and the blue water navy issue. the our responsibility, and chairman is right, to account for every penny of that. in the snapshot of things, that baseline where we started in 2006 was grossly inadequate from where it was. there were things that needed to

be correct. it's not the end money dollar. it's what we are getting for those dollars, and improvement of care for our veterans. several issues -- last week, congress passed a bipartisan budget act, included a the a budget cap $4 billion. -- v.a. budget cap $4 billion. needs andignificant backlogs and will be provided resources. morefocus is on spending on other things instead of hospitals, after 2.4 in supplemental funding emergency. between fiscal year '17-'19 request, communities benching will have increased -- spending will have increased 49%. time and again, members of this committee, keystone -- stakeholders, have raised concerns about privatization of the v.a..

you yourself mr. secretary said your intent is not to privatize the v.a.. you are seeking to merge congressionally mandated counts provided to provide greater accountability and transparency, and issue you have championed. how much care was being spent outside the v.a.? we will be delivering care to our nations veterans. i hope you can understand our concerns with that proposal. year thereof last were over 31,000 provider vacancies and others for human resources and contracting positions that had not been filled because of an unofficial hiring freeze. the hiringnow if freeze will continue. additionally, president trump's budget proposed is a paid freeze of fiscal year 2019. i want to know how the department will retain the best employees when our president does not appear to value their work trade last week, he testified in front of this committee that your commitment

would be reflected in this budget. i didn't see it. while you are willing to make astronomical request, here are not willing to do the same for caregiver community. the chairman has been a champion on this. i'm doing the best from our side to do the same. caregivers deserve no less than our commitment to expand all eras. the cost of this expansion is small compared to what veterans and their families and caregivers have been forced to pay. i'm pleased to see a request for the electronic health record. want to make sure we are updated . here is what i wanted to touch you on. the budget for the ice -- ig would be scaled back during 2019, leaving the oig for start -- far short of their staffing level. the optics of cutting the ig

today are bad. havesomething that i championed with the chairman together. our common goals are absolutely clear. our commitment to our nation, veterans are clear, getting the budget right is our job. i think this committee is up to the task, and i yield back. >> i think the gentleman for yielding. we are joined by the honorable david shulkin. welcome. the secretary is joined by the honorable john rachelle ski, assistant secretary management chief financial officer for veterans affairs, the cheek site -- the chief financial officer of the health administration, acting deputy undersecretary for the veterans benefits administration, the deputy forrsecretary for finance the national cemetery administration, and richard chandler, deputy assistant secretary for v.a. v.a. research management for the office of

information technology. you are now recognized. >> mr. chairman, i want to thank you. i want to thank all the members of the committee. many of you had a chance to come over to my office, spent some time talking about the issues. i know all of you are committed to the work we are doing. that's why i think we have the best committee, the veterans committees in the house and senate. we work well together in a bipartisan way. mr. chairman, ranking member, thank you for keeping the focus on the work we have. this is a big deal getting the resources right for our veterans. i do regret the decisions that have been made, that have taken the focus off of that important work. of you are's why all here. we care deeply about this subject. it's the reason why, to keep the attention on the important

things, that i've made this decision to reimburse the treasury, to follow ig recommendations, doing what we have to do to focus on veterans and make this better. today is about president trump's 2019 budget, and the two dozen 20 appropriations budget. it's very strong. it reflects the president's commitment to veterans and their families. it provides the resources to continue v.a. modernization and respond to changing needs, with increasing investments in our foundational services, greater access to care, better management practices, and modernizing infrastructure and our legacy systems. in the written statement i've willred, i detail how we target certain areas for innovation and improvement. the presidents 2019 -- the president's 2019 budget request billion, and.6 includes medical care

inlections, $109.7 billion mandatory benefits. the discretionary budget represents an increase of 6.8 billion dollars, 8.3% over the 2018 request. this request -- has two point $4 billion more, now available due to legislation to raise discretionary spending caps. the recent addendum to the budget request are important to fully fund the community care and choice program. although we are talking about fiscal 2019 today, i would ask for your support in securing a full appropriation for the v.a. in 2018. v.a. relies on the funding for a total requirements. the budget also seizes the opportunity to expand access to benefits and services, which are focused on the priorities i've outlined. providing veterans with greater choice, modernizing our systems,

focusing on resources and what is most important to veterans, improving timeliness and services, and preventing veteran suicide. suicide is my top clinical priority. the budget includes $8.6 billion for v.a.'s at health services, an increase, 5.8% above the 2018 current estimate. the increase enables 106-2000 more outpatients in 2019 for mental health, and directs 299 million more -- for suicide -- $299 million more for suicide outreach. to budget also enables us effectively implement the president's executive order that supports transitioning military members with mental health services -- to mental health services during the first critical year as veterans. we are also targeting women's health, one of our growing populations of the v.a., by

over 2018.nearly 6% the budget provides $1.1 billion in major construction spun -- funding as well. that this is the largest in the last five years, that will allow us to address 's aging infrastructure concerns that you mentioned, mr. chairman. this allows us to innovate operationally, and includes an increase of $129 million above the budget of last year to enhance access to the veteran -- to improve the veteran experience. another project made possible is the financial management business transformation, replacing the old financial systems, and providing us with a modern innovative financial management solution. it supports our electronic health record, as you mentioned, so we can coordinate care for veterans who have perceived care not only from v.a., but the parmer of defense and argument

-- the partner of defense and our community partners. this includes $1.2 billion to advance the limitation of this electronic health record. the two dozen 19 budget estimates important -- the 2019 budget also will hire more variousl for the offices, and hire an additional 225 field examiners to ensure protection of our vote -- most vulnerable population. this budget reflects our efforts practices business and do what is right for veterans, and allow the transformation. our response ability doesn't end when we ask for more money -- our responsibility doesn't end when we ask for more money. we will focus on the well-being of veterans, conducting administrative reviews of compensation payment rates, and extending the broad waste and abuse initiative in benefit

payments. we will make benefits more equitable for veterans and widely used -- wisely use taxpayer resources. we will significantly reduce the impact of certain disabilities on the lives of veterans. the needis to decrease for compensation. we have modernized the rating system. more importantly, veterans and their families deserve access, choice, and control of health care. v.a.'s working to improve -- build an improved integrated network. we call this the coordinated experienceswarding and veteran care. it will allow us to semper fi eligibility requirements, streamline administrative processes, and build a high-performing network to implement new care coordination for veterans. as secretary, my job is to build a sustainable v.a. for a changing world. more importantly, my job is to ensure that v.a.'s benefits, care, and policies are stronger

in the future. this supports us. our will help maintain commitment to our nation's veterans. i look forward to working with you and the committee on doing what is right, and i look forward to your questions. >> thank you doctor. i will start by saying that, to the ranking member, that we have started a great discussion on caregivers and will continue that with around table. i'd like to make that bicameral, so we get both the senators and us in a room together. i thought it was a great start the other day. i see a path forward where we can do this right and get this done, hopefully this year. that would be my goal. there's a great article, i still read my medical journals. february 6 medical association journal, a great article on ensuring timely access to quality care. i would encourage -- i will send them to your office. send them to your offices.

i encourage you to read them. mr. secretary, you mentioned -- mosty the v.a. people in the country don't realize how extensive the v.a. is. we work in all the facets of medical care, the benefits process, which we know has gotten slow down. we talked about that yesterday, concerned people, i'm that hiring people who don't have the skills to do it will actually slow the process down. you get someone who's a good claims adjudicated, they may be able to look at that claim and get it off their desk in a timely fashion, where someone is brand-new will kick it into the appeals process, where it gets really slow down. i would encourage you -- slowed down. i would encourage you to ensure 605e 6005 people a -- people are trained. these records are an end of the

-- these are all huge projects, under one umbrella of the v.a.. i want to get in my short period of time a look at the cemeteries. one thing the cemetery demonstration does is, i have a national cemetery within one mile and a half of where i live. it's a park like setting, an irreverent setting. i want to thank you all, every v.a. cemetery i have visited has been immaculate and well cared for and honored area want to thank you for that. -- honored. i want to thank you for that. they're looking at modernizing 106,000 plus holding, you are the largest villa stakeholders in the world, probably. getting that footprint, it's a huge project.\ i want to start out -- i want to start out because you asked us, this program will be put together sooner than we have. assuming legislation is added

next month, how much more funding for the existing choice program, existing non-v.a. care program, and the process itself will be necessary before implementing consolidation? my something is all of this is under the bipartisan budget act. is that correct? know, thes, as you president's budget as proposed funds community care, by putting this all into discretionary. that would be a 9% increase in funding above the 2018 levels. the situation we have right now is that without new legislation, we have funded the choice program through the end of this may. what this president's budget does is it, it essentially puts more money into the two dozen 13 budget so we can get through the 2013 budgetear --

so we can get through the end of the year. we will make this a single program, a better use of the money. >> i think you explained to us, it's about a year process to do this, correct? >> yes. to transition to a new system, integrate all programs together, to change eligibility requirements. >> mr. secretary, you announced your electronic health record last june. recently, the contest that was paused to conduct an assessment that was paused to

conduct an assessment. my time is about expired. >> i think, this is a huge decision. ever implemented an electronic health record change this big. we are taking it seriously. given the track record of implementing big i.t. projects, we have to really make sure we got this one right. we will clearly, first of all, there's four stages of interoperability. everyone at the v.a. thinks we have electronic health record, but we don't. we have 130 different parts of vista. this will bring us to a single electronic health record within v.a.. secondly, since this is proposed to be the same system that dod uses, we will have an interoperable system within dod. the reason i paused is because of want to make sure this 36% getting care, we can actually understand what care they got

and make sure we are doing the right job for veterans. so, we have to make sure that we can be interoperable with dozens of different health systems, documentation systems or records up -- health medication systems and other records, and that's something the american health system hasn't figured out. we think they can -- the v.a. can help lead this for the whole country. >> my time is expired. >> thank you, mr. secretary. there's lots of issues. we will dig down into deep ones, many members will ask. the big question, is striking that balance between the care and research in the v.a. vs the community care. we know in this room, that's always been there, trying to respond to some of the issues that arose several years ago. do we have enough money to make it till may in the choice program? >> we do, till the end of may. >> how do we know that? >> because we are tracking this

on a weekly basis. we are on a spend rate, the choice program between $350 million-$400 million. you authorized $2.1 billion back in december. when we do the math, we are ok until the end of may. >> are we providing care based on the amount of money, or providing care that the money will follow? >> the latter. we are putting the veterans -- the veterans needs first. >> we gave $4 billion for infrastructure. usedpears that won't be for the structure, and will go to community care. am i reading that correctly? >> i don't think that's exactly right. i will turn to john to explain the $4 billion. there has been confusion about tracking that money. theou are talking about

2019. >> correct. >> we are asking for the money where it is not -- most needed. i would point to the major and minor construction requests, one of the largest in five years. we looked to nonrecurring maintenance for the last two years. it is substantial, $1.9 billion and $1.4 billion. i'm not discounting the aging facilities. available, weunds could better use that funding, frankly, in community care. rep. walz: we are talking about the $20 billion in backlogs, have we have attempted to handle that. like many of you, i turned on my morning news and saw the president had an executive order on mental health, and issue i have been somewhat engaged in over the last 12 years. that's $500 million. where's that coming from?

dr. shulkin: we were able to get that once a deal was reached. we were given an additional $500 million to support that executive order. we had originally made the as you know ranking member, because we thought it was the right thing to do. worry about the money, but we are fortunate that the $500 million was given to us to make sure that was done thoroughly and appropriately. >> -- rep. walz: our phone number is down here. we were under the assumption that that money was going inside the v.a., which all the research in the rand corporation shows is far more successful than until health care. that will be a discussion for this committee to have. based on the baseline, and reflects close to a 50% increase in community care. is that the normal increase, 50% in the community? uhh, i don't think

so. i think we have seen a significant increase as we have addressed the axis crisis. this was a significant crisis in 2014. we still have some axis issues. out, inetting veterans a way we agree upon. we have reached essentially a much slower growth rate. we are doing what you said, which is making sure veterans are being cared for appropriately, then letting the money follow. we will see the same continued rate of growth. i think this was a choice program implemented that was complex, that people weren't able to use. three years later, they are understanding how to use it. that could lead to growth. rep. walz: choice is good, i've always supported. the choice not being given is a those 30,000ith

positions. we are making the choice that they will not get in the v.a., , wasse in the v.a. appointed's are open. the alternative is going to the community. instead of spending money for 30,000, we will shift. we have never been against trying to strike this balance, but when we appropriate for billion dollars and say it's for infrastructure and a big -- $4 billion and say it's for the structure but then going up, if we went through the regular order passed and signed into law -- but instead we have an executive order that none of us know about. my frustration is it's becoming more and more difficult, mr. secretary, to say i'm not supporting privatization of the v.a.. , say that not pejoratively because that's the best way to get veterans care. in many cases it is, but not in the bulk of it. thatll have deep concerns this buzz it -- this budget is going to continue that trend without the knowledge. i think that's the wrong approach, because veterans

themselves have made it clear they want that fully funded v.a. . i yield back. for thank the gentleman yielding. our care will be march 6. >> mr. secretary, in looking at iur construction budget, think it's $1.1 billion in major , smaller amounts for -- a different amount for cemetery spending. the last four hospitals the v.a. at leastere each hundreds of millions of dollars over budget, years behind schedule, the worst example being in my congressional district, which was $1 billion over budget and four years

behind schedule. one of the efforts i letting congress was to strip the v.a. of their construction management authority for building major construction projects, hospitals, $100 million and above. i think that number is way too high. i think it needs to go way down. the same people that had -- have their think prince on these for construction projects that were years behind -- these four construction projects that were years behind schedule and over inget, are the same people charge of construction in the department of veterans affairs. it is unchanged. the people that have their fingerprints on this stuff are the same people there. i want to encourage you without legislation, in a way that requires that we need to move it forward, that, that you need to, to find these people another job hopefully somewhere outside of the federal government.

you need to shift responsibility, as we did in my hospital, my district to the army corps of engineers, some third party outside the v.a.. it's a waste and abuse. it's just incredible. could you respond to that? dr. shulkin: congressman, you have been very vocal of that. -- shulkin: congress meant, you have been very vocal on that. we cannot continue to do business as usual. the army corps is involved in all of our construction projects above $100 billion. -- $100 million. we need to do that in a different way in the future, private part -- private-public partnerships. that's why we are excited about this project in omaha, nebraska,

a groundbreaking model of constructing v.a. facilities. $400 million of the major construction will be seismic improvements.we record those for a long time. in terms of reorganizing and different personnel, we are committed to doing that. we cannot continue to do it the same way. we are going to be reorganizing our whole internal route for construction and facilities and thattics, and the people job is being recruited for, we are going to look for people with outside expertise. we think you are pushing us in the right direction. rep. coffman: for your comment, for quickly on your idea introducing mandatory spending in terms of disability. sec. shulkin: yes. ou growth in this budgetr -- ,ur growth in this budget 2006-2020 is increasing. the federal budget has increased

by 52% during that same timeframe. we cannot continue to do is to assess usual and think -- to do business as usual and think the v.a. is a sustainable structure, which it used to be. we want our veterans to focus on getting veterans back to andpendence and well-being, all of our efforts should be to help restore the quality of life of our veterans. we want to change the focus of our program to make sure we are doing that. we believe this is good for veterans, and that will decrease the rate of spending of our mandatory program. rep. coffman: on the last point, and i know this is not about the investigation, but you issued a memorandum prior to your trip to europe last summer, travel."l employee i will quote from the report. beforewill be a request

approving any travel, a manager must determine if it is essential to generate savings within the v.a.. do you think your trip last summer met that criteria? sec. shulkin: i do. i believe this was essential travel. this was a conference, our allies who fight alongside us in every war, canada, new zealand, australia, the united states. we have had this coverage for 43 straight years. it has been attended by every v.a. secretary. if united -- if the united states, the largest of those -- thisoes not go conference was on veterans mental health. if the united states does not participate, that conference ends. i planned on going to it for a year and a half, because we plan these things ahead of time, but i do recognize the object of

this -- the objects of this are not good. i accept responsibility for that, but i do believe it's important the united states continue its work with allied countries. rep. coffman: it's not the optics that are not good. it's the facts that are not good. i yield back. chairman: thank you. to echoecretary, i want the sentiments of my colleagues. misuse of tax money is a significant breach of the trust we play -- place on those responsible for serving nations veterans. i'm profoundly frustrated that mismanagement has interfered with our mission of building a stronger and sustainable v.a.. it's vitally restore the trust of the american people and veterans so we can get back to the critical work for those who serve. i have gotten to know you and your dedication to the mission

of this department. to ask quickly a few questions. how does this budget address over 30,000 provider vacancies, and 4000 additional vacancies in administrative staff, specifically but just six, procurement, contracting for human services? is the official hiring freeze so affect? sec. shulkin: there is no hiring freeze. rep. takano: do support of fy19? on employee pay in sec. shulkin: i'm going to take a leadership from the president. essential for us to ,et the right people in v.a. that we have competitive salaries. i would be concerned if we fall behind. ability to dor that, particularly using title

30 to make sure that we are competitive. rep. takano: i gather there would be concern over a hiring freeze. how would a federal employee fate -- pay freeze affect the department? sec. shulkin: we are competing, rep. takano: i gather there would be concern over a hiring freeze. how would a federal employee fate -- pay freeze affect the department? sec. shulkin: we are competing, particularly in health care, but in all aspects of v.a. to get the best employees. we know we don't have competitive salaries, thinner vacancies stay open or we get the wrong people. it's essential that we remain competitive. rep. takano: with a hiring freeze, would you be willing to ask the president for a waiver if you felt that the needs of the v.a. -- sec. shulkin: i would. i want to make sure we are maximizing our authorities under title 38 and title five. if it got to the point where i was not able to recruit the

people that are veterans served, to have caring for them, i would ask for a waiver. >> i am pleased to hear that. when i recently met with management for might look when medical center they said they rather difficulty recruiting and maintaining housekeeping staff. housekeeping staff is vital to keep facilities clean and safe. in many cases, the cleaning staff has to be especially trained on bio hazards. wouldn't a pay freeze exacerbate this problem, and improve -- and hurt danger safety? sec. shulkin: there are a number of occupational hazards in the va. a -- this is one, where it when you clean a hospital -- this is not the same, i think you are saying

this -- this is not the same as cleaning an office building. making people understand the type of organisms that live in hospitals, and the reasons you have to clean these environments, is lifesaving. we are working to change the job specifications so that we can be competitive, but we have a big problem hiring enough environment to workers right now, so we have to change that. rep. takano: when to pay freeze exacerbate this problem and in danger patient safety? sec. shulkin: if we didn't change the grade of that position, that would. rep. takano: what resources do you need to ensure these are filled? sec. shulkin: we need to get more new ball about how we grade these positions and how the outside world changes. we need to make hiring practices easier to get the right people on board. this is work is underway right now. rep. takano: we've heard reports that the v.a. central offices has not proceeded on improving pay on jobs. is this true? sec. shulkin: if that is true,

that should not be followed. we want our facilities to do the market surveys. they need to be competitive. we have to fill these vacancies. there is no hiring freeze. our people who work in our facilities are our most valuable assets, and we have to make sure we have the right people serving veterans. rep. takano: my time is up. can i ask one more question? in many cases, vacancies are directly contributed to the postponement of procedures effected patient care. how does this budget address vacancies? sec. shulkin: this fully funds our needs. people should be filling those positions. i think you are right. in the case of the dcva, they were understaffed. we had to bring in a large

number of people in procurement. human resources should not be under resource without that. without that, the rest of the organization doesn't work. rep. takano: thank you. chairman: thank you for yielding. part of the problem is not the v.a., its countrywide. at home, our hospital is having a terrible time filling positions. it's not just hospital. the jobs are out there if we can find the trained people. you are recognized for five minutes. >> thank you, mr. chairman. as the new appeals process goes into place, the v.a. will prioritize and fill, go after the new system, those newly filed appeals, then walk away from the old legacy appeals. i know the president's budget, a request for initial 605 full-time equivalents, dedicated

to appeals. how many of those will the v.a. dedicated processing legacy appeals? sec. shulkin: that's a great question. jamie, the want to take that? jimmy is from the v.a.. jamie: the first thing we are are doing is giving a pellets the opportunity to opt in to the new appeal process as we speak. apellantsne to the longest appeale

and said "you have the first opportunity to opt in." we are sending letters to the people, telling them they can opt in. >> that's not my question. of those 605, how many are going to be dedicated to clearing up the old backlog? are they specifically going to be that or is it going to be across the board? jamie: all of our appeals personnel will be working. >> he's talking about the legacy. they are making progress. i don't think any of those, well, i guess the claims. what they have done is implemented something called a new type of claim, a "drc" claim that gets this done in 30 days, instead of the usual seven hut -- several hundred days. they are making great progress on the claims. >> and so concerned about this. -- i am still concerned about this. you are asking for 605 more employees. we've got to speed the process up. is that going to speed the process up to answer these appeals and get them taken care

of? jamie: absolutely. we have more, if you will, more f.t.e. to work appeals. we will do a blended approach with working with legacy and the new appeals. >> it's a concern of our committee, it's one thing to handle the new ones, but these people have been there for a long time. the concern that we see out there, and the weight on their families, trying to get an answer. the reason to change it was to straighten it up. jamie: absolutely. as i indicated earlier, we are giving them the opportunity to opt into this process. those have been waiting longest in the appeal line, if you will. rep. mike bost: mr. secretary, you didn't think any of them would go to --

sec. shulkin: the 605 are going to be focused on addressing the appeals, not on claims. rep. bost: ok. i want to go to another quick question. you know the problems i have had in my district. the budget is requesting millions for the office of inspector general to strengthen accountability. i have two questions. one, was this level of funding sufficient to properly inspect and keep up with problems in the v.a.? second, you need new authority to establish -- do you need new authority to establish qualifications for positions like h.r.? sec. shulkin: on the inspector general, my understanding, and

john i will ask you to confirm this, they increase the levels -- increased the levels last year. this allows them to continue what they raised last year. is that correct? >> they had some carryover funding, so they hired people above their baseline funding level last year. sec. shulkin: the funding for that was less than what they had hired above, so they requested an increase, didn't receive an increase. i think that we need to look at what the requirement is. you can't just have self-determined needs. it has to be validated. >> if you look at the line on that, it has decreased.

>> the fte, that's why i described how that occurred. it would carryover funds. they hired moreo thann they had money for ine year -- they hired more than they had money for in one year. they needed to be validated. it could be more, less. rep. bost: thank you. >> thank you, mr. chairman. mr. secretary, i wanted to focus a little on the open nominations. i think there's clearly a lack of consistent leadership within the v.a., that i think as a barrier to many of the challenges that the v.a. faces. the last i heard, eight out of 22 leadership positions in the v.a. today are being filled by individuals in an interim or acting role. i know we don't have an undersecretary for health,

undersecretary of benefits. what progress are we making, in terms of finding candidates to fill leadership in the v.a.? sec. shulkin: i push it that. i share that same concern. it's taking us too long. the under secretary for health, we had our third round of commissions. this is the third time we've had a commission interview candidates. that was on tuesday this week. yesterday, i was given three names from the commission, so they completed the work. i am in the process of evaluating them. if they are vetted through, we will take those names to the president for nomination. the under secretary for benefits, we did submit three names to the president. they are in the process of vetting those.

we've done the cio process in a similar way. we have submitted some names to the white house and they are vetting them. this is a long process, takes too long, but i feel like we are making recommendations to be able to get these positions filled. rep. brownley: are you waiting to get these filled for those folks who are in the position to hire to fill other important positions? sec. shulkin: no. no. rep. brownley: thank you. i share the concerns and line of questioning that my colleague, mr. takano asked. to me, these many vacancies throughout the v.a., i think the heart of the issue is predominantly around lack of human resource personnel. i need to hear a commitment from

you that you have a laser sharp focus to fill these positions so they can roll down their sleeves and work to fill these other critical positions across the country. sec. shulkin: i agree. i would be concerned if anybody out there believes that there is a freeze or any desire not to completely staff your human resources office. this is a critical area to be sure we are fully staffed in. rep. brownley: i know in my business in southern california and beyond, that the primary issue. when i ask the questions, it's because human resources isn't able to fulfill their responsibilities on a timely basis. i wanted to ask, in terms of the president's executive order on mental health in the community,

what is the limitation of that like? -- what does the implementation of that look like? sec. shulkin: we are planning on presenting a detailed plan back to the president march 9. what that looks like is pre-enrolling service members before they leave on the last day of service, so they don't have to wonder how they get access to benefits that they arty have right there. offering an initial, what we would call an introduction to the benefits and services that every service member would have, so that they understand that asking for help, getting the services offered through the v.a. is available to them. we feel like using peer counselors, because that is the strongest way to help people identify how they might get help, and what they are going through.

we are providing expedited access to those who need help at the right time. rep. brownley: when the plane is complete, you will present to the president. will you also presented to the committee? sec. shulkin: yes. chairman: my friend, he can have as much time as he wants. [laughter] >> we will stick with the five minutes. >> in the idea of flex ability and making decisions, it makes sense that we take a look at our underutilized resources. there is 131 vacant or mostly vacant buildings that have been repurposed of -- or disposed of. i'm wondering how much revenue we have gained from that, or did it cost us more to get rid of

them in the short term, but helped in the long-term? sec. shulkin: i think you are correct. part of the reason why these buildings remain standing and vacant, become problems is because it sometimes takes capital to knock them down and clear the scott -- clear the site. the savings from those 131 buildings is about $7 million per year. in some cases we have had to invest some money to remove those facilities, or get rid of them. its overall savings. the infrastructure bill introduced by the president will allow us to reinvest in v.a. and the structure. we are grateful for the present -- provision, which has not existed before. rep. wenstrup: that leads to my next question.

this goes from infrastructure to modernization. what is the plan? sec. shulkin: currently today, if we exit a property, that money gets returned to the u.s. treasury. we are not able to reinvest that. the infrastructure bill would change that. that's what we are supportive of that. what we save is the maintenance. that remains in our general, what we call our nrm budgets, recurring maintenance budgets. rep. wenstrup: will you be able to get an idea of how it is converted directly or indirectly to care or veteran services? sec. shulkin: yes, yes. what we would plan on doing is reinvesting.

we contract that. rep. wenstrup: one of the things the budget talks about his -- talks about is foundational services. the list includes geriatrics and primary care. i'm trying to understand what we considered foundational services. if you could give me some clarity on that. sec. shulkin: we spent a lot of time on this. there's a list of things that the v.a. needs to do well, and ensure we are doing it in a world-class way. there is no doubt that things like spinal cord injury and posttraumatic stress, focusing on the suicide issue, other things, clearly are foundational services.

as part of the v.a.'s definition of health, how we do things. we believe a system of strong, primary, geriatrics care for older people, women's health, as well as mental health, is the foundation of what a strong integrated system needs to have. we don't need to be doing everything. we can't do everything well. we have learned that in the past. these services, every v.a. facility needs to be focused on to do in a world-class way. rep. wenstrup: things for that clarity. i would tend to agree. something that can be connected can't be treated as efficiently if you don't have proper primary care. i yield back. chairman: thank the gentleman for yielding. >> i want to thank you, mr. chairman, for your focus on reducing veterans suicide.

you mentioned this is your number one clinical priority, the first being secretary to my knowledge, to make this in the high-profile issue. i'm convinced that as we acknowledge the problem, we know that for those veterans who have ,ther than honorable discharge hundreds of thousands of u.s. veterans have an honorable discharge. tens of thousands were diagnosed with post dramatic stress disorder or a dramatic brain injury, or other conditions caused by their service, who are effectively denied access to the health care. you worked with myself and others to save lives in el paso, expand access. there's a correlation between the number of health care providers and access to mental

health care health, reducing veterans suicide. we went from 68 full-time mental health care staff to 122. more veterans are getting care, seeing psychiatrist and therapists. i know you have personally taken an interest in this, and i want to thank you. to that point, if there are 30,000 authorized appropriated for, unfilled clinical positions, how many of those 30,000 positions are psychiatrists and psychologists, therapists, neurologists, others to help with unique conditions connected to service? sec. shulkin: last year, 763 psychiatrists and psychologists. unfortunately, it was only a 260 because of retirement, sometimes people chose other places to work. we have a need right now for at least 1000 mental health professionals in this fiscal

year. the budget allows us with an increase of $500 million in to fundealth funding for an additional 162,000 mental health visits. when you look at how you'd have to staff that, that's about 1000 mental health care professionals. >> how many of the 30,000 unfilled clinical positions are primary care providers? >> i don't have an exact number. my guess is this --when you say primary care providers, i am going to talk about family doctors, too. sen. shulkin: i am to hang out until the end of the hearing. i want to make sure -- this is a priority.

let's understand what we are going to do to bridge that gap, to hire resources and prioritize those hires. do you think that a veterans primary care provider should be in the veterans administration? >> my preference would be, since v.a. uses a different model of primary care, patients are usually seen about every 15 or 20 minutes. there is a more comprehensive evaluation. our definition includes health integration in a broader way. primary care providers need to have military confidence. sen. shulkin: is that a yes? >> the need to be trained well.

sec. shulkin: we made understand -- we may understand they need to be referred out. but if we make the veterans administration central to that care, they have taken care of other veterans and service members. that they are going to have a higher proficiency and a greater level of experience taking care of those veterans. i think the veterans are going to get better outcomes as a result. i think that needs to be v.a. policy. i would add that for those treatments that are unique to service in combat, most are traumatic stress disorder and traumatic brain injury,

amputation, spinal cord injuries. i would ask you to prioritize your hiring for those specialists to ensure that care for the veteran is anchored and shares some of the concerns others have raised, including veterans who have come to the town halls, that there is a move to privatize care. i want that care centered in the veterans administration. i am going to await the answers to these specific questions i asked on hiring. >> i'd -- i agree, it is better to have good numbers. what you just described is exactly our strategy around foundational services. you are focused on the things that veterans need is to be good at. i absolutely agree with your description. >> time has expired.

a v.a. primary physician who has never served would be as well-prepared as a veteran like myself, a doctor who retired from the military. there are people on the outside who can provide those services. others who served in the military certainly understand those needs. mr. higgins, you are recognized for five minutes. mr. higgins: thank you, mr. chairman. thank you to the secretary for appearing today. i thank you for your dedicated leadership. i will remind those present, including the media and my colleagues, that the nation of american veterans has fought to establish and maintain a nation of laws, where man is considered innocent until proven guilty. i would hope we're not sliding toward a nation of allegation and accusation.

regarding extended care facilities, i have seen the budget, there is a 66.7% request for grants for state facilities. and a 0% request for veterans cemeteries. there seems to be a disconnect there. especially with the aging veteran population, as we attempt to provide for these veterans who in some cases , certainly our vietnam veterans, and did not return to open arms from a nation they served. these are the same veterans that are not cared for in the caregiver program. they are approaching the last

years on this earth. in a long-term care facility, i would think we would at least seek to provide for the aging veterans, end-of-life, dignity, where they can be revered and visited by family in their community where they live, i just see a disparity in budget. would you please address that? sec. shulkin: we did significantly increase the amount of funds available to the state homes where 50% of the country of the veterans are being cared for right now in the state homes. i met with all of the directors this week and they are extremely grateful for the support we are providing, to be able to do that work. the number of veterans that are aging is increasing. of these cemeteries, we have $334 million increases in the

fiscal year. >> we have a large increase in the fiscal year 2019 to address major and minor construction for national cemeteries. the grants program is a flat , grants have matching funds and assurances necessary to provide the grants awarded for the fiscal year. rep. higgins: you think this is sufficient for states to perform at that level, the aging veteran population -- the next stop from extended and long-term care is a cemetery. it would be the goal as a nation to provide veterans with end-of-life dignity. that would include appropriate

services, military services, and to be buried amongst veterans. mr. sullivan: that is the mission. we work with our state partners to operate the network of our 135 national cemeteries, as well as 107 grant funded state cemeteries, providing national transport final resting places. rep. higgins: that is encouraging. mr. secretary, your witness testified previously that noninstitutional care settings are more cost-effective than institutional care settings. this budget allocates $556 million as a continued investment in noninstitutional settings. how does this budget invest in noninstitutional care settings? sec. shulkin: we believe it is better to allow people to remain in their home.

even things like adult day care, we want veterans to get access to that. with the advances in technology, we have a package of services that is now a priority focus for us to make sure we implement that. we are supportive, isaiah know you are, -- as i know you are, about expanding caregivers to older veterans. we think that is an important piece as well. rep. higgins: my time has expired. >> welcome, mr. secretary. i appreciate your comments at the top. i think it is important to restore confidence in our executive officials. i hope in the coming days you will be forthcoming with the

american people. i want to turn to the issue of coordination of care and collaboration. we will be introducing a bipartisan bill today that is a pilot project for integrating veteran character in our federally qualified health centers. in the rural, northern parts of the state, in the fqac, people can get access to care without traveling long distances. can you comment on that venture or other -- or other collaborations the veterans administration is getting into? sec. shulkin: i am not sure people realize how important the qualified health care centers are. they do amazing work for a vulnerable population. as a large provider of federal

health care services, i believe these organizations should look for the chance to collaborate more and to integrate in ways that we really haven't in the past. i think the pilot program in that aria -- area would be productive. rep. kuster: we look forward to working with your team as we go forward. i want to focus on the leadership structure in the v.a.. we we have that -- we have had issues around manchester, the veterans hospital. there have been serious concerns in the v.a. hospital in massachusetts. my biggest concern is i don't see anyone stepping in effectively, where there are problems in the v.a. hospitals. do you think we might have come to a time where we need to change this business organizational structure, and particularly with regards to hospital leadership and their

reporting directly to your team as compared to not being sufficiently responsive? sec. shulkin: i appreciate you sharing these concerns as you have. you have been a very strong advocate for getting this issue right. the concept was introduced over 15 years ago. it is time to take a look at how the modern health-care system operates. that is what we are doing in our modernization work. we have looked at trinity, kaiser, that have multiple hospitals throughout large regions. we are looking at those best practices and seeing what we need to do. the basic strategy is we have to give people running the facilities, the medical center directors, more authority and accountability to be responsible for the decisions. we have to look at what the role

of this is and how it modernizes. rep. kuster: we look forward to working with your team on reviewing that structure, particularly focusing in on hospitals where this has not been an effective oversight. in my last minute and a half, i would love to here your thoughts -- you have created a new account for the veterans administration, modernizing vela -- electronic health records system. will this new account included funds to support and maintain electronic vista health record during the modernization process, or well these funds only be used in the adoption and augmentation of the department of defense electronic health records? if you could walk us through?

sec. shulkin: it has to be both. in order to implement the new electronic medical record, we are going to have to invest in the infrastructure of our connectivity, servers, to get ready to do that. we will have to undergo significant change management. implementing this, about technology, it is only a little bit. this is about business. we are to take 130 different systems and really be creating a single instance. that is a major change. it should create improvements in quality as well. we are going to be focused on maintaining vista. we have 130 transitions to happen. that is why over a 10-year time,

you will be running vista up until that last instance. >> my time is up. i hope you will keep the committee informed of your timeline and progress. thank you. i yield back. >> just to comment, and i think we will get into this more as we go on, when i was at fairchild, i am not sure you were ever going to be as long as you are in the new system as you are in the old one. until the last of us die that are in that system, there is so much information -- that are in that system. there is so much information. they can download everything, so you have to look back. it is a major undertakings to do what they are doing. you are recognized. rep. banks: first and foremost, i am a enormously proud of what we have accomplished with this

event in partnership with this administration. we have done a lot of great work for veterans we should be proud of over the past 14 months. i appreciate the seriousness that you have taken in addressing this report. i look forward to continuing to see you do that. i know that you agree that veterans deserve a scheduling system that gives them immediate access to care, shorter wait times, the ability to track and manage information around the care continuum. as we appropriate money and pass budgets, i want to ensure the money we provide is effectively utilize to the v.a.. that is why you are here. we have seen the electronic health record run into some trouble. we have seen the delay of implementation even further. with the readily available cuts, solution, and appointments

scheduling system or mast program that can be deployed in a two-year time frame, what are your plans or timelines to be more specific and utilize the funds you received for i.t. improvements to pay for a full deployment is not dependent on the stalled h.r. rollout? sec. shulkin: specifically on scheduling? >> yeah. sec. shulkin: there are plenty of good commercial systems that are out there. the mass scheduling system is being unlimited right now in columbus, ohio. we very much look forward to seeing out how -- to seeing how that is working. the pilot is on track. >> it should be in march? >> in the next few months it

goes live. we are very much looking forward to see how that is working. we have other products that are being tested on three other sites. bedford is one of them. we are very much looking forward to seeing how that is working. right now, it has gone to 35,000 different veteran transactions, an internal system called veteran scheduling enhancements. the plan is to go towards and off the shelf product. rep. banks: i was disconcerted when the v.a. considered taking funds from a homeless program, homeless program case managers, and converting them to general-purpose funds. you and i and others on your team have talked about this. i appreciate to wanting to provide flexibility to the directors, but that should not come at a cost of assisting veterans that are most in need.

if less veterans find their footing, we will be spending more money and not saving money. it appears the v.a. revisits the possibility by submitting stakeholder input first, a healthy part of the process. if it remains opposed to this change, as it was overwhelmingly for fiscal year 18, can you guarantee they won't execute this change for homeless programs in fiscal year 2019? programs in fiscal year 2019? sec. shulkin: the mistake we made was letting anyone think we are taking the foot off the to aiding federal homelessness. veterans homelessness went in the wrong direction last year.

it went up 2%. there were five specific cities that led to that increase. seattle and los angeles where the overwhelming increase. we wanted to find a way to use to focus onllion where the veterans were having the most problems. we need stakeholder input. we need to do it thoughtfully before we make any changes. we do not want to have unintended consequences of anything we are doing. we will not do anything until we have a chance to sit down and review with stakeholders, making sure that decisions made will be good ones. we are not going to do anything until it is a thoughtful plan, but we do want to get the resources to where the veterans aren't homeless. -- are homeless. >> i yield that.

mr. chairman: i recognize bill raucus. rep. raucus: the fiscal year 29 budget request is $8.6 billion for veterans mental health services. this follows uniform service transition to civilian life. my colleagues and i on the committees have had multiple hearings, one just the other day, on the transition assistance process. can you tell me what the harm is doing to assist -- what you are doing to assist the transition in the upcoming year? sec. shulkin: we recognized we could be doing it a lot better. the veterans experience office has looked at this and made a number of recommendations that we are working through to make that a better program. changes already have taken place that have made it a better program. we need to pre-enroll veterans

in benefits so they know they have them when they leave, instead of wondering and going through a lengthy process after they leave, wondering how to get access to benefits. the big issue is to make sure people know these services are there and make it easy for them, and auto enrollment process so there is no work to be done. rep. bilirakis: the next question has to do with the blue water navy veterans. 2.9 million dollars is being sought for veterans benefits. programs for 4.5 million veterans and 600,000 survivors. as you know, blue water navy veterans are excluded from these benefits. you have said in the past these veterans shouldn't be waiting any longer. i want to know if the v.a. has

any plans to re-examine this in the upcoming year. if not, why? sec. shulkin: the problem is there is not much to re-examine. there is nothing much that we can do to go back. i have tried every which way to do microscopic analysis or new studies. there is not going to be new studies. this is about the obligation to those who have served. to simply keep on passing the buck and not honoring this country's obligations to our veterans, i don't think is morally the right thing. i am committed to working with you. i know the chairman feels the same way, to try and find a way to honor obligations to these veterans. we are working to have discussions with the administration to work with congress. we need to find those offsets, i

believe it is morally and ethically the right thing to do. there is not going to be scientific data. 40-50 years later, there is not going to be signed to the data to rely upon. rep. bilirakis: you would consider this the top priority? sec. shulkin: we have to do this and find the offsets to be able to go ahead and resolve this issue. they've waited too long. rep. bilirakis: the chairman has found the offsets. i know he wants to proceed. hopefully we can get this done real soon. they can't wait any longer. sec. shulkin: thank you. rep. bilirakis: question three, the fiscal year 2019 v.a. budget million for direct research. a 40% increase over fiscal year

2018. what about the efforts to improve research and treatment for veterans who may be experiencing negative health effects due to toxic exposure, such as burn pit inhalation during military service? i know it is a priority for a lot of members on the committee. what is the v.a. doing? sec. shulkin: i don't know the sec. shulkin: i don't know the answer to that question. can we get back to you on that? rep. bilirakis: please do. i have 20 seconds. i will yield back and submit the rest of the questions. thank you very much. mr. chairman: you are recognized for five minutes. >> thank you mr. chairman and secretary. thank you for taking the time to meet with us yesterday. it is important we keep open lines of communication. we are here to talk about how we can better deliver care for veterans and their families.

i know we have a shared goal around that. congress has a responsibility to make sure those taxpayer funds are wisely spent. i do appreciate your willingness to speak with us on this report. we will deal with that another time. i want to associate myself with the remarks of burn pits and blue water veterans. they are very big issues in my district. i have legislation on both of those and i am looking forward to passing them. and the other issue is what we discussed at breakfast yesterday, rethinking the disability-ability issue. what can we do for more temporary disability status in order to able our veterans. -- in order to able our veterans to get back and fully participate in the economy.

that is something i want to pursue. i want to focus with our time here, and i am reserving 30 seconds for my friend from minnesota in my former district. i want to turn to the modernization efforts and what we talked about over the last several months. as the appeal to modernization is enacted and ramp expands into new offices, do you feel the proposed fiscal year/2019 budget will appropriately handle the pending legacy appeals? sec. shulkin: i do. i think we are adding 605 f.t.'s to the appeals process. we are hoping we have as much as 25% better going into this

process in 2019. the numbers are extraordinary. of the 680 veterans that have chosen this process, they have gotten an answer in 38 days, versus over 1000 days in the traditional process. working with the bos' -- bso's and outreach efforts, we hope to get this resolved quickly. rep. etsy: we are encouraged by the drive to reduce redundancy of self reporting. this is an issue for pension benefits. income information will be provided by the social security administration and irs. what systems will take place to ensure recording errors will not? -- reporting errors will not? >> i will have to get back to you. rep. etsy: i will turn to a follow up on the caregivers hearing from last week.

you proposed limiting an expansion of the v.a. program of comprehensive assistance for family caregivers to all me those who have fallen into the most severely ill or injured veterans. can you clarify? there was some disagreement in the room, understanding what you meant by that limitation, whether your recommendation is to maintain the current eligibility criteria for post-9/11 veterans and expand only to pre-9/11 veterans in her-three, or the -- in tier three? sec. shulkin: this is your decision. i am giving you my advice on this in terms of our resources.

my recommendation is that everyone who currently has the program should be grandfathered under the current rues. -- current roles. i don't think it is fair to change them after you have started the process. for the 27,000 currently in the program, i would not recommend changing that. going forward, if there is a decision to expand eligibility, i believe you should pick a standard used by other professionals, which would be equivalent to a tier three. rep. etsy: thank you. mr. chairman: time has expired. five minutes. >> thank you all for being here. i had to step out to a different event for a while. i know my colleagues asked questions about the v.a. facilities.

in the reinvestment of the dollars you are getting from closing or shutting down unused space, can you track on a short-term basis and a long-term projection as to exactly how you are going to reinvest the dollars you save from not maintaining a space opened that is not being used? sec. shulkin: when we dispose of a property, sometimes large properties, like in pittsburgh, we dispose of the whole site we lost in katrina in new orleans. we give that back to gsa for the general treasury. under the president's infrastructure program he announced monday, there would be a proposal that v.a. could

retain those proceeds if we were to give back property. we trip -- would track that very specifically and they would be reinvested in infrastructure in v.a.. rep. bergman: you know they are being phased out. could we do a multiple listing in real estate? here is what we have in our inventory across the country? sec. shulkin: yeah. that is a great way to do it. we have been handling them individually. rep. bergman: i have been involved for decades -- i have been on both sides of the

equation, whether it be arguments for staying open or having something be repurposed. we have had extending -- outstanding examples as to how to do it. it takes an important partnership between trying to -- between those trying to dispose of the facilities and those in the local community or whoever might want to use that. i look forward to you continuing to develop that and providing that availability for those of us who want to see what the market looks like. a different subject, a more pamphlets, you talk a little bit about this, the addition of a full-time equivalents to handle new tasks, bringing people up and online. is there an alternative, rather than just adding full-time

people, can you be specific to that appeals process? there is probably a ramp with a peak. if you do it right, it will drop off. do we really need to add the full-time equivalents to the point where they will be up to speed in what they are doing in time for that peak? or do we have things synced up? >> we are taking a multi-pronged approach to get things available for processing claims when the laws are fully enacted. we are using a program to recruit military members as they are transitioning from service to civilian life and teaching them to be claims processors and appeals processors. rep. bergman: what is their job after the peak?

we have a certain number of veterans applying, and there will be a spike. what do we do with that full-time equivalent after the peak? >> a great question. we experience about 55 ftes per paid -- pay period in attrition. this will take care of any additional fte in the books. rep. bergman: as a committee, we have no easy decisions. as a committee, to work together, with all of you, the question we have is how do we work together? mr. chairman: you are recognized for five minutes. rep. bergman: thank you mr. chairman and ranking member for

holding this hearing. thank you secretary and your team for coming in to answer our questions. it is a pleasure to see you. thank you for yesterday's meeting. it was very useful. consistentlya boasts one of the highest rates of approved may -- improvement in the nation. i never get tired of emphasizing this fact. i am thankful for the veterans of the islands. increased enlistment means a disproportional amount of our community suffers from ptsd and other health issues associated with service. friends and neighbors bear these invisible wounds. it would be a dishonor to characterize the soldiers are victims, and an even greater one to not provide the care for their complex and often misunderstood health issues. several different charts and figures have come across my

desk. i hope you could help me interpret some contradicting figures. would you please clarify whether or not the budget proposal request more or less funding for medical research, compared to the 2018 request? and how much research funding do you hope to dedicate to mental health research? sec. shulkin: our research request in the 2019 budget is $727 million. 2019 budget is $727 million. small increase, but an increase from the fiscal year 2018, and in addition to that, we have about $1.1 billion of external grants, some of them government and some of them commercial. it is about a $2 billion budget for research. mental health is one of our key areas of focus. this is critical. i don't have the exact number, mark.

do you have it? >> the increase in appropriation 727 million dollars in 2019 from $640 million in 2018. del. radewagen: my staff and i have had meetings with companies and groups who are interested in working with the v.a. to do ptsd and mental health research. what role do private or public partnerships play in maximizing the v.a. budget, especially with regarding research and developing mental health care? to behulkin: we need doing more. the advances in science and technology are incredible. million we are27 proposing for research and match it with the $1.1 billion of federal and commercial grants.

very substantial amount of research dedicated to the health of veterans. of thatto be doing more and working with the private sector and reaching out more to what could help, particularly with ptsd and mental health issues. thank you, mr. chairman. i yield.man: five minutes. >> i want to focus on the of resources,pect the $12 billion in additional funding to deliver for veterans on behalf of the taxpayers. as someone who has helped run a government agency, i know the challenges you face. it is imperative you are able to manage your assets. the most important of your assets are your people, for any

position. people will this $12 billion translate into new people? sec. shulkin: i believe the budget, prior to the budget cuts 6200 was an incremental people. it may be more, not a care has been -- have been additional funds. rep rutherford: 6200 additional employees at the v.a., bringing the total number in the enterprise to -- >> 373,000. rep rutherford: that is your biggest budget expense? sec. shulkin: yes. rep rutherford: we have to get this right. thenitial introduction to veterans administration was frustrating with respect to performance in's

achieving the desired outcomes. accountability would be the core of that. a challenge, especially in bureaucracy, government, civil service, unions, you do this under the leadership of the chairman, the ranking member, the bipartisan efforts. we gave you at least some accountability, authority, and flexibility. how are you exercising it? do you need more? thank you for giving us that authority. since we have opened up the office of accountability and whistleblower protection, 1300 employees have been removed in the last eight months. we don't have a target for that. it is not the objective to reach that. we objective is to make sure are doing the job we are doing and everyone understands that they serve veterans.

we are focused on that. rep rutherford: can you tell the difference? do you feel a shift in the culture with this new set of tools? sec. shulkin: one of the things you learn when you run your organization as big as the v.a., there is a different culture at each v.a.. there is a lot of work to do at v.a.'s v.a. -- of the and other that has used this to improve. it is noticeable but not over all of the facilities. rep rutherford: i am so grateful to work with the ranking member and our subcommittee. have been ablewe to achieve a lot of bipartisan , probably the most

productive committee in congress. 35 bills passing the house. 12 will become law. great team, including the president. he is fighting for veterans, as are my colleagues. this is the biggest point of frustration for me, with respect to managing people and getting that right. my first hearing, we got a report from the gao that there were hundreds of that bank employees that were union members who spent 100% of their time on union -- hundreds of va employees that were union members who spent 100% of their time on union activity. texas,ple back in west 49 thousand rural counties, they find it outrageous that somebody would spend 100% of their time on something other than the job they were hired to do. can you tell me how you feel

about that? and what can we do to help you? after this answer, i yield back. sec. shulkin: i have come from the private sector. i have run institutions with large unions. i have not seen that before. on union time is usually supported by union dues. do believe the unions are productive partners with us. i do really appreciate the collaboration we have. i believe we care about getting the right services to veterans. believe the time spent at the government pays for should be to serve veterans in direct veterans services. this is not an antiunion position. i believe strongly we need to work with them. i believe we should be looking

at alternative ways to make sure union activity and direct veteran care are separated. chairman, thank you. you have created -- asked for an increase, the largest of which is a $400 million seismic corrections fund. language and stimulates the fund be available, regardless, of the estimated cost of the project. what does that mean, exactly? sec. shulkin: you are right in asking that question. i am not sure what that means. 400 million dollars should be $400 million. rep. dunn: i am thinking/fund. -- slush fund. let's revisit that. o has raised the ga

concerns about the capital projects linking system, skipped by improperly coding projects as seismic corrections. thesed like to be sure requested seismic fund projects are truly too hard in buildings in earthquakes owns. and you give me that assurance -- can you give me that assurance? sec. shulkin: are you familiar with skip ratings? the samecerned about thing, how highly prioritized the seismic issues were. i was afraid if you weren't in that part of the country, you wouldn't get any of that funding. we did change the prioritization of the seismic. haveis the first time we been able to substantially deal with some of the seismic issues that are decades old

inefficiencies. deficiencies. i know the specific projects the $400 million are going for -- we have the appendix that lists some of these projects, in arkansas, illinois, south carolina, earthquake zones. in thees are involved seismic correction projects, plus washington dc in puerto rico. -- and puerto rico. i would like to be sure these requested projects, along with $7.6 billion worth of seismic that these are truly for seismic projects. i am concerned about that.

sec. shulkin: you have raised several good issues about the language, and the criteria. if it is ok, we will get back to you and sit down with you. i am reading from the budget. even though some facility-level planning officials told us they didn't think these demolition projects would score high enough to get funding, officials who oversee this process told us that if the project's narratives ed to seismic- link corrections, they might get priority that they otherwise wouldn't. with that, i yield back. chairman: on the seismic issues, a little over 200 years

ago, there was an earthquake in the west tennessee ariella. -- area. church bells rang in philadelphia. there are needs along the mississippi you might not be aware of, one of the largest earthquake faults in the country. i recognize for five minutes. >> i appreciate it. i know the chairman put the scrap appear earlier. here earlier.up where would the business of caring for veterans -- we are in the business of caring for our veterans. when we have the world war ii folks and the korea folks moving the population of our veterans responsible -- we are

responsible for caring for is dropping. women young men and coming back from the middle east are greatly injured -- a lot of men and women coming back from the middle east are greatly injured. looking at is a budget that has grown dramatically over the last five or 10 years. it greatly outpaces growth of the total federal government and our economy. the point i am trying to make, you have an economy growing at x sixa department growing at that, it is not sustainable. you, theike to remind federal government is horribly in debt.

or almost.n, with interest rates rising into the economy picking up, there is going to be more pressure on interest rates, the debt service economy interest on that debt is going to continue to go up. back to us asking for another $12 billion in a budget that has gone up , greatly outpacing the growth of the rest of the federal government and the economy. it is clearly not sustainable. will you please in a nutshell two or what are the three top drivers that is and whythis to happen, you have to come back to us every year asking for, in this case, another $12 billion? sec. shulkin: i share your exact concerns. i think you said this correctly.

docannot continue to business as usual. this will eventually lead to us not being able to support the veterans of our country, which will be a great error and lapse of our responsibilities. we have to do things differently. we are dealing with problems that have been essentially neglected in the v.a. for putting in a financial management system that still programming,t running versions of an electronic health record that is 35 years old and we are putting in all our money to maintain it. dealing with old hiring practices and not having the right accountability. we are doing everything we can bring us that, to modernized systems, to decrease the rate of increase, and my team knows that is our goal.

drivers are vietnam veterans , getting older and requiring more services. talked about people that continue to return with significant needs. the mandatory benefits are rising at huge growth rates. thosens have earned benefits, but we have to make sure veterans -- benefits are designed to help people return to well-being. rep. poliquin: correct me if i am mistaken. the goal is when a veteran comes them better. to have them become independent. would you site for us what you talked about at breakfast, someone coming in who is an amputee with sleep apnea? sec. shulkin: we started to process six or seven years ago,

to read look at all of our body -- re-look at all of our body systems. sleep apnea has a 50 year service connection with it. ofare spending billions dollars on that. medical advancements have helped us to treat this condition. we need to diagnose it properly, treat it, management, -- manage it, and people can go on with their lights. -- with their lives. once we get people to function in the way that they should with adequate treatment, there should be a recognition of that and the benefits program. we are going through this the bs, to work with sos. system like this needs to evolve and change as science changes. rep. poliquin: may i have a few

more seconds to ask a question imperative to staff? that was a lean yes, thank you. to reimburse the judgment funds for claims and settlements. is the v.a. liable to the judgment fund? >> we have to get back to you. i have no further members. i will yield for closing statements. >> i yield to the gentleman from texas. i ask you for outstanding total mental health hires or vacancies. i also asked for all outstanding primary care hires. they gave us a number in the hundreds. i didn't ask the question the right way. i want to know how many outstanding primary care providers there are.

goneimary care provider is . i haven't been reassigned another one to go to. would you give that to me and the members of the committee? sec. shulkin: primary care, 270. i was handed what you were. it seems small. 'rourke: inadvertently, my colleague conflated two distinct terms. initial time and inactivity. -- official time and inactivity. if someone is pointing 100% of their job on official time, that is one thing. that is not union activity. to say official time, not union time. no one intends to spend 100% of their day on union time. sec. shulkin: thank you for clarifying. what distinguishes this

committee from any other, it has been noted, is the ability to focus together on the issues that matter. i am hoping the press were here for the budget, today. all of us know what that is. one isto be clear, no not taking those things seriously. it appears there have been allegations of criminal contact on those -- on both sides. those things need to be found out. the decision for to reimburse the federal government and move on. the reason this committee works is because we have chosen collectively not to allow partisan politics here. your predecessor was a democratic presence that was there. of have the unique position someone who spans both sides of the aisle. i hope everyone understands that. to clarify one

thing. i have set on this committee longer than anyone. the blue water navy has been a passion of mine. my disagreement is not about getting this done. bedisagreement is we should not asking for a group of wounded warriors to pay for another. take 1/10 of 1% up -- off of the tax bracket. toyou got a deferment vietnam, maybe you should pay for the ones who were there. chairman's commitment to fixing the blue water navy is second to no one in this country. i simplyting that, disagree with how we are doing it. he brings up a valid point. where you are at, we are all committed to getting this right. i understand that there is valid arguments. but they are not coming from a position that we do not care about getting it done.

i want to make that clear. act, 30% ofbility the people come from food service and laundry. perhaps we are quick to move people before we get them in. i believe strongly in accountability. i was there to craft this. my intention was not to get rid of housekeepers if these are things that can be corrected with training, human resources, and management. i think the gentleman -- thank the gentleman for clarifying positions on official time. now we are back to the work of the budget. i am grateful the president sent out a budget. the constitution is very clear on this. is not supposed to write the budgets. congress is supposed to find out from trusted folks, those who have to deliver that.

we need to have that conversation on budget growth. i don't disagree. we do have to ignore it, i would argue, the v.a., especially the clinical folks, are doing fantastic. who come toveterans the the a want to get their care there -- who come to the v.a. want to get their care there. if you go to where there is a cost that does not end with the last bullet, we have been at war for 16 years, we have asked people to go. we are going to have to budget. it may not be sustainable, but i do not see that this is discretion of funding. this is an absolute mandatory requirement for our veterans. i think the chairman for his leadership.

>> thank the gentleman and i thank the panel for being here today and certainly the start of the discussion of the 2019 budget. and i was sitting here thinking, as we close, about, for our folks that are watching this, just what are the services that va actually provides? and i've been here now nine, going on ten years. and basically, it provides quality health care for over 9 million veterans. and whether it's inside the va or outside the va, their commitment is to provide quality care wherever the veteran gets that care. it provides memorial benefits. we talked about that earlier to over 140,000 veterans a year who have now passed and those benefits to their families. pension benefits. hundreds of thousands of veterans get pension benefits. group life insurance. we don't think about that. 6 million. home loans. veterans now over 3 million get a home loan from the v.a..

compensation benefits over, what, four to five million of our benefits get the educational benefits. huge benefits, both the montgomery g.i. bill, the post 9/11 and now the forever g.i. bill and half, i think, of the young men and women who separate from the military use that g.i. benefit. one is sitting in this chair. and i want to thank the president for his focus on the va. i remember sitting up at night and late in the evening when he gave his acceptance speech and one of the first things out of his mouth was his commitment to the nation's veterans, and i very much appreciate that, and i don't think it's stopped. every time he talks about -- gives a speech, he mentions our nation's heroes. and i thank him for that. we have a huge -- this committee in a bipartisan way, as the ranking member mentioned, has got a huge amount of work to do this year. we have transition of the choice

program. we've got to get that done, so you can move on with that. we've got the asset review to get the va right sized, to begin to go down the pathway of more efficient care in the neighborhoods, in the communities where our veterans live. we've got ehr modernization. that's starting. we've got appeals reform that we're just now -- we've talked about that just a little this morning as mr. walz brought up. one of my passions i want to get off the table is our blue water navy friends. i want to get that solved. we've got caregivers. we're moving forward with that. the 7th of march, we have our first round table on that. statement veteran homes were mentioned. i think those are tremendous. everywhere i've been, i've looked at estate veteran homes. those are really quality places that our older veterans can go. you mentioned at as your number one health priority, suicide prevention. we've got enormous work to do on that and there's a huge investment in this budget for reducing the amount of suicide we have in this country.

and lastly, i know we always -- privatization comes up, it's hard to do that with a straight face. in the nine years i've been here, there were 250,000 employees at the va when i started on this committee, 2009. i think you just said there are now 373,000 and the budget's gone from $93 billion to $198 billion. that doesn't look like privatizing to me. that looks like a commitment this nation is making to its veterans and i'm proud of that. i think this is something, when i go home, and i live in a very conservative area of the country, i will never apologize for helping earn money we spend on our nation's veterans, and i don't think a person on this dais does. i think we can go home proudly and say that we have supported, in this entire congress, both republicans and democrats have done this. just lastly, as we close, we have a number of questions for the record and one of those i want to get out before is

transition to choice, and you don't have to answer it right now. but we have money that will last until the end of may, and then further money was appropriated. >> yes. >> and then that's until the end of the fiscal year, which is 1 october, 30 september. then how do we get from 30 september to march of '19 because that appears to be when we're going to have this -- you'll have the time, your team will have the time to get this new choice program fully implemented. you don't have to answer that right now but i need that. and will it be under the budget caps? with that being said, i ask unanimous consent that all members have five legislative days to revise and extend the remarks and include extraneous material. without objection, so ordered. hearing's adjourned.

-- me, he represents the the behaviors of the prior administration where it was lways let's sweep everything under the carpet, everything is going well. there's no admissions that here are problems. how can you solve anything when you have that sort of leadership? >> anything he could do to regain your trust? >> i think there's always been a question in my mind about him. i think the president wanted and campaigned on cleaning up he v.a. and what the president wanted was someone outside to come in. i think he went through three dencht picks who all backed away and so i think he just kind of gave up and went for somebody within the v.a. i think ultimately that's been a mistake. >> how do you think his

resignation affects the choice overhaul? i wonder if that's a major factor in the treatment of this report by this committee today. >> not at all. >> why? >> i think we're on that path. i think we'll continue on that path. we have to get the system to work. and obviously we have to pass authorizing leafplgts i don't think it would. that's a congressional issue. it's going to be debated between members of congress. >> i've seen over years now that the v.a.'s spending its mandatory funds through choice has a huge impact on how you have to move through response to make sure the veterans will have access to care. so i wonder if a vacancy at that high of a level could really threaten your ability to manage the program. >> it depends how long the vacancy is there. i hope it wouldn't be there for

long at all. >> douf anybody you would rather see? >> i know certainly rather see somebody from the outside who has experience that number one has a military background, number two has a background in managing a major hospital system. but that brings executive experience into the v.a. and that's not -- that's not going to be -- becoming part of the system. part of the culture of the v.a. which we've had in the past. it seems like when they get in there they become part of the system. part of the culture.

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>> health and human services secretary took questions on the president's proposed budget for 2019. he was asked about funding for medicare and medicaid, combating the opioid epidemic and the cost of prescription drugs. he testified before the senate finance committee.